If you're one of the many people who traveled or attended a festive holiday gathering in the past few weeks, it's a good idea to take a rapid COVID-19 test a few days afterward. But how to interpret your results isn't always obvious. And that's particularly true for people who keep testing positive late into their infections. For some, that may mean still testing positive at 10 days or more.
The winter holiday season came and went quickly. And, in the U.S., COVID-19 cases are climbing just as fast. That's partly due to the fact that two newish variants are causing more than half of all cases in the country, according to the most recent data from the Centers for Disease Control and Prevention. These two coronavirus variants, called BQ.1 and BQ.1.1, are both subvariants of omicron, the strain that caused last winter's massive post-holiday surge.
As BQ.1 and BQ.1.1 spread, the most common COVID-19 symptoms are changing too, TODAY.com reported previously. The most frequent symptoms these days include sore throat, runny nose, congestion and sneezing.
And to make things even more stressful, COVID-19 isn't the only seasonal illness we have to worry about right now. Rates of flu and respiratory syncytial virus (RSV) are also rising, as TODAY.com explained previously. And, of course, there's the common cold to think about, as well.
"What folks really need to understand is that right now we are in flu season and RSV season — and we still have COVID hanging around," Dr. Emily Volk, president of the College of American Pathologists, tells TODAY.com. And, because those illnesses all have similar symptoms, it's crucial to take a rapid test if you start to feel sick, she says.
So it's especially important to know when to take a COVID-19 rapid test, how to correctly interpret the results and when it’s OK to stop isolating — even if you’re still testing positive at 10 days and beyond.
When to take an at-home rapid test for COVID-19:
If you develop any symptoms that might signal COVID-19, you should take a home test immediately, the CDC says.
"Test as soon as you have symptoms," Volk recommends. "And if you get a positive test right out of the gate, you can trust that test (result)."
Keep in mind that the most common symptoms of COVID-19 may be somewhat different now than they were earlier in the pandemic. While cough, shortness of breath and fever are still possible symptoms of COVID-19, according to the CDC, the virus now seems to be causing a milder illness overall, experts say.
The most frequently reported COVID-19 symptoms now include sore throat, sneezing, congestion, runny nose, cough, muscle aches, hoarse voice and an altered sense of smell, according to a Dec. 13 report from the ZOE Health Study.
Some of those symptoms — congestion, sore throat, cough, fever — might be easily confused with other common illnesses, such as the flu, allergies, RSV or the common cold. But because we are still in the midst of a pandemic, it's a good idea to take a test to help rule out COVID-19 first, even if you may just be dealing with seasonal allergies.
It's particularly important to rule out COVID-19 if you're feeling under the weather before getting your updated COVID-19 booster shot, experts told TODAY.com previously. If your test is positive and you are in the midst of an active COVID-19 infection, you should wait until your isolation period is over before getting your vaccine, the CDC recommends. You can get your COVID-19 booster and flu shot at the same time.
After your booster, you might feel some familiar side effects, such as fatigue, muscle aches, fever and chills. Those symptoms should go away on their own within two days, experts said. But if they don't, something else might be going on — and you might actually have a COVID-19 infection. In that case, you should check with your doctor, the experts said, but a home rapid test could also come in handy at that point.
If you've been exposed to a close contact who has COVID-19, you should take a test at least five days after your last contact with that person.
The CDC suggests getting tested for COVID-19 before and after traveling. Try to take a rapid test as close to the time of your departure as possible to get the most accurate reading. And, if you're in high-risk situations on a trip (like a crowded indoor party), the CDC recommends taking a rapid test when you get back.
You can also take a test before attending an indoor gathering, especially if you know you won't be wearing a mask. Taking a rapid test can also help you determine whether to spend time with people who are particularly vulnerable to severe COVID-19 symptoms, like those with certain underlying health conditions.
Amid a recent surge in cases, the government brought back its program that provided free at-home COVID-19 tests to people in the U.S. The cost of tests you purchase yourself should also be covered by health insurance. And tests may be available at community health centers for people who don’t have insurance.
Many of the at-home tests the government sends out, as well as those you may have purchased, are good to use for six months or more. And some of their expiration dates have been extended even further, the Food and Drug Administration says. Check the expiration date for the particular test you're using to be sure you get accurate results.
And remember that even a faint line on a home COVID-19 test should be considered positive. If you’re not sure whether your test is truly positive, you should check with your doctor, get a PCR test or take a second rapid test the next day (and behave like you really do have COVID-19 in the meantime).
If you test positive for COVID-19...
If you test positive for COVID-19, you should follow instructions from your doctor and the CDC about isolation.
First, you should isolate from others for at least five full days after your positive test, current CDC guidelines state. If you have to be around others, you should wear a high-quality mask, such as a N95 or KN95 respirator.
You can leave isolation after five days if you never developed symptoms or if you had symptoms that are improving (including at least 24 hours without a fever and without the use of fever-reducing medications), the CDC says. You should continue to wear a mask when around others for a full 10 days.
Note that the use of fever-reducing medication includes the usual medications, like ibuprofen and acetaminophen, but it also includes any drugs (like over-the-counter cold and flu medicine) that contain those ingredients, Volk says. "So reading the labels of those medicines you might get over the counter is also important."
If your symptoms aren't improving after five days of isolation, you should stay isolated until you're feeling better — and you've gone 24 hours without a fever (and without using fever-reducing medications). Again, you should keep wearing a mask when you're around other people for 10 days.
Regardless of when you end isolation, anyone who tests positive for COVID-19 should take certain precautions for 10 full days, the CDC says — including masking around others, avoiding travel and limiting contact with people who have a high risk for severe COVID-19.
If it’s challenging to figure out what all those guidelines mean for your specific situation, take a look at the CDC’s new quarantine and isolation calculator tool.
After you test positive, does it make sense to keep taking at-home COVID-19 tests?
If you get a positive test on a home rapid antigen test, you can trust the result, Volk says, provided you performed the test correctly. That means you probably don't need to keep testing yourself throughout your illness.
For people who have mild symptoms, the CDC no longer recommends using results from rapid tests to determine when you can end isolation. Instead, you should follow your symptoms and count the days — and continue to mask up around others. But those with more moderate or severe cases, as well as those who are immunocompromised, may need to perform more tests to leave isolation based on advice from their medical team, the CDC says.
In the event that your test is negative even though you have noticeable COVID-like symptoms or you were exposed to someone with a confirmed case, the FDA now recommends taking a second test two days later. Depending on your symptoms and exposure, you may want to take a third rapid test another 48 hours after that, the FDA says.
"The FDA has now suggested that some of these home tests really require serial testing if you're testing negative to get the best, most accurate results," Volk explains.
How long you can expect to keep testing positive:
In the most general terms, people will likely test positive on an at-home rapid COVID-19 test for about six to 10 days, Dr. Stephen Kissler, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health in the department of immunology and infectious diseases, tells TODAY.com.
"Most people will clear this within 10 days," Volk agrees.
With PCR tests, which look for the virus's genetic material, people may test positive for even longer, Dr. Alberto Paniz-Mondolfi, associate professor at the Icahn School of Medicine at Mount Sinai, tells TODAY.com. "You can still have positivity that may persist for weeks and even months," he explains, noting that positive tests on PCR have been recorded for up to 60 days.
But there are a lot of factors that can affect how long someone may test positive.
Considering that different tests may perform differently, “and then you have all these variants, you’re changing the variables of the equation over and over again,” says Paniz-Mondolfi, who also leads the Saliva COVID Test Lab at Mount Sinai. That makes it difficult to predict exactly how many days someone will test positive.
Even with a rapid test, which detects molecules on the virus's surface as opposed to the virus's genetic material, it's not unheard of for people to test positive up to 14 days, especially for those who are unvaccinated, Kissler says.
"We see a ton of variation between people in how long they test positive," he explains. "While that average is closer to six to 10 days, there are people who will hang on for longer than that."
In a study published in JAMA Network Open in October, researchers looked at repeated rapid testing results for 942 people during last winter's omicron BA.1 wave. They found that 80% of those who had COVID-19 symptoms tested positive on day five. And 35% of them were still testing positive on day 10. Those without noticeable symptoms were less likely to test positive at both points. Still, 19% of those who were asymptomatic continued to test positive on day 10, the study found.
Keep in mind that it's possible to get COVID-19 more than once — even three or four times. So if there's a gap of weeks or months in between your positive tests, you might actually have a new infection.
Or you might be dealing with what's known as a Paxlovid rebound. Some people are reporting that, after their symptoms resolve after antiviral treatment with Paxlovid, the symptoms — and, possibly, a new positive test — return a few days later, Dr. Taison Bell, assistant professor of medicine at the University of Virginia, told TODAY.com previously.
With this kind of rebound, it’s also possible to get another positive test even if you tested negative just a few days earlier, the CDC noted. But, as experts told TODAY.com previously, rebound cases appear to be generally mild — and, crucially, antiviral medications are still keeping people out of the hospital.
If you're still testing positive for COVID-19, are you still contagious?
As long as you continue to test positive on a rapid at-home test, you should still consider yourself potentially contagious, Kissler says. But exactly how contagious you are “will change depending on where you are in the infection,” he explains.
In a study published in Clinical Infectious Diseases in June, researchers found that 17% of participants had active viral cultures beyond day five. And some had positive viral cultures for as long as 12 days after the onset of their symptoms, suggesting they could still be contagious even past the 10-day mark.
But people tend to be most infectious right at the beginning of their COVID-19 infection. So by the time you reach day eight, nine or 10, “you still have the chance to spread to other people, but it’s probably not as much as you did early in the course of your infection,” Kissler says.
When you get to that point, you can start weighing your options. If it's essential that you start interacting with other people again (due to your job, for example), assess how you can do so as safely as possible.
If you're still testing positive for 10 days or more, here's what to do:
The safest strategy is to continue to isolate until you're no longer testing positive, the experts stress.
For people for whom that might not be feasible, it’s not unreasonable to gradually leave isolation — even if you’re still testing positive on a rapid test, Kissler says. That's especially true if you're fully vaccinated, any symptoms you developed have resolved, and you continue to take other precautions (especially masking) until you get a negative result.
Ideally, if you have access to enough tests, you wouldn’t stop masking until you get two consecutive negative rapid test results taken 48 hours apart, Volk says. But “this is asking a lot of folks,” she adds. And the CDC notes that this approach may mean you wear a mask around others for longer than 10 days.
The truth is that “not everybody’s going have access to serial antigen testing like that,” Volk said. “It’s probably not realistic that most of the population is going to follow those instructions, even though that would be the best scenario possible.”
For someone who is still testing positive for COVID-19 after day 10, “it’s unlikely that they’re going to be very infectious,” Volk says. “It’s probably a good idea, out of an abundance of caution, to still wear a mask for 48 hours until they can take another test,” she adds.
If you must interact with others before testing negative, make sure to wear a high-quality mask, maintain distance from other people when you can, and avoid spending time in enclosed spaces around other people.
“You might be able to begin slowly sort of reintegrating while still being mindful of your contact," Kissler says. If you're going to be around other people, he recommended avoiding enclosed spaces with others and wearing a mask (ideally an N95, KN95 or KF94) when coming into contact with other people.
After 10 days, it's likely that "you're good to go," Paniz-Mondolfi agrees, and he says you're "even better to go" if you keep practicing those precautionary measures — especially wearing a mask — until you get a negative test.
And, of course, if you're concerned about how long you've been testing positive, check in with a health care provider for their guidance on your individual situation, Kissler advises.