COVID-19 positive test and travel: Ontario update from the experts

After almost two full years of living during a global pandemic, you may be ready to pack your bags and hit the road for your next vacation. Planning for a trip, whether it be to see family or visit a new place, has changed considerably over the course of the pandemic. Borders were closed to non-essential travel, flights were cancelled and events were postponed as our “normal” began to look different and different each passing day. The big question right now for people is, “when will we get back to normal?”.

With COVID-19 cases still rising throughout the world, and especially in Ontario and the Windsor-Essex region, getting ready to travel has been more stressful than ever. Not only do you have to plan ahead for your vacation, you now have to plan for a new part of your itinerary which could also come with an entirely new budget – COVID-19 testing. In order to get into most countries right now, you’re required to get tested to board a flight or even pass through a border crossing. Not only do you have to coordinate getting this test when you’re planning to travel, you have to hope for the best: that it’s negative. It turns out that if you feel well a positive test may not be that bad if you understand the rules well. We will go through this later on in the article as an update to our previously published guide to covid-19 testing and an update to our past positive test article which can be found here.

What is the difference between PCR and rapid antigen?

The two main tests that countries and airlines are looking for right now are the RT-PCR and the rapid antigen. The difference between a rapid antigen and the RT-PCR test you might ask? Depending on the situation, the antigen tests tend to be slightly less accurate than the PCR tests. What molecular PCR tests do differently is they are able to detect smallest amounts of virus. They do it by first multiplying (or amplifying) the viral material they are looking for. This means that there needs to be enough viral antigen on the rapid antigen test strip to generate a signal and show up as positive. For PCR tests, the small amount of material will first be multiplied several times and then be sent for detection. This way even a small amount of coronavirus genes in the patient’s sample can be detected. For differences between different types of PCR tests click here.

C19 results can be both negative and positive

Windsor-Essex residents looking to escape to their favourite tropical destination now have some planning to do. With the Windsor-Detroit border being open to fully vaccinated travellers for non-essential travel into the USA, getting a PCR test for travel is an option in both Windsor and Detroit, depending on if you plan to fly out of a Canadian airport or an American airport. If travelers receive a negative travel certificate after being tested, they’re free to board flights and cross borders within the time frame that the test is valid for. When the travel test comes back positive is when things start to get a little tricky. Asymptomatic travelers, especially after booking non-refundable vacation packages, are taken by surprise when testing positive. The go-to thought might be, “what if it’s a false positive?”

How accurate are the C19 PCR tests?

Let’s look at the facts about false positives before we delve into the rules about travelling with a previous positive test. Public Health Ontario states that the positive predictive value of COVID-19 PCR assays is excellent, and approaches 100%. False positive test results are typically avoided by maintaining all appropriate standards for the sample processing. This is because a false positive could happen due to a reagent contamination in the actual laboratory setting or a reagent arriving contaminated. To mitigate this, reputable processing centres have quality standards in place and it may be important to know your processing site and their quality systems.

At Safe Travels Clinic we follow strict sample processing standards for our RT-PCR and expedited express RT-PCR samples as well as for our rapid antigen tests. Our partner laboratory maintains ISO 15189 PLUS accreditation standard. Among the systems utilized to prevent false positive results are quality of materials used, cleaning protocols and equipment maintenance protocols, running control samples with new reagents. To conclude, it’s highly unlikely a positive PCR test is a false positive in a quality processing site following appropriate protocols.

Canada changes to PCR testing eligibility

Ontario continues to update its isolation guidelines for COVID-19 testing recently reducing the amount of testing for symptomatic individuals and exposure cases. Instead, the government funded tests were allocated for high risk individuals, and individuals who work in high-risk settings. As of December 2021, individuals with symptoms consistent with COVID-19 are presumed positive and should follow isolation and self monitoring guidelines. In a nutshell, fully vaccinated people with symptoms should isolate for a specific amount of days now and for a shorter period than the unvaccinated and immunocompromised, which will be explained in detail below. The fully vaccinated have now been awarded a significant advantage: potential exposure means symptom monitoring without the need of isolation! The result is a drastic reduction of PCR testing leaving case number measurements to approximation. This doesn’t necessarily mean you still can’t take a PCR test, especially if you need to travel.

New self isolation guidelines for symptoms

So you had symptoms and you could not get your test to confirm it and now an important trip is coming up. This is as stressful as things can get. What should you do? Now you need to isolate according to the latest COVID-19 isolation protocols published by Health Canada. We simply presume COVID-19 infection now based on symptoms. It may mean moving your flight as well. Here's what you have to do:

If you are fully vaccinated or under the age of 12:

- Self-isolate for a minimum of five days following the date when your symptoms started. Your household contacts will also be required to isolate alongside you. If, after five days, your respiratory symptoms have improved for at least 24 hours or your GI tract related symptoms improved for at least 48 hours you can end your isolation period.

*** Practical tip: This one is challenging because it indicates the minimum amount of days and it may be the case (although rare) that your coughing improved as late as day 7 so you would need to isolate for 24 more hours from feeling improvement (probably until day 8). If your symptoms were a low grade fever with vomiting and it improved on day 6 - you have to wait another 48 hours to end isolation. It is important to note that the guideline does not want your symptoms to completely go away but wants you to notice improvement - any noticeable improvement will count.

If you are not fully vaccinated or under the age of 12, or you have an immunocompromised condition:

- Isolate for at least 10 days and at least 24 hours of improvement in general for respiratory symptoms and 48 hours of improvement in GI tract related symptoms. No exceptions.

If you are a healthcare worker with symptoms:

- You must stay home from work for 10 days. However, you can return after isolating for 7 days if you test negative on a PCR test or two antigen tests taken on day 6 and 7 of your isolation period.

Is your test an RT-PCR test?

Getting an appropriate travel PCR test can be confusing, especially after recovering from COVID-19. Now that you’ve finished isolating from testing positive and are no longer symptomatic, you probably are itching to get on that vacation you had previously planned to go on. You may be looking for a required COVID-19 travel test. It is best to get C-19 tested in a reputable travel testing centre. If you learn that you require a PCR test for travel be aware of the different types of PCR tests. We have covered it before to some extent. Some countries require a specific higher quality and higher accuracy PCR test called the “RT-PCR” or real time reverse transcriptase test, which is typically more expensive than the technically simpler NAAT (nucleic acid amplification test). Beware of those tests that are approved for some countries only -- the results typically return back in 15 minutes and are less costly. We recommend to play it safe and go for the RT-PCR each time. Travelers may forget that connecting flights through other countries on the way have their own requirements other than their destination. The question you should ask is “is it an RT-PCR test?”. Here at the Safe Travels Clinic in Windsor we only offer the RT-PCR test, including the expedited 1 hour processing test, so you do not have to worry about being provided with an inappropriate test.

You completed the RT-PCR test - now what?

Now that you’ve completed your isolation period, you found a reputable COVID-19 testing centre in Ontario, you made sure your test was an RT-PCR, and you got your express RT-PCR results in one hour because you wanted peace of mind and didn’t want to wait another day for your results, you open your results and they say that you are C-19 positive. What now? The good news is: you’re not completely out of luck. You will still be allowed to travel with a positive test result as long as prove you have recovered and you meet the other criteria for it.

How is my test positive when I was told I already recovered from COVID-19?

Since we know the RT-PCR is the most accurate test to detect RNA of the COVID-19 virus, even in the smallest amounts, we can see that this actually can be problematic

at times. While it is important to detect small amounts of the virus at the beginning of an infection (virus amounts will grow and will soon start infecting others), the tiny amount of virus in people recovering from infection will come out as a positive test as well (the "dying" virus amounts are too low to infect others but not quite yet at zero). In some people the "dying" virus will stay present for longer than usual, sometimes for up to 90 days and for this reason their RT-PCR test may stay positive for 90 days. Some sources have reported 180 days of false positive results are possible (This is why some airlines will allow a 180 day grace period from a positive test). This is a known limitation of the PCR test - because it is not a test to see if you can infect others - it is a test looking for any slightest presence of virus or viral genes, even if not important for viral spread anymore. Some countries may require a serology test in addition to the above but this is uncommon since clinical significance of these tests is low.

How to travel with a positive COVID-19 test

Many different countries may have different requirements in terms of what kinds of tests they want to see when you enter. The same applies to what they allow in lieu of a negative test result. There is one thing in common about

it: countries more or less base their requirements on the same source: the CDC. Based on the CDC recommendations we know that a test can be showing presence of a virus after COVID-19 recovery without being infectious anymore.

Fit to fly medical note or travel certificate

So now based on the CDC recommendations and in limited circumstances, patients may be provided a medical note that a test is falsely positive. This note is sometimes called medical clearance or a fit to fly note or travel certificate. This is what you would need in order to obtain one of these notes from the Safe Travels Clinic doctor in Windsor.

1. Two positive recorded RT-PCR results within 11-90 days apart. Be aware Air Canada requires at least 14 days between positive tests.

2. Being asymptomatic for at least 24 hours or having symptoms improved for 24 hours.

3. Both positive RT-PCR tests being processed by our COVID-19 testing centre.

Please note not all airlines or countries are guaranteed to accept a medical clearance note in lieu of a negative test. Some will just require a positive test result after a period of isolation without a note. That would mean that a positive PCR test from 11-180 days prior to your boarding may be enough to board your plane at times. Some may even have different recommendations. Please confirm with your airline or border services agency first because regulations keep rapidly changing throughout the world.

Traveling with a positive test - Canada’s rules

Since analysis for every country would be outside the framework of this article we will focus on one specific example - the rules about entry into Canada with a positive test result. Ultimately, all Canadians will need to follow this set of rules when returning home from our travels from anywhere in the world!

Canada currently requires all travelers 5 years of age or older to provide proof of a COVID-19 molecular test to enter Canada. If the test was positive it will count when the test was taken within 11 to 180 days before the initial scheduled departure of your flight or your scheduled entry into Canada by land or by water. (What that means is that you have to be outside the infectious period of the first 10 days, but will not count for more than 180 days). In addition, proof of the positive result must be from an accepted type of molecular test: PCR (polymerase chain reaction), RT-PCR (reverse transcriptase polymerase chain reaction) Nucleic Acid Test (NAT), Nucleic Acid Amplification Test (NAATs) or the Reverse

Transcription Loop-Mediated Isothermal Amplification (RT-LAMP). These tests must be collected as a nasopharyngeal swab, nose swab or a saliva sample. Rapid antigen test results are not accepted to enter Canada. Canada doesn’t recognize rapid antigen tests, even with a travel-approved certificate valid for all other countries.

What information need to be on my PCR test results to Canada?

When providing proof of your appropriate test result, your test result must show the traveler’s name and date of birth, name and address of the laboratory or facility that administered the test, the date and time of test collection, the type of test taken, sample collection type and finally: the test result. As long as your positive PCR test has been taken within 11 to 180 days and contains all the above information, you’re set to cross the border back into Canada. Canada does not require a fit-to-fly note from a physician - they will solely base their entry requirement on the above, considering the test result in the appropriate window proof of COVID-19 recovery on its own.

When would you be denied entry or fined for a positive test?

If you have a positive pre-entry test result taken within less than 11 days of planned entry into Canada, you are in the COVID-19 virus infectivity period. Within this timeframe you are posing a threat to others and for this reason you would need to follow all isolation protocols instead of travelling. Foreign nationals trying to enter Canada with a positive test result from less than 11 days will be denied entry to the country, and Canadians may be fined $5,000 per traveler (plus surcharges). Please verify the latest regulations for entry as these rules are continuing to change on an ongoing basis.

The Importance of the ArriveCAN app

When returning to Canada do not forget to download and upload your results to the ArriveCAN mobile and desktop application. This is the comprehensive tool to verify all traveler’s contact information and travel details, vaccination information, pre-entry test results or previous positive result and travel history and quarantine plan. Once inside the application, you must follow the steps and answer every question in order to receive a confirmation at the end. The confirmation code is what you'll need to present to a customs officer at the border,

Will I need to get additional PCR tests and quarantine upon entry to Canada?

Despite receiving a negative pre-entry test or showing proof of recovery from COVID-19 you may be subject to additional testing on arrival when returning to Canada. Travelers coming from any other country other than the United States in the past 14 days should be prepared to take an arrival test and quarantine at a suitable place (such as your home) until you receive a negative arrival test result. This doesn’t mean that you will be denied entry to Canada, it just is a precaution taken by the government. An arrival test could be on-site at an airport, offsite at a different facility, or you may be given a self-swab test kit at the border to take home.

In conclusion

Traveling in general brings stress to everyday life, from booking flights and hotels, to budgeting and planning a full itinerary for your trip. Whether it be for work or for pleasure, there’s always a new (or old) destination to discover. Adding a global pandemic into the mix brings a whole new set of stressors to the table – like planning to travel after recovering from COVID-19, or figuring out which test you need to take and when to take it. I hope this has given you some information in terms of your options for planning your next trip and don't forget to book an appointment with us at Safe Travels Clinic to take care of all of your COVID-19 travel testing needs!