Testing positive weeks after a COVID-19 diagnosis: What it means for travel

Robin Ferré assumed his birthday trip to Los Angeles would go off without a hitch. He was triple vaccinated, had recovered from an assumed COVID-19 infection three weeks prior, and was armed with a negative rapid antigen test.

But then, the night before his flight back to Canada — on his birthday — his PCR test came back positive.

“It cost us a lot of money, and it caused us a lot of stress,” Ferré told Global News, speaking in French during an interview on Monday.

Ferré’s three-day trip in late January had suddenly became an 11-day stay — costing himself and his partner roughly $2,000 in unforeseen hotel bills, food and other expenses.

It’s a situation some Canadians are finding themselves in as travel becomes more common once again. They’re testing positive for COVID on a rapid test, recovering from the virus, then weeks later, they’re positive again on a travel-related PCR test.

“If you become sick and you test positive, it’s probably a legitimate result says that you’ve got COVID and you’re infected with the virus,” said infectious disease specialist Dr. Gerald Evans.

“The problem is that, in some people, that PCR test can actually continue to be positive for quite a long period.”

The culprit behind Ferré’s positive PCR test could have been something called the RNA molecule. It’s a “very sticky” molecule, according to Evans, and this “tricky, sticky molecule” can hide out in sneaky spots like your tonsils and throat — only to reappear when a PCR test carefully combs through your sample for any hint of COVID-19.

For most people, the RNA molecule is flushed out of the system within about 10 to 14 days. But in some instances, some might still test positive 28 days or longer after their infection.

In “very rare circumstances,” Evans said he’s seen people who, “six weeks or more” after contracting COVID-19, can “still test positive from a previous infection.”

This can create a problem for travellers who, despite being fully recovered from their COVID-19 infection weeks before, suddenly find themselves subject to a mandatory 14-day quarantine.

It’s something the travel industry is seeing more and more often, according to Will McAleer, executive director of the Travel Health Insurance Association of Canada (THIA).

“Several individuals I know who travelled this March break, they’re back now, and they’re being asked to  — or told to — quarantine, even though they can provide proof that they had previously tested positive and had recovered,” McAleer said.

Currently, the Canadian government does accept a previous positive molecular test result as an alternative to a negative test. To qualify to use this, you have to have no COVID-19 symptoms and your test must be between 10 and 180 calendar days old.

If this proof is accepted, you won’t have to take an arrival test or a test on day eight of quarantine.

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But this proof has to be in the form of a PCR test — it can’t be a rapid antigen test. PCR tests in Ontario are limited to specific, vulnerable groups right now, meaning many Canadians have no way of proving their previous COVID-19 diagnosis — including Ferré.

He and his partner got sick at the same time. Because of her asthma, she qualified for one of the limited PCR tests in Ontario. She was positive for COVID-19, and they both had the exact same symptoms. They both recovered, and tested negative before their trip at the end of January.

But when Ferré tested positive before returning return home, his partner was the only one with PCR proof of prior infection — and suddenly they were stuck. He says he took a rapid test that same day. It was negative.

Before Omicron, the consensus was that reinfections almost never happen within 90 days of your initial infection. With the advent of this more contagious variant, however, there are now reports of people getting a confirmed second infection after just 60 days, Evans explained.

At roughly three weeks since his COVID infection, Ferré was well within this threshold — he just had no way to prove it.

Without an old PCR test confirming his infection, the only way to prove his positive PCR test was a remnant of an past infection would have been to do “whole genome sequencing” on the RNA that was isolated in the PCR test, according to Evans.

The government recently announced that pre-arrival testing will no longer be required of fully-vaccinated passengers after April 1, so Ferré is unlikely to end up in this predicament again.

But a PCR test could still prove to be an issue is if you’re unvaccinated, are visiting a country with a PCR testing requirement — like Bulgaria, Cyprus, or Latvia, to name a few — or are randomly selected for a PCR test on arrival in Canada.

If you’re concerned about some sticky RNA putting a wrench in your looming travel plans, there are some things you can do to stave off the risk.

First, if you’re still sick, you can pay out of pocket for a PCR COVID-19 test — as Canada won’t accept a rapid test as proof you were previously infected.

“Let’s say you tested positive, you’re at home and you know you have travel plans coming up. I would strongly suggest that you go for the private PCR testing,” said Richard Vanderlubbe, who is president of tripcentral.ca and sits on the board of directors for the Association of Canadian Travel Agencies.

“When you’ve recovered, you’ve got that proof of immunity in case that you do test positive later.”

That’s what Ferré wishes he had done, he told Global News.

But the cost of confirming your positive rapid test with a PCR test from a private company can be upwards of $150 — and that’s only if they agree to see you despite your positive rapid test and any symptoms you might have.

Another thing you can do is get insured. That way, if you draw the short straw and a PCR test picks up that little molecule of sticky RNA, you won’t be stuck with the entire bill of an extended quarantine stay.

“It’s not a significant amount of premium in order to cover off a quarantine…because typically what you’d see is maybe a $250 a day benefit, up to a certain maximum. So it’s not a significant amount of benefit,” said McAleer.

“The key is you want to make sure you’re covered in case you catch COVID while you’re away. That’s where a medical emergency could take place. That could be significantly more costly.”

Before splashing cash on a costly PCR test or an insurance premium, you might also want to look up the entry requirements for the country you plan to visit. If they don’t require a negative PCR test, or if they accept a rapid test as an alternative — which doesn’t hunt for that sticky RNA — you might be worrying about a non-issue.

On top of that, epidemiologists believe this issue is “rare.”

“We don’t know exactly how rare, because we don’t systematically test people after COVID infection to prove that they’re negative, because the assumption is — and I think it’s a very reasonable assumption — is that once your symptoms are over and enough time has passed, it’s very unlikely that you would still be infectious,” said Dr. Christopher Labos, a Montreal-based cardiologist and epidemiologist.”

“It probably happens very, very rarely, but there have been documented cases where that does happen.”

At the end of the day, travelling during the pandemic — even at this stage — still carries some risk. But it’s up to you if you want to gamble on it.

“It’s this transitional period that is really, really challenging,” said Evans.

“You just have to be careful and throw the dice. I think all the odds are in your favour if you’re travelling right now.”