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Got a cold? Get a COVID-19 test. University of Chicago expert explains the do’s and don’ts of testing during omicron.

With COVID-19 cases surging, thanks in large part to the highly infectious omicron variant, this isn’t the time to ignore a runny nose or a persistent cough, according to Dr. Emily Landon, an infectious disease specialist at the University of Chicago.

“If you have any cold symptoms, you need to be tested (for COVID-19),” said Landon. “Right now, COVID is far and away more likely than anything else.”

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But with demand for testing on the rise at pharmacies and clinics, you may be in for a wait. Should you turn to the increasingly popular home-testing option? Can you trust the results? And how long do you have to stay home if you test positive?

Landon broke down the COVID-testing landscape in a recent interview.

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Which test should you get?

It’s fine to start with a rapid antigen test, either a home test or one administered at a pharmacy or clinic. These tests can tell you very reliably that you do have COVID-19, Landon said. So if you test positive, there’s no reason to wait in line for a PCR test.

What if you test negative?

Unfortunately, a negative antigen test doesn’t mean you’re COVID-free. At this point, you do need to schedule a PCR test, which often involves a wait. The PCR test is much better at detecting small amounts of COVID-19 than the antigen test, so if you test negative on the PCR test, congratulations. You’re considered free of COVID-19 and can resume normal activities.

When should you start self-isolating?

With omicron surging, you should start self-isolating as soon as you notice cold symptoms, Landon said. Don’t wait for the results of your COVID-19 test.

What if you get a positive antigen test and a negative PCR test?

If you have any cold symptoms, go with the positive antigen test and assume you have COVID-19, Landon said. If you are asymptomatic, you may want to check with your testing center about next steps. But because antigen tests are so unlikely to have false positives, Landon would still follow the guidelines for people who have COVID and self-isolate.

How can a PCR test be negative when an antigen test, which is less sensitive to the virus, comes out positive?

Good question. Doctors are seeing this happen more often than they would expect, and they’re still trying to figure out the answer, Landon said. Among the most likely explanations: A fully vaccinated person could have a high viral load on Monday — and test positive on the antigen test. But two days later, the viral load could already have decreased to a point where even the more sensitive PCR test would not detect it. Both tests would be accurate, but for different moments in time. Human error could also be a factor, with some people — both home-testers and medical professionals — failing to collect a good sample.

Can a blood test settle the question?

No. A blood test can show your doctor whether you have antibodies to COVID-19, a sign that you previously had it. But it isn’t used for diagnosing current COVID, Landon said.

Can you get a test to speed your return to work after COVID-19?

Not unless you’re a health care worker. The Centers for Disease Control and Prevention recently issued new guidelines for health care workers, saying they can return to work after seven days if they are asymptomatic and test negative for COVID-19, and in some cases they can return sooner.

Alexa Ruiz, 10, gets her temperature taken by health care worker Jessica Gonzalez at the Epsperanza Health Centers' drive-thru COVID-19 testing pod on Dec. 20, 2021, in Chicago. The Ruiz family was there getting tested as a precaution following exposure to a classmate in CPS who tested positive.
Alexa Ruiz, 10, gets her temperature taken by health care worker Jessica Gonzalez at the Epsperanza Health Centers' drive-thru COVID-19 testing pod on Dec. 20, 2021, in Chicago. The Ruiz family was there getting tested as a precaution following exposure to a classmate in CPS who tested positive. (Stacey Wescott / Chicago Tribune)

What about everyone else?

While there’s no testing-out-of-isolation option at this point, on Monday the CDC shortened the recommended isolation period for the general public from 10 days to five, provided symptoms have stopped or are resolving. The infected person should continue to wear a mask around others for another five days.

Why isn’t the highly sensitive PCR test used by health care workers who want to return to work early?

The PCR test is very good at detecting COVID-19 — in fact, a bit too good for this purpose, Landon said. You can continue to test positive for COVID-19 on a PCR test for months, even though you’re no longer sick or infectious.

Should I take a rapid COVID-19 test before visiting with friends and family?

That’s a good idea, Landon said. She and her relatives did that before a small gathering over the holidays. But it’s important to take the test right before the event, and to remember that the test isn’t perfect. It may pick up some asymptomatic COVID-19 cases, but it may miss some too. “This test isn’t going to make up for having gone to the bar and three Christmas parties,” Landon said.

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