You Might Be Most Contagious With COVID *Before* You Develop Symptoms
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When you hear that COVID cases are ramping up in the U.S. again, and there's the threat of a "tripledemic"possibly looming, it’s only natural to have new questions about the virus. In the mix: When are you most contagious with COVID? Like, if you happened to just grab brunch with a buddy who later tested positive, should you be worried? Ditto if you got a positive result and want to venture back out into the world soon.
It's important to include this disclaimer upfront: Everyone’s course of illness with COVID-19 can be slightly different and there’s no magic amount of time when all contagiousness and symptoms stop. That said, there is a general consensus on when you should consider yourself in the clear or free to go about your usual activities. Here, infectious disease experts break it all down.
Meet the experts: Thomas Russo, MD, is a professor and chief of infectious diseases at the University at Buffalo in New York.
William Schaffner, MD, is an infectious disease specialist and professor at the Vanderbilt University School of Medicine.
Amesh A. Adalja, MD, is a senior scholar at the Johns Hopkins Center for Health Security.
What is an incubation period—and what is it for COVID?
An incubation period is the amount of time from when you got exposed-slash-infected with a virus to when you actually developed symptoms, says Thomas Russo, MD, a professor and chief of infectious diseases at the University at Buffalo in New York.
The incubation period of COVID-19 has changed slightly over time. It used to be 6.5 days, then dropped to 4.3 days (according to a study conducted during high levels of Delta variant transmission), and more recently, studies "performed during high levels of Omicron variant transmission reported a median incubation period of 3-4 days," according to the Centers for Disease Control and Prevention (CDC).
How long are you contagious with COVID?
You can be contagious with COVID for a while via something called viral shedding, where you release particles of the virus that can make people sick.
In general, most people are contagious for about six days or so, says William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine. But there is some variation here and you should take that with a grain of salt. If you have a fever five days after your symptoms developed, for example, you may still be contagious, he says. (Skip to "Isolation Guidelines" for more info on best practices for when to venture out into the world again!)
When are you *most* contagious with COVID?
Again, no two people are alike. Still, “contagiousness is likely highest just before symptoms commence,” says infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security. “People are maximally contagious the first five days of illness and then contagiousness drops off,” he adds. “But some people actually continue to excrete viruses for longer,” Dr. Schaffner says.
However, for most people, you’re looking at a peak contagious window of a day before you get sick through about four to five days after you develop symptoms.
Are there any special considerations for different COVID variants?
While a ton of new variants have cropped up since the pandemic began, there is no official guidance from the CDC on how long you’re personally contagious per variant.
Current Testing Recommendations
Back to that brunch date that turned into cause for COVID concern. Test yourself for COVID-19 five to seven days after you have close contact with a person with a suspected or confirmed case of COVID-19, the CDC recommends. If you're at high-risk, you might consider testing yourself daily on days three, four, and five, Dr. Schaffner adds.
If you have symptoms of COVID-19—whether or not you had known contact with someone who is infected—it’s a good idea to go ahead and test yourself, Dr. Russo says. “If it’s positive and you have symptoms, you can assume you have COVID-19,” he says. But if it’s negative and you have the classic COVID-19 symptoms of fever, cough, fatigue, headache, and more, he suggests re-testing yourself in a day or calling your doctor about getting a PCR test (which is considered the gold standard of COVID-19 testing).
Isolation Guidelines If You Have COVID
Isolation guidelines haven’t changed much in the past year but, since it’s likely been a while since you read up on them, here’s a recap. If you test positive for COVID-19, stay home for at least five days and do your best to isolate from others in your home, per the CDC. When you need to be around others, it's best to wear a well-fitting mask, like an N95, to protect the people in your household, Dr. Adalja says.
You can end your isolation after five days if you’re fever-free without the use of medication. But if you still have a fever, you should continue to isolate until you’ve been fever-free for 24 hours or your symptoms are improving. If you had a moderate illness—meaning, you had shortness of breath or difficulty breathing—or you experienced severe illness, the CDC recommends staying isolated for 10 days.
Regardless of when you end your isolation, be cautious for up to 11 days around people who are at high risk of COVID-19 and wear a mask for up to 10 days or until you test negative twice, 48 hours apart, the CDC suggests.
Should you take antiviral medication like Paxlovid?
Dr. Russo is in favor of this, given that it can shorten the course of illness and lower your risk of serious complications of COVID-19—including long COVID. But, of course, that requires calling your doctor and getting a prescription.
If you’re not sure if an antiviral medication like Paxlovid is right for you, contact your doctor and discuss your symptoms. They should be able to guide you from there.
Bottom line: It’s still important to be mindful when it comes to helping prevent the spread of COVID. While you're likely most contagious a day before you get sick through about four to five days after you develop symptoms, this can vary.
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