In addition to welcoming foreign visitors coming from previously-banned countries and imposing a new vaccination requirement on non-residents entering the U.S. by air (with exceptions) there are new rules for unvaccinated Americans returning to the U.S.

• Vaccinated Americans still have to present a negative Covid-19 test taken within 3 days prior to travel. Children of vaccinated Americans are exempt from more onerous the testing requirement.

• Those with documented recent prior infection (positive COVID-19 test within the past 90 days and letter from healthcare provider clearing you to travel) remain exempt. It’s the only place where prior infection appears to be recognized by the U.S. health establishment. And it’s recognized as better than vaccination for this purpose.

• But unvaccinated American residents will have to test no more than one day prior to departure.

• Children under 18 don’t have to be vaccinated. They do have to test. And when they have to test depends on their parents’ vaccination status.

• Children aged 2-17 traveling with an unvaccinated adult are required to test within one day of travel. Children traveling with a vaccinated adult can test within 3 days of travel.

Many testing facilities will not perform tests on children under 5, or under 3. Even with the Delta variant children remain less likely to get and spread the virus compared to adults. And an antigen test three days prior to travel tells you very little about current infectious on the day of travel in any case (let alone about carrying the virus but not yet being infectious).

Antigen tests are good for determining current infectiousness, while PCR tests determine viral load in the body (including both pre- and post-infectiousness). Antigen tests are allowed for travel because,

1. They’re faster and more convenient
   
2. The testing requirement doesn’t protect the U.S. against spread of the virus, both because of the tests accepted and because the introduction of marginally more people with the virus doesn’t change the course of the pandemic at this point (especially given the levels of immunity in the United States, even though it may not have ultimately mattered given U.S. strategy earlier on).
   
3. It also doesn’t protect against introduction of new variants, land border crossings don’t have the same regime and even Australia saw the introduction of Delta. In any case the virus mutates in a similar fashion around the world so as long as it remains highly pervasive.

The closer-in testing requirement for children traveling with unvaccinated adults is pretty clearly punitive. Like the pending OSHA rule for large employers (announced September 9th, still not issued, yet was ‘urgent’). It’s meant to make life more difficult for unvaccinated people so they’ll get vaccinated.

Some of you might say ‘but a child traveling with someone unvaccinated is more likely to be infectious on the precise day prior to travel than they would be three days prior to travel’ but this isn’t mathematically compelling, and certainly not based on any plausible public health theory about saving lives and preventing the overwhelming of hospitals.

I’m 100% sympathetic to vaccines. I was vaccinated and I’ve gotten my booster shot. The success of the mRNA vaccines especially is truly remarkable. But the policies promulgated aren’t about the science.

Otherwise the U.S. would recognize immunity from prior infection and a single dose of an mRNA vaccine, as is recommended commonly in Europe if it’s going to recognize two doses of Sinovac’s Coronavac vaccine which was claimed to be 51% effective against symptomatic disease pre-Delta and which the World Health Organization says has no evidence of reduced infection or transmission. I mean, for 9 months of the Biden administration unvaccinated Russians and Peruvians who have tested negative have been fine, but as case loads fall in the U.S. those who received the Sputnik vaccine aren’t welcome a single J&J dose counts (when many experts on FDA and CDC advisory panels were reluctant to approve a second J&J dose rather than an mRNA booster even).

If you want to argue that life should be made more difficult for the unvaccinated using whatever limited levers are available to the Administration then make that argument but don’t dress up U.S. policy as guided by science.

Wanting to see more people vaxxed is unquestionably a good thing, but remember the huge miss for this administration I wrote about back in March that the stimulus bill should have tied $1400 payments to vaccination, but they thought they could win votes handing out no-strings checks. Now they’re left with sticks rather than carrots, but you’d think they’d allow those fully vaccinated with an mRNA vaccine within the past 6 months, or boosted, to skip testing the way that those recently-recovered can do.