When should you test for COVID-19 before holiday gatherings?

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The holiday season is fast approaching in the United States, but cold and flu season is already in full swing. As the weather gets colder and people increasingly gather indoors for events like Thanksgiving dinner and holiday parties, respiratory viruses will have ample opportunity to spread.

There are already warning signs that this winter could be worse than past years. An unusually early and intense surge in respiratory syncytial virus or RSV among young children is overwhelming children’s hospitals across the country, TODAY previously reported, and flu season is off to an early start as well.

COVID-19 is not gone either. The U.S. could see a wave of infections in the next few months fueled by new SARS-CoV-2 variants, TODAY explained previously. Experts have warned about a potential “tripledemic” — simultaneous surges of RSV, flu, and COVID-19 — that could strain health systems or lead to medication shortages.

With the abundance of viruses making people sneeze, cough, and ache right now, testing will remain a critical tool to keep yourself and others safe. Knowing your COVID status is especially important during the holidays if you are planning to attend large indoor gatherings or spend time unmasked around high-risk individuals, such as older family members.

How do I know if I need to test before gatherings?

The current recommendations per the U.S. Centers for Disease Control and Prevention are that anyone who has COVID-19 symptoms should test immediately, and anyone who is exposed to COVID-19 should test five days after exposure.

If neither of the above conditions apply to you, the decision to test ahead of a gathering comes down to several factors as well as the comfort level of those around you, according to experts.

“I would first look at what your recent risk is …  because the more you’ve been at risk, the more likely you’re going to have a positive test,” Dr. Scott Weisenberg, MD, infectious disease specialist at NYU Langone Health, told TODAY. If you’ve been engaging in higher risk activities like spending time in crowded indoor areas without a mask or hanging around sick people, that will increase your chances of having any respiratory virus, Weisenberg noted.

Next, you should consider who is going to be attending the gathering. “If people are concerned about the consequences of infection for vulnerable individuals, particularly elderly or people with compromised immune systems, then they really want to make plans to try to minimize respiratory virus transmission,” said Weisenberg. This includes COVID-19 testing but also masking, distancing, and ventilation, Weisenberg added.

In any case, there’s really no downside to taking a COVID-19 test out of precaution before going to an event or being around high-risk people, the experts noted.

Which type of test should I take and when? 

“If you want to be absolutely sure, the more sensitive test is the PCR test,” Dr. Thomas Murray, associate medical director for infection prevention at Yale New Haven Children’s Hospital in Connecticut, told TODAY. These are the most reliable tests for people with or without symptoms, per the CDC, but they are usually performed in a laboratory so it takes longer to get results.

The ideal timing for taking a PCR test depends on how fast you can get the test results back, said Murray. “If you can find a place that has a 24 to 48 hour turnaround, then a couple of days before the event is ideal,” said Murray. While waiting for the PCR results, people can opt to take extra precautions like wearing a mask or isolating, said Murray, especially if they are going to see someone who’s very high risk. 

It’s important to note PCR tests can remain positive for weeks or even months after a person recovers from COVID-19, the experts pointed out. “It doesn’t necessarily correlate with infectiousness,” said Weisenberg, because the more sensitive PCR tests can detect remnants of the virus and produce a positive result long after a person is contagious. Anyone who thinks they are in this situation should speak to their healthcare provider, said Weisenberg.

Additionally, people should check with their insurance provider about the cost of PCR testing beforehand. “In many places, symptomatic testing remains covered but asymptomatic screening may not be covered,” said Murray.

The next best choice are rapid at-home antigen tests, said Murray, and the closer to the time of the gathering you take it the better — for example, the morning before Thanksgiving dinner. “There is some evidence that if you do more than one (rapid) test in the two days leading up, and those are both negative, then that’s better than a single test,” Murray added. 

Anyone with health insurance or Medicare can get up to eight free rapid tests per month, and there are still ways to get them for free or low-cost if you aren’t covered.

However, rapid antigen tests are most accurate when used by people with symptoms so they do not perform as well when used for asymptomatic screening, said Murray. “That’s probably because asymptomatic individuals don’t have as high of a viral load, so the (rapid) test doesn’t pick it up … it’s not as good at detecting smaller amounts of virus,” said Murray. 

Rapid tests also work best when they are performed exactly as instructed, said Murray, which not everybody does. So it’s important to read the directions closely and check the testing kit’s expiration date, TODAY previously reported. Some expiration dates have been extended by the the U.S. Food and Drug Administration.

People can also combine both types of tests. “You can still consider getting a PCR test the day or two before and then doing an antigen test right before (the event),” said Weisenberg.

In any case, a negative COVID-19 test does not 100% guarantee that you are not infected with the virus and you won’t transmit it to others, said Weisenberg. But it does offer a snapshot of your SARS-CoV-2 status in that moment, the experts noted, which is why testing is important to help prevent transmission.

Anyone who is testing negative but still has symptoms should stay home until they are feeling better, the experts emphasized. Even if it’s not COVID-19, it could be any number of respiratory viruses — which may cause a mild cold for a healthy person but a severe illness for a vulnerable person, said Weisenberg. “If you’re sick, don’t go to gatherings, period,” Weisenberg added. 

You may also consider going to the doctor to get an influenza test, said Murray, because the symptoms of flu and COVID-19 are often difficult to tell apart.

If you’re still concerned about being around high-risk individuals, the experts recommend dialing up the precautions: wearing a mask, distancing, opening windows to allow ventilation, or holding events outdoors if possible. “If you’re able to afford it, an appropriate-sized portable HEPA filtration (system) can be very helpful if you’re going to engage in unmasked activities like Thanksgiving dinner,” said Murray.

The best way to protect yourself against COVID-19 is by making sure you are up to date with your vaccinations, the experts noted. “People want to reduce the risk of getting infected and then subsequently transmitting the virus to people by getting the new bivalent booster,” said Weisenberg. Everyone ages 6 months and older should also get their seasonal flu shot, the experts said.

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