COVID-19 Positive Test: What to Do Next

How Accurate Are COVID-19 Home Tests?

COVID-19 home rapid antigen tests have 70-90% sensitivity compared to PCR tests. A positive result is highly reliable and confirms infection. A negative result is less certain, especially early in infection, so retesting after 24-48 hours is recommended if you have symptoms.

When you purchase a COVID-19 home test, typically called a rapid antigen test or lateral flow test, you're using a diagnostic tool that detects viral proteins from the SARS-CoV-2 virus. These tests work by identifying the nucleocapsid protein, which is present in high quantities when you're actively infected and most contagious. Understanding how these tests work helps you interpret your results correctly and make informed decisions about your health.

The accuracy of home tests depends significantly on timing. These tests perform best when viral load is highest, which typically occurs during the first few days of symptoms. Studies published in the Cochrane Database show that sensitivity ranges from 70-90% in symptomatic individuals, meaning the test will correctly identify most infections when you're experiencing symptoms. However, the tests are less sensitive in the first 1-2 days after exposure, before symptoms develop, and in the later stages of infection when viral shedding decreases.

A positive result on a home test is highly reliable and should be trusted. False positives are rare, occurring in less than 1% of tests when performed correctly. If your test shows two lines – one at the control (C) position and one at the test (T) position – you have COVID-19, even if the test line is faint. The intensity of the line does not indicate severity of illness; it simply confirms the presence of the virus.

What If My Test Is Negative But I Have Symptoms?

A negative result does not completely rule out COVID-19, particularly if you're in the early stages of infection or your viral load is low. If you have typical COVID-19 symptoms such as fever, cough, sore throat, or loss of taste or smell, you should repeat the test after 24-48 hours. Many people will test negative on their first test but positive on a subsequent test as their viral load increases.

The timing of your test matters considerably. Testing too early after exposure often yields false negatives because the virus hasn't replicated enough to be detected. If you know you were exposed to someone with COVID-19, wait at least 3-5 days before testing, or test immediately if symptoms develop. Serial testing – testing multiple times over several days – increases the likelihood of detecting an infection.

How Long Should I Isolate After Testing Positive?

Current guidelines recommend isolating for at least 5 full days from the day of symptom onset or positive test. After day 5, if you're fever-free for 24 hours without medication and your symptoms are improving, you can end strict isolation but should wear a high-quality mask around others for an additional 5 days.

Isolation is one of the most effective ways to prevent spreading COVID-19 to others. When you test positive, you become the center of an infection control effort that protects your family, coworkers, and community. Understanding the rationale behind isolation periods helps you comply with guidelines while planning your recovery.

The isolation period is based on scientific understanding of viral shedding patterns. Research shows that people with COVID-19 are most contagious in the days immediately before and after symptom onset. Viral shedding typically peaks around days 1-3 of symptoms and gradually decreases thereafter. By day 5, most people who are recovering have significantly reduced viral loads, though some infectious virus may still be present.

Day 0 is the day your symptoms started or the day you tested positive if you never develop symptoms. From there, count five full days. If your symptoms began on Monday, that Monday is day 0, and you can potentially end isolation on Saturday – but only if you meet the criteria for ending isolation safely. This counting system ensures you isolate during your most contagious period.

Criteria for Ending Isolation

Before ending isolation after day 5, you must meet specific criteria that indicate you're no longer highly contagious. First, you should be fever-free for at least 24 hours without using fever-reducing medications like acetaminophen or ibuprofen. A persistent fever indicates your body is still actively fighting the infection, and you may still be shedding significant amounts of virus.

Second, your other symptoms should be improving. While you don't need to be completely symptom-free, you should notice that symptoms like cough, congestion, and fatigue are getting better rather than worse. If symptoms are worsening or remaining severe after day 5, continue isolating and contact a healthcare provider.

Even after ending isolation, you should wear a high-quality mask (N95, KN95, or KF94) whenever around other people for an additional 5 days. This is days 6-10 after your symptoms started. Avoid situations where you can't wear a mask, such as eating in restaurants or attending crowded events. Also avoid contact with people at high risk for severe illness during this time.

Isolation Guidelines for Different Situations

Some people may need to isolate longer than 5 days. Those who had severe illness or who are immunocompromised should isolate for at least 10 days from symptom onset and may benefit from consulting a healthcare provider before ending isolation. People with persistently positive tests or ongoing fever should continue isolating until they meet the criteria described above.

What Are the Common Symptoms of COVID-19?

COVID-19 symptoms typically include fever, cough, fatigue, body aches, headache, sore throat, congestion, and sometimes loss of taste or smell. Symptoms usually appear 2-14 days after exposure, with most people developing symptoms around day 5. Symptom severity ranges from mild cold-like illness to severe respiratory disease.

COVID-19 can present with a wide range of symptoms, and the specific symptoms you experience may depend on the variant causing your infection, your vaccination status, and your individual health factors. Understanding the full spectrum of possible symptoms helps you monitor your condition and recognize when medical attention might be needed.

The most common symptoms of COVID-19 include fever or chills, dry cough, and fatigue. These core symptoms occur in the majority of cases and often appear together. Fever, defined as a temperature of 38°C (100.4°F) or higher, may come and go over several days. The cough is typically dry and persistent, sometimes causing throat irritation. Fatigue can be profound, with many people describing an exhaustion that exceeds typical illness fatigue.

Respiratory symptoms beyond cough are also common. These include shortness of breath, particularly with exertion, chest tightness, and nasal congestion. Some people develop a runny nose similar to a common cold. Sore throat affects many patients and can range from mild irritation to significant pain with swallowing.

Neurological and Sensory Symptoms

One distinctive feature of COVID-19 is the potential loss of taste (ageusia) or smell (anosmia). While less common with recent variants than with earlier strains, these symptoms remain a telling sign of COVID-19 infection. The loss can be partial or complete and typically resolves within a few weeks, though some people experience prolonged alterations in taste or smell.

Headache is another frequent symptom, often described as a dull, persistent ache that differs from typical tension headaches. Some people experience muscle and body aches similar to influenza. Neurological symptoms can also include difficulty concentrating, often described as "brain fog," and in some cases, dizziness.

Gastrointestinal Symptoms

COVID-19 can affect the digestive system, causing nausea, vomiting, diarrhea, and abdominal pain. These symptoms are more common in some individuals and may appear before or alongside respiratory symptoms. Maintaining hydration is particularly important if you're experiencing gastrointestinal symptoms.

The severity and duration of symptoms varies considerably between individuals. Some people experience only mild symptoms lasting a few days, while others have more intense symptoms persisting for one to two weeks. Factors that influence symptom severity include age, vaccination status, previous infection, underlying health conditions, and the specific variant causing infection.

How Can I Treat COVID-19 Symptoms at Home?

Most COVID-19 cases can be managed at home with rest, hydration, and over-the-counter medications. Take acetaminophen or ibuprofen for fever and pain, drink plenty of fluids, and get adequate sleep. Monitor your symptoms daily and watch for warning signs that indicate the need for medical care.

Home treatment for COVID-19 focuses on supporting your body as it fights the infection and managing symptoms to keep you comfortable. While there's no cure for COVID-19, your immune system will typically clear the virus within one to two weeks. Your goal during this time is to rest, stay hydrated, and prevent the infection from worsening.

Rest is perhaps the most important component of recovery. Your body expends significant energy fighting viral infections, and adequate rest supports your immune response. Sleep as much as your body needs, and avoid strenuous activities until you're feeling substantially better. Many people find that pushing themselves too hard during recovery prolongs their illness.

Hydration is equally critical. Fever, sweating, and reduced appetite can lead to dehydration, which can worsen symptoms and prolong recovery. Aim to drink plenty of fluids throughout the day – water, herbal tea, broth, and electrolyte drinks are all good choices. If you're struggling to drink enough, try taking small sips frequently rather than large amounts at once.

Over-the-Counter Medications

Several over-the-counter medications can help manage COVID-19 symptoms. Acetaminophen (paracetamol) and ibuprofen are both safe and effective for reducing fever and relieving pain, including headache and body aches. Follow the dosing instructions on the package and be careful not to exceed the maximum daily dose. Early concerns about ibuprofen worsening COVID-19 have not been supported by evidence.

For sore throat, consider throat lozenges, honey (for adults and children over 1 year), warm liquids, and saltwater gargles. These can soothe irritation and make swallowing more comfortable. Cough suppressants may help if a dry cough is disrupting your sleep, though coughing serves the important function of clearing mucus from your airways, so use these judiciously.

Nasal congestion can be relieved with saline nasal sprays, which are safe for frequent use, or decongestant medications. If using decongestant sprays, limit use to 3 days to avoid rebound congestion. A humidifier in your bedroom can help keep airways moist and reduce coughing and congestion.

Nutrition During Recovery

Maintaining nutrition during illness can be challenging, especially if you've lost your appetite or sense of taste. Focus on easy-to-digest foods that provide energy and nutrients: soups, broths, toast, crackers, fruit, yogurt, and smoothies are often well-tolerated. Small, frequent meals may be easier to manage than large ones.

Some people find that their appetite returns before their sense of taste, making eating feel like a chore. Try foods with strong textures or temperatures to make eating more interesting. Adding spices or seasonings that you can detect may help, and focusing on the nutritional importance of eating can provide motivation even when food doesn't taste appealing.

When Should I Seek Emergency Care for COVID-19?

Seek emergency medical care immediately if you experience difficulty breathing or shortness of breath at rest, persistent pain or pressure in the chest, new confusion or inability to stay awake, bluish lips or face (cyanosis), or oxygen saturation below 94%. These symptoms indicate potentially severe disease requiring urgent treatment.

While most people with COVID-19 recover at home without complications, a small percentage develop severe illness that requires medical intervention. Recognizing the warning signs of severe COVID-19 can be lifesaving, as early treatment significantly improves outcomes. It's essential to monitor your symptoms throughout your illness and act quickly if concerning changes occur.

Difficulty breathing is the most important warning sign. It's normal to feel slightly short of breath when you have COVID-19, particularly with activity, but breathing should be comfortable when you're sitting still. If you find yourself struggling to breathe at rest, if you can't complete sentences without stopping for breath, or if you feel like you can't get enough air, seek emergency care immediately. This could indicate pneumonia or other serious lung involvement.

Persistent chest pain or pressure should not be ignored. While COVID-19 can cause mild chest discomfort from coughing, sustained pain or pressure in the chest warrants evaluation. This symptom can indicate inflammation affecting the heart or lungs, or in some cases, blood clots. Chest pain combined with shortness of breath is particularly concerning.

Neurological Warning Signs

Changes in mental status are serious warning signs. New confusion, disorientation, or an inability to stay awake or be aroused from sleep indicate that the illness may be affecting brain function, possibly due to low oxygen levels or other complications. If you notice these changes in yourself or someone you're caring for, seek emergency care.

Pale, gray, or bluish color in the skin, lips, or nail beds – called cyanosis – indicates that blood oxygen levels have dropped to dangerous levels. This is a medical emergency requiring immediate treatment. The discoloration may be subtle and is sometimes easier to see in the lips, gums, or around the eyes.

Monitoring Oxygen Levels

If you have access to a pulse oximeter, monitoring your blood oxygen saturation can help you catch problems early. Normal oxygen saturation is typically 95-100%. A reading below 94% at rest is concerning and warrants medical evaluation. A reading below 90% is a medical emergency. Note that some people with COVID-19 experience "silent hypoxia" – dangerously low oxygen levels without feeling particularly short of breath – making objective monitoring valuable.

How Should I Notify My Close Contacts?

Inform people you were in close contact with during the 48 hours before your symptoms started or positive test. Close contact means being within 2 meters (6 feet) for 15 or more minutes. Contacts should monitor for symptoms and consider testing 3-5 days after exposure, even if vaccinated.

Notifying your close contacts is an important step in breaking the chain of transmission. People you may have exposed should know about their potential exposure so they can monitor for symptoms, take precautions to avoid exposing others, and seek testing if appropriate. This responsibility can feel uncomfortable, but it's a crucial public health action.

Close contact is generally defined as being within approximately 2 meters (6 feet) of an infected person for a cumulative total of 15 minutes or more over a 24-hour period. This includes people you live with, coworkers you sat near, friends you met for coffee, and anyone else you spent time with in close proximity. The 48 hours before symptom onset is important because people are often contagious before they feel sick.

When notifying contacts, you don't need to share detailed medical information – simply let them know you've tested positive for COVID-19 and that they may have been exposed. Many people find it easiest to send a brief message: "I wanted to let you know that I've tested positive for COVID-19. We were together on [date], so you may have been exposed. Please monitor for symptoms and consider testing."

What Should Exposed Contacts Do?

People who have been exposed to COVID-19 should monitor themselves for symptoms for 10 days following exposure. Common symptoms to watch for include fever, cough, sore throat, fatigue, and changes in taste or smell. If symptoms develop, they should isolate and test immediately.

Even without symptoms, exposed individuals should consider testing 3-5 days after exposure. Testing too early may yield a false negative because the virus hasn't had time to replicate to detectable levels. During the monitoring period, contacts should wear a high-quality mask around others, especially when indoors or around people at high risk for severe illness.

Vaccination status affects but doesn't eliminate the need for precautions after exposure. While vaccinated individuals are less likely to become infected and tend to have milder illness if infected, breakthrough infections occur. All exposed individuals, regardless of vaccination status, should take the steps described above.

How Can I Protect Others in My Household?

Protect household members by isolating in a separate room with the door closed, using a separate bathroom if possible, wearing a mask when you must be in shared spaces, improving ventilation by opening windows, and having another person handle food preparation. Clean and disinfect high-touch surfaces daily.

Living with others while infected with COVID-19 requires careful attention to infection control measures. The virus spreads primarily through respiratory droplets and aerosols produced when infected people breathe, talk, cough, or sneeze. Reducing household transmission protects your family members and prevents the infection from cycling through the household.

Physical separation is the most effective measure. If possible, stay in one room with the door closed and use a separate bathroom. Designate your room as the "sick room" and stay there except when absolutely necessary. If you must leave for essential reasons like using a shared bathroom, wear a well-fitting mask and limit the time spent in common areas.

Ventilation significantly reduces indoor transmission. The virus spreads more easily in poorly ventilated spaces where aerosols can accumulate. Open windows in your room and in shared spaces to increase airflow. If weather permits, spending time outdoors is safer than being in enclosed spaces together. Using air purifiers with HEPA filters can also help reduce viral particles in the air.

Hygiene and Cleaning Practices

Frequent hand hygiene is essential for everyone in the household. Wash hands thoroughly with soap and water for at least 20 seconds, especially after any contact with the infected person or their belongings. Hand sanitizer with at least 60% alcohol is an acceptable alternative when soap and water aren't available.

Clean and disinfect frequently touched surfaces daily. These include doorknobs, light switches, countertops, faucet handles, toilet handles, and electronic devices. Use EPA-registered disinfectants effective against SARS-CoV-2, or a solution of bleach diluted according to manufacturer instructions. Wear gloves when cleaning and wash hands afterward.

Avoid sharing personal items like towels, utensils, dishes, and drinking glasses. The infected person should have their own dedicated set of these items, which should be washed thoroughly with soap and hot water after each use. Laundry from the sick person can be washed with the rest of the household laundry using regular detergent and the warmest appropriate water setting.

Caring for Someone with COVID-19

If you're caring for a household member with COVID-19, take extra precautions. Wear a well-fitting mask when entering their room. Consider wearing gloves when handling their laundry or cleaning their space. Limit the number of caregivers to reduce exposure risk, and ensure the caregiver is someone not at high risk for severe illness if possible.

Monitor the sick person for warning signs of severe illness as described earlier. Checking in regularly, even if just through a closed door, ensures you can respond quickly if their condition worsens. Keeping a thermometer and pulse oximeter available allows objective monitoring of their status.

Who Should Contact a Healthcare Provider?

Contact a healthcare provider promptly if you're over 65, pregnant, immunocompromised, or have chronic conditions like diabetes, heart disease, or lung disease. Early antiviral treatment within the first 5 days of symptoms can significantly reduce the risk of severe illness and hospitalization in high-risk individuals.

While most people with COVID-19 recover without medical intervention, certain groups face higher risks of severe illness and may benefit from early medical treatment. Identifying whether you fall into a high-risk category helps you make informed decisions about seeking care.

Age is one of the strongest risk factors for severe COVID-19. People over 65 are at significantly higher risk of hospitalization and death from the disease. This risk increases further with advancing age. If you're in this age group and test positive, contacting your healthcare provider promptly is advisable, even if your initial symptoms seem mild.

Immunocompromised individuals face particular risks from COVID-19. This includes people with HIV/AIDS, those taking immunosuppressive medications for conditions like rheumatoid arthritis or organ transplants, people receiving cancer treatment, and those with primary immunodeficiency disorders. A weakened immune system may be less able to control the infection, and standard isolation periods may need to be extended.

Chronic Conditions That Increase Risk

Several chronic health conditions increase the risk of severe COVID-19. These include cardiovascular disease, diabetes, chronic kidney disease, chronic lung diseases like COPD and asthma, obesity, and liver disease. If you have one or more of these conditions, your healthcare provider may recommend antiviral treatment or closer monitoring.

Pregnancy is another important risk factor. Pregnant individuals with COVID-19 are at higher risk of severe illness and adverse pregnancy outcomes. If you're pregnant and test positive, contact your obstetrician or midwife promptly. They can advise on monitoring, treatment options, and any special precautions you should take.

Antiviral Treatment Options

Several antiviral medications are available that can reduce the severity of COVID-19 when started early in the illness. Paxlovid (nirmatrelvir-ritonavir) is an oral antiviral that significantly reduces the risk of hospitalization and death in high-risk individuals when started within 5 days of symptom onset. Other options include molnupiravir and remdesivir.

These treatments are most effective when started early, which is why prompt contact with a healthcare provider is important if you're at high risk. Your provider can evaluate whether antiviral treatment is appropriate for your situation, considering factors like your specific risk factors, current medications (some antivirals have drug interactions), and the timing of your illness.

What Should I Expect During Recovery?

Most people recover from COVID-19 within 1-2 weeks, with symptoms gradually improving after the first few days. Some symptoms like fatigue and cough may persist longer. Returning to normal activities should be gradual, listening to your body and resting when needed. Some people experience lingering symptoms for weeks to months (Long COVID).

Understanding the typical course of COVID-19 recovery helps you set appropriate expectations and recognize when your recovery may be departing from normal patterns. While individual experiences vary considerably, most people follow a broadly similar trajectory from illness to wellness.

The first few days of COVID-19 are typically the most difficult. Symptoms usually peak around days 2-4 of illness, when viral replication is at its highest. During this time, you may feel quite unwell, with significant fatigue, fever, and other symptoms. Rest is particularly important during this phase.

After the peak, most people notice gradual improvement. Fever typically resolves within 3-5 days, and acute symptoms like sore throat and body aches improve over the first week. Cough and fatigue often persist longer than other symptoms, sometimes continuing for 2-3 weeks or more. This is normal and doesn't necessarily indicate ongoing infection or complications.

Returning to Normal Activities

Return to normal activities gradually. Even after isolation ends and acute symptoms resolve, you may not be back to your baseline for several days to weeks. Start with light activities and increase intensity as tolerated. Pushing too hard too soon can prolong recovery and may increase the risk of developing prolonged symptoms.

Exercise should be resumed cautiously. Many health authorities recommend waiting at least 10 days from symptom onset and at least 7 days after symptoms resolve before returning to vigorous exercise. Start with light activity at about 50% of your usual intensity and increase gradually. Stop and rest if you experience unusual shortness of breath, chest pain, or excessive fatigue.

Long COVID

Some people experience symptoms that persist for weeks to months after the initial infection, a condition known as Long COVID or post-COVID syndrome. Common persistent symptoms include fatigue, shortness of breath, cognitive difficulties ("brain fog"), headache, joint pain, and altered taste or smell. While anyone can develop Long COVID, it appears more common in those who had severe initial illness, though it can occur after mild cases as well.

If you're experiencing symptoms that persist beyond 4 weeks from infection, discuss them with your healthcare provider. While there's no specific treatment for Long COVID, your provider can help manage individual symptoms and rule out other causes. Most people with Long COVID do improve over time, though recovery can be slow.