Distinguishing between CDC and State Department travel alerts

During 2020 and 2021, you likely observed a surge in travel alerts from the U.S. government, warning Americans about international travel amid the ongoing COVID-19 pandemic. But what exactly do these alerts signify, and how much importance should be assigned to them?

Each week, the U.S. Centers for Disease Control and Prevention and the U.S. Department of State jointly publish updated guidance regarding travel levels for countries worldwide, categorized from Level 1 to Level 4 based on the overall health situation of a country — including COVID-19 and other factors.

These alerts are based on ongoing safety concerns across various aspects, not solely linked to the pandemic, although there is likely a connection between a country's safety status and its ability to handle the pandemic for both residents and visitors.

While both are issued simultaneously, the CDC's COVID-19 travel guidelines and the State Department's travel advisories differ in scope; the latter addresses current issues beyond just COVID-19. Hence, the information provided in each should be tailored to your specific circumstances as a traveler.

Dr. Daniel Caplivski, director of the travel medicine program and infectious diseases professor at Mount Sinai, emphasizes that travel data should be tailored to each individual traveler. He recommends adhering to guidance from government agencies.

Travel recommendations regarding COVID-19 from the CDC

As I've noted before, the CDC provides guidance for countries based on COVID-19 statistics sourced from the World Health Organization.

For countries with populations over 100,000, the CDC analyzes the number of new COVID-19 cases reported in the last 28 days, along with testing rates and the ratio of tests to cases during that period. The incidence rate serves as the primary criterion, while the other two metrics are considered secondary. For locations with fewer than 100,000 residents, the evaluation relies on case numbers and testing data.

These figures are utilized to formulate international travel recommendations, assessing the risk of COVID-19 transmission for both vaccinated and unvaccinated travelers.

On November 21, 2020, the CDC updated its three-level notice system to a four-level framework for COVID-19, aligning with incidence rate and case count thresholds established by recognized public health authorities, and sharing a similar 4-level structure with the U.S. Department of State's Travel Advisory system.

Countries that fail to provide official COVID-19 statistics, like Monaco or Venezuela, will have their travel health notice level marked as "unknown," and should be treated as Level 4 countries.

Level 1: Low Level of COVID-19: 50 cases or fewer

Level 1 applies to nations reporting fewer than 50 COVID-19 cases per 100,000 residents over the past 28 days. The CDC advises that only fully vaccinated travelers should consider visiting these areas.

Level 2: Moderate Level of COVID-19: 50-99 cases

Level 2 applies to regions that have reported between 50 and 99 COVID-19 cases per 100,000 individuals during the past 28 days.

The CDC states, "Unvaccinated travelers who are at higher risk for severe illness from COVID-19 should steer clear of nonessential travel to this destination."

Level 3: High Level of COVID-19: 100-500 cases

Level 3 is designated for areas with between 100 and 500 cases per 100,000 people, with the CDC again advising that "unvaccinated travelers should avoid nonessential travel to this destination."

Level 4: Very High Level of COVID-19: 500 or more cases

Level 4 indicates the highest level of concern, including countries that have more than 500 COVID-19 cases per 100,000 residents. According to the CDC, all Americans should "avoid travel to this destination," regardless of their vaccination status.

The CDC previously stated, "The criteria for establishing Travel Health Notice levels were revised to more effectively differentiate between countries facing severe outbreaks and those with sustained but manageable COVID-19 transmission. This update provides tailored travel advice for both vaccinated and unvaccinated travelers based on the THN level, ensuring these levels accurately reflect the current global situation and adhere to international travel guidance."

As of the time of publication, the CDC had not responded to four requests for comments.

Travel advisories issued by the State Department

As expected, the State Department issues advisories that integrate CDC recommendations while also considering additional factors beyond a country's health conditions. This includes specific crime categories reflecting ongoing safety issues, which are represented by eight risk-specific indicators, noted with initials in the top right corner:

• C=Crime.
• T=Terrorism.
• U=Civil unrest.
• H=Health risks, including COVID-19.
• N=Natural disaster.
• E=Time-sensitive event.
• O=Other potential risks not included in previous categories.
• K=Kidnapping/hostage situations.

According to a State Department official, "In each Travel Advisory, we provide a comprehensive Advisory level and clearly outline the risk associated with each indicator while detailing the safety and security issues involved," shared in a background email.

Similar to the CDC, the State Department also categorizes advisories according to risk levels, with Level 1 indicating the lowest risk and Level 4 the highest danger.

• Level 1: Exercise normal precautions.
• Level 2: Exercise increased caution.
• Level 3: Reconsider travel.
• Level 4: Do not travel.

According to a State Department official, "We continuously monitor safety and security conditions in destinations worldwide and will revise specific information when necessary. We regularly evaluate COVID-19 conditions at each location, and as circumstances change that significantly impact U.S. citizen safety, we will update the information provided to U.S. citizens—whether in the Travel Advisory or through timely health and safety Alerts—to assist them in making informed travel choices."

The distinctions between them

The CDC explains that its travel health notices "alert travelers and healthcare providers about current health issues affecting travelers' safety, such as disease outbreaks, special events, gatherings, and natural disasters, globally." While the agency issues non-COVID-19 travel health notices, most travelers currently focus on COVID-19-specific alerts. In general, the CDC prioritizes health-related concerns, with most being related to COVID-19 at this time.

The State Department stated, "The CDC's Travel Health Notices are solely focused on health-related issues, while the Department of State's Travel Advisories consider a wider array of risk factors." This means that in certain cases, the advisory level for a specific country may differ from the CDC's notice for that same location.

As of September 16, 84 countries fall under the CDC's Level 4: Very High Level of COVID-19, while 105 out of a total of 216 locations globally are classified as Level 4: Do Not Travel by the State Department.

Understanding the two

You might be curious about how to weigh the travel advisories from the CDC and the State Department. The short answer is to consider both equally.

Dr. Caplivski stated, "The CDC's approach is sensible for many travelers as a general guideline. However, I recommend looking at the overall situation in the country beyond just the risk of infectious diseases. There could be other factors aside from COVID-19 that influence a person's choice to avoid traveling to a particular country."

For travelers who are moderately to severely immunocompromised, a U.S. government travel advisory takes on a more personal significance, as the CDC indicates they are "particularly vulnerable to COVID-19."

Dr. Caplivski states, "We aim to tailor the risk evaluation based on a person's vaccination status and immune system condition. For some individuals, it may be wise to postpone travel until COVID-19 levels decrease significantly."

Every advisory takes into account the capacity of government officials to aid Americans during emergencies overseas.

Caplivski added, "The State Department is informing you that their ability to evacuate you during an emergency may be restricted in a country with a Level 4 travel advisory. COVID-19 continues to be a global pandemic, including in the U.S. We closely monitor the balance of available healthcare resources along with actual COVID-19 infection rates. It's important to know if local hospitals can handle a surge in cases during an emergency."