The COVID-19 pandemic and associated attempts to contain its spread have created unprecedented hurdles to international trade. This paper reviews trade facilitation measures implemented in North and Central Asia (NCA), including transport and trade finance facilitation. All NCA countries have sought to protect the public health by restricting movement of people (including across borders) and applying special sanitary regulations at border crossings. These have included requirements to sanitize trucks, protect customs officials, change drivers, and requiring COVID-19 tests from drivers. Such requirements continue to create significant logistical issues, with often insufficient facilities for drivers. Sanitary requirements have proved simpler to implement for rail freight, creating an advantage for countries with well-developed rail networks. A number of common patterns emerge from the efforts of NCA countries to facilitate trade and transit.