As the holiday season kicks off United States, so does another, less enjoyable winter tradition: respiratory virus season.
Although COVID-19 cases and hospitalizations have been trending downward in recent weeks, experts anticipate infections will rise again, as they have for the last few winter seasons.
Ahead of a potential surge driven by new COVID variants, health officials are urging Americans to get the updated COVID-19 vaccine to protect against serious disease outcomes.
As of Nov. 13, only 13.9% of adults and 4.9% of children in the U.S. have gotten the new shot, according to data from the U.S. Centers for Disease Control and Prevention.
Officials are also recommending people get their seasonal influenza vaccine as flu season begins and cases start to rise across the country. Meanwhile, viruses that cause cold symptoms such as rhinovirus and respiratory syncytial virus (RSV) are also circulating.
Last winter, a spike in COVID-19 infections coincided with an early and virulent flu season, as well as a severe surge in RSV among children, which was dubbed a “tripledemic."
The coming weeks will present many opportunities for these highly contagious respiratory viruses to spread as people travel and gather with loved ones for holiday festivities. Given that these viruses can all cause similar upper respiratory symptoms (coughing, runny nose, sore throat, to name a few) it will be nearly impossible tell what's making you sick just based on how you feel.
That's why at-home testing remains a critical tool to protect yourself and others. Knowing your COVID-19 status is especially important if you are planning to visit or spend time unmasked with high-risk individuals, like elderly family members.
But which type of COVID-19 test should you take? And when should you take it before a gathering? We spoke to experts about how and when to use COVID-19 tests to stay safe.
How do I know if I need to take a COVID-19 test?
The current testing recommendations from the CDC are that anyone who has COVID-19 symptoms should test immediately, and anyone who is exposed to COVID-19 should test five days after exposure.
Possible COVID-19 symptoms include congestion, runny nose, sore throat, cough, fatigue, muscle aches, headache, fever, shortness of breath and loss of taste or smell, TODAY.com previously reported.
If neither of the above conditions apply to you, the decision to test ahead of a gathering comes down to several factors, as well as the comfort level of those around you, according to experts.
“I would first look at what your recent risk is ... because the more you've been at risk, the more likely you're going to have a positive test," Dr. Scott Weisenberg, infectious disease specialist at NYU Langone Health, told TODAY.com. If you’ve been engaging in higher risk activities, like spending time in crowded indoor areas without a mask or hanging around sick people, that will increase your chances of having any respiratory virus, Weisenberg noted.
Next, you should consider who is going to be attending the gathering. “If people are concerned about the consequences of infection for vulnerable individuals, particularly elderly or people with compromised immune systems, then they really want to make plans to try to minimize respiratory virus transmission,” said Weisenberg. This includes COVID-19 testing but also masking, distancing and ventilation, Weisenberg added.
In any case, there's really no downside to taking a COVID-19 test out of precaution before going to an event or being around high-risk people, the experts noted.
Which type of test should I take and when?
There are two types of COVID-19 tests: polymerase chain reaction (PCR) tests and antigen tests.
“If you want to be absolutely sure, the more sensitive test is the PCR test,” Dr. Thomas Murray, associate medical director for infection prevention at Yale New Haven Children’s Hospital in Connecticut, told TODAY. These are the most reliable tests for people with or without symptoms, per the CDC, but they are usually performed in a laboratory, so it takes longer (up to three days) to get results.
The ideal timing for taking a PCR test depends on how fast you can get the test results back, said Murray. “If you can find a place that has a 24 to 48 hour turnaround, then a couple of days before the event is ideal,” said Murray. While waiting for the PCR results, people can opt to take extra precautions like wearing a mask or isolating, said Murray, especially if they are going to see someone who’s very high risk.
It’s important to note PCR tests can remain positive for weeks or even months after a person recovers from COVID-19, the experts pointed out. “It doesn’t necessarily correlate with infectiousness,” said Weisenberg, because the more sensitive PCR tests can detect remnants of the virus and produce a positive result long after a person is contagious. Anyone who thinks they are in this situation should speak to their health care provider, said Weisenberg.
Additionally, people should check with their insurance provider about the cost of PCR testing beforehand. “In many places, symptomatic testing remains covered but asymptomatic screening may not be covered,” said Murray. Additionally, coverage and policies around testing may have changed since the U.S. ended the federal public health emergency for COVID-19 this May.
The next best choice are rapid at-home antigen tests, said Murray, and the closer to the time of the gathering you take it the better — for example, if you're meeting family for Christmas Eve dinner, do it that morning. “There is some evidence that if you do more than one (rapid) test in the two days leading up, and those are both negative, then that’s better than a single test,” Murray added.
If you're traveling, get tested as soon as possible before leaving and then when you arrive at your destination, recommended NBC News medical contributor Dr. Natalie Azar.
Rapid antigen tests are most accurate when used by people with symptoms, said Murray. “That’s probably because asymptomatic individuals don’t have as high of a viral load, so the (rapid) test doesn’t pick it up. … It’s not as good at detecting smaller amounts of virus.”
Rapid tests also work best when they are performed exactly as instructed, said Murray. It's important to read the directions closely and check the testing kit’s expiration date, TODAY previously reported. Some expiration dates have been extended by the the U.S. Food and Drug Administration.
For an extra level of safety, you can take a PCR test a day or two before a gathering and an antigen test right before, said Weisenberg.
Everyone can still order four free at-home COVID-19 tests from the government, which will be delivered by mail via the U.S. Postal Service.
Otherwise, the cost of PCR and at-home COVID-19 tests will vary depending on your health insurance. Uninsured individuals may still be able to access low- or no-cost tests at community health centers and select pharmacies, per the U.S. Department of Health & Human Services.
In any case, a negative COVID-19 test does not 100% guarantee that you are not infected with the virus and you won’t transmit it to others, said Weisenberg. But it does offer a snapshot of your SARS-CoV-2 status in that moment, the experts noted, which is why testing is important to help prevent transmission.
Anyone who is testing negative but still has symptoms should stay home until they are feeling better, the experts emphasized. Even if it's not COVID-19, it could be any number of respiratory viruses — which may cause a mild cold for a healthy person but a severe illness for a vulnerable person, said Weisenberg. “If you’re sick, don’t go to gatherings, period.”
You may also consider going to the doctor to get an influenza test, said Murray, because the symptoms of flu and COVID-19 are often difficult to tell apart and you don't want to spread the flu either.
If you’re still concerned about being around high-risk individuals, the experts recommend dialing up the precautions: wearing a mask, distancing, opening windows to allow ventilation and holding events outdoors. “If you’re able to afford it, an appropriate-sized portable HEPA filtration (system) can be very helpful if you’re going to engage in unmasked activities like (Christmas) dinner,” said Murray.
One of the best ways to protect yourself and others against COVID-19 is by making sure you are up to date with your vaccinations, the experts noted. The updated COVID-19 vaccine is recommended by the CDC for everyone ages 6 months and older and provides good protection against newer variants. It's not too late to get the new booster if you haven't already.
“Reduce the risk of getting infected and then subsequently transmitting the virus to people by getting the vaccinated,” said Weisenberg.
Everyone ages 6 months and older should also get their seasonal flu shot, the experts said.