COVID Q&A: Can I use an expired test? Time to get boosted? How to cope with the sneaky summer surge

California’s COVID positivity rate has topped 10% and is still on a steep upward path, nearly tripling since June, according to new data from the state’s Department of Public Health.

“Anecdotally, I feel like everybody I know has been getting COVID,” said Dr. Errol Ozdalga, a clinical associate professor of medicine at Stanford.

But unless your social circle has been hit by the virus recently, this wave might have caught you by surprise. The public health emergencies are over, testing has become harder to find, and data monitoring has been largely abandoned. But the virus is still among us, and more so now than in May or June.

Once again Bay Area residents are scrambling to do the right thing when a family member tests positive, or they start feeling a tickle in their throat. What are the best practices these days for handling this persistent virus? What have we learned with three years of pandemic practice under our belts? We checked in with the experts.

Q: I’m feeling sick. Is it COVID?

A: If you’re feeling sick, “it’s reasonable to assume it is” COVID, said Dr. Bob Wachter, UCSF’s medical department chair.

The state’s positivity rate, one of the few metrics that can help us compare current virus levels to earlier surges, is reaching levels we’ve seen only during the notable COVID waves of the past several years, suggesting your chances of encountering it right now are significantly higher than just a few weeks ago.

So if you’re feeling any symptoms, like a sore throat, a cough, or unusual fatigue, “do a rapid test,” Wachter advises. “If it’s positive, you have COVID. If it’s negative, we don’t know and you should do another (test) in one to two days,” he said.

Even if you have two negative at-home tests, you do not have a green light to proceed as normal. If you are feeling sick, “it’s reasonable to stay home or wear a mask … because you probably have an infectious disease,” said Wachter. “It’s contagious.”

Q: I’ve been exposed to someone who has COVID. Should I take an at-home test?

A: Many families are dealing with this scenario right now: Someone in your home has tested positive. Now what? “You should immediately isolate … to increase the odds that you won’t get it,” Wachter suggests. “It’s not at all definite that you’re going to get it,” he said, citing a household infection rate of just about 50%.

If you have been exposed and you are feeling sick, you probably have COVID. Still, taking an at-home test and identifying the virus early can be especially important for people from higher-risk groups so they can seek therapeutic treatments.

What if you had a minor exposure, but are not feeling sick? “The key thing is to watch out for first symptoms,” said Wachter. If you never notice any symptoms, two negative tests taken a few days after exposure and a few days apart can bring some peace of mind.

Q: Can I still get a free at-home COVID test?

A: When the federal and state public health emergencies ended earlier this year, most of the free testing opportunities ended with them, but some insurance providers still cover the cost of tests. It depends on where you live, if you have insurance, and what type of insurance you have.

Reach out to your insurance provider to ask about free at-home tests, and if you do end up paying for them out of pocket at your local pharmacy, remember it is a qualified expense for a health savings account, if you have one.

Q: What about that pile of old COVID tests I have lying around: Can I still use them?

The answer is probably, even if the expiration date seems to have passed. So don’t throw them away just yet!

Many people stocked up on rapid at-home tests when you could order from the federal government at no cost. Now some of those expiration dates have come and gone, but for many of the popular at-home tests, the U.S. Food and Drug Administration has retroactively extended the expiration dates. You can check the FDA website to see when your at-home tests actually expire.

Q: What should I do if I have COVID? How long should I isolate?

A: The main question is whether to take Paxlovid. “I think it’s the right thing to do for someone who is older, probably older than about 50, or has medical comorbidities,” advises Wachter. But you have to get the medication within five days of the start of symptoms.

While the at-home tests aren’t always great at catching infections early on, they are our best available tool to measure infectiousness. Wachter and Ozdalga both used a negative test to mark the end of their isolation, which can take anywhere from a few days to two weeks typically.

Recommendations from the Centers for Disease Control and Prevention suggest five days of isolation for those who had no symptoms or had minor symptoms and are improving and fever-free.

Q: What variants are currently circulating?

A: The newest dominant variant, EG.5, nicknamed Eris, is the one that the CDC is watching.

It is believed to be more immuno-evasive, meaning vaccinations and previous infections are less effective at preventing infection than for the other recent omicron subvariants.

Luckily, Eris does not seem to be more dangerous, even if it is spreading more efficiently.

Despite many of the people around him catching the virus, and an obvious wave going on, Ozdalga has not seen a notable increase in patients hospitalized with the virus at Stanford. Statewide there has been a gradual increase in hospitalized patients since a low in June.

Q: When am I due for a new vaccine?

A: Only a fraction of adults in the U.S. are up to date on their COVID vaccines. Some health experts are advising those who are due for a new booster might consider waiting a few months until a newly formulated booster is developed and authorized in late September or October. The reformulated booster likely will provide better protection from the newest variants.

Q: When will this be over? When will we stop hearing about new COVID waves?

A: “Never,” answered Wachter, simply. “It’s a bummer of an answer, nobody likes that.”

Even without eliminating the virus, the prognosis is not doom and gloom. The ebb and flow of COVID waves might be here to stay, but an evolving virus, plans for annual vaccinations, and high population immunity has brought COVID more in line with the colds and flus we are used to, in terms of its prevalence and the risk it poses.

“People simply aren’t getting as sick,” Ozdalga said.

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