What happens if you test positive during a COVID-tested flight?

Sitting in the COVID-19 testing area at several airports recently, I wondered, "What happens if my test comes back positive?"

After all, one of the most significant risks of taking COVID-19 tests while traveling is that you could test positive. Whether you contract COVID-19 or have the misfortune of a rare false positive, getting a positive result certainly complicates your trip.

Multiple TPG staffers have gotten positive test results unexpectedly while away from home. For example, one TPG staffer tested positive on a layover in San Francisco. Another saw a three-night spring break turn into a 15-day quarantined mess. So, getting an unexpected positive result during your trip is certainly possible.

As of May 16, 2021, American tourists can visit Italy without quarantine when arriving on a COVID-tested flight. But, these flights require one or two COVID-19 tests before departure. You'll also need to take a COVID-19 test when you land in Italy. So, what happens if you test positive at any point during the journey?

Since I flew on a Delta-operated COVID-tested flight recently and picked up some documentation about what happens in the case of a positive result, I'll focus primarily on what happens if you test positive on one of Delta's COVID-tested flights from New York-JFK to Milan, Italy (MXP). But, much of this information will also apply to American and United COVID-tested flights.

Testing positive before travel begins

Delta, United and American all require travelers to provide a negative COVID-19 test result before check-in for COVID-tested flights to Italy.

You typically need to take your test within 48 to 72 hours of the scheduled departure time for your flight to Italy. But, each airline has different requirements regarding what tests are acceptable.

Delta's website provides the following information about what happens if you test positive before beginning travel:

Customers who receive a positive PCR test result will need to postpone their trip, should self-isolate in accordance with health guidelines and should not come to the airport for check-in. Customers will receive an eCredit for the unflown portion of their ticket and change fees will be waived.

When asked about what happens if a passenger tests positive, an American Airlines spokesperson said, "We have an existing policy that makes exceptions for people with illnesses or health-related issues prior to traveling on American. With proper documentation, we work with the customer to meet their travel needs."

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A United spokesperson echoed the sentiment, saying, "All of our normal change and cancellation [or] refund options would apply if a customer tested positive during their travels."

Related: Airline coronavirus change and cancellation policies: A complete list of major carriers

So, in short, if you test positive before travel, you should follow the advice given to you by your health care provider. This may involve retesting but will likely also mean you'll need to cancel or postpone your trip. After all, the formal statement I had to fill out and give to a border police officer when entering Italy required me to declare:

If you tested positive on an antigen test and then negative on a molecular test, your health professional may clear you for travel. When I checked in for my Delta flights, I had to check that "In the past 10 days, [I] have not had a COVID-19 diagnosis and have not experienced the onset of any one of the primary symptoms of COVID-19."

But, a United spokesperson told TPG that "customers need to confirm that they have not tested positive in the last 14 days in order to travel."

That's why I recommend getting a molecular test instead of an antigen test whenever possible. After all, molecular tests are the current gold standard to diagnose COVID-19 infections because they detect the specific genetic makeup of the virus.

Related: Traveling soon? Here’s where you can quickly get a COVID-19 PCR test for travel

Testing positive at the airport before departure

If you're flying on a Delta COVID-tested flight, you'll also need to take a second COVID-19 test at the airport before boarding your flight to Italy. Delta's website notes:

Customers who receive positive COVID-19 results at the airport prior to boarding will undergo a second test to confirm the result. Once confirmed, local regulatory guidelines for medical treatment and quarantine will be followed. Affected customers who test positive at the airport will be issued an eCredit and may request a refund of the remainder of their Delta ticket.

When I got a test at the XpresCheck JFK before my Delta flight last Sunday, the lab analyzed my sample using the BinaxNOW antigen test. But, if I'd tested positive on the initial examination, I assume a molecular test would have been used to confirm the result.

It's unclear whether I'd be allowed to fly if my initial result was positive, but the second test was negative. I reached out to Delta for confirmation but didn't receive a response in time for publication.

Finally, I didn't need to pay anything extra for the initial test at JFK. But, it's unclear whether I would need to pay for a required follow-up test if my initial results come back positive.

Related: How to book a COVID-tested flight to Italy from 51,000 miles round-trip

Testing positive upon arrival

And finally, if you're flying on a COVID-tested flight to Italy, you'll need to take a rapid COVID-19 antigen test at the airport when you arrive. Based on documents I received at the Milan airport when agreeing to the test, the following will occur in the case of a positive or inconclusive result:

• You'll "undergo a viral RNA diagnostic investigation by means of an additional nasopharyngeal swab"
• The health personnel will activate procedures involving home isolation for you and your close contacts. Home isolation will continue until a new viral RNA swab is negative.

The result certification sheet I received in Milan showing my negative test result gave slightly more information. This sheet noted

In the event of a positive test result, the positivity to SARS CoV-2 infection must be confirmed with a second swab performed with a molecular method within 12 hours.

So, it's unclear whether you can do the second swab at the airport or whether you'd need to go elsewhere in Milan to get a molecular test. But, based on how organized testing was in the Milan airport when I arrived Monday morning, I assume you'll get more detailed instructions if you test positive.

Related: Italy is reopening: 11 things I learned as a tourist there this week

Bottom line

I didn't worry much about testing positive during my recent COVID-tested flight to Italy as I'm fully vaccinated. So, my chances of becoming infected with COVID-19 are low -- especially when combined with masks, social distancing and other risk-mitigation techniques.

Plus, I took an RT-PCR molecular test about 24 hours before my first flight, so I knew I was negative at that point.

There's still a risk, however, that I could test positive along the way. And, this is the reason some travelers don't want to travel outside the U.S. until the U.S. removes its reentry testing requirement. So, you should carefully consider your risk as well as your willingness to change plans last minute or even quarantine away from home. The risk may not be worth the reward for some travelers.

But for me, I decided my risk was adequately low and I enjoyed my last-minute quarantine-free trip to Italy.