So You Have COVID—Now What? 10 Common Questions Answered

When we marked two years of the COVID-19 pandemic back in March, my family was part of an ever-shrinking group of Canadians that had managed to avoid the virus. This was part privilege (my husband and I both work from home), part prevention (we’re fully vaccinated, boosted and are still wearing masks in public spaces) and part luck (because really, COVID is everywhere right now). Unfortunately, that luck ran out when one of my kids brought COVID home from school and within days, we all had it.

It seems like more people than ever before are getting COVID right now, but there are best practices to limit further spread when you’re sick. Here’s what you need to know about testing properly, isolating, treating your symptoms at home, accessing antivirals and more.

What symptoms should I be looking for at this stage in the pandemic?

It’s important to monitor yourself for classic COVID symptoms—coughing, fever, headaches, fatigue and muscle aches, for example—but recent variants like BA.2 seem to show up in the upper respiratory system first. “I would say that anyone who has a sore throat should highly suspect COVID,” says Nili Kaplan-Myrth, a physician and medical anthropologist in Ottawa. “The thing that’s different from two years ago is that a sore throat is often the first symptom—a sore throat or a dry mouth.”

“Previously, we didn’t see that much [nasal] congestion and sore throats,” says Earl Rubin, a pediatric infectious diseases specialist and medical microbiologist at Montreal Children’s Hospital. Gastrointestinal symptoms may also occur with COVID, so if you’re vomiting or having diarrhea, don’t brush it off.

Who has access to PCR testing?

Unfortunately, it’s very difficult to get a government-funded PCR test right now unless you’re a healthcare worker, immunocompromised, in another high risk group or over the age of 70. Each province has their own specific guidelines—here’s an updated list of who qualifies in Ontario. If you’re admitted to hospital, you may also be given a PCR test.

Limited tests have resulted in a lack of transparency around case numbers in many provinces. “Without [widespread] PCR testing, there isn’t reporting—we are guesstimating based on wastewater levels and predictive models,” Kaplan-Myrth says.

Many private labs now offer PCR testing for a fee (often around $100 plus applicable taxes). These are unobserved tests, so they aren’t valid for travel—they’re just to confirm whether or not you have the virus. However, some labs and pharmacies offer PCR and/or antigen tests specifically for travel clearance.

Are rapid tests accurate?

Rapid antigen tests have been an incredible tool throughout the pandemic as they help identify COVID cases in order to reduce community spread. Unfortunately, as the virus has mutated and new variants have emerged, these tests have become less effective at catching those positive results. “People have to really understand the limitations [of],” Rubin says. “There are a lot of false negatives.” He estimates that the accuracy of a rapid test taken by an asymptomatic individual is around 50 percent, and that when symptoms are present, the accuracy of the test is highest several days after symptoms initially present—perhaps around 70 percent. Knowing this, if you have COVID symptoms but test negative on a rapid test, it’s best to assume you have COVID, isolate accordingly and if possible, re-test after several days.

What’s the right way to do a rapid test?

Kaplan-Myrth says that the tests are actually fairly sensitive, but user error is common. “The majority of people are not doing them correctly,” she says. And while some recent guidance suggests swabbing the back of their throat before swabbing their nasal passages, you shouldn’t be aiming for your tonsils—instead, brush the back of your tongue and inside of your cheeks. Kaplan-Myrth also recommends testing first thing in the morning before eating, drinking or brushing your teeth, and checking the test results after 30 minutes as well as at the 15 minute mark. “Any line—it doesn’t matter how faint—is a positive.”

Rubin notes that false positives are very rare, so a positive test should always be assumed to be accurate.

What should you do when you test positive or show symptoms of COVID-19?

Provincial guidelines vary, but in terms of community risk minimization, it’s best to isolate immediately and inform any close contacts that you have symptoms and/or a positive test. Kaplan-Myrth notes that while many provinces only require an isolation period of five days, the majority of individuals will still be contagious at that point. “At five days, you still have a high viral load,” she says, noting that most people will test negative after seven to 10 days. Wearing a mask helps somewhat but unless everyone in the room is wearing one, the opportunity for transmission is still very high, Kaplan-Myrth says. And because masks aren’t mandated in most workplaces, public spaces or schools, a person who is still testing positive is likely to spread the virus to others.

“If you can, stay home for 10 days from the onset of symptoms to limit potential transfer,” Rubin agrees.

“The five-day isolation period is just to avoid workplace shortages, but sending people back to work while sick is not sound health policy,” Kaplan-Myrth says. To truly avoid spreading the virus, you can “test to exit”—essentially, isolating until symptoms are largely gone and your rapid test is negative.

If you are unable to continue testing or must return to work after the five day isolation period, Rubin emphasizes the importance of masking, distancing and avoiding interaction with vulnerable individuals.

Who is considered a close contact?

This is a bit of a judgment call, but essentially, it’s anyone you’ve had prolonged recent contact with (masked or unmasked—the longer the interaction, the higher the risk), or anyone you had recent unmasked contact with, even if only for a few minutes. Indoor contact is always higher risk than outdoor contact, but any contact leaves the door open to transmission—particularly with Omicron and its sub-variants. “It's highly contagious, it’s airborne and we’re not protected from getting COVID because we’ve had the vaccine—we’re protected from severe illness,” Kaplan-Myrth says.

And if you’ve been told that someone you had close contact with now has COVID? Government regulations in most provinces will not require you to isolate, but you should definitely exercise caution. “Public health is easing restrictions so they allow close contacts to go about their usual business,” Rubin acknowledges. “Avoid contact with vulnerable people and monitor for symptoms.” It’s also best to wear a mask in indoor public spaces if you aren’t already.

If you have COVID, should your roommates or family members isolate as well?

Rubin suggests acting with caution and avoiding vulnerable individuals but notes that many provincial guidelines don’t require fully vaccinated close contacts to isolate—even if a member of their own household has COVID. Kaplan-Myrth asserts that there’s a clear difference between legal requirements and community care—the latter of which is her concern. “There’s what the rules say in each province or each workplace or school, but then there’s what’s actually the responsible thing to do if you acknowledge that we’re all connected,” she says. “So if a member of your household has COVID, you’re probably going to test positive a day or two later, and four to five days later you’re very, very likely to all have COVID.” If you have a known positive case in your household, it’s best to stay home from work, school, social events and extracurricular activities.

Kaplan-Myrth acknowledges while following a model of community care and risk mitigation is ideal, many individuals simply do not have the supports in place to isolate when exposed to COVID or, if positive, beyond the required five day isolation period. A person should stay home to rest, recover and avoid spreading the virus to others—but for a single mom or a family living on the edge of poverty, that’s not always realistic. “How do we tell someone to isolate [for] when they have a job with no sick leave and have to go to work that day or they can’t buy their groceries or pay their rent?” Kaplan-Myrth says. “That person is going to work because they have to, and that is our failure as a system more broadly.”

How do you treat COVID-19 at home—and when should you seek medical attention?

Healthy individuals who have been fully vaccinated against the virus are unlikely to face severe outcomes such as hospitalization or death, but they may feel pretty terrible. If you have COVID, make an effort to rest as much as possible and stay hydrated. You can take Advil or Tylenol for fever and pain relief, both physicians advised. This advice applies to children as well as adults, though it’s important to remember that children cannot take cough syrup as it isn’t safe for kids and can actually suppress breathing. “Honey is a natural cough suppressant,” Kaplan-Myrth advises, and it’s safe for kids over 12 months old. “It won’t make COVID go away, but it’s good symptom management.”

You should seek medical attention immediately if you’re struggling to breathe or feeling sudden severe chest pain, Kaplan-Myrth says. Rubins adds that parents should seek medical attention for their children if they become extremely lethargic, show signs of respiratory distress or aren’t urinating regularly.

While antiviral treatments like Paxlovid have been shown to be fairly effective, the vast majority of Canadians are not eligible to receive them at this time. “It’s really only for very select individuals,” Rubin says. Depending on the province, this may include people with certain autoimmune conditions, those receiving chemotherapy or individuals over the age of 70. And, Kaplan-Myrth adds, there are a number of common medications that are contraindicatory to antivirals—meaning, some people who qualify won’t be able to take them due to potentially harmful interactions with other medications they’re on.

Unvaccinated or immunocompromised individuals are far more likely to face severe outcomes from a COVID-19 infection. This includes many seniors, cancer patients who are undergoing chemotherapy, individuals on immunosuppressant drugs, and children under the age of five who don’t currently have access to vaccine protection.

If someone has had COVID before, can they get reinfected?

A vaccinated individual who has recently had COVID-19 will have a fairly high level of protection from reinfection, but not for long. Rubin estimates that this protection may last up to three months, but Kaplan-Myrth has seen reinfection occur after as little as three or four weeks after a previous case. “You are at just as much risk of getting COVID again for the same reasons you got it the first time,” she says, adding that many people are shocked when they get it a second time in a relatively short time period. So, if a close contact or someone in your household gets COVID a month after you had it, don’t assume you’re protected—you may have a better chance of avoiding transmission, but there’s no guarantee.

What about long COVID—is it still a risk?

Long COVID refers to symptoms that linger for weeks or months after a COVID-19 infection, including respiratory issues, fatigue, headaches and cognitive dysfunction (or “brain fog”). Long COVID is a serious concern for anyone who’s been infected including formerly healthy adults and children, and as we see more infections (and reinfections), the health care system is at risk of being completely overwhelmed. “[Long] happens with mild cases, too,” Kaplan-Myrth points out. Prevention is critical, and both doctors agree that vaccination remains one of our best tools. “I think it’s really important to get your third shot, at minimum, realizing that it may not protect you from getting infected but it may protect you from getting too sick,” Rubin says, noting that this is even more important if you’re around young kids, seniors or other vulnerable individuals.

In addition to adults and kids getting fully vaccinated, Kaplan-Myrth wants to see better ventilation in indoor settings, including HEPA filters and open windows, universal masking in indoor public spaces and increased social supports to allow individuals to isolate until they’re no longer contagious. “It shouldn’t be a privilege and only those who can afford to do so can stay home.”