CDC Global COVID Testing Order

CENTERS FOR DISEASE CONTROL AND PREVENTION
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ORDER UNDER SECTION 361
OF THE PUBLIC HEALTH SERVICE ACT (42 U.S.C. 264)
AND 42 CODE OF FEDERAL REGULATIONS 71.20 & 71.31(b)
REQUIREMENT FOR NEGATIVE PRE-DEPARTURE COVID-19 TEST RESULT
OR DOCUMENTATION OF RECOVERY FROM COVID-19
FOR ALL AIRLINE OR OTHER AIRCRAFT PASSENGERS ARRIVING
INTO THE UNITED STATES FROM ANY FOREIGN COUNTRY 1

SUMMARY:
Pursuant to 42 CFR 71.20 and as set forth in greater detail below, this Notice and Order prohibit
the introduction into the United States of any aircraft passenger departing from any foreign
country unless the passenger: (1) has a negative pre-departure test result for SARS-CoV-2, the
virus that causes COVID-19 (Qualifying Test); or (2) written or electronic documentation of
recovery from COVID-19 after previous SARS-CoV-2 infection in the form of a positive viral
test result and a letter from a licensed health care provider or public health official stating that
the passenger has been cleared for travel (Documentation of Recovery).
The negative pre-departure test must be a viral test that was conducted on a specimen collected
during the 3 days preceding the flight’s departure from a foreign country (Qualifying
Test). Alternatively, if the passenger has recovered from COVID-19, the passenger may instead
travel with written or electronic documentation of a positive viral test result that confirms
previous SARS-CoV-2 infection and a letter from a licensed health care provider or public health
official stating that the passenger has been cleared for travel (Documentation of Recovery). A
passenger must retain written or electronic documentation reflecting the negative Qualifying Test
result or Documentation of Recovery presented to the airline or other aircraft operator. A
passenger must also produce such Qualifying Test result or Documentation of Recovery upon
request to any U.S. government official or a cooperating state or local public health authority.
Pursuant to 42 CFR 71.31(b) and as set forth in greater detail below, this Notice and Order
constitute a controlled free pratique to any airline or other aircraft operator with an aircraft
arriving into the United States. Pursuant to this controlled free pratique, the airline or other
aircraft operator must comply with the following conditions to receive permission for the aircraft
to enter and disembark passengers in the United States:
•

Airline or other aircraft operator must verify that every passenger—2 years of age or
older—onboard the aircraft has attested to receiving a negative Qualifying Test result or

1

This Order supersedes the previous order signed by the U.S. Centers for Disease Control and
Prevention (CDC) Director on January 12, 2021.
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to having recovered from COVID-19 after previous SARS-CoV-2 infection and being
cleared to travel by a licensed health care provider or public health official.
•

Airline or other aircraft operator must confirm that every passenger onboard the aircraft
has documentation of a negative Qualifying Test result or Documentation of Recovery
from COVID-19.

STATEMENT OF INTENT:
This Order shall be interpreted and implemented to achieve the following paramount objectives:
•
•
•
•

Preservation of human life;
Preventing the further introduction, transmission, and spread of the virus that causes
COVID-19 into the United States, including new virus variants;
Preserving the health and safety of crew members, passengers, airport personnel, and
communities; and
Preserving hospital, healthcare, and emergency response resources within the United
States.

DEFINITIONS:
Aircraft shall have the same definition as under 42 U.S.C. 40102(a)(6). “Aircraft” includes, but
is not limited to, commercial, general aviation, and private aircraft destined for the United States
from a foreign country.
Aircraft Operator means an individual or organization causing or authorizing the operation of an
aircraft.
Airline shall have the same definition as under 42 CFR71.1(b).
Attest/Attestation means having completed the attestation in Attachment A. Such attestation may
be completed in written or electronic form. The attestation is a statement, writing, entry, or other
representation under 18 U.S.C. 1001. 2

2

CDC encourages airline or aircraft operator to incorporate the attestation into paperless checkin processes. Airline or aircraft operator may use a third party (including a third-party
application) to collect attestations, including to provide translations. But airline or aircraft
operator has sole legal responsibility to provide and collect attestations, to ensure the accuracy of
any translation, and to comply with all other obligations under this Order. Airline or aircraft
operator is responsible for any failure of a third party to comply with this Order. Airline or
aircraft operator may not shift any legal responsibility to a third party.
2

Confirm that every passenger onboard the aircraft has documentation reflecting a negative
Qualifying Test result means confirmation that:
1) the personal identifiers (e.g., name and date of birth) on the negative Qualifying Test
result match the personal identifiers on the passenger’s passport or other travel
documents;
2) if the passenger is arriving on a direct flight to the United States, the specimen was
collected within the 3 days preceding the flight’s departure;
3) if the passenger is arriving via one or more connecting flights the specimen was collected
within the 3 days preceding the departure of the initial flight;
4) the test performed was a viral test (as defined below); and
5) the test result states “NEGATIVE,” “SARS-CoV-2 RNA NOT DETECTED,” “SARSCoV-2 ANTIGEN NOT DETECTED,” or “COVID-19 NOT DETECTED.” A test
marked “invalid” is not acceptable.
Confirm that a passenger alternatively has written or electronic documentation of recovery from
COVID-19 means confirmation that:
1) the passenger has presented documentation of a positive test result and a signed letter on
official letterhead that contains the name, address, and phone number of a licensed
healthcare provider or public health official stating that the passenger has been cleared
for travel; 3
2) the positive test result occurred within the last three months (90 days) preceding the
passenger’s flight to the United States, or at such other intervals as specified in CDC
guidance; 4
3) the personal identifiers (e.g., name and date of birth) on the positive test result and signed
letter match the personal identifiers on the passenger’s passport or other travel
documents;
4) the test performed was a viral test (as defined below); and
5) the test result states “POSITIVE,” “SARS-CoV-2 RNA DETECTED,” “SARS-CoV-2
ANTIGEN DETECTED,” or “COVID-19 DETECTED.” A test marked “invalid” is not
acceptable.
Foreign country means anywhere that is not a state, territory, or possession of the United States.
Negative Pre-departure Test Result for COVID-19 or negative Qualifying Test result means
documentation of a negative COVID-19 test taken within the 3 days preceding a flight’s
departure. Such documentation may be in paper or electronic format as required by this Order.
Testing must be performed using a viral test. The documentation must also include sufficient
3

Health care providers and public health officials should follow CDC guidance in clearing
patients for travel to the United States. Applicable guidance is available at
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html.
4

https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
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verification information—such as the name and contact information for the laboratory or
healthcare personnel who performed the test.
Viral test means a viral detection test for current infection (i.e., a nucleic acid amplification test
or a viral antigen test) approved or authorized by the relevant national authority for the detection
of SARS-CoV-2.
United States has the same meaning as “State” and “U.S. Territory” in 42 CFR 71.1(b).
EXEMPTIONS:
The following categories of individuals and organizations are exempt from the requirements of
this Order:
•

Crew members of airlines or other aircraft operators provided that they follow industry
standard protocols for the prevention of COVID-19 as set forth in relevant Safety Alerts
for Operators (SAFOs) issued by the Federal Aviation Administration (FAA). 5

•

Airlines or other aircraft operators transporting passengers with COVID-19 pursuant to
CDC authorization and in accordance with CDC guidance. 6

•

Federal law enforcement personnel on official orders who are traveling for the purpose of
carrying out a law enforcement function, provided they are covered under an
occupational health and safety program in accordance with CDC guidance. Those
traveling for training or other business purposes remain subject to the requirements of
this Order.

•

U.S. Department of Defense (DOD) personnel, including military personnel and civilian
employees, dependents, contractors (including whole aircraft charter operators), and other
U.S. government employees when traveling on DOD assets, provided that such
individuals are under competent military or U.S government travel orders and observing
DOD precautions to prevent the transmission of COVID-19 as set forth in Force
Protection Guidance Supplement 14 - Department of Defense Guidance for Personnel
Traveling During the Coronavirus Disease 2019 Pandemic (December 29, 2020)
including its testing guidance.

5

https://www.faa.gov/other_visit/aviation_industry/airline_operators/airline_safety/safo/all_safos
/media/2020/SAFO20009.pdf. Airlines, aircraft operators, and their crew members may follow
even stricter protocols for safety, including testing protocols.
6

Interim Guidance for Transporting or Arranging Transportation by Air into, from, or within the
United States of People with COVID-19 or COVID-19 Exposure available at
https://www.cdc.gov/quarantine/interim-guidance-transporting.html
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•

Individuals and organizations for which the issuance of a humanitarian exemption is
necessary based on both 1) exigent circumstances where emergency travel is required to
preserve health and safety (e.g., emergency medical evacuations) and 2) where predeparture testing cannot be accessed or completed before travel. Additional conditions
may be placed on those granted such exemptions, including but not limited to, observing
precautions during travel, providing consent to post-arrival testing, and/or self-quarantine
after arrival in the United States, as may be directed by federal, state, territorial, tribal or
local public health authorities to reduce the risk of transmission or spread.

BACKGROUND:
The COVID-19 pandemic has spread throughout the world. Individuals who travel may be at
risk for exposure to SARS-CoV-2 before, during, and after travel. This could result in USbound travelers further spreading the virus to others during travel, upon arrival in the United
States, and at their destinations.
Over the last few weeks, the United Kingdom (UK) has faced a rapid increase in COVID-19
cases in South East England, leading to enhanced epidemiological and virological
investigations. On December 14, 2020, Public Health England announced that a new variant
of SARS-CoV-2 had been identified across the southeast of England. 7 Preliminary analysis in
the UK suggests that this SARS-CoV-2 variant may be more transmissible than previously
circulating variants, with an estimated potential to increase the reproductive number (R0) by
0.4-0.7 or greater with an estimated increased transmissibility of up to 70 percent. 8
On December 19, 2020, in response to the emergence of the UK variant, the countries
comprising the UK announced stricter measures to be applied from December 20 and over the
coming weeks, with affected areas entering a ‘Tier 4’ level with movement restrictions within
and between more and less heavily affected areas. These measures have included
recommendations for residents of the most affected areas to restrict movements and travel,
including international travel, outside of these areas. The government of Scotland announced
a travel ban between Scotland and the rest of the UK. In addition, the Netherlands issued a
travel ban from the UK effective through January 1, 2021, and Belgium temporarily halted
flight and train travel from the UK. Other countries took similar measures to restrict travel
from the UK.
A second new variant of SARS-CoV-2 was reported in the Republic of South Africa (RSA) on
December 18, 2020, that also appears to spread more rapidly than earlier variants of the virus.
The RSA variant is distinct from the UK variant but shares a mutation in the spike protein that
appears to increase transmissibility. Since being identified, the new variant has spread inland
from coastal regions of RSA and has become the predominant variant in some areas of the
7

https://www.gov.uk/government/news/phe-investigating-a-novel-variant-of-covid-19.

8

https://www.ecdc.europa.eu/en/publications-data/threat-assessment-brief-rapid-increase-sarscov-2-variant-united-kingdom.
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country.
During December 21-26, 2020, several countries implemented restrictions on travel from
South Africa, including China, El Salvador, Germany, Guatemala, Israel, Panama, Sudan,
Switzerland, Turkey, and the UK. The Netherlands imposed a ban on travel from RSA on
December 21 but lifted the ban for both the UK and RSA on December 23, stating that
travelers will instead need to present a negative COVID-19 test result obtained within 72
hours of their scheduled arrival in the Netherlands, followed by 10 days of self-quarantine.
On December 28, Japan imposed a ban on entry of all foreign nationals through the end of
January 2021. On December 28, the Government of South Africa announced new restrictions
on businesses and public movement. As of January 7, 2021, Canada requires air passengers 5
years of age or older to test negative for COVID-19 before arrival. On January 8, the United
Kingdom announced a pre-departure testing requirement for all inbound international travelers
with limited exceptions; a 10-day post-arrival quarantine will still be required.
On December 25, 2020, CDC issued an Order requiring proof of a negative Qualifying Test
result for all airline passengers arriving from the UK to the United States. Since then, cases of
the UK and RSA variants have been discovered in four Canadian provinces, including in
individuals with no travel history indicating spread in Canada. The UK variant has also been
found in at least 50 countries and the RSA variant has also been detected in at least 15
countries. The first case of the UK variant in the United States was found in Colorado on
December 29, in an individual with no known travel history. On December 30, a second case
was reported in California. Since then, the UK variant strain has accounted for 144 cases in 20
U.S. states. Another new variant strain of concern initially detected in South America in
March 2020 has been detected in at least 19 countries on 5 continents through late December
and has mutations in the spike protein that raise concerns of increased infectivity.
While it is known and expected that viruses constantly change through mutation leading to the
emergence of new variants, these new variants have emerged at a time when numbers of new
cases in the United States have continued to increase at alarming rates. Additional new virus
variants are also likely to emerge as the virus continues to evolve and mutate. Accordingly,
further action is needed to help mitigate the spread of these and other new virus variants into
the United States.
Based on increased transmissibility and spread of these new variants of SARS-CoV-2, and to
reduce introduction and spread of these and future SARS-CoV-2 variants into the United States,
expanding current UK pre-departure testing requirements to all foreign countries and U.S.bound passengers is warranted. This approach to testing-based risk assessment has been
addressed in CDC guidance and the Runway to Recovery guidance jointly issued by the
Departments of Transportation, Homeland Security, and Health and Human Services. 9 Testing
for SARS-CoV-2 infection is a proactive approach and not dependent on the infecting strain.
9

Runway to Recovery 1.1, December 21, 2020, available at
https://www.transportation.gov/briefing-room/runway-recovery-11
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Approximately 120 countries now use testing in some form to monitor risk and control
introduction and spread. With case counts and deaths due to COVID-19 continuing to increase
around the globe and the high proportion of infected people with asymptomatic or presymptomatic infections, the United States must take a dual approach to combatting the virus.
This means concurrently mitigating and slowing the introduction and spread of SARS-CoV-2
and controlling transmission within U.S. communities that are currently being overwhelmed by a
surge in infections, hospitalizations, and deaths.
Pre-departure testing may detect travelers infected with SARS-CoV-2 before they initiate their
travel. CDC recommends viral testing and receipt of results 1-3 days 10 before departure for
international travelers, particularly those traveling long distances or passing through
transportation hubs such as airports where social distancing may be challenging. CDC modeling
indicates that pre-departure testing is most effective when combined with self-monitoring. 11
Testing before departure results in the greatest reduction of transmission risk during travel when
the specimen is collected close to the time of departure. Earlier testing (i.e., more than 3 days
before travel) provides little benefit beyond what self-monitoring alone can provide.
For persons previously diagnosed with COVID-19 who remain asymptomatic after recovery,
CDC does not recommended retesting within 3 months after the date of symptom onset (or the
date of first positive viral diagnostic test if their infection was asymptomatic) for the initial
SARS-CoV-2 infection. 12 Persons who develop any symptoms of COVID-19 during this time
period should not travel and seek care for testing and evaluation. This guidance may be updated
as additional information about people who have recovered from COVID-19 becomes available.
Pre-departure testing does not eliminate all risk. However, when pre-departure testing is
combined with other measures such as self-monitoring for symptoms of COVID-19, wearing
masks, social distancing, and hand hygiene, it can make travel safer by reducing spread on
conveyances, in transportation hubs, and at destinations. For international air travelers and
others with higher risk of exposure, CDC additionally recommends a post-arrival test 3-5 days
after arrival at destination, combined with self-monitoring and a 7-day period of staying home
(or in a comparable location such as a hotel room) to further reduce the risk of translocating the
virus into destination communities. 13
As cases of COVID-19 continue to rise across the globe and travel volume increases, routine predeparture testing of all U.S.-bound aircraft passengers is needed not only to reduce introduction
10

https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-air-travel.html.

11

Johansson MA, Wolford H, Paul P, et al. Reducing travel-related SARS-CoV-2 transmission
with layered mitigation measures: Symptom monitoring, quarantine, and testing, available at
https://www.medrxiv.org/content/10.1101/2020.11.23.20237412v1.
12

13

https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
https://www.cdc.gov/coronavirus/2019-ncov/travelers/after-travel-precautions.html
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of the two known SARS-CoV-2 variants from UK and RSA, but also future variants that might
be more transmissible and cause more severe illness.
ACTION:
For these reasons, I hereby determine that passengers covered by this Order are at risk of
transmitting the new SARS-CoV-2 virus variants or other potential variants and that requiring
such passengers to demonstrate either negative COVID-19 test results or recovery from COVID19 after previous SARS-CoV-2 infection is needed as a public health measure to protect the
health of fellow travelers and U.S. communities.
1.

Requirements for Airlines & Other Aircraft Operators

Any airline or other aircraft operator with passengers arriving into the United States from a
foreign country, for each passenger onboard the aircraft arriving into the United States, shall —
a. Verify that each passenger has attested to having received either a negative Qualifying
Test result or to recovery from COVID-19 after previous SARS-CoV-2 infection and
clearance to travel. Airlines or other aircraft operators must retain a copy of each
passenger attestation for 2 years. The attestation is attached to this order as Attachment
A.
b. Confirm that each passenger aged 2 years or older has documentation of a negative
Qualifying Test result or Documentation of Recovery from COVID-19.
c. Not board any passenger without verifying the attestation and confirming the
documentation as set forth in 1.a-b.
Any airline or other aircraft operator that fails to comply with section 1, “Requirement for
Airlines & Other Aircraft Operators,” may be subject to criminal penalties under, inter alia, 42
U.S.C. 271 and 42 CFR 71.2, in conjunction with 18 U.S.C. 3559 and 3571.
2.

Requirements for Aircraft Passengers

Any aircraft passenger departing from any foreign country with a destination in the United States
shall —
a) Provide an attestation to the CDC, through the airline or other aircraft operator, of having
received a negative Qualifying Test result or of recovery from COVID-19 after previous
SARS-CoV-2 infection and clearance to travel. The attestation is attached to this order as
Attachment A. Unless otherwise permitted by law, a parent or other authorized
individual should attest on behalf of a passenger aged 2 to 17 years. An authorized
individual may attest on behalf to any passenger who is unable to attest on his or her own
behalf (e.g., by reason of physical or mental impairment).
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b) Retain a copy of the negative Qualifying Test result or Documentation of Recovery from
COVID-19 in his/her possession and present it for inspection to the airline and upon
request by an agent of the U.S. government or a cooperating state or local public health
authority.
Any passenger who fails to comply with the requirements of section 2, “Requirements for
Aircraft Passengers,” may be subject to criminal penalties under, inter alia, 42 U.S.C. § 271 and
42 CFR71.2, in conjunction with 18 U.S.C. 3559 and 3571. Willfully giving false or misleading
information to the government may result in criminal penalties under, inter alia, 18 U.S.C. 1001.
CDC may modify this Order by an updated publication in the Federal Register or by posting an
advisory to follow at www.cdc.gov.
This Order shall be enforceable through the provisions of 18 U.S.C. 3559, 3571; 42 U.S.C. 243,
268, 271; and 42 CFR71.2.
EFFECTIVE DATE:
This Order shall enter into effect on January 26, 2021 and shall remain in effect until the earliest
of (1) the expiration of the Secretary of Health and Human Services’ declaration that COVID-19
constitutes a public health emergency; (2) the CDC Director rescinds or modifies the order based
on specific public health or other considerations; or (3) December 31, 2021.
In testimony whereof, the Director, Centers for Disease Control and Prevention, U.S.
Department of Health and Human Services, has hereunto set her hand at Atlanta, Georgia this
25th day of January 2021.

Rochelle P. Walensky, MD, MPH
Director, Centers for Disease Control and Prevention

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