Throughout much of 2020 and 2021, you’ve probably noticed increased travel warnings issued by the U.S. government, cautioning Americans who traveling abroad during the ongoing COVID-19 pandemic. But exactly what do these warnings mean and how much weight should be placed on them?
Each week, the U.S. Centers for Disease Control and Prevention and the U.S. Department of State congruently release updated guidance with the latest travel levels for countries across the world, ranging in severity from Level 1 to Level 4, reflective of the overall literal health of a country — COVID-19 and otherwise.
They are issuing guidance based upon ongoing safety concerns of all types. Not necessarily resulting just from the pandemic, although you could probably draw a causal relationship between a country’s safety outlook and its subsequent ability to manage the pandemic for its residents and visitors.
Although issued congruently, the CDC’s COVID-19 travel recommendation and State Department’s travel advisory essentially are different in scope in that the latter encompasses present concerns beyond COVID-19. Therefore, the information presented in each should be personalized to your situation as a traveler.
“The data has to be individualized to the traveler,” says Dr. Daniel Caplivski, director of the travel medicine program and a professor in the division of infectious diseases at Mount Sinai. “I would follow the advice of these government agencies.”
CDC’s COVID-19 travel recommendations
As I’ve previously reported, the CDC offers recommendations for countries based on COVID-19 data from the World Health Organization.
For countries whose population exceeds 100,000 residents, the CDC examines the number of new COVID-19 cases in a given area within the past 28 days, along with the testing rate and test-to-case ratio in the preceding 28 day days. The incident rate is the primary criteria used; the other two are secondary. In places with fewer than 100,000 people, levels are based on case count and testing data.
Together, those numbers are used to provide international travel advice based on the risk of contracting COVID-19 for vaccinated travelers versus unvaccinated travelers.
On Nov. 21, 2020, the CDC modified its three-level notice system to a four-level system for COVID-19 to “align with the same incidence rate or case count thresholds adopted by recognized public health organizations and shares a common 4-level structure with the U.S. Department of State’s Travel Advisory external icon system.”
If a country does not provide official government data on their COVID-19 numbers, such as Monaco or Venezuela, their THN level will be marked as “unknown” and should be treated as if it is a Level 4 country.
Level 1: Low Level of COVID-19: 50 cases or less
Level 1 is reserved for countries that have reported fewer than 50 cases per 100,000 people in the last 28 days. The CDC says only fully vaccinated travelers should visit.
Level 2: Moderate Level of COVID-19: 50-99 cases
Level 2 is for places that recorded between 50 and 99 cases per 100,000 people in the 28-day window.
“Unvaccinated travelers who are at increased risk for severe illness from COVID-19 should avoid nonessential travel to this destination,” says the CDC.
Level 3: High Level of COVID-19: 100-500 cases
Level 3 is for destinations with anywhere from 100-500 cases per 100,000 people, and again the CDC advises that “unvaccinated travelers should avoid nonessential travel to this destination.”
Level 4: Very High Level of COVID-19: 500 or more cases
Level 4 is the most severe and all-encompassing as it incorporates countries with more than 500 cases of COVID-19 per 100,000 people. Per the CDC, all Americans, regardless of vaccination status, should “avoid travel to this destination.”
“Primary and secondary criteria used to determine Travel Health Notice levels were updated to better differentiate countries with severe outbreak situations from countries with sustained, but controlled, COVID-19 spread,” the CDC previously said. “This update gives specific travel advice for vaccinated and unvaccinated people according to the THN level, ensuring THN levels reflect the current global situation and are aligned with guidance for international travel.”
The CDC did not respond to four requests for comment at the time of publication.
State Department’s travel advisories
The State Department, as you might suspect, issues advisories that incorporate those of the CDC but also encompass additional factors outside of a country’s health situation, namely specific crime segments reflective of ongoing safety concerns in a given place, which accounts for eight risk-specific indicators, marked with initials in the top right-hand corner:
- C=Crime.
- T=Terrorism.
- U=Civil unrest.
- H=Health risks, including COVID-19.
- N=Natural disaster.
- E =Time-limited event.
- O =Other potential risks not covered by previous risk indicators.
- K= Kidnapping/hostage-taking.
“In each Travel Advisory, we provide an overall Travel Advisory level and clearly explain the risk level for each indicator and describe the safety and security concerns,” a State Department official said on background via email.
Like the CDC, the State Department also categorizes advisories based on risk level, with Level 1 being the safest and Level 4 being the most dangerous.
- Level 1: Exercise normal precautions.
- Level 2: Exercise increased caution.
- Level 3: Reconsider travel.
- Level 4: Do not travel.
“We routinely review safety and security conditions in destinations across the world, and will update destination-specific information when it is appropriate,” the State Department official said. “We assess COVID-19 related conditions in each destination regularly, and as conditions change that materially affect U.S. citizen safety, we will update the information we provide to U.S. citizens – whether in the Travel Advisory or through timely health and safety Alerts – to help them make informed travel decisions.”
The difference between them
The CDC notes that their travel health notices “inform travelers and clinicians about current health issues that impact travelers’ health, like disease outbreaks, special events or gatherings, and natural disasters, in destinations around the world.” While the agency issues non-COVID-19 travel health notices, most travelers these days are paying attention to their COVID-19-specific warnings. Overall, the CDC focuses exclusively on health-related concerns, the majority of which are tied to COVID-19 at the moment.
“The CDC’s Travel Health Notices focus exclusively on health-related concerns, while the Department of State’s Travel Advisories are based on a broader set of risk indicators,” said the State Department. “This means that in some instances, the Department’s advisory for a given country will reflect a different level than the CDC’s notice for that country.”
As of Sept. 16, 84 countries are at the CDC’s Level 4: Very High Level of COVID-19 and 105 (out of 216 total) locations across the world are at the State Department’s Level 4: Do Not Travel status.
Interpreting the two
When it comes to travel advisories issued by the CDC and State Department, you might be wondering how much weight to place on the two. In short, the answer is to pay attention to both.
“The CDC’s methodology makes sense for many travelers as a general recommendation. I would look at the broader picture in the country beyond the infectious diseases risk,” said Dr. Caplivski. “There may be additional factors beyond COVID-19 that might affect a person’s decision to avoid a country.”
A U.S. government-issued travel advisory becomes much more personal for moderately to severely immunocompromised travelers, who the CDC says are “especially vulnerable to COVID-19.”
“We try to individualize the risk assessment based on their vaccination status and the state of their immune system,” says Dr. Caplivski. “For some patients, they might decide to wait on travel until the levels of COVID-19 are significantly lower.”
Each advisory considers the ability of government officials to assist Americans abroad in emergency situations.
“The state department is letting you know that their ability to evacuate you in an emergency might be limited in a country with a Level 4 travel advisory,” Caplivski continued. “COVID-19 remains a global pandemic, including here in the U.S. We often watch out for the balance of available health care resources in addition to the actual COVID-19 infection rates. In the event of an emergency, it is good to be aware of whether local hospitals have the capacity to respond to a surge of cases.”
