Another country was added to the Centers for Disease Control and Prevention’s highest-risk COVID warning category for American travelers on Monday as cases of the virus continue to rise in the Indian Ocean island nation of Madagascar.

Madagascar, now listed as a Level 4 “very high” COVID risk destination by the CDC, was previously a Level 3 “high” risk nation last week but has seen its virus situation worsen.

The CDC deems a Level 4 location as having more than 500 COVID cases per 100,000 residents reported in the past 28 days.

Madagascar, which is located off the southeastern coast of Africa, was the only destination added to the Level 4 category on Monday. There are now about 120 nations on the list since hitting its all-time high of about 140 locations in February.

However, the Level 4 “very high” risk category still holds more nations than any other category the agency has listed.

The CDC warns Americans to avoid Level 4 nations even if they have been fully vaccinated, saying that “Even if you are up to date with your COVID-19 vaccines, you may still be at risk for getting and spreading COVID-19.”

Last week, the CDC updated the category to include the Indian Ocean island nation of Mauritius. Other locations in the Level 4 category include Canada, most of Europe, and the Caribbean.

Also seeing updates on Monday were five destinations that slid into the Level 3 “high” risk category – Albania, Bolivia, Botswana, Colombia, and Guyana.

All five nations saw an improvement in their COVID situations as cases of the virus declined in the last week, dropping them from the Level 4 “very high” risk category.

A Level 3 nation has between 100 and 500 COVID cases per 100,000 residents reported in the past 28 days, according to the CDC.

The CDC’s Level 2 “moderate” category saw four additions, with Guinea, Guinea-Bissau, Morocco, and Nepal added on Monday. The four locations had previously been listed in the Level 3 “high” risk category.

The CDC determines a Level 2 nation when it has between 50 and 99 cases of the virus per 100,000 residents in the past 28 days.

Cruise ship travel is also listed in the Level 2 “moderate” risk category.

Also making moves on Monday were six additions to the Level 1 “low” risk category - Cameroon, Cape Verde, Gabon, The Gambia, Mozambique, and the Democratic Republic of Congo.

The biggest mover was the Democratic Republic of Congo, which had a huge improvement in its COVID cases, dropping from Level 4 “very high” risk to Level 1, while Cape Verde moved from Level 3 “high” risk.

The remaining locations were previously listed in the Level 2 “moderate” risk category.

A Level 1 nation has fewer than 50 new cases of the virus per 100,000 residents over the past 28 days.

No new additions were made to the CDC’s “unknown” category, where reliable information is unknown about a location’s COVID situation. The agency does warn against traveling to an “unknown” country due to the unknown COVID risk.

Nosy Be, Madagascar
Nosy Be, Madagascar creative commons/rita willaert
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