COVID-19 has become a part of our lives, and while it might not dominate headlines as it once did, the virus continues to circulate, mutate, and cause illness. As we navigate this evolving landscape, many people are still unsure about the practical aspects of dealing with COVID-19. Key questions remain: How long are you contagious after a diagnosis? How long should you isolate? And what are the most current guidelines to follow?
According to Dr. Brandon Bet, an infectious disease expert at Henry Ford Health, “The COVID situation is different from the beginning of the pandemic in 2020. Immunity from infections and vaccines, along with new COVID variants, has significantly changed things. However, COVID can still be serious for some, and vigilance is still important.”
Here’s what you need to know about contagiousness and isolation periods for COVID-19 in the current viral season, based on expert recommendations and the latest research.
Understanding the Latest COVID Strain and Symptoms
Q: What is the current dominant COVID variant, and what are its symptoms?
A: “The XEC variant is currently the most common COVID strain,” explains Dr. Bet. “It’s an Omicron subvariant and is expected to remain dominant through the winter, accounting for about half of all cases. Currently, XEC doesn’t appear to be more severe or spread more easily than other recent COVID variants. The symptoms are also similar to previous variants.”
COVID-19 symptoms are known for their variability. They can range from mild cold-like symptoms to a more severe flu-like illness, and in some cases, can be much worse. The severity often depends on factors like age, underlying health conditions, and vaccination status. The CDC lists the following as common COVID symptoms:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Sore throat
- Congestion or runny nose
- Loss of smell or taste
- Fatigue
- Muscle or body aches
- Headache
- Nausea, vomiting, or diarrhea
Research suggests that COVID symptoms might appear in a typical order: fever, cough, sore throat/muscle pain/headache, followed by nausea/vomiting, and finally diarrhea. “However,” Dr. Bet clarifies, “this order isn’t fixed, and you might not experience all these symptoms. The only definitive way to confirm if your symptoms are due to COVID is through testing.”
COVID-19 Severity in the Current Landscape
Q: How serious is COVID-19 now compared to earlier in the pandemic?
A: Thanks to vaccines and effective treatments, hospitalization and death rates are lower than at the pandemic’s peak. However, it’s important to note that even in 2023, there were still increases in hospitalizations and deaths. Unvaccinated individuals are at a higher risk of hospitalization and severe illness compared to those who are vaccinated.
Dr. Bet emphasizes, “Individuals aged 65 and older, and those with underlying health conditions such as diabetes, chronic heart, lung, liver, or kidney disease, or weakened immune systems, are at greater risk of serious COVID infection. Pregnancy is also considered a high-risk category, as pregnant women are more susceptible to severe illness from COVID, potentially leading to pregnancy loss in severe cases.”
Long COVID remains a significant concern, with symptoms that can persist for months or even years after the initial infection. These symptoms include brain fog, loss of smell and taste, fatigue, depression, anxiety, and joint or muscle pain. Unvaccinated individuals and those who experienced severe initial infections are more likely to develop long COVID.
Understanding COVID-19 Contagiousness and Duration
Q: How contagious is COVID-19, and crucially, how long after a COVID diagnosis are you contagious?
A: While recent COVID strains have a similar level of contagiousness to previous ones, the timeline of when someone is most contagious has shifted.
“In 2020, when COVID-19 first emerged, no one had immunity,” Dr. Bet explains. “This meant that a single infected person could transmit the virus to a larger number of people, particularly before public health measures like lockdowns were implemented.”
Previously, people were considered contagious even before symptoms appeared. However, a 2023 study indicates that peak contagiousness occurs around day four after symptoms begin, similar to other respiratory viruses like the flu and RSV. On average, individuals remain contagious for approximately eight days, although this period can vary depending on the severity of the illness. It’s crucial to take precautions to prevent transmission during this contagious period.
Isolation Guidelines After a Positive COVID Test
Q: What are the current recommendations for how long to isolate if you have COVID-19?
A: “Isolation guidelines have evolved, causing some confusion,” notes Dr. Bet. “Initially, a 10-day isolation period after a positive test was recommended. Later, the CDC updated this to allow ending isolation after five days, followed by wearing a mask for an additional five days.”
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The CDC’s current guidance is based on balancing risks and benefits and understanding when people are most contagious. Now, the CDC advises that if you have been fever-free for 24 hours without using fever-reducing medication and your symptoms are improving, you can end isolation. This means the isolation period can be shorter or longer depending on the course of your illness. Even after ending isolation, it’s still recommended to take precautions such as wearing a well-fitting mask, maintaining distance, and practicing good hand hygiene.
Taking another COVID test can also help determine if you are still positive, especially before attending gatherings, particularly those involving individuals at high risk for severe COVID.
“These changes in recommendations reflect the high level of population immunity to COVID and the availability of effective antiviral treatments like Paxlovid,” Dr. Bet explains. According to the CDC, over 98% of the U.S. population has some level of COVID immunity from vaccination, prior infection, or both.
Dr. Bet also points out, “Isolation guidelines in healthcare settings may differ from those in typical workplaces, and workplace policies can also vary.”
COVID-19 Test Accuracy and Timing
Q: How accurate are COVID tests, and when is the best time to test?
A: PCR tests, administered by healthcare professionals, remain the most accurate for diagnosing COVID-19. At-home rapid tests are also effective, but the FDA recommends these guidelines for the most accurate results:
- If you have symptoms and get a negative rapid test result, take another test 48 hours later to confirm.
- If you were exposed to COVID-19 but don’t have symptoms and receive a negative rapid test, take two more tests, each 48 hours apart, to confirm. For accurate results after exposure, wait five days before taking your first test.
- A positive rapid test result is generally considered accurate.
“With holiday gatherings approaching, it’s wise to have COVID tests readily available,” advises Dr. Bet. “Every household can order four free at-home tests from the government here.”
The Importance of Updated COVID Vaccination
Q: Do I need to get the updated COVID vaccine?
A: The CDC recommends that everyone aged 6 months and older receive an updated COVID vaccine for the 2024-2025 viral season. Similar to the flu vaccine, the COVID vaccine is updated annually to target the most recent circulating strains.
“Updating the vaccine each year enhances its effectiveness,” Dr. Bet states. “It’s not just a ‘booster’ but an updated vaccine. Vaccination doesn’t guarantee you won’t get COVID-19, but it significantly reduces the severity of illness if you do.”
Updated COVID vaccines are available from Moderna, Pfizer, and Novavax. The Moderna and Pfizer vaccines are FDA-approved for individuals aged 12 and older and authorized for emergency use for those aged 6 months to 11 years. The Novavax vaccine is authorized for individuals 12 and older. The CDC recommends a second dose six months after the initial updated vaccine for those aged 65 and older and those with moderate to severe immunocompromise.
Seeking Treatment for COVID-19
Q: When should I seek medical treatment for COVID-19?
A: If you are in a high-risk group for COVID-19, it’s recommended to start antiviral treatment, such as Paxlovid, as soon as symptoms appear, ideally within 48 to 72 hours.
“Paxlovid is a pill pack containing two medications,” Dr. Bet explains. “One is the active medicine, and the other boosts its effectiveness. Paxlovid reduces the risk of hospitalization by over 50% and the risk of death by 75%. However, it must be started early to be effective.”
If you are over 50, have underlying health conditions, and are experiencing COVID-19 symptoms, get tested and consult your doctor promptly. For life-threatening symptoms like difficulty breathing, call 911 or go to the nearest emergency room immediately.
Reviewed by Dr. Brandon Bet, D.O., infectious disease physician at Henry Ford Medical Center – Springport Rd.
