Greenland Travel Restrictions

Traveler's COVID-19 vaccination status

Traveling from the United States to Greenland

Open for vaccinated visitors

COVID-19 testing

Not required

Not required for vaccinated visitors

Restaurants

Not required in public spaces, enclosed environments and public transportation.

Greenland entry details and exceptions

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Can I travel to Greenland from the United States?

Most visitors from the United States, regardless of vaccination status, can enter Greenland.

Can I travel to Greenland if I am vaccinated?

Fully vaccinated visitors from the United States can enter Greenland without restrictions.

Can I travel to Greenland without being vaccinated?

Unvaccinated visitors from the United States can enter Greenland without restrictions.

Do I need a COVID test to enter Greenland?

Visitors from the United States are not required to present a negative COVID-19 PCR test or antigen result upon entering Greenland.

Can I travel to Greenland without quarantine?

Travelers from the United States are not required to quarantine.

Do I need to wear a mask in Greenland?

Mask usage in Greenland is not required in public spaces, enclosed environments and public transportation.

Are the restaurants and bars open in Greenland?

Restaurants in Greenland are open. Bars in Greenland are .

Eye on the Arctic

Eye on the Arctic

Issues affecting circumpolar nations

Greenland’s new domestic and international COVID-19 rules in effect until March 6

greenland covid travel

Greenland has extended and updated its international and domestic COVID-19 travel rules as of December 6 and will keep them in effect for at least three months, the government said in a series of announcements on Sunday.

As of Monday, all travellers into Greenland over two years old must be able to present a negative PCR test taken within 72 hours of departure. Starting from December 8, the test must be taken within 48 hours of departure.

Travellers who are not residents of Greenland are also required to show proof that they’re fully vaccinated.

Recreational boaters and cruise ship passengers are not allowed to disembark in Greenland if they’ve previously stopped in Denmark, the Faroe Islands or a foreign port within the last 14 days.

However, passengers ships can still dock in Greenland if no travellers or crew members go ashore.

Domestic  travel

Those travelling domestically between Greenland’s towns or settlements must now be fully vaccinated or be able to show a negative PCR test done within 48 hours.

greenland covid travel

Unvaccinated people must quarantine for 14 days upon arrival at their destination, or until they’ve tested negative. While observing quarantine, visitors are able to go to grocery stores as long as they’re masked, but are otherwise banned from attending local events or gatherings.

Masking requirements

Masks are also now obligatory both in big towns and small settlements with COVID-19 outbreaks and where authorities have been unable to establish the infection chain.

Limited exceptions include places like stores if physical barriers like plastic have been put up blocking direct contact between the employee and the customers.

As of December 6, three communities fell under this ordinance including the capital city of Nuuk, Upernavik and its surrounding settlements, and the western town of Qasigiannguit

Restrictions to public places

Proof of vaccination, or proof of a negative COVID-19 test, will also now be required for those 12 years old and over to access public places like restaurants, bars, cultural events, hairdressers and libraries.

greenland covid travel

Essential services like airports, government services, grocery stories and airports will be exempt.

Towns and communities that have no testing facilities, or that have had no COVID-19 outbreaks within the last 14 days and where there are no unknown infection chains, will also be exempt from restrictions to public places.

As of Monday, December 6, Greenland was reporting 202 active COVID-19 infections.

All new COVID-19 rules are set to stay in place until March 6, 2022.

Write to Eilís Quinn at eilis.quinn(at)cbc.ca

Related stories from around the North:

Canada : Omicron variant cases in Canada prompt new travel rules for Nunavik, Quebec , Eye on the Arctic

  • ← Peatlands in Canada’s Northwest Territories store 24 billion tonnes of carbon and are worth protecting, experts say
  • After a month stuck in Arctic sea ice, nine vessels make it to Kara Sea →

greenland covid travel

Eilís Quinn, Eye on the Arctic

Eilís Quinn is an award-winning journalist and manages Radio Canada International’s Eye on the Arctic news cooperation project. Eilís has reported from the Arctic regions of all eight circumpolar countries and has produced numerous documentary and multimedia series about climate change and the issues facing Indigenous peoples in the North.

Her investigative report " Death in the Arctic: A community grieves, a father fights for change ," about the murder of Robert Adams, a 19-year-old Inuk man from Arctic Quebec, received the silver medal for “Best Investigative Article or Series” at the 2019 Canadian Online Publishing Awards. The project also received an honourable mention for excellence in reporting on trauma at the 2019 Dart Awards in New York City.

Her report “ The Arctic Railway: Building a future or destroying a culture? ” on the impact a multi-billion euro infrastructure project would have on Indigenous communities in Arctic Europe was a finalist at the 2019 Canadian Association of Journalists award in the online investigative category.

Her multimedia project on the health challenges in the Canadian Arctic, "Bridging the Divide," was a finalist at the 2012 Webby Awards.

Her work on climate change in the Arctic has also been featured on the TV science program Découverte, as well as Le Téléjournal, the French-Language CBC’s flagship news cast.

Eilís has worked for media organizations in Canada and the United States and as a TV host for the Discovery/BBC Worldwide series "Best in China."

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Traveltrade - Visit Greenland

– Covid-19 situation –

Guidelines for operators.

We are aware how serious COVID-19 is and are working hard to save and rebuild Greenland’s tourism industry for the future.

Please click on the links for more information.

Visit Greenland delivers a series of webinars focusing on developing and addressing the needs of the industry. For online resources for the industry, please visit our webinar page .

  for interacting with tourists during different activities

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Information from health authorities in Greenland

The Greenlandic health authority’s website www.nun.gl is the official website for information and knowledge about Coronavirus in Greenland. The information is based on current knowledge, but because the situation surrounding the novel Coronavirus is constantly developing, the site is continually being updated. We recommend that everyone follow developments on www.nun.gl .

Travellers from abroad to Greenland

If you are a Danish citizen and are travelling from a high risk area, it is recommended that you refrain from entering Greenland until 14 days have passed since you left the high risk area. See more on www.nun.gl .

If you have flu-like symptoms and are on the way back to Greenland (before boarding a flight to Greenland), you should contact the local health centre by telephone, and stay indoors until you receive instructions on further treatment. It could be that you may not continue travelling to Greenland until it is confirmed that you are not or no longer infected.

Passengers on Air Greenland’s flights from Copenhagen to Kangerlussuaq can risk being held in Kangerlussuaq if the cabin crew becomes suspicious that someone is infected.

Visit Greenland is working behind the scenes

We are aware of how drastic the COVID-19 situation is for the industry. Visit Greenland, together with the DMOs and other stakeholders are working hard trying to find ways to salvage and rebuild the tourism industry for the future. Some initiatives include solving immediate problems, but also planning for the future recovery:

Dialogue with the Industry and important stakeholders

  • finding solutions and influence on how to get more funding and support for the tourism branch so they can carry out activities and survive, such as the tourism help package. 
  • Keep a dialogue with key stakeholders so we can draft plans together for the best interest of the Greenland industry

Skill development

  • Developing further platforms that will allow tourism operators to improve their skills, such as digital proficiency and business development knowhow.

Reacting to closures and planning for tourism’s reopening

  • communicating change, such as introducing a cancelled cruise call list 
  • planning optimal scenarios for the reopening of Greenland, and working on approach plans for our key markets which are severely hit by the crisis
  • actively promote and develop domestic tourism opportunities such as the staycation project
  • planning the framework for execution of the reopening such as Health and safety guidelines for tourists and tour providers

Risk of infection for tourist operators

As a tourist operator, you risk coming in close contact with people with flu-like symptoms, or who have recently been in one of the high risk areas. You should evaluate yourself whether you want to cancel a booking if a tourist is showing flu symptoms, or has recently been in one of the high risk areas. You and your customers should also follow the health authority’s hygiene guidelines for limiting the risk of infection:

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Prevent transmission of the novel Coronavirus – COVID 19

The novel Coronavirus typically spreads in places with a lot of people, through handshakes, coughing and sneezing. Protect yourself and others with this advice.

  • Wash your hands often and use hand sanitizer.
  • Cough or sneeze in a tissue or your arm – not in your hands.
  • Avoid spitting. This can be a source of contamination for others.
  • Avoid shaking hands, kissing and hugging – limit physical contact.
  • Pay attention to cleaning – both at home and at your place of work.
  • Avoid being in places where there is close contact with a lot of people.

Official information From The National Health Authorities

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Travel Advisory June 7, 2023

Kingdom of denmark - level 2: exercise increased caution.

Reissued after periodic review with minor edits.

Exercise increased caution in the Kingdom of Denmark due to  terrorism .

Country Summary: Terrorist groups continue plotting possible attacks in the Kingdom of Denmark. Terrorists may attack with little or no warning, targeting tourist locations, transportation hubs, markets/shopping malls, local government facilities, hotels, clubs, restaurants, places of worship, parks, major sporting and cultural events, educational institutions, airports, and other public areas.

Read the  country information page for additional information on travel to the Kingdom of Denmark which includes the Faroe Islands and Greenland.

If you decide to travel to the Kingdom of Denmark:   

  • Be aware of your surroundings when traveling to tourist locations and crowded public venues.
  • Follow the instructions of local authorities.
  • Monitor local media for breaking events and adjust your plans based on new information.
  • Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive Alerts and make it easier to locate you in an emergency.
  • Follow the Department of State on  Facebook  and  Twitter . 
  • Review the  Country Security Report  for Denmark.
  • Visit the CDC page for the latest Travel Health Information related to your travel.
  • Prepare a contingency plan for emergency situations. Review the  Traveler’s Checklist .

Embassy Messages

Safety and security messages.

View Alerts and Messages Archive

Quick Facts

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Embassies and Consulates

U.S. Embassy Copenhagen

Dag Hammarskjölds Allé 24 2100 Copenhagen Denmark

Telephone: +(45) 3341-7100

Emergency After-Hours Telephone: +(45) 3341-7400

Fax: +(45) 3538-9616

[email protected]

U.S. Consulate Nuuk

Postboks Nr. 552 Kujallerpaat 1 Nuuk 3900, Greenland

Telephone: +(45) 3341-7100 

Emergency After-hours Telephone: +45 3341-7400

Fax: +(45) 3538-9616

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

Denmark is a party to the  Schengen Agreement . Visit the  U.S. Embassy  website for the most current visa information.

  • Passport should be valid for at least six months beyond your stay.  For additional details about travel into and within Schengen countries, please see our  Schengen fact sheet .
  • You may enter  Denmark for up to  90 days for tourist purposes  without a visa.
  • Further useful information, in English and Danish, can be found on the  Danish Immigration Service website .
  • If you are a  student or prospective student , your student visa allows you to enter 30 days prior to the start of your program and remain for 14 days after the end of your program. More detailed information is available on the  Danish Immigration Service website .
  • Greenland and the Faroe Islands  are not party to the Schengen Agreement; however, you may travel to either location for 90 days for business or tourism purposes without a visa.
  • Residence and work permits issued exclusively for Greenland or the Faroe Islands are not valid for travel to Schengen countries.

Traveling Through Europe : If you are planning to visit or travel through European countries, you should be familiar with the requirements of the Schengen Agreement . 

  • Your passport should be valid for  at least six months beyond the period of stay.  If you plan on transiting a Schengen country review our  U.S. Travelers in Europe page .   
  • You will need s ufficient proof of funds  and a  return plane ticket . 
  • For additional information about visas for the Schengen area, see the  Schengen Visa page.

HIV/AIDS Restrictions: The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Denmark.

Dual Nationality: As of September 1, 2015, Denmark allows the acquisition of dual citizenship.

Find information on  dual nationality,   prevention of international child abduction  and  customs regulations  on our websites.

Safety and Security

Terrorism: Credible information indicates terrorist groups continue plotting possible attacks in Europe. European governments are taking action to guard against terrorist attacks; however, all European countries remain potentially vulnerable to attacks from transnational terrorist organizations.  Terrorists are increasingly using less sophisticated methods of attack - including knives, firearms, and vehicles – to more effectively target crowds. Frequently, their aim is unprotected or vulnerable targets, such as:

  • High-profile public events (sporting contests, political rallies, demonstrations, holiday events, celebratory gatherings, etc.)
  • Hotels, clubs, and restaurants frequented by tourists
  • Places of worship
  • Shopping malls and markets
  • Public transportation systems (including subways, buses, trains, and scheduled commercial flights) 

For more information, see our  Terrorism  page. 

Crime: Organized crime groups operate in Denmark, including in and around Copenhagen. Travelers should be aware of their surroundings and immediately leave the area if they feel threatened. In response to crime, police may establish “Search Zones” (“visitationszoner” in Danish) and stop and search individuals. 

Pickpockets  and  purse-snatchers  operate aggressively in areas frequented by tourists, as well as on trains and buses, and at transit stations, including Copenhagen Central Station, Copenhagen Airport, and cruise ship quays. Do not place any bags containing valuables, such as your passport or credit cards, on the ground or on the back of a chair in public places, such as restaurants, bars, and cafes.  Watch your laptop and mobile devices, which are particularly desirable to thieves. U.S. citizens are encouraged to review the  OSAC Crime and Safety Report  for more information on crime in the Kingdom of Denmark.

When traveling or living in the Kingdom of Denmark, you should:

  • Be aware of the local security situation and take appropriate steps to bolster your personal security.
  • Monitor media and local information sources , and factor updated information into personal travel plans and activities.
  • Address specific safety concerns to Danish law enforcement authorities who have responsibility for the safety and security of all residents and visitors.
  • Exercise caution if in the vicinity of any large gatherings, protests, or demonstrations.
  • If stopped by the police, cooperate and be prepared to present identification.

Freetown Christiania , located in the Christianshavn area of Copenhagen, is known for  illicit drug activity . Drug enforcement efforts have resulted in clashes between the police and Christiania residents.  Christiania residents have imposed a strict no-photography policy; tourists have been  assaulted  and  robbed  for taking pictures. Police and emergency services are limited in Christiania.

Demonstrations  occur regularly in Denmark. They may take place in response to political or economic issues, on holidays, or during international events. 

  • Demonstrations can be unpredictable, avoid areas around protests and demonstrations. 

Bear in mind that large public gatherings can affect transportation arteries in the city.

  • Monitor local media for updates and traffic advisories. 

International Financial Scams: See the  Department of State  and the  FBI  pages for information on scams.

Victims of Crime:  Report crimes to the  local police  at  112  and contact the  U.S. Embassy  at  +45 3341-7100  or  +45 3341-7400  for after-hours assistance. For non-life threatening situations, individuals in the greater Copenhagen area may dial 1813 to reach an urgent medical helpline. Local authorities are responsible for investigating and prosecuting crimes.

See our webpage on  help for U.S. victims of crime overseas .

  • help you find appropriate medical care
  • assist you in reporting a crime to the police
  • contact relatives or friends with your written consent
  • explain the local criminal justice process in general terms
  • provide a list of local attorneys
  • provide our information on  victim’s compensation programs in the United States
  • provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution
  • help you find accommodation and arrange flights home in cases of destitution
  • replace a stolen or lost passport

Victim Compensation Program: Denmark has a program to provide financial compensation to victims who suffer serious injuries due to crime.

  • A police report must be filed within 72 hours.
  • Local police or the  Danish Criminal Injuries Compensation Board  can provide the forms to file for compensation.
  • Processing time can vary from  one to three months  to receive compensation.
  • More information about compensation payments to victims of serious crime is available at the  Compensation Board’s website.
  • If you are victim of crime in Greenland or the Faroe Islands , please contact the Embassy at  +45 3341-7100  or  +45 3341-7400  (after hours) for further assistance.

Domestic Violence:  U.S. citizen victims of domestic violence may contact the Embassy for assistance. Domestic violence victims are also encouraged to file a police report with local law enforcement at 112.

Tourism:  The tourism industry is regulated and rules with regard to best practices and safety inspections are enforced. Hazardous areas/activities are identified with appropriate signage and professional staff is typically on hand in support of organized activities. In the event of an injury, appropriate medical treatment is widely available throughout the country. Outside of a major metropolitan center, it may take more time for first responders and medical professionals to stabilize a patient and provide life-saving assistance. This is especially true in Greenland – a semi-autonomous, self-governing part of the Kingdom of Denmark. Greenland is vast and remote, and the weather can be unpredictable, making it especially difficult for first responders to access areas. U.S. citizens are encouraged to purchase medical evacuation insurance . 

Local Laws & Special Circumstances

Criminal Penalties:   You are subject to local laws . If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned.

Furthermore,  some laws are also prosecutable in the U.S. , regardless of local law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice  website.

Arrest Notification:  If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy immediately. See our  webpage  for further information.

  • Penalties for possessing, using, or trafficking in illegal drugs are strict, and convicted offenders can expect long jail sentences and heavy fines.
  • Driving under the influence may lead to confiscation of your driver’s license and could land you immediately in jail.
  • Possession of dangerous weapons, including pocketknives, may result in criminal penalties.
  • Your U.S. passport won’t help you avoid arrest or prosecution if you break the law in the Kingdom of Denmark.

Danish Compulsory Military Service: All male citizens 18 years of age and resident in Denmark must participate in a military draft. Conscription periods vary from four to 12 months, according to specialization.

Greenland: Special Circumstances

Removal of Natural Resources:

  • Greenland has  strict laws  regarding removal of natural resources, including any precious and semi-precious metals, stones, and gemstones. Check with local authorities before attempting to extract or export any of these materials.

Cruise Ship Travel: If you are considering travel on cruise ships near Greenland, you should:

  • Be aware that search and rescue capabilities are restricted due to limited capacity and long distances between populated areas.
  • Check the operational records and the experience of captains and crews operating vessels in Arctic waters when selecting cruises off the shores of Greenland.

Greenland by Land: Greenland’s landscape is vast and remote. Periods of darkness, extreme temperatures, and fast-changing weather are common.

  • You should use experienced guides.
  • Official permission is required  for travel into the huge Northeast Greenland National Park or for treks across the central ice fields. Check with your tour operator to make sure that the company has received the necessary permission for such trips.
  • Persons unfamiliar with the area can become disoriented easily and risk long-term exposure to the elements.
  • Greenland mountains are of moderate altitude but are technically difficult. You should be familiar with ascent and descent routes.
  • Local authorities will rescue individuals in difficulty, but land search and rescue capabilities are limited and subject to weather restrictions.
  • You may be billed for the cost of rescue services.
  • For more information about traveling to Greenland please visit  Greenland Tourism .

Faith-Based Travelers:  See our following webpages for details:

  • Faith-Based Travel Information
  • International Religious Freedom Report  – see country reports
  • Human Rights Report  – see country reports
  • Hajj Fact Sheet for Travelers
  • Best Practices for Volunteering Abroad

LGBTI Travelers:  There are  no legal restrictions  on same-sex sexual relations or the organization of LGBTQI+ events in the Kingdom of Denmark.

See our  LGBTQI+ Travel Information  page and section six of our  Human Rights report  for further details.

Travelers Who Require Accessibility Assistance:  Danish law  prohibits discrimination  against persons with physical and mental disabilities in employment, education, and access to health care or other state services. In addition:

  • Danish law mandates access to buildings, education, information, and communications for persons with disabilities.
  • Public transportation can accommodate persons with disabilities, but many buildings and outdoor sites are not easily accessible for the disabled.
  • Accessibility information is available at  Visit Denmark .

Students:  See our  Students Abroad  page and  FBI travel tips .

Women Travelers:  See our travel tips for  Women Travelers .

Excellent medical facilities are widely available in Denmark. Hospitals are modern and fully equipped. Medical facilities in Greenland and the Faroe Islands are limited, and evacuation is required for serious illness or injury.

For emergency services in the Kingdom of Denmark, dial 112.

  • Emergency medical treatment may be free of charge; however, the patient is charged for follow-up care.
  • In Denmark, you must call in advance to be admitted to an emergency room for immediate treatment for nonlife-threatening emergencies. If you show up at an emergency room unannounced you may be turned away. Dial 1813 to speak to the national medical helpline, staffed by physicians and nurses, who will determine which emergency room or clinic you should go to for care and coordinate an appointment for you.
  • Ambulance services are widely available throughout Denmark but are limited in Greenland and the Faroe Islands.

We do not pay medical bills.   Be aware that U.S. Medicare does not apply overseas.  

Medical Insurance:  Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See our webpage for more information on insurance coverage overseas. Visit the  U.S. Centers for Disease Control and Prevention  for more information on type of insurance you should consider before you travel overseas.

We strongly recommend  supplemental insurance  to cover medical evacuation.

If traveling with  prescription medication , check with the  government of Denmark  to ensure the medication is legal in the Kingdom of Denmark. Always carry your prescription medication in original packaging, along with your doctor’s prescription. 

Vaccinations:  Be up-to-date on all  vaccinations  recommended by the U.S. Centers for Disease Control and Prevention.

Further health information:

World Health Organization

U.S. Centers for Disease Control and Prevention  (CDC)

Travel and Transportation

Road Conditions and Safety:  Danish roads are of high quality and connect all areas of the country.

  • Driving in the Kingdom of Denmark is on the right side of the road.
  • Road signs use standard international symbols.
  • Many urban streets have traffic lanes reserved for public transport only.
  • Bicycles are widely used in Denmark, and bike lanes are very common.
  • Bicycles have the right-of-way.  Many accidents occur when pedestrians and vehicles fail to give the right-of-way to bicycles.

Greenland has no established road system between towns.  Most domestic travel is by foot, boat, or air.

The majority of the  Faroe Islands  are interconnected by roads and tunnels, and boats. On the large islands even small hamlets are generally accessible by road. Travel on the smaller islands is mostly done on foot.

Traffic Laws:

  • You must be 18 years of age to drive a car in the Kingdom of Denmark.
  • Your U.S. state’s driver’s license is acceptable in the Kingdom of Denmark for up to 90 days.
  • Long-term residents must obtain a valid Danish driver’s license.
  • In Denmark, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 130km/h on expressway, unless otherwise noted on traffic signs.
  • You must use your seat belt  while driving in a vehicle.
  • Children  between 3-12 years of age or under 36kg and/or 135 cm in height must be in a  car seat .
  • Driving any vehicle, including a bicycle,  under the influence of alcohol or drugs  is considered a very serious offense. 
  • It is  illegal  to make a  right turn on a red  light in the Kingdom of Denmark.
  • It is  illegal  to use a  hand-held cell phone  while driving.
  • Laws are strictly enforced and violations can result in  high fines  and  jail sentences .

Public Transportation: Denmark has an extensive and efficient public transportation system. Trains, buses, and ferries connect Copenhagen with other major cities in Denmark and with Norway, Sweden, Poland, and Germany. There are municipal bus services in large Greenlandic towns, but service times vary and are posted only in Danish and Greenlandic. Consider travel on foot or by cab.

See our  road safety page  for more information. Also, we suggest that you visit  Visit Denmark  and Denmark’s  Ministry of Transport  for more information.

Aviation Safety Oversight:  The U.S. Federal Aviation Administration (FAA) has assessed the government of Denmark’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Denmark’s air carrier operations.  Further information may be found on the  FAA’s safety assessment page .

Maritime Travel:  Mariners planning travel to the Kingdom of Denmark should also check for  U.S. maritime advisories and alerts .  Information may also be posted to the  U.S. Coast Guard homeport website , and the  NGA broadcast warnings  (select “broadcast warnings”).

For additional travel information

  • Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
  • Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
  • See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
  • Follow us on  Twitter  and  Facebook .
  • See  traveling safely abroad  for useful travel tips.

Assistance for U.S. Citizens

Denmark map, learn about your destination, enroll in step.

Enroll in STEP

Subscribe to get up-to-date safety and security information and help us reach you in an emergency abroad.

Recommended Web Browsers: Microsoft Edge or Google Chrome.

Make two copies of all of your travel documents in case of emergency, and leave one with a trusted friend or relative.

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South Africa

South Korea

South Sudan

Switzerland

The Bahamas

Timor-Leste

Trinidad and Tobago

Turkmenistan

Turks and Caicos Islands

United Arab Emirates

United Kingdom

Vatican City (Holy See)

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I’m a U.S. Citizen. Where in the World Can I Go?

For Americans eager to resume international travel, here are the countries that currently allow U.S. citizens to enter, though there may be restrictions, including vaccine requirements.

greenland covid travel

By Paige McClanahan

This list is no longer being updated. Find the latest coronavirus updates here .

Most of the world’s countries are open to travelers from the United States, and many nations are easing their requirements for visitors to test or quarantine. Some countries that had fully closed to foreign tourists — including Israel, Morocco, Bhutan, Australia and New Zealand — have now reopened to U.S. visitors, although they may continue to impose testing, vaccination or quarantine requirements.

In Europe, a growing number of nations — including Germany, Greece, Italy, Ireland, Switzerland and the United Kingdom, among many others — have eliminated their Covid-related travel restrictions for the summer travel season. Meanwhile, several Southeast Asian nations that had closed their borders to tourists have now reopened. Laos, Thailand, Vietnam, Indonesia, Malaysia, Myanmar and Cambodia are once again welcoming American visitors, although vaccine or testing requirements are in force in most cases.

For its part, the United States has lifted the requirement that inbound passengers, including returning Americans, provide a negative test result taken within one day of departure. The decision to lift the test requirement will be re-evaluated in September; the rule could be reinstated if authorities deem it necessary.

The Centers for Disease Control and Prevention, meanwhile, continues advising Americans not to travel internationally until they are fully inoculated against Covid-19.

Those wanting to learn about the coronavirus risk in a specific country can visit the C.D.C. website where a four-tier ranking system provides guidance. The agency reserves the highest “Level 4” ranking for countries with “special circumstances” that include spiking case numbers, the emergence of worrying variants, or threats to the viability of health care infrastructure. (Levels 1 to 3 are still based primarily on Covid-19 case counts.) At the moment, no countries are classified at Level 4; those at Level 3, which have a “high” incidence of Covid-19, are indicated in the list below. For information on entry requirements like testing and quarantine, as well as curfews and movement restrictions, the State Department’s website offers detailed information by country.

What follows is a list of countries that are open to tourists from the United States. Many require visitors to complete a health form, provide proof of vaccination, and present a recent negative Covid-19 test result. To qualify as fully vaccinated in places such as France, Spain and the Netherlands, a visitor must have received either a booster shot or a second dose within a specified period.

As of May 1, visitors are no longer required to provide a negative test result or proof of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Travel to Andorra is over land from Spain or France, so check the entry requirements for those countries first. There are no limits on movement between Spain and Andorra, nor for travelers entering Andorra from France. Travelers 12 and over departing Andorra for France must provide proof of full vaccination, a certificate of recent recovery, or a negative antigen test result from the previous 24 hours. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must complete a registration form before travel. They must also present a negative result from an R.T.-P.C.R. test administered no more than 72 hours before departure and pay about $20 on arrival to undergo a rapid antigen test at the airport. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Angola.

All adult visitors must be vaccinated. Arriving passengers must also carry a negative result from a Covid-19 test. The result may be either from a rapid test taken within two days of arrival, or from an R.T.-P.C.R. test, N.A.A.T. test, or other molecular test administered within three days of arrival. Visitors who completed their primary course of vaccination more than six months previously and who have not received a booster are also required to test on arrival, at their own expense. Guests staying for more than eight days may undergo a free test on day 4 of their visit. The C.D.C. risk assessment for Covid-19 is Level 3: High.

ANTIGUA and BARBUDA

Vaccinated travelers are no longer required to test before travel, provided they are asymptomatic. Unvaccinated visitors must present either a negative result from a P.C.R. test conducted no more than three days before arrival, or a negative result from an antigen test from the previous 24 hours; they must also be without symptoms. On arrival, they must submit to an R.T.-P.C.R. test at their own expense and self-quarantine for 14 days. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Americans may now enter Argentina without testing. Visitors must complete an electronic sworn statement within 48 hours of traveling and provide proof of medical insurance that covers Covid-19 treatment and quarantine. The government recommends that all visitors age 6 and over undergo a Covid-19 test within 24 hours of arrival, regardless of their vaccination status. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country has lifted its pandemic-related travel restrictions.

The country is open to visitors from the United States who have finished a primary course of vaccination (two doses of an mRNA vaccine or one dose of Johnson & Johnson). All passengers arriving by air must submit the Digital Passenger Declaration within 72 hours of their departure for Australia; they are no longer required to test before travel. Depending on their final destination within Australia, visitors may have to quarantine on arrival, even if they are vaccinated. Travelers should check the rules of the state or territory they are visiting to find the relevant quarantine requirements. Prospective visitors who are not fully vaccinated must qualify for an exemption . The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country lifted all pandemic-related travel restrictions on May 16. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors age 18 and over must present proof of vaccination or a certificate of recovery from Covid-19 infection.

THE BAHAMAS

All travelers age 18 and older must apply for a Bahamas Travel Health Visa; the cost of the visa includes insurance coverage and varies with the length of stay and vaccination status of the traveler. Health visa applications can take up to 24 hours to process; travelers must present their visa confirmation before departure to the Bahamas. Travelers with valid proof of vaccination may now enter without a negative test result. Unvaccinated travelers age 2 and over must present a negative result from a rapid antigen or R.T.-P.C.R. test taken within 72 hours of travel. The C.D.C. risk assessment for Covid-19 is Level 3: High.

According to the U.S. Embassy, visitors must download the “ BeAware Bahrain ” app before travel. Arriving passengers are no longer required to test or show proof of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must complete a health declaration form within three days of arrival. Vaccinated travelers may enter without a pretest. (A booster is not required to qualify.) Unvaccinated travelers age 12 and older must provide a negative result from an R.T.-P.C.R. test taken within 72 hours of departure. Symptomatic passengers may be subject to testing on arrival.

Vaccinated travelers may now enter without testing. Before departure, visitors should download the BIMSafe app and complete an online immigration and customs form . Vaccinated visitors may enter without quarantine, although they may be randomly selected for testing on arrival. Unvaccinated travelers age 5 and above must obtain a negative result from an R.T.-P.C.R. test taken within three days of arrival, or from a rapid test taken within one day of entry; they must also undergo a rapid test on arrival. Children under 18 who aren’t vaccinated must follow the guidelines of their accompanying adult. The C.D.C. risk assessment for Covid-19 is Level 3: High.

U.S. visitors may now enter without testing or proof of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Travelers with proof of vaccination may enter without a negative test result. Unvaccinated visitors age 5 and over must show a negative result from a P.C.R. test taken within 72 hours of arrival, or from a rapid test taken within 48 hours of arrival. Alternatively, testing is available on arrival at the airport for $50; only cash payments are accepted. All foreign tourists must show proof of having purchased Belize travel insurance ($18 for 21 days). The C.D.C. risk assessment for Covid-19 is Level 3: High.

All visitors to Benin must apply online for an eVisa before departure. Predeparture testing is no longer required.

Arriving passengers must show proof of vaccination (booster shots are not required) as well as a negative result from a rapid antigen test taken no more than two days before arrival, or a negative result from a P.C.R., N.A.A.T, T.M.A., or L.A.M.P. test taken within four days of arrival. Children under 2 are exempt from the pretest requirement, while children under 12 are exempt from the vaccination requirement. Visitors must pay $40 to apply for a travel authorization , which they can do up to one month before departure. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Vaccinated travelers must quarantine for five days after arrival; unvaccinated travelers must quarantine for ten days. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Bhutan.

Arriving passengers must present either proof of vaccination or a valid negative result from a Covid-19 test. The test result may be from an R.T.-P.C.R. test taken no more than 72 hours before boarding, or from a rapid antigen test taken no more than 48 hours before boarding. Children under 5 are exempt from the requirements.

BOSNIA AND HERZEGOVINA

The country lifted its pandemic-related travel restrictions on May 26; travelers may now enter without a negative test result or proof of vaccination.

Visitors must have completed at least a primary course of vaccination; they are not required to test. The C.D.C. risk assessment for Covid-19 is Level 3: High.

U.S. tourists age 12 and older must present proof of vaccination, even if they have recovered from Covid-19; they no longer need to test before travel. Unvaccinated children under 12 who are traveling with vaccinated adults may also enter without testing. Unvaccinated adults must qualify for an exemption to be allowed entry. The C.D.C. risk assessment for Covid-19 is Level 3: High.

BRITISH VIRGIN ISLANDS

Regardless of their vaccination status, all visitors over age 5 must present a negative result from a Covid-19 test (either rapid antigen or R.T.-P.C.R.) taken within 48 hours of arrival. Travelers who have recovered from Covid-19 in the previous 90 days may present proof of recovery in lieu of a negative test result. Anyone arriving without a valid test result or proof of recovery must pay $50 to undergo testing on arrival. The C.D.C. risk assessment for Covid-19 is Level 3: High.

As of May 1, Bulgaria has removed all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

BURKINA FASO

Arriving passengers must present proof of full vaccination or a negative result from a P.C.R. or rapid test taken in the previous five days. Travelers who arrive without proof of vaccination or a valid negative test result will be required to pay roughly $45 to undergo a rapid antigen test on arrival. To exit the country by air, travelers must present either proof of vaccination or a negative P.C.R. test dated within three days of their departing flight. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Burkina Faso.

Arriving passengers must present a negative result from a P.C.R. test administered no more than 72 hours before boarding their flight to Burundi. According to the U.S. Embassy, travelers must also pay $100 for an on-arrival test and self-isolate at an accommodation of their choice until they receive a negative result, usually within 24 hours. A negative P.C.R. result is also required to exit the country. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Burundi.

Arriving passengers must present either proof of vaccination or a negative Covid-19 test result. The result may be from a P.C.R. test taken no more than 72 hours before departure, or from a rapid antigen test taken no more than 48 hours before departure. Visitors must also register , pay an airport fee, and complete a health questionnaire before travel. Arriving passengers are subject to a temperature check. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors may now enter without testing. Fully vaccinated travelers are not required to quarantine. Those who are unvaccinated must quarantine for seven days at a designated facility at their own expense; they must also undergo a rapid test on the final day before being released. The government encourages all travelers to purchase Covid-19 travel health insurance. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Cambodia.

Visitors from the United States who hold a valid tourist visa may enter Cameroon. Passengers age 5 and above must present a negative result from a P.C.R. test administered no more than 72 hours before arrival; the result must include a QR code.

Vaccinated U.S. citizens and residents may enter Canada for nonessential reasons, including tourism, without providing a negative test result. (A booster is not required to qualify.) All travelers must use the ArriveCAN system to enter their proof of vaccination and other traveler information within 72 hours of entry into Canada. Unvaccinated and partially vaccinated children under 12 are no longer required to test before travel if they are accompanied by a vaccinated adult. Unvaccinated and partially vaccinated minors ages 12 to 17 are subject to testing requirements and a 14-day quarantine. Unvaccinated adults must qualify for an exemption; if approved for entry, they are also subject to testing and quarantine requirements. The current rules are expected to remain in force until at least September 30 . The C.D.C. risk assessment for Covid-19 is Level 3: High.

CAYMAN ISLANDS

As of June 30, vaccinated travelers may enter without testing. Unvaccinated visitors age 12 and over will not be allowed entry unless they can prove that they have a close tie to the country. Visitors are encouraged to test themselves daily during their first week in the country. The C.D.C. risk assessment for Covid-19 is Level 3: High.

THE CENTRAL AFRICAN REPUBLIC

A negative P.C.R. test from the previous 72 hours is required for both entry and departure. According to the U.S. Embassy, tourists from the United States must quarantine for 14 days after arrival; employees of international and humanitarian organizations may end their quarantine early if they receive a negative result from a post-arrival P.C.R. test at the local Pasteur Institute. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Travelers with proof of vaccination may enter without a pretest. Unvaccinated travelers 12 and older must present a negative result from a P.C.R. test taken within 96 hours of arrival.

Arriving passengers must complete a traveler’s affidavit within 48 hours of boarding and provide proof of travel medical insurance that covers a minimum of $30,000 worth of Covid-19 medical expenses in Chile; they may now enter without testing. Visitors are no longer required to obtain a mobility pass (which requires proof of vaccination) to enter the country, but they may be required to present the pass to enter restaurants, participate in group tours, and attend concerts and sports events. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Arriving passengers age 18 and older must present either proof of vaccination or a valid negative result from a Covid-19 test. The result may be from a P.C.R. test taken within 72 hours of travel or from an antigen test taken in the 48 hours before travel. Incoming passengers must also complete an online form within 72 hours of boarding their flight.

Visitors may enter with a negative result from a P.C.R. test conducted in the 72 hours before travel. A negative P.C.R. result that is no more than 72 hours old is also required to leave the country. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Comoros.

The country has lifted its pandemic-related entry requirements. The C.D.C. risk assessment for Covid-19 is Level 3: High.

COTE D’IVOIRE

Fully vaccinated travelers may now enter without a negative test result. (A booster is required to qualify if the primary course of vaccination was completed more than nine months previously.) Unvaccinated travelers must carry a negative result from a P.C.R. test taken within 72 hours of arrival in Abidjan. All passengers will have their temperatures checked and must undergo rapid antigen testing on arrival. Departing passengers who are unvaccinated must present a negative P.C.R. test from no more than 72 hours before travel, regardless of the testing requirements of their destination. Land and maritime borders remain closed to U.S. citizens.

Croatia has removed its Covid-related border rules; U.S. visitors may now enter as before the pandemic. The C.D.C. risk assessment for Covid-19 is Level 3: High.

General tourism is not permitted, but Americans are allowed to visit to see family and under certain professional and humanitarian circumstances. All incoming passengers must complete an online sworn statement before they depart for Cuba. Visitors are no longer required to present proof of vaccination or a negative Covid-19 test result. Health authorities will randomly select passengers for Covid-19 screening on arrival.

As of June 1, visitors are no longer required to present proof of vaccination or a negative Covid-19 test result. The C.D.C. risk assessment for Covid-19 is Level 3: High.

CZECH REPUBLIC

The country has removed all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

DEMOCRATIC REPUBLIC OF CONGO

Before traveling, visitors should register at INRBCOVID.com . All travelers age 11 and older must present a negative result from a Covid-19 test taken within three days of departure. Unvaccinated travelers must undergo another test on arrival at their own expense and self-quarantine until they receive a negative result, generally within 24 hours. Visitors should also have proof of health and medical evacuation insurance and a certificate of yellow fever vaccination. To exit the country, travelers age 11 and over must present a negative result from a Covid-19 test taken at a government-approved lab within three days of departure. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to the D.R.C.

Denmark has lifted all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Potential visitors must apply online for an eVisa before travel. All arriving passengers 11 and older must provide proof of vaccination as well as a negative result from a Covid-19 test taken within 72 hours of boarding their flight, and not more than 120 hours before their arrival in the country. Upon landing, travelers are given another test at a cost of $30. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Djibouti.

As of April 4, arriving passengers are no longer required to complete a health questionnaire before entry. Vaccinated travelers may enter without a pretest, though they may be tested on arrival if they display symptoms. Unvaccinated travelers must present a negative result from a P.C.R. test taken within 72 hours of arrival or from an antigen test taken within 48 hours of arrival. Children aged 12 and under assume the status of their accompanying parent or guardian. The C.D.C. risk assessment for Covid-19 is Level 3: High.

DOMINICAN REPUBLIC

Visitors may now enter without testing or providing proof of vaccination. Passengers age 7 and over may be selected for random testing on arrival; those who can present a valid vaccination certificate will be exempt from the random test. The C.D.C. risk assessment for Covid-19 is Level 3: High.

DUTCH CARIBBEAN

Aruba allows visitors to enter without a negative test result or proof of vaccination. Arriving passengers are required to purchase Aruba Visitors Insurance and to complete an Embarkation/Disembarkation card before arrival. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Bonaire has lifted its pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Curaçao has lifted its pandemic-related travel restrictions. However, visitors must complete a digital immigration card before travel. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Saba has removed its pandemic-related travel restrictions.

Sint Eustatius has removed its pandemic-related travel restrictions.

Sint Maarten , which is Dutch, and French St. Martin are primarily entered through Princess Juliana Airport on the Dutch side. Visitors must register online at least 12 hours before travel. Vaccinated travelers, those who have proof of recovery from Covid-19 in the previous nine months, and children under 5 are not required to test before entry. Unvaccinated travelers 5 and over must present a negative P.C.R. result from the previous 48 hours or a negative antigen result from the previous 24 hours. Before travel, all visitors must submit a health authorization form , the completion of which includes the purchase of mandatory Covid-19 insurance. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country no longer requires a negative test result for entry; however, the U.S. Embassy notes that airlines may impose their own requirements. Passengers who display symptoms on arrival may be subject to testing. The Embassy advises potential visitors to confirm the latest entry rules with the Timorese Embassy in Washington before travel.

All arriving passengers age 3 and over must provide either proof of vaccination or a negative result from an R.T.-P.C.R. test taken no more than 72 hours before boarding their flight to Ecuador. They must also complete a declaration of traveler health . Visitors may be subject to random antigen testing on arrival. Those traveling to the Galápagos must provide proof of vaccination or a negative R.T.-P.C.R. test result from the previous 72 hours; they must also obtain a transit control card from the government of Ecuador. The C.D.C. risk assessment for Covid-19 is Level 3: High.

EL SALVADOR

Visitors may now enter without testing or proof of vaccination.

EQUATORIAL GUINEA

All arriving passengers must present a negative result from a P.C.R. test taken within 48 hours of travel; travelers age 18 and over must also present proof of vaccination. Visitors must quarantine for three days after arrival at an accommodation of their choosing and obtain a negative test result before being released. A negative P.C.R. test result is also required to exit the country.

Visitors must present a negative result from a P.C.R. test taken within 72 hours of entry and submit to an antigen test on arrival. Unvaccinated travelers must quarantine for five days, then obtain a negative test result before exiting quarantine. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Eritrea.

Arriving passengers must complete an online form in the 72 hours before entering the country. Visitors from the United States who are vaccinated or who have recovered from Covid-19 in the previous 180 days may enter without testing. (Travelers who have received two doses of vaccine are considered fully vaccinated for nine months after completing their primary course of vaccination; a booster dose extends the period of validity for one year.) Unvaccinated and unrecovered visitors may enter with a negative result from an R.T.-P.C.R. or antigen test taken in the 48 hours before arrival. Children under 12 are exempt from the requirements. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Vaccinated visitors and those who have a certificate of Covid-19 recovery from the previous 90 days are no longer required to test before travel. (A booster is not required to qualify.) Unvaccinated visitors over age 12 must carry a negative result from a P.C.R. test taken within 72 hours of departure, or a negative result from an antigen test taken within 24 hours of arrival.

All visitors must provide proof of vaccination, proof of travel insurance, and confirmation that they have pre-booked a rapid test to be taken after arrival. (Children under 12 are exempt from the in-country test requirement; children under 16 are exempt from the vaccination requirement.)

The country lifted its pandemic-related travel restrictions on June 30. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Fully vaccinated visitors no longer need to test before arrival. (To qualify as fully vaccinated, arriving passengers must have received their second dose of vaccine within the past nine months; those who have also received a booster dose are not subject to a time limit.) Unvaccinated travelers from the U.S. must present a negative result from a P.C.R. test taken within 72 hours of departure or a negative result from an antigen test from the previous 48 hours. The C.D.C. risk assessment for Covid-19 is Level 3: High.

FRENCH POLYNESIA

The country is open to fully vaccinated tourists from the United States. Those who have received only two doses of vaccine qualify as “fully vaccinated” for nine months following the date of their second dose; those who have also received a booster face no time limit. Arriving passengers aged 12 or older who are flying to French Polynesia directly from the United States are required to present a negative result from an R.T.-P.C.R. taken within 72 hours of boarding or a negative result from an antigen test administered within 48 hours of boarding. Those who are unvaccinated must provide a compelling reason for their visit to French Polynesia. If permitted entry, unvaccinated travelers must test before travel and quarantine for seven days after arrival. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to French Polynesia.

FRENCH WEST INDIES

(Most islands consider two weeks after the second injection as full vaccination, and four weeks for Johnson & Johnson.)

St. Barts is open to fully vaccinated travelers without a test requirement. Unvaccinated visitors must present a negative result either from a P.C.R. test conducted no more than 72 hours before departure, or from an antigen test from the previous 48 hours. All visitors must present a sworn statement that they have no symptoms and that they are not aware of Covid-19 exposure in the previous 14 days. The C.D.C. risk assessment for Covid-19 is Level 3: High.

St. Martin : See Sint Maarten under Dutch Caribbean.

Guadeloupe and Martinique are open to vaccinated travelers, but those 12 and older who are coming from the United States need a negative result from a P.C.R. or antigen test taken in the 24 hours before departure. They may also be subject to testing on arrival. Unvaccinated visitors must show proof of a compelling reason to travel. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country has lifted its pandemic-related restrictions. Visitors may now enter without a negative test result.

Fully vaccinated travelers do not need a pretest, but they may be subject to rapid testing on arrival if they display symptoms. Unvaccinated travelers must present a negative result from a P.C.R. test administered no more than 72 hours before departure.

The country has lifted its pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country has suspended its pandemic-related travel restrictions until the end of August. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Non-citizen and non-resident visitors who are 18 or older must show proof of vaccination in order to qualify for an entry visa (a booster is not required). Arriving passengers no longer need to provide a negative test result. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Ghana.

As of May 1, visitors may enter without providing proof of vaccination or recovery or a negative Covid-19 test result. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country has removed its pandemic-related travel requirements. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Greenland.

Travelers must present either proof of vaccination (a booster is not required) or a negative result from a P.C.R. or antigen test conducted no more than three days before check-in at the airport or arrival at a land border. Children under 10 are exempt.

The government of Guinea no longer requires pre-departure testing, but the U.S. Embassy recommends that travelers confirm the latest rules with their airline before departure. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; if you are unvaccinated, the agency recommends that those who are unvaccinated avoid travel to Guinea.

GUINEA-BISSAU

Visitors may enter with a negative result from a P.C.R. test taken in the previous 48 hours. Travelers must also obtain a negative P.C.R. result within 72 hours of their departure from the country; tests can be obtained in the capital city of Bissau for about $45.

Arriving passengers must show proof of full vaccination and carry a negative result from a Covid-19 test administered within 72 hours of arrival. Anyone arriving with an expired test result must pay about $85 to undergo testing at the airport and quarantine until they receive a negative result. Unvaccinated travelers over the age of 12 will not be allowed entry. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors to Haiti must present a negative result from either a P.C.R. or antigen test administered no more than 72 hours before travel. Passengers who have had Covid-19 may present their positive test as well as documentation from their doctor confirming recovery.

Fully vaccinated tourists are not required to pretest, but others must have a negative result from a Covid-19 test taken in the previous 72 hours. Visitors must also complete an online pre-check form before travel.

Hungary has lifted all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country lifted all Covid-related border restrictions on Feb. 25. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Passengers arriving from the United States must submit either proof of vaccination (with or without a booster) or a negative result from a P.C.R. test taken within 72 hours of departure. Travelers should upload the relevant documentation to the Air Suvidha portal before departure. Two percent of arriving passengers are randomly selected to undergo testing on arrival. Children under 5 are exempt from testing unless they develop Covid-19 symptoms. All travelers are asked to monitor their health for 14 days after arrival and self-isolate if they develop Covid-19 symptoms.

U.S. travelers are eligible for a visa on arrival if they can show proof of vaccination (with or without a booster; children under 12 are exempt). They must also download the PeduliLindungi app before departure; submit to a temperature screening on arrival; provide proof of health insurance that covers at least $25,000 worth of medical treatment in Indonesia; pay a visa fee of approximately $35; carry a passport with a validity of at least six months; and be able to present either a return ticket or a ticket for onward travel to another country. Covid-19 testing is no longer required. The U.S. Embassy recommends that travelers consult the Indonesian Embassy in the United States for the latest entry rules.

Visitors must apply for a tourist visa , which can be done online. Arriving passengers must present proof of vaccination as well as a negative result from a P.C.R. test conducted within 72 hours of arrival.

Arriving passengers must present either proof of vaccination or a negative result from a P.C.R. test taken in the previous 72 hours. The U.S. Embassy advises that all arriving passengers should be prepared to pay in cash for on-arrival testing at the airport, although this requirement is unevenly enforced. Visitors to the Iraqi Kurdistan Region require a negative P.C.R. result from the previous 48 hours; anyone without a negative test result must test on arrival. Visitors must also pledge to self-isolate for 14 days.

Ireland has removed all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must provide a completed incoming passenger form and show proof of insurance covering Covid-19 treatment. Testing is no longer required. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Italy lifted its pandemic-related travel restrictions on June 1. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Jamaica has removed all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Japan has reopened to U.S. visitors who are pre-booked on package tours. After applying for their visa, visitors must obtain a negative result from a Covid-19 test taken within 72 hours of departure; install the MySOS app and complete the app’s questionnaire; register their information on Visit Japan Web , which will generate a required QR code; and purchase health insurance to cover Covid-19 treatment in Japan. Visitors are required to wear masks in the country. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors age 5 and over must complete an online declaration and present the resulting QR code when boarding. Testing is no longer required. According to the U.S. Embassy, non-Jordanians must present proof of health insurance.

According to Air Astana, the country’s biggest airline, passengers arriving in Kazakhstan are no longer required to present a negative test result or proof of vaccination. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Kazakhstan.

Fully vaccinated visitors may enter without a pretest. Unvaccinated travelers age 5 and above must present a negative P.C.R. result from up to 72 hours before departure; they must also pay $30 to undergo rapid testing on arrival. Visitors should upload their proof of vaccination or negative test result to the Global Haven platform before departure. They must also complete a health surveillance form and present the resulting QR code when traveling.

The country has removed its pandemic-related entry requirements.

The country has lifted its pandemic-related travel requirements. U.S. visitors must apply online for an eVisa before departure. The C.D.C. risk assessment for Covid-19 is Level 3: High.

KYRGYZ REPUBLIC

The country has lifted its pandemic-related travel requirements. However, the U.S. Embassy notes that the rules may change with little or no advance notice and that airline requirements may differ from those of the government.

Visitors with proof of vaccination may enter without restriction; C.D.C. cards are accepted. Unvaccinated travelers age 12 and over must obtain a negative result from a Covid-19 test within 48 hours of their departure for Laos; rapid tests are accepted. The C.D.C. risk assessment for Covid-19 is Level 3: High.

As of April 1, visitors may enter without proof of vaccination or a negative test result, provided that their point of departure is not on Latvia’s list of “high-risk countries” (at the moment, no countries are on this list). The C.D.C. risk assessment for Covid-19 is Level 3: High.

Fully vaccinated travelers may enter without a negative test result. (Visitors who completed their primary course of vaccination more than six months previously must have also received a booster dose to qualify as vaccinated.) Unvaccinated travelers age 12 and over must present a negative result from a P.C.R. or antigen test taken with 48 hours of departure. They must also undergo a P.C.R. test on arrival and avoid public places until they receive a negative result, usually within 24 hours.

Travelers must present a negative result from a P.C.R. test taken in the 72 hours before departure. All passengers are screened on arrival; those presenting Covid-19 symptoms may be denied entry. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Travelers age 18 and over must show proof of vaccination and complete a health screening form via the Lib Travel app . In addition, all travelers age 5 and over must present a negative result from a P.C.R. or rapid antigen test taken in the 72 hours before departure.

U.S. citizens may enter with a negative result from a P.C.R. test administered no more than 48 hours before travel. According to the U.S. Embassy, visitors from the United States may be required to quarantine; it recommends that travelers confirm the latest rules with the Libyan Embassy in Washington, D.C. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Libya.

LIECHTENSTEIN

See Switzerland.

As of May 1, U.S. visitors are no longer required to provide proof of vaccination or a negative test result on entry; the requirement to complete an arrival form has also been removed. The C.D.C. risk assessment for Covid-19 is Level 3: High.

U.S. tourists may enter with proof of vaccination or recovery. Travelers are considered vaccinated for nine months following the completion of their primary course of vaccination; a booster extends the validity of their vaccination certificate indefinitely. Recovery certificates are valid for 180 days. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Arriving passengers must present a negative result from an R.T.-P.C.R. test administered no more than 72 hours before boarding. A second test is required on arrival, at a cost of $20. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Madagascar.

Arriving passengers must present a negative result from a P.C.R. test taken within 72 hours of departure; children under the age of 1 are exempt. A negative result from the previous 72 hours is also required to exit Malawi, regardless of the requirements of the destination country.

Fully vaccinated travelers and children age 12 and under may enter without testing. Visitors who were vaccinated outside of Malaysia must upload their proof of vaccination via the MySejahtera app before departure. Unvaccinated adult visitors must obtain a negative result from a P.C.R. test taken within two days of departure; they must also submit to a test within 24 hours of arrival and quarantine for five days. Additional travel restrictions apply for travel to the states of Sabah and Sarawak . The C.D.C. risk assessment for Covid-19 is Level 3: High.

Arriving passengers no longer need to present a negative test result, but they must complete a Traveler Health Declaration form within 72 hours of departure. They must also carry proof of a booking at a registered tourist accommodation. No quarantine is required for travelers who do not exhibit symptoms. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to the Maldives.

Arriving passengers must present either proof of vaccination or a negative result from a P.C.R. test taken in the previous 72 hours. The same rule applies to those departing the country.

Arriving passengers must present one of the following: proof of vaccination, a certificate of recovery, or a valid negative test result. U.S. travelers should verify their C.D.C. vaccination cards through the VeriFLY app . To qualify as fully vaccinated , travelers aged 18 and over who have undergone only a primary course of vaccination must have received the final dose in the previous 270 days; those who have also received a booster dose are considered vaccinated indefinitely. (Minors are considered vaccinated indefinitely following a primary course of vaccination.) Recovery certificates are valid for 180 days. Negative test results are valid for 24 hours (if from an antigen test) or 72 hours (if from a P.C.R. test). Children under 12 are exempt from the requirements. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must present proof of vaccination or a negative result from a P.C.R. test conducted within three days of entry. Passengers are subject to a temperature check on arrival. The U.S. Embassy notes that some visitors have reported that their airlines have demanded a negative test result in addition to their proof of vaccination.

Visitors must complete a travel form . Vaccinated travelers do not need to test before departure but must undergo testing on arrival. In addition to the travel form and on-arrival test, unvaccinated travelers age 18 and over must also self-isolate for seven days after arrival in an accommodation of their choice. They must test on day 7 and, if the result is negative, are free to move around the island on day 8. The C.D.C. risk assessment for Covid-19 is Level 3: High.

U.S. travelers may enter Mexico without testing or quarantine, though they may be subject to health screenings on arrival. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Moldova has lifted all Covid-related entry requirements.

The United States is on the list of “green zone” countries, which means that travelers 16 and over may enter Monaco by presenting one of the following: proof of full vaccination against Covid-19; proof of recovery in the past six months; or a negative result from a P.C.R. or antigen test conducted within the previous 24 hours. To qualify as fully vaccinated, everyone 18 or over must have received a booster dose of an mRNA vaccine no later than nine months following the completion of their first course of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

The country has removed its Covid-related entry requirements. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Arriving passengers are no longer required to present proof of vaccination or a negative test result. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Arriving passengers must present a completed health form . They must also provide either proof of vaccination or a negative result from a P.C.R. test taken in the 72 hours before travel. Children under 12 are exempt from the requirements.

Vaccinated visitors as well as children age 11 and younger may now enter without testing. Unvaccinated travelers over the age of 11 must present a negative result from a P.C.R. test administered within 72 hours of their departure for Mozambique; alternatively, they may choose to pay to undergo a rapid test on arrival. The U.S. Embassy encourages U.S. travelers to obtain their visa before departure via the Mozambican Embassy in Washington, D.C. or the Mozambican consulate in New York.

Visitors must carry a valid tourist visa. They must also present either proof of vaccination or a negative result from a P.C.R. test within 72 hours of departure. (Children under 6 are exempt.) In addition, they must carry Covid-19 insurance, complete a health declaration, and pay to undergo rapid testing on arrival.

Passengers who present proof of vaccination may enter without testing. Unvaccinated visitors age 5 and over must provide a negative result from a P.C.R. test taken within 72 hours of travel. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors age 5 and over arriving by air must present either proof of vaccination or a negative result from a Covid-19 test (R.T.-P.C.R., N.A.A.T., or Gene Xpert) taken within 72 hours of departure. Travelers who display symptoms may be subject to testing on arrival.

NETHERLANDS

Vaccinated visitors from the United States may now enter without a negative test result. (A booster dose is required if more than 270 days have passed since the traveler completed his or her primary course of vaccination.) Unvaccinated travelers 18 and over are not allowed entry unless they qualify for an exemption . The C.D.C. risk assessment for Covid-19 is Level 3: High.

NEW CALEDONIA

U.S. tourists age 12 and over must present one of the following: proof of vaccination, a certificate of recovery from the previous six months; a negative result from an R.T.-P.C.R. test taken within 72 hours of boarding; or a negative result from a rapid antigen test taken in the previous 48 hours. At the time of boarding, they must also present a sworn statement in which they commit to undergo testing within two days of arrival. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to New Caledonia. The C.D.C. risk assessment for Covid-19 is Level 3: High.

NEW ZEALAND

New Zealand is now open to vaccinated visitors from the United States and other “visa waiver” countries. Arriving passengers must complete an online declaration ; provide a negative test result before departure; and self-test on arrival and on day 5 or 6 in the country. Children under 2 are exempt from the pre-departure test requirement; babies under 6 months are exempt from the post-arrival test requirement. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Travelers who can provide proof of vaccination may now enter without testing. Unvaccinated travelers must present a negative result from an R.T.-P.C.R. test taken within 72 hours of entry. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Nicaragua.

Travelers must obtain a negative result from a P.C.R. test taken no more than 72 hours before departure and register the result online. A negative test result from the previous 72 hours is also required to exit the country.

Arriving passengers must register online before travel. Fully vaccinated travelers may now enter without testing (a booster is not required to qualify). Unvaccinated travelers must upload a negative result from a P.C.R. test administered within 48 hours of departure; they must also pre-pay for tests on days 2 and 7 and isolate after arrival until they receive a negative result from the second test. Children under 18 are exempt from the requirements. Travelers leaving Nigeria must present either proof of vaccination or a negative result from a P.C.R. test conducted within 48 hours of departure.

NORTH MACEDONIA

Visitors are no longer required to provide a negative test result or proof of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Norway has lifted all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Vaccinated travelers may enter without a pretest. Unvaccinated travelers over the age of 12 must present a negative result from a P.C.R. test taken within 72 hours of boarding. All passengers should download the Pass Track App before travel and should be aware that they may be subject to rapid testing on arrival.

Palau is open to fully vaccinated visitors. Arriving passengers must provide a negative result from a P.C.R., N.A.A.T., R.T.-P.C.R. or other approved molecular test taken within three days of their departure. Alternatively, they may present a negative result from an antigen test taken no more than one day before departure, or documentation of recovery from Covid, including proof of a recent positive viral test and a letter from a health care provider or a public health official clearing the person to travel. All travelers will also undergo testing after arrival in Palau.

Travelers are required to submit a completed health affidavit to their airline before boarding. Vaccinated travelers can enter Panama without a pretest (a booster is not required to qualify). Unvaccinated travelers must present a negative result from a P.C.R. or antigen test. If the test result is more than 72 hours old at the time of the traveler’s arrival in Panama, a rapid Covid-19 test will be performed at the airport, at a cost of $50. Accompanied children under 17 are exempt from the requirements. The C.D.C. risk assessment for Covid-19 is Level 3: High.

PAPUA NEW GUINEA

U.S. visitors must apply for a tourist visa before travel. Visitors age 18 and over must show proof of vaccination; testing is no longer required. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Foreign visitors with proof of vaccination are no longer required to test before travel. Unvaccinated travelers must present a negative result from an R.T.-P.C.R., L.A.M.P., or N.A.A.T. test taken no more than 72 hours before departure; children under 12 are exempt.

Visitors must present either proof of full vaccination or a negative result from a molecular test taken within 48 hours of departure; they must also complete an affidavit of health . Children under 12 are exempt from the testing and vaccination requirements but must be without Covid-19 symptoms at the time of boarding.

PHILIPPINES

Visitors from the United States are allowed entry provided they carry the following documents: proof of vaccination; passports that are valid for at least six months beyond their date of arrival; and a ticket for outbound travel within 30 days of arrival. Visitors must also complete a health declaration card ; they are no longer required to test before entry. Unvaccinated visitors over age 12 will not be allowed entry.

Visitors may now enter without testing, quarantine or proof of vaccination.

Arriving passengers age 12 and over must present a negative result from an R.T.-P.C.R. or N.A.A.T. test conducted no more than 72 hours before boarding, or from a rapid test from the previous 24 hours. Travelers who carry an E.U. Digital Covid Certificate or proof of vaccination issued in one of several approved countries may enter without a negative pretest. The United States is not among the approved countries; however, some travelers have reported that their airlines have told them that their C.D.C. vaccination cards will be accepted in lieu of a negative test result. There is no official guidance on this point, so the U.S. Embassy “ strongly recommends ” that travelers carrying C.D.C. vaccination cards arrive with a valid negative test result. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must register online before travel. Fully vaccinated and recovered travelers from the United States and other countries that do not appear on Qatar’s red list may enter with a negative result from a P.C.R. test taken within 48 hours of departure. In addition to the pretest, unvaccinated travelers from the United States must also quarantine for five days after arrival and undergo a P.C.R. test on arrival and a rapid test on day 5. The C.D.C. risk assessment for Covid-19 is Level 3: High.

REPUBLIC OF CONGO

Those planning to travel to the Republic of Congo must complete an online form , pre-pay roughly $68 for a Covid-19 test to be administered on arrival, and print the receipt for that payment to carry with them while traveling. Anyone who tests positive on arrival must isolate until they receive a negative result. Departing travelers must present a negative result from a virus test conducted no more than 72 hours before their scheduled departure.

Romania has lifted all pandemic-related travel restrictions.

Before traveling to Rwanda, visitors must complete a passenger locator form and obtain a negative result from an antigen test conducted no more than 72 hours before their flight departure. Visitors must also pay $5 to undergo an additional rapid test on arrival. Travelers leaving Rwanda must obtain a negative Covid-19 test result within 72 hours of their departing flight. Children under 5 are exempt from testing. Tourists to the national parks may face additional requirements.

ST. KITTS AND NEVIS

All visitors 18 and over must be fully vaccinated, while unvaccinated minors may enter with their accompanying vaccinated adults and follow the same regulations. In addition to their proof of vaccination, arriving passengers must present either a negative result from an R.T.-P.C.R. or N.A.A.T. test taken within three days of arrival, or a negative result from a rapid antigen test taken within one day of arrival. Each visitor must also complete an embarkation form no later than 24 hours before departure. Travelers who have recovered from Covid-19 are not exempt from the pretest requirement. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must complete a health screening form before departure. As of April 2, fully vaccinated travelers are no longer required to test before travel. Unvaccinated travelers 5 and over must present a negative result from a P.C.R. test conducted in the five days before arrival. The C.D.C. risk assessment for Covid-19 is Level 3: High.

ST. VINCENT AND THE GRENADINES

Fully vaccinated visitors from the United States no longer need to test before travel; they must complete a health form on landing and may be subject to testing. Unvaccinated travelers must arrive with one of the following: a negative result from a P.C.R. test conducted in the previous 72 hours, or a negative antigen result from the previous 24 hours. They may be subject to testing on arrival; they must quarantine for 5 days and undergo an additional test on day 3 or 4 of quarantine. Minors follow the protocol of their parents or guardians. The C.D.C. risk assessment for Covid-19 is Level 3: High.

See Italy. The C.D.C. risk assessment for Covid-19 is Level 3: High.

SÃO TOMÉ AND PRÍNCIPE

The government has lifted all pandemic-related travel restrictions.

SAUDI ARABIA

Visitors must apply for a tourist visa before travel. According to the U.S. Embassy, they must also show proof of insurance that covers illness related to Covid-19.

Arriving passengers must present either proof of vaccination or a negative result from a P.C.R. or R.T.-P.C.R. test taken in the 72 hours before arrival. Children under 2 are exempt.

The country has removed its pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must apply for travel authorization up to 72 hours before departure. Most applications are processed within 12 hours of submission; expedited processing is available for an additional fee. In applying for authorization, unvaccinated visitors must upload a negative result from an R.T.-P.C.R. test administered no more than 72 hours before departure or a negative result from a rapid antigen test from within 24 hours of departure. Vaccinated travelers do not need to provide a negative test result. (Travelers age 18 and over who completed their primary course of vaccination more than six months previously must also have received a booster dose to qualify as vaccinated.) Visitors must also submit their accommodation bookings as well as proof of travel insurance with full medical coverage valid for the duration of their stay. The C.D.C. risk assessment for Covid-19 is Level 3: High.

SIERRA LEONE

Visitors must register online before departure. Vaccinated travelers may enter without testing. Unvaccinated travelers do not need a pre-departure test, but they must pay in advance to undergo both a rapid test and a P.C.R. test on arrival. All passengers are subject to a health screening at the airport. To exit the country, all travelers, regardless of their vaccination status, must obtain a negative result from a P.C.R. test taken between 48 and hours before departure. Children under 5 are exempt from the test requirements.

All visitors must complete an arrival card within three days of entry and install the TraceTogether app. Vaccinated travelers as well as unvaccinated children born in or after 2010 may now enter without testing or quarantine. Unvaccinated travelers born in or before 2009 must apply for permission to enter. If approved, they must obtain a negative result from either a P.C.R. test or an antigen test administered within two days of departure. (Unvaccinated travelers who have a positive test result dated between 14 and 90 days before their departure for Singapore may be exempt from the pre-departure test.) Unvaccinated travelers must also quarantine for seven days after arrival. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Slovakia has eliminated all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors arriving from the United States are no longer required to test or show proof of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must present a negative result from a Covid-19 test conducted within 72 hours of arrival and submit to a health screening on entry. Travelers to Somaliland may avoid a 14-day quarantine by presenting a negative result from a Covid-19 test taken in the previous 96 hours. The C.D.C. risk assessment for Covid-19 is Level 3: High.

SOUTH AFRICA

South korea.

Visitors should register their information on the Q-Code website before departure. Arriving passengers must present proof of full vaccination (including a booster shot if more than 180 days have passed since the completion of the traveler’s first vaccine series). Travelers must also complete a health questionnaire and travel record declaration. In addition, visitors must provide a negative result from a supervised rapid antigen test taken within 24 hours of departure, or a negative result from a P.C.R. test taken in the previous 48 hours. In addition, all travelers must undergo a P.C.R. test within three days of entry. Travelers who display symptoms on arrival may be subject to testing at the airport. The C.D.C. risk assessment for Covid-19 is Level 3: High.

SOUTH SUDAN

Both inbound and outbound passengers must present proof of vaccination and a negative result from a P.C.R. test taken in the previous 72 hours. The C.D.C. risk assessment for Covid-19 is Level 3: High.

U.S. visitors may enter Spain with one of the following: proof of vaccination; a certificate of recovery from the previous 180 days; a negative result from an N.A.A.T. test performed within 72 hours of departure; or a negative result from a rapid antigen test performed within 24 hours of departure. To qualify as vaccinated, visitors who have completed only a primary course of vaccination must have received their final dose within the past nine months; those who have also received a booster dose face no time restriction. Children under 12 are exempt from the requirements. Before departure, all visitors must complete a health control form , which will generate a QR code that must be presented at the time of boarding and upon entry in Spain. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Fully vaccinated visitors as well as children under 12 may enter Sri Lanka without testing. Unvaccinated travelers age 12 and over must present a negative result from P.C.R. test taken within 72 hours of departure, or a negative result from a rapid antigen test conducted within 48 hours of departure. All visitors must purchase Covid-19 insurance at a cost of $12 per month.

Visitors age 8 and over arriving from the United States must present either a certificate of vaccination or a negative result from a P.C.R. test administered no more than 96 hours before arrival. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Sudan.

Travelers who are vaccinated or who can document their recovery from Covid-19 in the previous six months are no longer required to test before entry. Unvaccinated visitors age 12 and over must carry a negative result from a P.C.R. test conducted within 48 hours of travel or from an antigen test from the previous 24 hours. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Sweden has lifted all pandemic-related entry restrictions.

SWITZERLAND

As of May 2, U.S. visitors may enter without testing or providing proof of vaccination. The C.D.C. risk assessment for Covid-19 is Level 3: High.

All travelers age 3 and over must show either proof of vaccination or a negative result from a P.C.R. test taken within 72 hours of their arrival in the country. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Tajikistan.

Visitors to Tanzania must complete a health surveillance form within 24 hours of arrival. (Those traveling directly to Zanzibar should complete this form instead.) Travelers who present a vaccination card that includes a QR code may enter without testing. (The U.S. Embassy advises travelers to look here for information on how to obtain a QR code for a C.D.C. vaccination card.) Unvaccinated travelers must present a negative result from an R.T.-P.C.R. or N.A.A.T. test administered within 72 hours of travel; the test result must include a QR code. Children 5 and under are exempt from the test requirement.

Fully vaccinated and recovered international visitors may now enter Thailand without quarantine or testing. Travelers must apply for a Thailand Pass before departure and provide proof of health insurance to cover at least $10,000 in medical expenses. Unvaccinated travelers must provide a negative result from an R.T.-P.C.R. test conducted within 72 hours of departure. They must also apply for a Thailand Pass and provide proof of insurance. Unvaccinated travelers who arrive without a valid negative test result must follow the instructions of the public health officer they meet on arrival. All passengers undergo health screening on arrival, including a temperature check. The C.D.C. risk assessment for Covid-19 is Level 3: High.

All visitors must complete a travel form and upload a negative result from a P.C.R. test taken no more than three days before their departure for Togo. Visitors must also pay in advance for a second P.C.R. test, to be administered upon their arrival at Lomé Airport; proof of payment for the test must be shown before boarding. Arriving passengers must self-isolate until they receive a negative result from their on-arrival test, usually within 24 hours. Visitors are required to download the Togo Safe app; those who refuse may have to quarantine in a state facility for at least two weeks. Exit testing at the traveler’s expense is required no more than 72 hours before their departing flight.

TRINIDAD AND TOBAGO

As of July 1, visitors will no longer be required to test before entry. They also no longer need to show proof of vaccination or apply for a travel pass. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Arriving passengers must complete an online questionnaire . Travelers who are fully vaccinated do not need to test before travel. Unvaccinated travelers 6 and over must present either a negative result from a P.C.R. test taken no more than 48 hours before departure or a negative result from an antigen test that is no more than 24 hours old. Travelers may be subject to random testing on arrival.

TURKS AND CAICOS

Fully vaccinated visitors may now enter without testing (a booster is not required to qualify). Unvaccinated travelers age 18 and over are not allowed entry. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Fully vaccinated travelers and children age 5 and under may enter without testing. Unvaccinated and partially vaccinated travelers must present a negative result from a P.C.R. test conducted no more than 72 hours before boarding.

UNITED ARAB EMIRATES

Vaccinated visitors to Abu Dhabi are no longer required to test before travel. Unvaccinated travelers age 16 and over must present either a negative result from a P.C.R. test taken in the previous 48 hours, or a Covid-19 recovery certificate dated within 30 days of departure; the certificate must have a QR code. Visitors must be fully vaccinated to enter most public places in Abu Dhabi.

Fully vaccinated visitors to Dubai no longer need to test before travel; their proof of vaccination must include a QR code. Unvaccinated travelers age 12 and over must present a negative result from a P.C.R. test from the previous 48 hours; alternatively, they may present proof of recovery from Covid-19 in the previous month. The U.S. Embassy advises travelers to check with their airlines for the latest information on testing requirements. The C.D.C. risk assessment for Covid-19 is Level 3: High.

UNITED KINGDOM

The United Kingdom has lifted all pandemic-related travel restrictions. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Visitors must complete a health declaration form before departure and carry proof of travel insurance. Vaccinated travelers and those who have recovered from Covid-19 in the previous 90 days may now enter without testing. Unvaccinated and unrecovered travelers age 6 and over must present a negative result from a P.C.R. or antigen test conducted in the 72 hours before departure; in addition, they must either quarantine for 14 days or undergo a P.C.R. test on day 7. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Travelers may now enter without testing or proof of vaccination; they must complete a health screening form on arrival and may be subject to testing if they display symptoms. The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Uzbekistan.

Arriving passengers must present either proof of vaccination or a negative result from an R.T.-P.C.R. test taken within 72 hours of entry. (A booster dose is required to qualify as vaccinated if more than 270 days have passed since the completion of the first vaccine series.) The C.D.C. risk assessment for Covid-19 is “Level Unknown”; the agency recommends that those who are unvaccinated avoid travel to Venezuela.

Foreign visitors must present proof of travel insurance worth at least $10,000 and download and use the PC-COVID app while in the country. Travelers are not required to test or provide proof of vaccination, but they are asked to monitor their health for 10 days and inform authorities if they develop any Covid-19 symptoms. The C.D.C. risk assessment for Covid-19 is Level 3: High.

Vaccinated travelers may now enter without testing (a booster is not required to qualify). Unvaccinated travelers must carry a negative result from a P.C.R. test taken in the 72 hours before departure; children under 12 are exempt. All passengers undergo health screening on arrival; symptomatic travelers must isolate for 14 days and may be required to undergo testing.

Vaccinated visitors may now enter without testing. Unvaccinated visitors must present a negative result from a P.C.R. test administered no more than 48 hours before travel.

Heather Murphy, Ceylan Yeginsu, Concepción de León and Karen Schwartz contributed reporting.

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COVID-19 international travel advisories

If you plan to visit the U.S., you do not need to be tested or vaccinated for COVID-19. U.S. citizens going abroad, check with the Department of State for travel advisories.

COVID-19 testing and vaccine rules for entering the U.S.

  • As of May 12, 2023, noncitizen nonimmigrant visitors to the U.S.  arriving by air  or  arriving by land or sea  no longer need to show proof of being fully vaccinated against COVID-19. 
  • As of June 12, 2022,  people entering the U.S. no longer need to show proof of a negative COVID-19 test . 

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LAST UPDATED: December 6, 2023

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Travel Vaccines and Advice for Greenland

Passport Health offers a variety of options for travellers throughout the world.

Travellers coming to Greenland will see how remote and colorful this country is. The scenery and nature of Greenland will draw you into this country. Greenland has the world’s smallest population with a blend of Inuit and Danish people. There’s so much to see and do when you stay in Greenland.

If you’re interested in the history of Greenland, this country has so many museums to explore. The Paamiut Museum, the Greenland National Museum and the Tele-Museum are just a few.

If you’re interested in the natural features of Greenland, visit the Southern Fjords and IIulissat Kangerlua. These natural wonders will make you want to capture these sites on camera.

Greenland offers visitors the wonder of nature and its history. It’s a must-visit.

Do I Need Vaccines for Greenland?

Yes, some vaccines are recommended or required for Greenland. The PHAC and WHO recommend the following vaccinations for Greenland: COVID-19 , hepatitis A , hepatitis B , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

See the bullets below to learn more about some of these key immunizations:

  • COVID-19 – Airborne – Recommended for all travellers
  • Hepatitis A – Food & Water – Recommended for most travellers
  • Hepatitis B – Blood & Body Fluids – Accelerated schedule available
  • Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travellers and those who may come in contact with animals.
  • Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
  • TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
  • Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
  • Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
  • Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
  • Influenza – Airborne – Vaccine components change annually.
  • Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.
  • Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Due to the country’s location and climate, few infections are present in Greenland. But, traveller’s diarrhea is still a risk. Be sure to bring a traveller’s diarrhea kit with you to prevent any unwanted symptoms.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Do I Need a Visa for Greenland?

A passport which is valid for at least 3 months from the expected date of departure is required to enter the country. A business and tourist visa is not required for stays up to 90 days.

Sources: Embassy of Greenland and Canadian Travel and Tourism

Greenland is not a part of the EU’s Schengen Agreement. Resident and work permits are not valid for people who plan to travel to Schengen countries.

Visit the Canadian Travel and Tourism website for more information on entry and exit requirements.

What Is the Climate like in Greenland?

Greenland’s weather changes between regions. This country experiences great differences in temperature over the seasons.

  • Arctic Temperatures — Summer temperatures are around 10 degrees Celsius. The air quality is the best in the world because of the country’s location to the high north. Southern regions can reach 18 degrees in June, July, or August.
  • Coastal and Inland Climate — The sea affects the climate on land and the coastline. During the summer it is warm and dry on the land nearby the ice sheet. The weather is likely to change in all parts of the country. It can differ from fjord to fjord and from one valley to the next.
  • Low Humidity — The air is dry for the most part in Greenland. The low humidity results in the temperatures not being as cold as you might think it would be. You do need to drink more water as a result of the dry air. The low humidity also allows travellers to see more than you are use to seeing. When you see mountain crests, they may appear to be close but in reality it is further away. Hikers need to keep this in mind.

How Safe Is Greenland?

When you travel to Greenland, you should be aware of your surroundings and be safe. You should also be aware of the media because it’s important to know what’s going on in the country you are visiting. You should also let the authorities know about suspicious activity. Avoid demonstrations, and large public gatherings.

Crime is low for the most part in Greenland. But, it doesn’t hurt to be prepared if something should happen while you are in this country. Pick-pocketing and purse snatching can occur. Keep a close eye on your valuables while travelling.

The Northern Lights: Aurora Borealis

If you’re interested in experiencing one of Greenland’s most beautiful wonders, you should see the Northern Lights. It is known as the ‘biggest light show on earth,’ and it’s an opportunity of a lifetime you can’t miss.

The best time to see the aurora borealis is in the wintertime. You can probably see the Northern lights in November and March. December through February are the best months to go because the night sky is clearer.

What Should I Take to Greenland?

Before you make your way to Greenland, there are some things you need to pack to be ready to travel.

  • Travel Documents — You will need a passport that is at least six months beyond the time you plan to stay in Greenland. You don’t need a visa unless you plan to stay for more than 90 days.
  • Winter Clothing — During the cold weather, dress in layers. Temperatures can be perilously cold, it’s important to make sure you’re protected. This is true in summer as well.
  • Sunglasses — Snowy environments and high concentration of UV light makes these a must.
  • Bug Spray — While mosquitoes are rare in winter, they thrive in summer months. Make sure to have some repellent with you.

Canadian Embassy in Greenland

Canadian consular services can help travellers with many issues they may face including passport services. Once in Greenland, the information for the Canadian consulate is:

Canadian Consulate in Greenland Tuapannguit 48, 3900 Nuuk, Greenland Phone: (299) 31-1647

Ready to start your next journey? Call us at or book online now !

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Passport health – travel vaccines for greenland.

On This Page: Do I Need Vaccines for Greenland? Do I Need a Visa for Greenland? What Is the Climate like in Greenland? How Safe Is Greenland? The Northern Lights: Aurora Borealis What Should I Take to Greenland? Canadian Embassy in Greenland

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Greenland COVID 19 Restrictions: Learn More

Are you visiting Greenland in the coming future? Do you know Greenland COVID 19 restrictions? As per the latest Greenland COVID 19 restrictions, you need to apply for a Greenland Sumut Form before your travel date.

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What is the procedure to apply for a Greenland Sumut Form with iVisa.com?

You can apply for a Greenland Sumut Form with iVisa.com in the most relaxed way from the comfort of your home:

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Applying in advance is significant as you can get your perfect document before your departure date without any rush. We just need your travel dates and we will make sure to get your document ready by then even if you don’t remember.

To get more information about Greenland COVID 19 restrictions, you can go through the section given below:

Frequently Asked Questions

Do i need a covid vaccine or vaccination certificate to enter greenland.

No, you don’t need a COVID-19 vaccine to enter this country, but you must still fill in the travel registration form. Since information may change quickly, we advise you to follow up on the latest Greenland travel updates and/or contact your local embassy.

Do I need to take the COVID-19 PCR Test before traveling to Greenland?

  • COVID test requirements: There are no testing requirements.

Do I need to quarantine when I get to Greenland?

  • COVID quarantine requirements: There are no quarantine requirements.

What do you mean by a Greenland Sumut Form?

A Greenland Sumut Form is a mandatory Health Declaration Form that has been introduced by the Greenland government to keep a track of every traveler entering the country. You have to give your basic details about your current health status, latest trips, and contacts.

Explore More about the Greenland COVID 19 restrictions.

What is the validity of a Greenland Sumut Form?

As per the latest Greenland COVID 19 restrictions, you can use a Greenland Sumut Form only once. If you are traveling to the country more than once, you have to apply for this form again.

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What are the items required for the application for a Health Declaration Form?

For the application for a Health Declaration Form, you will need a few items that are:

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Visiting Greenland offers you a variety of activities to do and a large number of options to see. Among these, whale watching is one of the best activities to do in Greenland especially at the Ilulissat Ice-fjord. For a fun trip spent cruising among icebergs and watching whales, we recommend that you head to this tourist destination in June and July as most of the fjords will have melted by May. You can take this tour from different towns like Nuuk, Qeqertarsuaq, and Aasiaat. This tour can be rewarding and you can get an opportunity to see minke, humpback, and fin whales. In rare cases, narwhals, blue whales, beluga whales, pilot whales, and sperm whales can be seen. You just have to be patient and keep looking at the water’s surface during this tour. Another beautiful location that you must add to your travel itinerary is the Greenland National Museum in Nuuk. You can find numerous kayaks, hunting equipment, carvings, and Viking relics in this museum.

To visit this amazing place Get Your Application Form Here!!

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Administrator Samantha Power at the MANA Nutrition Factory

Fitzgerald, georgia.

ADMINISTRATOR SAMANTHA POWER: So I'm the one who is giving all of you a standing ovation. Consider me standing, giving you that ovation. This is an incredible experience for me, and I know for my team that has come here from Washington. Congressman [Austin Scott], it's going to be great to partner with you. Bipartisanship is not something that happens on every issue, I love it when we find things that are so accord – not only with our values and our ideals, but with the interests of the nation, and with the interests of communities like this one in Fitzgerald, this is awesome. So we will take this show on the road, even more than we have already. 

Amy [Towers], thank you for being an early adopter – the early adopter – and bringing all the skills that you have from your backpack into this vital cause. Mark [Moore], you’re a force of nature, and I’m glad I got to see you in person, see what you're building. But what's so clear about you is that you see the unseen. So I'm now seeing what you and Chris [Hohn] cooked up – just probably a relatively short time ago – but what's really interesting is also all the lies ahead, and all the good that your people do. And I just can’t wait to see where your mind keeps taking you, even as you continue to take orders from Chris. And I don't know, it's a little bit of a contrast between the story of him, and the [inaudible] and me playing baseball, but I – I understand.

I was not as preternaturally oriented in the humanitarian direction, I guess, as Chris – who’s done so much in such a short time to catalyze, just as much as he, himself built. But I will say that the seeds to me – being here, we're planted right here in the state of Georgia. I went to Lakeside High School, about three and a half hours up the road in DeKalb County. And so much of my views on justice, my desire to change my little slice of the world, those seeds were planted at Lakeside, right here in Georgia. And so, it's incredibly inspiring for me to be back in my home state and to see what is brewing here. And the kind of global leadership being extended by peanut farmers, by people who are doing the blending, by the builders, by the young people who are – and the parents and grandparents – who are getting exposed to a very simple idea, which is that you can change the world. It's very easy these days to think that you can’t, ‘cause so much is so messed up. But this is a reminder of what happens when people take a risk, and when you combine head and heart around a vision, and you bring powers of persuasion, you bring coalitions together, you bring unlikely bedfellows together. And lo and behold, you rebuild a lifesaving remedy and you scale it. 

There is a lot of famine pending in the world, there’s a ton of food insecurity. This effort, this vision, meets the moment. And it could not be more timely, more necessary, or more important. So Fitzgerald, Georgia, hats off to you, and all of you who have made this happen, hats off to you. Please, let’s give a round of applause.

So I just had a chance to tour the facility and to go back to one of the things that Amy said, I want to just state for the record, there are no bystanders here, only upstanders. It is very rare to visit a place that is so unabashedly idealistic at every layer of the enterprise. It's extremely inspiring for us visitors, and it's something that we are going to carry with us, not just for the rest of our time in these jobs, but for the rest of our lives – it's extremely moving.

The importance of the work here has already been described, and it really can't be overstated. But I was really struck in one of the encounters I had on the tour with a young woman named Tina, who is a mom of three. And I said, what’s it like, what do you tell your kids? She said I tell my kids all the time about the work we're doing, about the good we're doing. And then she said, you know, I tell my kids you don't have to go to college to be a doctor – I'm saving lives right here at MANA in Fitzgerald, Georgia. And that’s just awesome. 

But in my short time here, I want to transport you from this lifesaving enterprise here in Fitzgerald, Georgia to pass along something that I heard when I visited a wasting clinic –  or a clinic that was treating wasted children – wasting children in Kenya in 2022. Parents there shared with me what it felt like for them to hear their kids cry. 

Now, any parent here knows that what that usually feels like – it's not a lot of fun. When you hear your kids crying it causes worry, causes anxiety, distress, you know, what is it? What's going on? Let's get to the bottom of it. What is bringing your child pain – emotional or physical pain that is causing them to cry. But for these parents in northern Kenya, hearing their children cry didn't spark any of the feelings that it sparks in us usually here in the U.S. or in developed economies. 

Hearing their children cry actually sparked relief. Joy. Prayers of gratitude.

You see, while children, of course, cry when they are hungry. That is only true up to a point. Once hunger becomes truly dire, kids actually lose the energy to cry. They become listless, and then they go silent altogether. And that is what we're talking about when we are talking about wasting. Gone untreated, as we know, this severe hunger will hinder a child's cognitive and physical development forever. And for some, roughly 8,000 kids worldwide, every single day – it is a death sentence. But the RUTF surrounding us, here, in this warehouse, can bring these kids back to life – saves lives and prevents the long term developmental consequences. 

It can bring color back to a child's cheeks. It can make kids cry again. The first step to them going on to laugh, and to talk, and to grow. 

Many parents of these kids get to hear the sweetest sound in the world again – the return to crying, thanks to the efforts of so many of you. The peanut farmers, building on Georgia’s incredible tradition of feeding the world. First thing my parents told me we were moving to Georgia, they told me about the peanuts. It was the Jimmy Carter era, so that was very much talked about at the time. One hundred twenty workers and counting in this plant processing the food that farmers grow to turn peanuts into medicine because fundamentally that is what this is about. Right now your work is more important than ever. 

Today, this global food security crisis, that is exacerbated by the climate crisis, historic levels of conflict, the overhang from COVID-19 and all the damage it did, debt distress – has put 164 million people at risk of acute food insecurity. That is a 92 percent increase from before the pandemic. That is a really sharp increase. When we have solutions like the ones in this building – solutions that work, that are affordable, that are readily available – we should be moving toward ending severe hunger for good. For right now you're actually seeing the problem of severe hunger actually increase. So we are taking action with partners around the world to reverse this trend. 

Last year, the World Health Organization took the critical step to improve guidelines for preventing and managing wasting. So that now, community health workers are encouraged to treat children with wasting on the spot at home rather than in a sense requiring mothers to travel often long distances to reach a clinic. This will get more kids into treatment, and thus will save many more lives. But we need to get RUTF to those families who can now be treated in more places. So we are hustling up more resources to meet this growing need. 

In 2022, we made a historic one time – USAID made a historic one time contribution of $200 million to expand access to Ready-to-Use-Therapeutic Foods. We issued a call to action to partner governments, philanthropic foundations, individuals, anyone to match that donation and in total together – and Chris was a huge part of this –  we managed to raise another unprecedented $330 million for wasting treatment around the world. We are building on that commitment today. I, here at Fitzgerald, Georgia, at one of our key productions partner facilities, am really pleased to announce USAID’s commitment to provide another $200 million in dedicated funding to RUTF and other commodities to treat wasting. 

We are the privileged ones. We are very fortunate – we can make resources available, so many people here are the ones that do the work. You do the work. And when you do the work, we and our people out on the field meet you at tarmacs and we make sure that your work doesn't go to waste and that we meet the needs of those kids and those parents. There could be nothing worse in the world than not be able to meet the needs of your kid when they are suffering wasting. 

This funding will allow us to purchase many more of these life-saving products, and support the World Food Program and UNICEF to get them to millions of children around the world. I was trying to find a way to – how do we give some sense of scale – if you look around at the RUTF in this warehouse room, the aisles upon aisles of the packages stacked high – imagine twenty of these warehouses. That is at least as much lifesaving RUTF that USAID will be able to procure this year for very sick kids around the world. 

And it really is very important that this also is providing jobs and investment for this community in the process. I also want to recognize that this increased supply is possible because of the expansion of this very facility. And the $200 million investment by Sir Chris Hon to make that expansion possible. So again I want to just thank you, Chris, for bringing this issue to my attention, my first month in the job – educating me and so many people here and around the world. And then as they say, putting your money where your mouth is again and again and again, and allowing us all to continue to dream together about what more we can do. As you say this is a soluble problem. There are a lot of insoluble problems out there or ones that are really hard to chip away at – this is one we can achieve something very major on together. 

To continue this work, we need Congress to reauthorize the Food for Peace Act, so we can continue delivering high-quality commodities from American farmers and producers like MANA to people with the greatest need. At the same time – and this is really important actually for this cause – we need to retain flexibility in our funding so that we can treat, and even better prevent, wasting in the most cost effective manner. And sometimes this gets lost a little bit in the focus on the commodities themselves. It never gets lost for the folks who work this cause because they know how essential the services are to go along with the commodity. And how all of us want to live in a world where this is prevented and RUTF is not actually needed because wasting itself is a phenomenon that we take away. 

So this – we need resources for local food distributions, complementary feeding, again, and of course the vital RUTF produced in facilities like this one. That flexibility also allows us to make the necessary investments in the health system we rely on to administer this lifesaving treatment and in the food systems that are going to be critical over time to keep hunger crises from happening in the first place. 

So again, if you take nothing else, especially young people here – global hunger is a soluble problem.

And you all in this room, you are an essential part of that solution. The fact that you are helping make millions of kids cry may not sound like an obvious achievement. That’s not – you didn’t grow up saying I want to make kids cry. But what that means is that you are bringing back to them the spark of life, the spark of growth, and you are putting them in a position to get back on the path to vitality – there is no more precious gift than that. And the gift you have given all of us, Mark, Chris and team is to just be along for the ride. So thank you for letting us be your partner. Thank you so much.

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Article Contents

Conclusions, supplementary data, favorable antiviral effect of metformin on severe acute respiratory syndrome coronavirus 2 viral load in a randomized, placebo-controlled clinical trial of coronavirus disease 2019.

ORCID logo

D. R. B. and J. D. H. contributed equally to this work.

Potential conflicts of interest. J. B. B. reports contracted fees and travel support for contracted activities for consulting work paid to the University of North Carolina by Novo Nordisk; grant support by NIH, PCORI, Bayer, Boehringer-Ingelheim, Carmot, Corcept, Dexcom, Eli Lilly, Insulet, MannKind, Novo Nordisk, and vTv Therapeutics; personal compensation for consultation from Alkahest, Altimmune, Anji, Aqua Medical Inc, AstraZeneca, Boehringer-Ingelheim, CeQur, Corcept Therapeutics, Eli Lilly, embecta, GentiBio, Glyscend, Insulet, Mellitus Health, Metsera, Moderna, Novo Nordisk, Pendulum Therapeutics, Praetego, Stability Health, Tandem, Terns Inc, and Vertex.; personal compensation for expert testimony from Medtronic MiniMed; participation on advisory boards for Altimmune, AstraZeneca, and Insulet; a leadership role for the Association of Clinical and Translational Science; and stock/options in Glyscend, Mellitus Health, Pendulum Therapeutics, Praetego, and Stability Health. M. A. P. receives consulting fees from Opticyte and Cytovale. A. B. K. has served as an external consultant for Roche Diagnostics; received speaker honoraria from Siemens Healthcare Diagnostics, the American Kidney Fund, the National Kidney Foundation, the American Society of Nephrology, and Yale University Department of Laboratory Medicine; research support unrelated to this work from Siemens Healthcare Diagnostics, Kyowa Kirin Pharmaceutical Development, the Juvenile Diabetes Research Foundation, and the NIH; support for travel from College of American Pathologists Point-Of-Care Testing Committee; participation on an advisory board for the Minnesota Newborn Screening Advisory Committee; grants from NIH and JDRF for multiple unrelated clinical research projects and Kyowa Kirin Pharmaceutical Development and Siemens Healthcare Diagnostics for unrelated clinical research studies; and leadership roles for the American Board of Clinical Chemistry, Association for Diagnostics and Laboratory Medicine (ADLM) Evidence-Based Laboratory Medicine Subcommittee, and ADLM Academy Test Utilization Committee. M. R. R. reports consulting fees from 20/20 Gene Systems for coronavirus disease 2019 testing. D. B. R. reports grants from the NIH NCATS ACTIV-6 Steering Committee Chair. K. C. reports stock or stock options for United Health Group. C. T. B. reports consulting fees from NCATS/DCRI and the ACTIV-6 Executive Committee and support for travel from Academic Medical Education. All other authors report no potential conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

  • Article contents
  • Figures & tables

Carolyn T Bramante, Kenneth B Beckman, Tanvi Mehta, Amy B Karger, David J Odde, Christopher J Tignanelli, John B Buse, Darrell M Johnson, Ray H B Watson, Jerry J Daniel, David M Liebovitz, Jacinda M Nicklas, Ken Cohen, Michael A Puskarich, Hrishikesh K Belani, Lianne K Siegel, Nichole R Klatt, Blake Anderson, Katrina M Hartman, Via Rao, Aubrey A Hagen, Barkha Patel, Sarah L Fenno, Nandini Avula, Neha V Reddy, Spencer M Erickson, Regina D Fricton, Samuel Lee, Gwendolyn Griffiths, Matthew F Pullen, Jennifer L Thompson, Nancy E Sherwood, Thomas A Murray, Michael R Rose, David R Boulware, Jared D Huling, for the COVID-OUT Study Team, Favorable Antiviral Effect of Metformin on Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load in a Randomized, Placebo-Controlled Clinical Trial of Coronavirus Disease 2019, Clinical Infectious Diseases , 2024;, ciae159, https://doi.org/10.1093/cid/ciae159

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Metformin has antiviral activity against RNA viruses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The mechanism appears to be suppression of protein translation via targeting the host mechanistic target of rapamycin pathway. In the COVID-OUT randomized trial for outpatient coronavirus disease 2019 (COVID-19), metformin reduced the odds of hospitalizations/death through 28 days by 58%, of emergency department visits/hospitalizations/death through 14 days by 42%, and of long COVID through 10 months by 42%.

COVID-OUT was a 2 × 3 randomized, placebo-controlled, double-blind trial that assessed metformin, fluvoxamine, and ivermectin; 999 participants self-collected anterior nasal swabs on day 1 (n = 945), day 5 (n = 871), and day 10 (n = 775). Viral load was quantified using reverse-transcription quantitative polymerase chain reaction.

The mean SARS-CoV-2 viral load was reduced 3.6-fold with metformin relative to placebo (−0.56 log 10 copies/mL; 95% confidence interval [CI], −1.05 to −.06; P = .027). Those who received metformin were less likely to have a detectable viral load than placebo at day 5 or day 10 (odds ratio [OR], 0.72; 95% CI, .55 to .94). Viral rebound, defined as a higher viral load at day 10 than day 5, was less frequent with metformin (3.28%) than placebo (5.95%; OR, 0.68; 95% CI, .36 to 1.29). The metformin effect was consistent across subgroups and increased over time. Neither ivermectin nor fluvoxamine showed effect over placebo.

In this randomized, placebo-controlled trial of outpatient treatment of SARS-CoV-2, metformin significantly reduced SARS-CoV-2 viral load, which may explain the clinical benefits in this trial. Metformin is pleiotropic with other actions that are relevant to COVID-19 pathophysiology.

NCT04510194.

COVID-OUT was a multisite, phase 3, quadruple-blinded, placebo-controlled, randomized clinical trial to test whether outpatient treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevented severe coronavirus disease 2019 (COVID-19) [ 1 ].

The selection of metformin was motivated by in silico modeling, in vitro data, and human lung tissue data that showed that metformin decreased SARS-CoV-2 viral growth and improved cell viability [ 2–4 ]. The in silico modeling identified protein translation as a key process in SARS-CoV-2 replication, similar to protein mapping of SARS-CoV-2 [ 3 ]. Metformin inhibits the mechanistic target of rapamycin (mTOR) [ 5 ], which controls protein translation [ 6 , 7 ]. Metformin has shown in vitro antiviral actions against the Zika virus and against hepatitis C via mTOR inhibition [ 8–11 ].

Severe COVID-19 was defined using a binary, 4-part composite outcome (1 reading <94% SpO 2 on a home oximeter/emergency department visit/hospitalization/death) through 14 days and was not significant. After removing the 1 oxygen reading <94% component per the prespecified statistical analysis plan (SAP), metformin reduced the odds of emergency department visits/hospitalizations/death by day 14 by 42%, of hospitalization/death by day 28 by 58%, and of long COVID diagnoses by day 300 by 42% [ 1 , 12 ].

Here, we present the viral load quantification from samples obtained during the COVID-OUT trial. The trial used a 2 × 3 factorial design of parallel treatments to efficiently assess 3 medications: immediate-release metformin, ivermectin, and fluvoxamine at doses not previously studied in COVID-19 trials.

Study Design, Sample, and Oversight

COVID-OUT was an investigator-initiated, multisite, phase 3, quadruple-blinded, placebo-controlled randomized clinical trial ( Supplementary Tables 1 and 2 ) [ 1 ] that enrolled from 30 December 2020 to 28 January 2022. COVID-OUT was decentralized to prevent SARS-CoV-2 spread. The participants, care providers, investigators, and outcomes assessors remained blinded to treatment allocation.

Institutional review boards (IRBs) at each site and the Advarra Central IRB approved the protocol. An independent data and safety monitoring board (DSMB) monitored safety and efficacy. All analyses and covariates were prespecified in the SAP, which was submitted to the DSMB before enrollment ended and submitted in February 2022 with the primary outcome manuscript and then published [ 1 ]. An independent monitor oversaw study conduct per the Declaration of Helsinki, Good Clinical Practice Guidelines, and local requirements.

COVID-OUT excluded low-risk individuals, limiting enrollment to standard-risk adults aged 30 to 85 years with a body mass index (BMI) in the overweight or obesity categories, documented + SARS-CoV-2 within 3 days, and no prior confirmed SARS-CoV-2 infection. Pregnant women were randomized to metformin or placebo and not to ivermectin or fluvoxamine. Exclusion criteria included hospitalized, symptom onset >7 days prior, and unstable heart, liver, or kidney failure [ 1 ].

Metformin dosing was as follows: 500 mg on day 1, 500 mg twice daily on days 2–5, and 500 mg in the morning and 1000 mg in the evening on days 6–14. Fluvoxamine dosing was as follows: 50 mg on day 1 and 50 mg twice daily on days 2–14. Ivermectin dosing was as follows: a median of 430  µg/kg/day (range, 390 to 470  µg/kg/day) for 3 days.

Clinical and Virologic End Points

The primary end point was severe COVID-19 by day 14, defined using a binary, 4-part composite end point: 1 reading <94% SpO 2 on home oximeter/emergency department visit/hospitalization/death due to COVID-19. Secondary end points included hospitalization or death by day 28 and long COVID over the 10-month follow-up. The virologic secondary end point was overall viral load in follow-up, adjusted for baseline viral load as prespecified in the SAP.

Self-collection of anterior nares samples was an optional component of the randomized trial. Supply chain shortages caused administrative censoring of 78 participants who did not receive materials for collecting day 1, day 5, or day 10 samples; 3 did not receive materials for day 5 or day 10 samples ( Supplementary Figure 1, Supplementary Tables 3–6 ).

Laboratory Procedures

Participants received written instructions with pictures on self-collecting from the anterior mid-turbinate, which has excellent concordance with professionally collected nasal swabs [ 13 ]. Viral load was measured via reverse-transcription quantitative polymerase chain reaction using N1 and N2 targets in the SARS-CoV-2 nucleocapsid protein, with relative cycle threshold values converted to absolute copy number via calibration to droplet digital polymerase chain reaction. Detailed methods can be found in Supplementary Table 7 .

While participant self-collection may vary between participants, self-collection of samples is done by the same individual at baseline and follow-up. Thus, participant self-collection may have less variability between baseline and follow-up than when study or clinical staff obtain samples.

Statistical Analyses

We evaluated randomized study drug assignment on the impact of log 10 -transformed viral load on day 5 and day 10 with a linear Tobit regression model where the effect of study drugs was allowed to differ on day 5 and day 10. This was decided a priori as a rigorous analytic approach to account for left censoring due to the viral load limit of quantification. Repeated measures were accounted for using clustered standard errors within participants. Analyses of viral loads estimated the adjusted mean reduction averaged over time and the adjusted mean reduction at day 5 and day 10. We evaluated impact over time on the probability of viral load being undetectable using generalized estimating equations with a logistic link; estimates are reported as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

The COVID-OUT trial was a 2 × 3 factorial design of parallel distinct treatments ( Supplementary Table 2 ). All analyses were adjusted for baseline viral load, vaccination status, time since last vaccination for those vaccinated before enrollment, receipt of other study medications within factorial trial, laboratory that processed the nasal swabs, and exact time and date of specimen collection. Additional details and the results of the analyses with dropping of adjustment variables are presented in Supplementary Tables 8 and 9 .

To handle missing values, we used multiple imputation with chained equations to multiply impute missing viral load outcomes and vaccination status. Missing covariate information was jointly imputed along with missing outcomes using random forests for the univariate imputation models. Along with outcome and vaccination status information, imputation models were informed by sex, BMI, symptom duration, race/ethnicity, baseline comorbidities, clinical outcomes, and enrollment time categorized by the dominant pandemic variant. Complete case analysis without imputation of missing data is presented in Supplementary Figures 2–4 . Heterogeneity of effect was assessed across a priori subgroups of baseline characteristics. Starting metformin in <4 days of symptom onset is a subgroup that aligns with antiviral trials and reflects real-world use, as metformin is widely available.

Among 1323 randomized participants in the COVID-OUT trial, 999 (76%) chose to participate in the optional substudy and provided at least 1 nasal swab sample ( Table 1 , Supplementary Figure 1 ). The demographics of the participants who submitted swabs were similar to those who did not submit nasal swabs ( Supplementary Tables 3–5 ). Day 1 samples were provided by 945 participants, 871 provided day 5 samples, and 775 provided day 10 samples ( Supplementary Table 6 ). The overall viral load was a median of 4.88 log 10 copies/mL (interquartile range [IQR], 2.99 to 6.18) on day 1, 1.90 (IQR, 0 to 3.93) on day 5, and 0 (IQR, 0 to 1.90 with 0 representing the limit of quantification) on day 10.

Baseline Characteristics of Participants Who Submitted Any Nasal Swab

Values are percent (n) or median (interquartile range) unless specified. Cardiovascular disease defined as hypertension, hyperlipidemia, coronary artery disease, past myocardial infarction, congestive heart failure, pacemaker, arrhythmias, or pulmonary hypertension.

Abbreviation: BMI, body mass index.

a Unknown n = 22.

The overall mean SARS-CoV-2 viral load reduction with metformin was −0.56 log 10 copies/mL (95% CI, −1.05 to −0.06) greater than placebo across all follow-up ( P = .027). The antiviral effect of metformin compared with placebo was −0.47 log 10 copies/mL (95% CI, −0.93 to −0.014) on day 5 and −0.64 log 10 copies/mL (95% CI, −1.42 to 0.13) on day 10 ( Figure 1 ). Neither ivermectin nor fluvoxamine had virologic effect ( Figure 2 , Supplementary Figure 2 , Supplementary Tables 8–10 ).

Effect of metformin versus placebo on viral load over time, detectable viral load, and rebound viral load. A, Adjusted mean change in log10 copies per milliliter (viral load) from baseline (day 1) to day 5 and day 10 for metformin (lower line) and placebo (upper line). Mean change estimates are based on the adjusted, multiply imputed Tobit analysis (the primary analytic approach) that corresponds to the overall metformin analysis presented in Figure 2. B, Adjusted percent of viral load samples that were detectable at day 1, day 5, and day 10. The percent viral load detected estimates were based on the adjusted, multiply imputed logistic generalized estimating equations (GEE) analysis corresponding to the overall metformin analysis depicted in Figure 3. Odds ratios correspond to adjusted effects on the odds ratio scale. C, Bar chart depicting the percent of participants whose day 10 viral load was greater than the day 5 viral load and the odds ratio for having viral load rebound using the multiply imputed logistic GEE. Abbreviation: CI, confidence interval.

Effect of metformin versus placebo on viral load over time, detectable viral load, and rebound viral load. A , Adjusted mean change in log10 copies per milliliter (viral load) from baseline (day 1) to day 5 and day 10 for metformin (lower line) and placebo (upper line). Mean change estimates are based on the adjusted, multiply imputed Tobit analysis (the primary analytic approach) that corresponds to the overall metformin analysis presented in Figure 2 . B , Adjusted percent of viral load samples that were detectable at day 1, day 5, and day 10. The percent viral load detected estimates were based on the adjusted, multiply imputed logistic generalized estimating equations (GEE) analysis corresponding to the overall metformin analysis depicted in Figure 3 . Odds ratios correspond to adjusted effects on the odds ratio scale. C , Bar chart depicting the percent of participants whose day 10 viral load was greater than the day 5 viral load and the odds ratio for having viral load rebound using the multiply imputed logistic GEE. Abbreviation: CI, confidence interval.

Overall results for metformin, ivermectin, and fluvoxamine on viral load; heterogeneity of treatment effect of metformin versus placebo. This is a forest plot that depicts the effect of active medication compared with control on log10 copies per milliliter (viral load), overall, and at day 5 and day 10. Viral Effect* denotes the adjusted mean change in viral load in log10 copies per milliliter with 95% confidence intervals for the adjusted mean change. Analyses were conducted using the primary analytic approach, a multiply imputed Tobit model. The vertical dashed line indicates the value for a null effect. The top 3 rows show ivermectin, the next 3 rows show fluvoxamine, and the following 3 rows show metformin. Below these, the effect of metformin compared with placebo is shown by a priori subgroups of baseline characteristics. Abbreviation: CI, confidence interval.

Overall results for metformin, ivermectin, and fluvoxamine on viral load; heterogeneity of treatment effect of metformin versus placebo. This is a forest plot that depicts the effect of active medication compared with control on log10 copies per milliliter (viral load), overall, and at day 5 and day 10. Viral Effect* denotes the adjusted mean change in viral load in log10 copies per milliliter with 95% confidence intervals for the adjusted mean change. Analyses were conducted using the primary analytic approach, a multiply imputed Tobit model. The vertical dashed line indicates the value for a null effect. The top 3 rows show ivermectin, the next 3 rows show fluvoxamine, and the following 3 rows show metformin. Below these, the effect of metformin compared with placebo is shown by a priori subgroups of baseline characteristics. Abbreviation: CI, confidence interval.

When the adjustment covariates were dropped one at a time—baseline viral load, vaccination status, time since last vaccination, other study medications within the factorial trial, and the laboratory processing the nasal swabs—in addition to dropping all adjustment covariates, the results were similar. The range in the estimated average effect was −0.51 log 10 copies/mL (95% CI, −1.04 to 0.01; P = .056) to −0.66 log 10 copies/mL (95% CI, −1.215 to −0.097; P = .021) with the latter arising from the unadjusted model ( Supplementary Table 9 ).

Those in the metformin group were less likely to have a detectable viral load than those in the placebo group (OR, 0.72; 95% CI, .55 to .94; Figure 1) . This effect was higher at day 10 (OR, 0.65; 95% CI, .43 to .98) when 1500 mg/d of metformin was being prescribed than at day 5 (OR, 0.79; 95% CI, .60 to 1.05) when 1000 mg/d was prescribed. Viral rebound was defined as having a higher viral load at day 10 than day 5. In the placebo group, 5.95% (22 of 370) of participants had viral rebound compared with 3.28% (12 of 366) in the metformin group (adjusted OR, .68; 95% CI, .36 to 1.29) for metformin compared with placebo ( Figure 1) .

Metformin's effect on continuous viral load and conversion to undetectable viral load was consistent across a priori identified subgroups of baseline characteristics ( Figures 2 and 3 ). Subgroups should be interpreted with caution because of low power, risk of making multiple comparisons without correction, and sparse data bias. One subgroup warrants additional detail for interpretation. The antiviral effect on geometric log 10 scale was greater among those with baseline viral loads <100 000 copies/mL (mean −1.17 log 10 copies/mL reduction) than among those with >100 000 copies/mL (mean −0.49 log 10 copies/mL reduction); although the reduction in absolute copies per milliliter would be greater among those with higher viral loads ( Figures 2 and 3 ). Mean, median viral load levels are presented in Supplementary Table 11 ; sensitivity analyses are presented in Supplementary Figures 5–7 and Supplementary Table 12 .

Overall results for metformin, ivermectin, and fluvoxamine on detectability of viral load; heterogeneity of treatment effect of metformin versus placebo. This is a forest plot that depicts the effect of active medication compared with control on the proportion of participants with a detectable viral load, overall and at days 5 and 10. Estimate* denotes the adjusted mean risk difference in the percent of samples with detected viral load with 95% confidence intervals for the adjusted risk difference. The vertical dashed line indicates the value for a null effect. The estimated risk differences are derived from the adjusted, multiply imputed logistic generalized estimating equations (GEE) analytic approach. The top 3 rows show ivermectin, the next 3 rows show fluvoxamine, and the following 3 rows show metformin. Below these, the effect of metformin compared with placebo is shown by a priori subgroups of baseline characteristics. Abbreviation: CI, confidence interval.

Overall results for metformin, ivermectin, and fluvoxamine on detectability of viral load; heterogeneity of treatment effect of metformin versus placebo. This is a forest plot that depicts the effect of active medication compared with control on the proportion of participants with a detectable viral load, overall and at days 5 and 10. Estimate* denotes the adjusted mean risk difference in the percent of samples with detected viral load with 95% confidence intervals for the adjusted risk difference. The vertical dashed line indicates the value for a null effect. The estimated risk differences are derived from the adjusted, multiply imputed logistic generalized estimating equations (GEE) analytic approach. The top 3 rows show ivermectin, the next 3 rows show fluvoxamine, and the following 3 rows show metformin. Below these, the effect of metformin compared with placebo is shown by a priori subgroups of baseline characteristics. Abbreviation: CI, confidence interval.

In the virologic end point of the COVID-OUT phase 3, randomized trial, metformin significantly reduced SARS-CoV-2 viral load over 10 days [ 1 ]. The mean reduction was −0.56 log 10 copies/mL greater than placebo. The antiviral response is consistent with the statistically significant and clinically relevant effects of metformin in preventing clinical outcomes: severe COVID-19 (emergency department visit, hospitalization, or death) through day 14, hospitalization or death by day 28, and the diagnosis of long COVID [ 1 , 12 ]. The magnitude of effect on clinical outcomes was larger when metformin was started earlier in the course of infection at <4 days from symptom onset, with metformin reducing the odds of severe COVID-19 by 55% (OR, 0.45; 95% CI, .22 to .93) and of long COVID by 65% (hazard ratio = 0.35; 95% CI, .15 to .95; Figure 4) . An improved effect size for clinical outcomes when therapies are started earlier in the course of infection is consistent with an antiviral action [ 14 ].

Overview of results from the COVID-OUT trial. This is a forest plot that combines the severe, acute coronavirus disease 2019 outcome as well as the long-term follow-up outcome from the COVID-OUT trial [1, 12]. Two a priori subgroups from the COVID-OUT trial are also presented: pregnant individuals and those who started the study drug within 4 days of symptom onset, to match the primary analytic sample of other antivirals. Abbreviations: COVID-19, coronavirus disease 2019; ITT, intention to treat; mITT, modified intention to treat; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Overview of results from the COVID-OUT trial. This is a forest plot that combines the severe, acute coronavirus disease 2019 outcome as well as the long-term follow-up outcome from the COVID-OUT trial [ 1 , 12 ]. Two a priori subgroups from the COVID-OUT trial are also presented: pregnant individuals and those who started the study drug within 4 days of symptom onset, to match the primary analytic sample of other antivirals. Abbreviations: COVID-19, coronavirus disease 2019; ITT, intention to treat; mITT, modified intention to treat; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

The objective of the COVID-OUT trial was to determine whether metformin prevented severe COVID-19. Severe COVID-19 was defined with a binary, 4-part composite outcome (<94% SpO 2 on a home oximeter/emergency department visit/hospitalization/death) at a time when the implications of “silent hypoxia” were unknown and fears of overwhelmed emergency services caused concern that deaths would occur at home before patients reached the emergency department. As a scientific community, we now understand that 1 reading below 94% is not severe COVID-19. An accurate definition of severe COVID-19 (emergency department visit/hospitalization/death) was ascertained within the same data-generation process. In such situations, recommendations are sometimes made based on the totality of evidence from a single randomized trial [ 15–17 ].

The antiviral effect in this phase 3, randomized trial is also consistent with emerging data from other trials. In a phase 2, randomized trial with 20 participants, the metformin group had better clinical outcomes, achieved an undetectable viral load 2.3 days faster than placebo ( P = .03), and had a larger proportion of patients with an undetectable viral load at 3.3 days in the metformin group ( P = .04) [ 18 ]. A recent in vitro study showed that metformin decreased infectious SARS-CoV-2 titers and viral RNA in 2 cell lines, Caco2 and Calu3, at a clinically appropriate concentration [ 19 ].

Conversely, an abandoned randomized trial testing extended-release metformin 1500 mg/d without a dose titration did not report improved SARS-CoV-2 viral clearance at day 7 [ 20 ]. Several differences between the Together Trial and the COVID-OUT trial are important for understanding the data. First, the Together Trial allowed individuals already taking metformin to enroll and be randomized to placebo or more metformin [ 20 , 21 ]. To compare starting metformin versus placebo, the authors excluded those already taking metformin at baseline and reported that emergency department visit or hospitalization occurred in 9.2% (17 of 185) randomized to metformin compared with 14.8% (27 of 183) randomized to placebo (relative risk, 0.63; 95% confidence interval, .35 to 1.10, Probability of superiority = 0.949) [ 22 ]. Thus, the Together Trial results for starting metformin versus placebo are similar. Second, 1500 mg/day without escalating the dose over 6 days would cause side effects, especially if the study participant was already taking metformin [ 23 ]. Third, extended-release and immediate-release metformin have different pharmacokinetic properties. Immediate-release metformin has higher systemic exposure than extended-release metformin, which may improve antiviral actions, but this is not known [ 24 , 25 ]. Given the similar clinical outcomes between immediate and extended-release, a direct comparison of the 2 may be important for understanding pharmacokinetics against SARS-CoV-2.

In comparison with other SARS-CoV-2 antivirals, when considering all enrolled participants, at day 5, the antiviral effect over placebo was 0.47 log 10 copies/mL for metformin, 0.30 log 10 copies/mL for molnupiravir, and 0.80 log 10 copies/mL for nirmatrelvir/ritonavir [ 26 , 27 ]. At day 10, the viral load reduction over blinded placebo was 0.64 log 10 copies/mL for metformin, 0.35 log 10 copies/mL for nirmatrelvir, and 0.19 log 10 copies/mL for molnupiravir [ 26 , 27 ]. We note that the 3 trials enrolled different populations and at different times and locations during the pandemic. In the COVID-OUT metformin trial, half were vaccinated [ 1 , 12 ].

The magnitude of metformin's antiviral effect was larger at day 10 than at day 5 overall and across subgroups, which correlates with the dose titration from 1000 mg on days 2–5 to 1500 mg on days 6–14. The dose titration to 1500 mg over 6 days used in the COVID-OUT trial was faster than typical use. When used chronically, that is, for diabetes, prediabetes, or weight loss, metformin is slowly titrated to 2000 mg daily over 4–8 weeks. While metformin's effect on diabetes control is not consistently dose-dependent, metformin's gastrointestinal side effects are known to be dose-dependent [ 25 ]. Thus, despite what appears to be dose-dependent antiviral effects, a faster dose titration should likely only be considered in individuals with no gastrointestinal side effects from metformin.

When assessing for heterogeneity of effect, metformin was consistent across subgroups. Metformin's antiviral effect in vaccinated versus unvaccinated of −0.48 versus −0.86 log 10 copies/mL at day 10 mirrors nirmatrelvir, for which the effect in seropositive participants was smaller than in the overall trial population, −0.13 versus −0.35 log 10 copies/mL at day 10 [ 26 ]. Effective primed memory B- and T-cell anamnestic immunity prompting effective response by day 5 in vaccinated persons may account for this trend in both trials. Subgroups should be interpreted with caution because of low power and multiple comparisons [ 28 ].

Both nirmatrelvir and molnupiravir are pathogen-directed antiviral agents. Therapeutics may have an important role in targeting host factors rather than viral factors, as targeting the host may be less likely to induce drug-resistant viral variants through mutation–selection [ 11 , 29 ]. We did not study the mechanism for the antiviral activity or an antiinflammatory action in this trial. Previous work has shown that metformin's inhibition of mTOR complex 1 may depend on AMP-activated protein kinase (AMPK) at low doses but not high doses [ 5 ]. An AMPK-independent inhibition of mTOR may be more efficient. Additionally, metformin demonstrates a dose-dependent ability to inhibit interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha in the presence of lipopolysaccharide, inflammatory products that correlate with COVID-19 severity [ 30 , 31 ].

In addition to antiviral activity, metformin appears to have relevant antiinflammatory actions. In mice without diabetes, metformin inhibited mitochondrial ATP and DNA synthesis to evade NLRP3 inflammasome activation [ 32 ]. In macrophages of mice without diabetes infected with SARS-CoV-2, metformin inhibited inflammasome activation, IL-1 production, and IL-6 secretion and also increased the IL-10 antiinflammatory response to lipopolysaccharide, thereby attenuating lipopolysaccharide-induced lung injury [ 32 ]. In a recent assay of human lung epithelial cell lines, metformin inhibited the cleavage of caspase-1 by NSP6, inhibiting the maturation and release of IL-1, a key factor that mediates inflammatory responses [ 7 ]. The idea of pleiotropic effects is being embraced in novel therapeutics being developed for both antiviral and anti-inflammatory actions [ 33 ].

Strengths of our study include the large sample size and detailed participant information collected, including the exact time and date of specimen collection. One limitation was the sampling time frame of only day 1, day 5, and day 10 due to limited resources. By day 10 post-randomization, 77% of participants in the placebo group and 86% in the metformin group had an undetectable viral load. As viral load is lower in vaccinated persons [ 34 ], this degree of undetectable viral loads differs from findings from earlier clinical trials conducted in unvaccinated participants without known prior infection [ 26 , 27 ]. Sampling earlier and more frequently, that is, day 1, day 3, day 6, and day 9 in future trials, may better characterize differences in viral shedding earlier in the infection and over time, dependent on the duration of therapy and timing of enrollment.

Future work could assess whether synergy exists between metformin and direct SARS-CoV-2 antivirals, as previous work showed that metformin improved sustained virologic clearance of hepatitis C virus and improved outcomes in other respiratory infections [ 35–37 ]. The biophysical modeling that motivated this trial predicts additive/cooperative effects in combination with transcription inhibitors. Combination therapy might decrease selective pressure, and metformin has few medication interactions, so treatment with metformin could continue beyond 5 days while home medications are restarted. Additionally, continuing metformin could reduce symptom rebound, given its effects on T-cell immunity [ 38 , 39 ]. Further data are needed to understand whether decreased viral load and faster viral clearance decrease onward transmission of SARS-CoV-2.

Metformin is safe in children and pregnant individuals with and without preexisting diabetes [ 40–42 ]. Individuals with or without diabetes do not need to check blood sugar when taking metformin. Historical concerns about lactic acidosis were driven by other biguanides; metformin does not increase risk of lactic acidosis [ 43 ]. Metformin improves outcomes in patients with heart, liver, and kidney failure, as well as during hospitalizations and perioperatively [ 44–48 ].

In a large randomized, controlled trial conducted in nonhospitalized, standard-risk adults, metformin reduced the incidence of severe COVID-19 by day 14, of hospitalizations by day 28, and of long COVID diagnosis by day 300. In this virologic analysis, we found a corresponding significant reduction in viral load with metformin compared with placebo and a lower likelihood of viral load rebound. While 22% of participants in the trial were enrolled during the Omicron era, metformin has not been assessed in individuals with a history of prior infection and thus should be trialed in the current state of the pandemic. Metformin is currently being trialed in low-risk adults [ 49 ].

Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.

Disclaimer. The funders had no influence on the design or conduct of the trial and were not involved in data collection or analysis, writing of the manuscript, or decision to submit for publication. The authors assume responsibility for trial fidelity and the accuracy and completeness of the data and analyses.

Financial support . The fluvoxamine placebo tablets were donated by the Apotex Pharmacy. The ivermectin placebo and active tablets were donated by the Edenbridge Pharmacy. The trial was funded by the Parsemus Foundation, Rainwater Charitable Foundation, Fast Grants, and the UnitedHealth Group Foundation. C. T. B. was supported by grants (KL2TR002492 and UL1TR002494) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and by a grant (K23 DK124654) from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH. J. B. B. was supported by a grant (UL1TR002489) from NCATS. J. M. N. was supported by a grant (K23HL133604) from the National Heart, Lung, and Blood Institute (NHLBI) of the NIH. D. J. O. was supported by the Institute for Engineering in Medicine, University of Minnesota Office of Academic and Clinical Affairs COVID-19 Rapid Response Grant, the Earl E. Bakken Professorship for Engineering in Medicine, and by grants (U54 CA210190 and P01 CA254849) from the National Cancer Institute of the NIH. D. M. L. receives funding from NIH RECOVER (OT2HL161847). L. K. S. was supported by NIH grants (18X107CF6 and 18X107CF5) through a contract with Leidos Biomedical and by grants from the HLBI of the NIH (T32HL129956) and the NIH (R01LM012982 and R21LM012744). M. A. P. receives grants from the Bill and Melinda Gates Foundation (INV-017069), Minnesota Partnership for Biotechnology and Medical Genomics (00086722) and NHLBI (OT2HL156812).

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