As far as we can tell, we’re going to be living with COVID-19 for a while. All signs point to the disease becoming endemic, which means that like the cold, flu and measles, it could be around forever. We still don’t know what that will look like: yearly seasons, like the flu? Small, fast-moving outbreaks every few years like measles? Every other week, OPB will answer listener and reader questions as we figure out how to live in an eternal pandemic. Submit your own here.
As fall continues, flu season is ramping up. With so many different respiratory viruses around, there’s that nagging question: Is this cough the flu? Or do I have COVID-19?
We got a question from John, who is vaccinated. He wants to know, “Are there specific symptoms of a breakthrough case we should be keeping an eye out for? Or should we just be extra cautious and get tested anytime we have a cough/sore throat/runny nose, etc.?”
Guidance by the Center for Disease Control and Prevention for people vaccinated against COVID-19 has changed several times over the last year. Right now, the CDC recommends everyone, including the vaccinated, wear masks in indoor public spaces. The CDC recommends that anyone showing COVID-19 symptoms get tested, regardless of whether or not they are vaccinated, and quarantine as they wait for test results. If they are exposed by a close contact, fully-vaccinated people should get tested five to seven days after a known exposure. If they do not show symptoms, they do not need to quarantine, but should wear masks indoors for 14 days, or until they get a negative test result. And if someone tests positive for COVID-19, regardless of vaccination status, they should avoid others for at least 10 days after the positive test result.
What COVID-19 symptoms should I look out for?
Symptoms can really vary, especially in breakthrough cases. Your only symptom could be a cough, or a fever, or a headache.
I’m vaccinated. Do I really need to get tested? Can I spread it?
Testing is especially important now that there are more contagious variants around. Although the vaccine is extremely effective at preventing severe illness requiring hospitalization, the delta variant is pretty good at getting past a vaccinated person’s defenses and causing a mild illness that can be passed on to others. You can’t just assume it’s a cold.
Odds are, if someone is vaccinated like John, they won’t get super sick. But if they have symptoms, the risk of giving COVID-19 to another person, even another vaccinated person, is real. And that chance goes up if it’s someone you live with or spend a lot of time with. There have been a lot of family clusters reported — where the delta variant is passed from vaccinated family member to vaccinated family member. So it’s really important to know if you have COVID — even if you’re vaccinated, so you don’t get other people sick.
What’s the best testing option right now?
It really depends on the situation. Obviously, the best test is the one you can get. But a PCR test is most likely to be accurate. That’s because PCR tests don’t need a lot of virus in a sample to get an accurate test result.
Is it still the same test, with the nose swabs?
Sort of. The tests have gotten better — for one, a lot of tests use shorter swabs, which are much more comfortable to use. The tests have also gotten more complex. PCR works by making a bunch of copies of a gene, so that scientists can read the sequence. PCR tests use “primers,” which are little pieces of DNA, to tell a gene-copying-molecule what part of the gene to copy. So before, our test had a primer for one part of the coronavirus’ genetic material, copied it, and read the sequence. That meant it could tell if someone had COVID-19 or not COVID-19, and that was all.
New tests have primers for more than one part of the coronavirus genome, which makes them more accurate. Other tests have added primers that check for different strains of the flu, or RSV, another common respiratory virus. If you test negative for COVID and positive for the flu, that’s really, really good evidence that you actually have the flu. PCR tests do take a little bit of time to process, but right now a lot of places, especially county labs and community testing centers, are turning them around in a day.
How do you get one?
Start by checking your county’s testing webpage: they’ll have a list of COVID-19 testing sites that offer PCR, and the lists will tell you which are free and which require insurance. The hours at county-run clinics can be limited, though. If you can’t get an appointment, reach out to your doctor or look into other, more convenient but less-accurate testing options.
More convenient options. Would that be things like rapid tests and at-home tests?
Absolutely. Rapid tests are less accurate than PCR tests, but they’re still a really important tool. They really only work if you have a really high viral load — a lot of virus in your body. And there’s a pretty narrow window of time when they’re at their most accurate. They’re also less accurate for vaccinated people, because vaccines help your body kill viruses, and that’s what the tests are looking for.
But you can buy a rapid test pretty much anywhere, at just about any pharmacy. And they give you results right away! You can even buy some and take them home. If you get a negative rapid test and you have symptoms, it’s a good idea to get tested again in a day or two. Rapid tests give false negatives often enough that one negative test doesn’t mean you’re in the clear. (False positives, which would say you have COVID-19 when you don’t, are much less common.)
There are also at-home PCR kits: you do the swab yourself at home, and mail it to a lab. But those can also have a long turn-around time.
What if my kid is sniffling? Should I get THEM tested? Is in-school testing enough?
Absolutely, yes. There are two state testing programs that schools can sign up for. One does weekly PCR screenings for COVID-19, and the other uses rapid tests for kids who start to show symptoms at school. But you really can’t have enough testing, especially since kids are unvaccinated. If a test is negative, and your child has symptoms and hasn’t tested positive for the flu, it can’t hurt to get a second test.
People need negative COVID-19 tests to attend some sporting events. Are we just going to be getting COVID-19 tests forever?
Honestly, if regular testing for COVID-19 and flu becomes a part of life in the future, that’s not a bad thing. We’re probably going to be living with this virus for a long time, and we’ve had really bad disease surveillance for a long time. We know now that COVID-19 was in the U.S. for a few months before the first cases were confirmed. But because U.S. flu surveillance has been on the decline, early surges in influenza-like illness were assumed to be the flu. We didn’t recognize the 2009 H1N1 swine flu in advance in part because we weren’t doing enough flu tests.