The CDC warns US travelers to avoid more than 135 destinations. Do people care?

Just weeks before Shelby Kalma left for Germany and the Czech Republic in late December, federal health officials issued a red alert warning: Avoid travel to both countries because of COVID-19.

The guidance didn’t stop the Tacoma, Washington resident, who spent three weeks in Europe with her husband. The trip was a last-minute decision, but the couple was itching to travel and the two countries allowed them in with proof of full vaccination.

"It was a risk we took," Kalma said. "In our heads, COVID's not going anywhere. Tomorrow's not promised. For us, it's like – do we live in fear or do we keep putting our dreams aside because of the pandemic?"

She's not the only one. Every week, the Centers for Disease Control and Prevention updates its list of countries that should be avoided due to COVID-19 risk. After nearly two years of living in the pandemic, travelers are ignoring the agency's guidance.

"There are a lot of people in this country who don’t feel confident in CDC messages," Mark Dworkin, professor and associate director for epidemiology at the University of Illinois at Chicago’s school of public health, told USA TODAY.

► CDC level 4: Australia, the Bahamas and 20 other countries added to CDC's 'avoid travel' list

Is travel to a level 4 country safe?

The CDC suggests travelers make sure they are "up to date" with all recommended COVID-19 vaccines – including any eligible booster doses – before international travel and offers specific guidance for each country based on COVID-19 levels.

The agency looks at new case rates and new case trajectories when deciding which risk level to assign. For a larger country to make level 4, it must have a "very high" risk of COVID, with more than 500 new cases reported per 100,000 people over the last 28 days.

Level 4 is the largest category, with more than 135 destinations listed as of Wednesday. Only seven destinations were categorized level 1.

But with COVID-19 cases within the United States surging just as much as level 4 countries, just how dangerous are these destinations to U.S. travelers?

"It's a little silly to say 'Don't travel to 'fill in the blank,' Paris or Buenos Aires or wherever, when you have the same risk," said David Weber, a professor of medicine, pediatrics and epidemiology at the University of North Carolina at Chapel Hill, in January. "Virtually every area in the U.S. is now the highest risk rate that the CDC has. ... I think if you're going to go to New York, you have the same risk as going to Paris."

Because air travel poses a low risk of infection because of the planes' filtration systems, Weber said a traveler's actions while abroad have the most impact on their likelihood of contracting the virus.

Dining maskless indoors, for instance, or chatting with people outside of their bubble can increase the risk of contracting COVID-19. A traveler's vaccination status and mask usage also play a role in how protected they are from the virus.

► Is it safe to travel right now?: How health experts are traveling

Should I travel right now?

While there are ways to mitigate risks, health experts advise delaying near-term travel plans.

Katelyn Jetelina, an epidemiologist at Texas' UTHealth school of public health, suggested avoiding unnecessary travel – domestic or international – until the omicron surge subsides.

The U.S. reported a seven-day moving average of more than 215,000 new daily cases as of Feb. 9.

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"If (travel) is not necessary, wait until the wave calms down a bit," Jetelina said. "The U.S. is in a very high transmission area, and we want to try and decrease spread. One way to do that is to decrease travel."

Nina Harawa, a professor of epidemiology and medicine at the University of California, Los Angeles, agrees that it is "wisest not to travel," but said she understands why people are traveling nearly two years into the pandemic.

"There's this strong desire for people to return to everyday life, and travel for many people is a part of that," she said.

► Free COVID-19 tests are on their way: Will they work for travel?

Travelers weigh the risks

Kelly Landaverde of North Carolina was supposed to visit Italy with her boyfriend in January but pulled the plug on the trip after the CDC bumped Italy to level 4.

Landaverde, a social worker who works with HIV- and AIDS-positive clients, wanted to avoid any chance of carrying the virus to her clients. Still, she was disappointed when she had to cancel yet another trip.

"I love traveling. … I didn't realize how important it was to me for my sanity until we got locked down," she said. "I probably could wait, but what suffers and what do I balance? Do I balance my mental health or do I balance my physical health? How do I go about doing this and not seeming selfish?"

In the end, the couple decided on a trip to Mexico. Landaverde planned to find a secluded area where she and her boyfriend could enjoy the beach while social distancing.

The country was listed as a level 3 destination at the time, with the CDC suggesting travelers get fully vaccinated before entering the country.

"That was kind of the deciding factor," Landaverde said in January. "At level 4, it's like OK, do not go. … A level 3 is kind of like, 'We caution against it, but it's not really forbidden.' So I'm like, OK, that's the yes. I'm going to go ahead and do this."

Mexico has since been moved to the level 4 category.

Other travelers, like Cori-Anne Bonfilio of Orlando, Florida, are hoping their destination's COVID-19 risk level drops by the time their flight takes off.

Bonfilio plans to go to Rome this March to celebrate her younger sister's birthday. She has some concerns about the COVID-19 risk in Italy, but has found reassurance in travel blogs that say Rome has been "pretty empty."

"I'm hoping that there's some leeway in the guidelines," she said. "I am hoping that it's not as probable to contract COVID going over there."

To be safe, Bonfilio is planning additional precautions that can help limit their COVID-19 exposure, such as limiting how much time they spend on buses. She said she's not too concerned about catching the virus – she's an essential worker who has already had it twice – but she doesn't want to test positive and get stuck in quarantine in a foreign country.

"I'm still very paranoid about going," she said. "I don't want to get stuck in another country if I test positive. … (But) it's not something that's going to go away. We have to adapt to living with it, wash our hands, wear your mask. But I can't sit home. I'm bored."

With some experts predicting that omicron has hit its peak, travel may be safer by the time Bonfilio flies out in March. Jetelina noted that she's "very optimistic" the omicron wave will settle by mid-March or April, right around spring break.

"I think that if you're fully vaccinated and you wear a mask, you can certainly plan on traveling for spring break," she said.

What are the current CDC level 4 countries?

As of Monday, the CDC's level 4 travel health notice included:

• Albania

• Andorra

• Anguilla

• Antigua and Barbuda

• Argentina

• Armenia

• Aruba

• Australia

• Austria

• Azerbaijan

• The Bahamas

• Bahrain

• Barbados

• Belarus

• Belgium

• Belize

• Bermuda

• Bolivia

• Bonaire

• Bosnia and Herzegovina

• Botswana

• Brazil

• British Virgin Islands

• Bulgaria

• Burkina Faso

• Burma (Myanmar)

• Canada

• Cape Verde

• Cayman Islands

• Central African Republic

• Chad

• Chile

• Colombia

• Comoros

• Costa Rica

• Croatia

• Cuba

• Curaçao

• Cyprus

• Czech Republic

• Democratic Republic of the Congo

• Denmark

• Dominica

• Dominican Republic

• Ecuador

• Egypt

• Estonia

• Faroe Islands

• Fiji

• Finland

• France

• French Guiana

• French Polynesia

• Georgia

• Germany

• Gibraltar

• Greece

• Greenland

• Grenada

• Guadeloupe

• Guernsey

• Guyana

• Haiti

• Hungary

• Iceland

• Iraq

• Ireland

• Isle of Man

• Israel

• Italy

• Jamaica

• Japan

• Jersey (part of the United Kingdom)

• Jordan

• Kosovo

• Kuwait

• Latvia

• Lebanon

• Liechtenstein

• Libya

• Lithuania

• Luxembourg

• Maldives

• Malta

• Martinique

• Mexico

• Moldova

• Monaco

• Mongolia

• Montenegro

• Namibia

• The Netherlands

• Niger

• North Macedonia

• Norway

• Oman

• Panama

• Papua New Guinea

• Paraguay

• Peru

• Philippines

• Poland

• Portugal

• Qatar

• Réunion

• Romania

• Russia

• Saint Barthelemy

• Saint Kitts and Nevis

• Saint Lucia

• Saint Martin

• Saint Pierre and Miquelon

• Saint Vincent and the Grenadines

• San Marino

• São Tomé and Príncipe

• Saudi Arabia

• Serbia

• Seychelles

• Singapore

• Sint Maarten

• Slovakia

• Slovenia

• Somalia

• South Korea

• South Sudan

• Spain

• Suriname

• Sweden

• Switzerland

• Trinidad and Tobago

• Tunisia

• Turkey

• Turks and Caicos Islands (U.K.)

• Ukraine

• United Arab Emirates

• United Kingdom

• Uruguay

Follow USA TODAY reporter Bailey Schulz on Twitter: @bailey_schulz.

This article originally appeared on USA TODAY: CDC guidelines for COVID: Are travelers paying attention?