Oct. 29, 2024 — So you feel stuffy or a little feverish. What’s your move?
Since the pandemic, our impulses and choices have changed. This fall — the start of cold and flu season — there are now at-home combo tests for both COVID and the flu. One thing hasn’t changed: Staying home is smart, and it’s an instinct that Americans are likely to follow now, a CDC survey says.
While at home, you now have a choice of nine rapid tests that can detect COVID or the flu at the same time. They’re like the familiar COVID tests in style, effectiveness, and cost (about $10 to $12 per test). One from Pfizer that looks for genetic material costs about $40.
But let’s say you take a test and it’s negative. Should you ride it out, keep to your routine, call the doctor, or what? This year, with the added threats of RSV and whooping cough, your reaction is important for your health and for others’, experts say.
In a nutshell: Track your symptoms and know your risks. Here’s how.
1. Take Your Temperature
The most important test in the first 24 hours of feeling sick is to take your temperature and assess your symptoms. The CDC recommends taking a sick day and staying home whenever you feel ill.
If you’re on the mend after 24 hours and without a fever (and not taking a fever-reducing medication), the CDC suggests these measures for the next five days to inhibit the spread of a virus:
- Wear a well-fitting mask.
- Increase hygiene, like washing hands.
- Increase access to fresh air by opening windows, holding events outdoors, or using a high-efficiency particulate air (HEPA) filter while indoors.
- Keep your distance from others.
2. Pay Attention to Symptoms
The CDC changed its guidelines this year to focus on symptoms rather than testing. That’s because the public’s behavior around COVID has changed, said Eric Chow, MD, MPH, chief of communicable disease epidemiology and immunization for Seattle and King County, Washington. Fewer people are testing now, he said. Some people have “testing fatigue.” Others have less accessibility to tests than they did in years past.
Monitoring your symptoms is fairly easy: “Obviously, people know when they have a fever,” Chow said.
Sticking to symptom-based guidelines rather than testing will help curb most infectious outbreaks, according to the CDC. That’s how they do it in Australia, France, and Canada, without noticeable increases in disease spread. (That said, it’s worth noting that COVID, influenza, and RSV viruses all can be spread by people who show no symptoms or haven’t yet started showing them.)
This season, besides the usual COVID and flu concerns, we have RSV (respiratory syncytial virus) to worry about, as well as whooping cough, rates of which are returning to pre-pandemic levels.
Whooping cough (a.k.a. pertussis) rates this fall are five times higher than last year, the CDC reported. That sounds scary, but whooping cough regularly recorded just over 10,000 cases nationwide per year before the pandemic. Most infections were treated at home. The predicted 2024 increase comes after historically low rates during the pandemic.
All of these illnesses can show up as “flu-like symptoms” like fever, congestion, body aches, and cough. Risk factors, prevention, and treatments are similar as well.
Even after your fever breaks and symptoms improve, the CDC guidelines suggest remaining home and away from others for another 24 hours. Fever and other flu-like symptoms could improve on the same day or several days apart.
People who fall ill and test negative for COVID may think it’s safe to dive back into everyday life. That’s where knowing your risk comes in.
3. Review Your Risks
As you rest in bed, drink fluids, and stay away from others, consider how risky it is for you to have a respiratory illness — and how risky it might be for loved ones in your household.
“Most people who have respiratory virus infections recover without needing treatment, but it’s important that people at higher risk of severe disease seek medical care as soon as symptoms begin because antiviral treatment works best for COVID-19 and influenza when started early,” said Rosa Norman, a CDC spokesperson.
People at high risk for severe reactions to respiratory illness include:
- Pregnant women
- Children under 5 years old and infants under 6 months old
- Adults 65 and older, especially those with weakened immune systems and underlying medical conditions
- People with compromised immune systems, such as patients undergoing cancer treatment, organ transplant recipients, or people with an immune system disorder
- People with disabilities due to regular group caregiving facilities and underlying medical conditions
Not on that list? Keep in mind that even relatively healthy adults can become dangerously ill. Whether you’re in a high-risk category or not, warning signs should result in seeking immediate emergency medical care, Norman said.
4. Watch for These Warning Signs
Waiting out a respiratory illness in relative isolation is fine, but know the signs that should prompt you to call your doctor or 911:
- Trouble breathing
- Pain or pressure in the chest
- Uncharacteristic confusion
- Extreme sleepiness or falling unconscious
- Blue, gray, or pale coloring on lips or nail beds
5. Track Your Progress (or Lack of It)
Duration must be considered when deciding whether to call your doctor.
Treatments for the flu must be taken within the first 48 hours of symptoms. These include Relenza (zanamivir), Tamiflu (oseltamivir), and Xofluza (baloxavir marboxil).
Treatments for COVID, like Lagevrio (molnupiravir) and Paxlovid (nirmatrelvir and ritonavir), must be started in the first five days of symptoms to be effective.
There is no specific treatment for RSV.
A positive test outside of the treatment window means fewer options to battle symptoms.
A negative COVID and flu test with persistent or worsening symptoms could mean it’s time to get help. Overlapping flu-like symptoms for multiple seasonal diseases make diagnosis without testing difficult, Norman said.
“Testing is at the discretion of treating physicians, but that decision-making process can be influenced by things like the age and medical history of the patient,” Norman said.
If you have a fever lasting longer than three days or flu-like symptoms persisting a week or more, tell your doctor. Flu-like symptoms that continue for a week or more could signal a secondary infection like pneumonia or bronchitis.
While bronchitis can be treated at home, most pneumonia infections need antibiotics.
6. Next Time, Don’t Forget Prevention
We can all help curb the spread of respiratory diseases with frequent handwashing and wearing masks in crowded places.
But vaccination remains the smartest way to avoid COVID and the flu. For RSV, the CDC recommends vaccinations for:
- Adults 60-74 with increased risk factors
- Adults 75 and older
- Pregnant people between weeks 32 and 36 of pregnancy
- Infants whose mothers did not receive the RSV vaccination the previous year
- Infants ages 8 to 19 months with increased risk factors
