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What to do if you've just tested positive for Covid

With the fast-spreading omicron variant, there has been a rise in cases, including breakthrough infections. These are the steps to take if you test positive.
Covid-19 testing specialists at a drive-up location on Dec. 21. Elaine Thompson / AP

The highly transmissible omicron variant has led to a Covid-19 surge that is expected to continue to spike in the coming weeks.

While the coronavirus poses the greatest risk to the unvaccinated, the Centers for Disease Control and Prevention has warned that the new strain is likely to lead to breakthrough infections in vaccinated people, too.

If you test positive for Covid, what should you do? These are the steps that experts say to take.

Isolate at home.

If you have Covid, the CDC recommends you isolate for five days at a minimum, with the option to stop isolating at that point if your symptoms are resolving or if you have no symptoms at all.

The guidance — which applies to everyone, regardless of vaccination status — is a recent change. Previously, the CDC had recommended isolating for 10 days. The agency now recommends five days of isolation followed by five days of wearing a mask around other people if you are well enough to leave isolation.

Isolating means staying home and avoiding others. If you share a household with a roommate or family members, “confine yourself to a bedroom and maybe have an assigned bathroom” if possible, said Dr. William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine and the medical director of the National Foundation for Infectious Diseases. 

If a home has only one bathroom, he suggested cleaning it with disinfecting wipes. If you have to venture out into common areas, you and others you live with should wear masks.

Good ventilation is critical in a shared household, said Rachael Piltch-Loeb, a preparedness fellow and research associate at the Harvard T.H. Chan School of Public Health. 

She recommended opening windows — even if it's cold out — and using HEPA air cleaners. 

While cities such as New York are offering free hotel isolation stays, completely isolating can be difficult in many situations, Piltch-Loeb said.

“So what are some kinds of modifications that are safe?” she said. “If you have someone who is immunocompromised in your family, you want to limit your interactions with that person. You would do that for as long as feasible, especially while you are actively symptomatic.” 

Notify your close contacts.

A close contact is anyone you were with, without a mask, within a distance of 6 feet for 15 minutes or more within a 24-hour period.

Inform the close contacts you were around not only once you started feeling sick or once you took your test, but also those whom you were with in the days leading up to that point, said Dr. Khalilah Gates, an associate professor of medicine in pulmonary and critical care at the Northwestern Feinberg School of Medicine.

“Anyone who you came in contact with 48 to 72 hours before should be notified,” she said, “because we know there’s an incubation period where you could be infectious but not symptomatic.”

While PCR tests for Covid are the gold standard, rapid tests done in clinics and at home are very reliable, the experts said. If you get a positive on an at-home test, the CDC recommends you notify your health care provider, in addition to any close contacts. Your county may also want you to submit your at-home test result to your local health department.

Your close contacts will need to take action, too.

If your close contacts have been recently vaccinated or boosted, the CDC does not require them to quarantine, although the agency recommends they wear a mask around others for 10 days. They should also get tested five days after they were exposed if possible.

And they shouldn’t rush to get tested, Schaffner said.

“If it’s only been two days since their exposure, that test is very likely to be negative.”

“If it’s only been two days since their exposure, that test is very likely to be negative,” he said. 

Certain close contacts will need to quarantine. As of late December 2021, that includes people who are unvaccinated as well as those who received two doses of mRNA Covid shots more than six months prior, but have not yet received a booster shot, as well as those who received a Johnson & Johnson shot more than two months prior but have not yet received a booster shot.

They should stay home for five days, the CDC says, and then continue to wear a mask for five additional days.

If you have an underlying health condition, notify your doctor.

If you get Covid and are over age 65, you are obese, have lung conditions such as asthma or chronic obstructive pulmonary disease, or have any other underlying conditions that put you at risk for complications, “you should absolutely contact your physician — even if you feel OK,” Gates said.

That’s because you may be a candidate for monoclonal antibodies, which, when taken at the onset of a Covid infection, can prevent severe illness.

But cocktails of monoclonal antibodies used for prior variants may not be effective against omicron, and the new formula that has been shown to be effective is in short supply, said Dr. Aditya Shah, an infectious disease consultant at the Mayo Clinic.

He urged anyone at high risk for disease progression to find out as soon as they get a positive Covid test result if they are eligible for the treatment.

“Usually your eligibility is decided based on the supply of monoclonal antibodies that your health care supplier has,” he said. 

Monitor your symptoms. Most won’t require hospitalization.

In most cases, treatment for Covid will be similar to how you would care for a common cold.

“Simple things, like getting enough hydration by water or fluids, getting enough rest and sleep, getting nutritious food is important,” Shah said. 

Tylenol and ibuprofen can be used to reduce fevers, body aches and headaches, he said.

The vast majority of people with Covid will feel better on their own with these measures. If your symptoms worsen or you have trouble breathing, check in with your doctor, an urgent care center or an emergency room, the experts said. A pulse oximeter, a small medical device you place on your finger, can help you monitor your blood oxygen level; the level should be around 95 percent or higher.

“If you feel like it’s a cold, fine,” Gates said. “If you’re having chest pain, shortness of breath, difficulty breathing, things don’t feel right — then you need to seek guidance.”

Stop isolating when it’s safe to do so.

The five-day-minimum rule is firm for isolation, but if you live with a family, there may be some situations where it doesn’t make sense to isolate away from your household.

“One thing to think about is the point of time at which you test positive, it is very likely you have already exposed your family, so the best practice is to isolate, but your family should also consider getting tested within a couple of days,” Piltch-Loeb said. “If they are all exposed, you should all isolate as a pod together.”

Roommates, on the other hand, may have separate enough lives that they have not shared the virus with one another, she said. 

Don’t count on natural immunity for future protection.

When you test positive for Covid, laboratories won’t tell you which variant you had, but with omicron spreading so quickly, “there is a fair assumption” that most cases going forward will be that strain, Shah said.

Regardless of which strain you catch, natural immunity alone is no guarantee of future protection against reinfection. Studies indicate a booster shot is the best bet.

“There are data now to suggest that if you’ve been vaccinated and have had Covid, you are in very, very solid shape in terms of protection,” Shaffner said. “Does that mean it’s impossible for you to get infected? No, but you are in very good shape.”

If you have not gotten vaccinated, he added, “you are in much less good shape, even though you have had Covid and recovered.”