COVID-19 might not dominate headlines as it once did, but the virus is still actively circulating, evolving, and causing illness. As we navigate the ongoing presence of COVID, many people are unsure about the current guidelines and best practices for dealing with it. Key questions arise, particularly concerning how long someone remains contagious with COVID-19.
“The COVID landscape has indeed shifted significantly since the pandemic’s onset in 2020,” explains Dr. Brandon Bet, an infectious disease expert at Henry Ford Health. “The combination of immunity from vaccinations and prior infections, coupled with the emergence of new COVID variants, has altered the dynamics. However, it’s crucial to recognize that COVID-19 can still lead to severe illness in vulnerable individuals, and vigilance remains important.”
In this article, we delve into the crucial aspects of COVID-19 contagiousness during the 2024-2025 viral season, drawing insights from Dr. Bet to provide clarity and actionable information.
Understanding the Latest COVID-19 Strain and Symptoms
What is the Predominant COVID Variant Right Now?
“Currently, the most prevalent COVID-19 variant is XEC,” states Dr. Bet. “This is an Omicron subvariant, and it’s projected to be the dominant strain throughout the winter months, accounting for approximately half of all detected cases. Fortunately, initial data suggests that XEC does not appear to be more severe or easily transmissible than previous recent COVID strains. The symptom profile also remains largely consistent with earlier variants.”
Recognizing COVID-19 Symptoms
One of the challenges with COVID-19 is the wide spectrum of symptoms individuals can experience. For some, it might present as a mild cold, while others may develop a more pronounced flu-like illness. In more severe cases, the impact can be significantly greater. The intensity of symptoms is often influenced by factors such as age, underlying health conditions, and vaccination status.
According to the Centers for Disease Control and Prevention (CDC), common COVID-19 symptoms include:
- Fever or chills
- Persistent cough
- Shortness of breath or breathing difficulties
- Sore throat
- Nasal congestion or runny nose
- Loss of taste or smell
- Fatigue and weakness
- Muscle or body aches
- Headache
- Nausea, vomiting, or diarrhea
Research indicates a potential order in which COVID-19 symptoms might appear: fever, cough, sore throat/muscle pain/headache, followed by nausea/vomiting, and finally diarrhea. However, Dr. Bet emphasizes, “It’s important to remember that symptom presentation can vary greatly. You might not experience all of these symptoms, or they might not appear in this specific sequence. The only definitive way to determine if your symptoms are due to COVID-19 is through testing.”
COVID-19 Severity and Risk Factors
Is COVID-19 Still a Serious Concern?
Thanks to widespread vaccination and effective treatments, the rate of COVID-19-related hospitalizations and deaths is significantly lower compared to the pandemic’s early stages. However, data from 2023 demonstrates that hospitalizations and fatalities still experience upticks, highlighting the ongoing risk. Unvaccinated individuals face a considerably higher risk of hospitalization and severe illness compared to their vaccinated counterparts.
Dr. Bet highlights vulnerable populations: “Individuals aged 65 and older, along with those of any age with underlying health conditions such as diabetes, chronic heart, lung, liver, or kidney disease, and those who are immunocompromised, are at elevated risk for severe COVID-19 infections. Pregnancy also poses a higher risk category. Pregnant individuals are more susceptible to severe illness from COVID-19, and severe cases can unfortunately lead to pregnancy loss.”
The Persistent Threat of Long COVID
Long COVID remains a significant concern, with symptoms that can persist for months or even years following the initial infection. Long COVID encompasses a wide range of debilitating symptoms, including brain fog, loss of smell and taste, persistent fatigue, depression, anxiety, and joint or muscle pain. Individuals who were unvaccinated or experienced severe initial COVID-19 infections are at a greater risk of developing long COVID.
Contagiousness of COVID-19: How Long Are You Infectious?
Understanding the Contagious Period
Current COVID-19 variants maintain a similar level of contagiousness to previous strains, but the timeframe of peak contagiousness has evolved.
Dr. Bet explains the shift: “In the early days of the pandemic in 2020, when population immunity was virtually non-existent, individuals with COVID-19 were capable of infecting a much larger number of people. This was particularly evident before widespread public health measures like lockdowns were implemented.”
Initially, people were considered contagious even before symptoms appeared. However, a 2023 study indicates that peak contagiousness now typically occurs around day four after symptom onset, aligning with other respiratory viruses such as influenza and RSV (Respiratory Syncytial Virus).
Despite the shift in peak contagiousness, individuals remain contagious with COVID-19 for an average of approximately eight days, although this duration can vary depending on the severity of the illness. It is crucial to take precautions during this period to prevent transmission to others.
COVID-19 Isolation Guidelines: How Long to Isolate?
Navigating Evolving Isolation Recommendations
“The question of isolation duration is a source of considerable confusion due to changes in recommendations over time,” notes Dr. Bet. “Early in the pandemic, a 10-day isolation period following a positive COVID-19 test was the standard recommendation. Subsequently, the CDC revised its guidelines to allow individuals to end isolation after five days, provided they wore a mask for an additional five days.”
These adjustments were based on a careful evaluation of risk-benefit considerations and emerging data regarding the period of peak contagiousness. Currently, the CDC guidelines.#:~:text=and%20not%20testing%3F-,The%20updated%20Respiratory%20Virus%20Guidance%20recommends%20that%20people%20stay%20home,using%20fever%2Dreducing%20medication).) recommend that if you are fever-free for 24 hours (without fever-reducing medication) and your symptoms are improving, you can discontinue isolation. This updated guidance means the isolation period can be shorter or longer depending on the individual’s illness course.
Even after ending isolation, it remains important to continue taking preventative measures, such as wearing a well-fitting mask, maintaining physical distance from others, and practicing diligent hand hygiene.
Utilizing COVID-19 Testing for Clarity
Taking another COVID-19 test can provide additional reassurance, particularly before attending gatherings, especially if vulnerable individuals will be present.
Dr. Bet emphasizes the rationale behind the evolving guidelines: “These updated recommendations are informed by the high levels of population immunity to COVID-19, along with the availability of effective antiviral treatments like Paxlovid.” The CDC estimates that over 98% of the U.S. population now possesses some level of immunity to COVID-19 through vaccination, prior infection, or both.
It’s important to note that isolation protocols may differ in healthcare settings and workplace policies may also vary.
COVID-19 Testing Accuracy and Timing
Understanding COVID-19 Test Types and Accuracy
PCR tests, administered by healthcare professionals, remain the most accurate method for diagnosing COVID-19. At-home rapid antigen tests are also effective, but the FDA recommends specific guidelines to enhance accuracy:
- Symptomatic Individuals with Negative Rapid Test: If you are experiencing symptoms and receive a negative rapid test result, it’s crucial to take a follow-up test 48 hours later to confirm the initial result.
- Asymptomatic Individuals with Known Exposure and Negative Rapid Test: If you were exposed to COVID-19 but are not experiencing symptoms and receive a negative rapid test, take two additional tests, spaced 48 hours apart, to increase accuracy. It is advisable to wait approximately five days post-exposure before taking the first test.
- Positive Rapid Test Result: A positive rapid test result is generally considered accurate and should be treated as such.
Stocking Up on COVID-19 Tests
“With holiday gatherings and increased social interactions, it’s prudent to have COVID-19 tests readily available,” advises Dr. Bet. “Every household in the U.S. can order four free at-home tests from the government here.”
Updated COVID-19 Vaccination Recommendations
The Importance of Updated Vaccines
The CDC recommends that everyone aged 6 months and older receive an updated COVID-19 vaccine for the 2024-2025 viral season. Similar to the annual flu vaccine, the COVID-19 vaccine is updated annually to target the most recent circulating strains.
“Modifying the vaccine each year significantly enhances its effectiveness,” explains Dr. Bet. “It’s not simply a ‘booster’; it’s an updated vaccine formulation. Vaccination does not guarantee complete prevention of COVID-19 infection, but it is highly effective in reducing the severity of illness if infection occurs.”
Updated COVID-19 vaccines are available from Moderna, Pfizer, and Novavax. The Moderna and Pfizer vaccines are fully FDA-approved for individuals aged 12 and older and are authorized for emergency use in children aged 6 months to 11 years. The Novavax vaccine is authorized for use in individuals aged 12 and older. The CDC recommends a second dose of the updated vaccine for individuals aged 65 and older and those who are moderately to severely immunocompromised, administered six months after the initial updated dose.
When to Seek COVID-19 Treatment
Timely Antiviral Treatment for High-Risk Individuals
Individuals in high-risk categories for severe COVID-19 should seek antiviral treatment, such as Paxlovid, as soon as symptoms appear, ideally within 48 to 72 hours of symptom onset.
“Paxlovid is administered as a pill pack containing two medications,” explains Dr. Bet. “One component is the active antiviral agent, and the other enhances its effectiveness. Paxlovid significantly reduces the risk of hospitalization by over 50% and the risk of death by 75%. However, prompt initiation of treatment is critical for its efficacy.”
Individuals over 50 and/or those with pre-existing health conditions who experience COVID-19 symptoms should get tested promptly and consult their healthcare provider as soon as possible. For life-threatening symptoms, such as severe breathing difficulty, immediate medical attention is crucial – call 911 or go to the nearest emergency room without delay.
Reviewed by Brandon Bet, D.O., Infectious Disease Physician at Henry Ford Medical Center – Springport Rd.
