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You’re not feeling so hot. Is it a cold or COVID-19?

A health worker took a swab sample from a resident at a Covid-19 drive-through testing site.
A health worker took a swab sample from a resident at a Covid-19 drive-through testing site.SAEED KHAN/AFP via Getty Images

You wake up with a cough and a headache, and you start to worry: Is this a cold or COVID-19? With a rising number of cases in Massachusetts, many are wondering when is the right time to get tested.

Public health officials and researchers say COVID-19 tests remain the surest way to evaluate symptoms consistent with respiratory viruses. That’s true even for vaccinated people, who generally develop milder symptoms in the rare cases in which they contract the virus.

“Unfortunately, without a diagnostic test, there are no specific signs or symptoms that can differentiate COVID from some of the other respiratory viruses, including the flu — influenza — or some of the other viruses that are circulating now and are sure to be circulating even more in the fall and the winter,” said Dr. Daniel Solomon, an infectious disease physician at Brigham and Women’s Hospital.

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So if I have symptoms, should I get tested?

Yes. Public health officials advise that anyone should stay home and get tested if they develop any symptoms that can come along with COVID-19, even if they’re mild.

Symptoms listed by the Massachusetts Department of Public Health include fever, chills, cough, shortness of breath, fatigue, sore throat, headache, body aches, and a new loss of taste or smell. Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, are less common signs but still may present during infection.

Other symptoms may include “COVID toes,” which can present as painful lesions on toes. Older adults or chronically ill people may also be impacted by alterations in mental status or blood glucose control, according to the DPH.

Solomon said people should “absolutely” get tested if they experience symptoms. He said testing will play a “really important role” in how COVID is managed in the fall.

“People may choose to act differently if their symptoms are due to COVID, even if they’re not really sick, because of the potential for transmission, and the potential for other people in our community to get really sick,” he said. “So having a test is going to be really useful for allowing people to make important decisions about their lives.”

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The US Centers for Disease Control and Prevention advise people who test positive for COVID to isolate at home, monitor their symptoms, and wash their hands and any other “high-touch” surfaces regularly. People who have had symptomatic cases can generally be around others 10 days after their symptoms first appeared, if they have had 24 hours without a fever and their other symptoms are improving.

Do I need to get tested if I’m vaccinated?

Yes again. The vaccines are highly effective at preventing infection, Solomon said, but even fully vaccinated people can get infected and spread COVID.

“Getting tested … will be very helpful to help people make choices about activities that they engage in and people that they see,” Solomon said. “Even though [vaccinated] people are protected, and most people who get vaccinated are not going to get very sick, it can help people make choices about their lives.”

It’s rare for vaccinated people to get COVID-19, but when they do, they typically have mild symptoms that don’t lead to hospitalization or death, according to the University of California Davis Health System. Most people will experience cold symptoms — such as cough, fever, and headache — and a loss of smell.

In Massachusetts, 0.18 percent of fully vaccinated people have had a breakthrough case of COVID-19, according to DPH data released Tuesday. An even smaller percentage of vaccinated individuals have been hospitalized or died.

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A DPH spokesperson wrote in an e-mail that “anyone who has COVID-like symptoms should stay home and seek testing.”

Can I use an at-home COVID test, or do I need to go to a testing site?

While there is “no wrong door for testing,” Solomon said he was a “big proponent” of at-home tests because of how widely available and quick they are at delivering results. He said they’re particularly useful when trying to determine whether people with mild symptoms have a cold or COVID-19.

Solomon said he recently gave his young son an at-home test when he had a runny nose. After receiving a negative test, his son was able to visit his grandmother.

“Having those at-home tests can take people who have mild symptoms and allow them to feel more comfortable with some of the choices that they make,” he said.

The US Food and Drug Administration has authorized several at-home testing kits. Solomon said he hopes these kits can become even cheaper for more people to use: Depending on the kind of at-home test people purchase, they can run for anywhere around 25 to 55 dollars.

The PCR test, a molecular diagnostic test that is very accurate, is not available for direct at-home testing, but people can collect samples at home to send to a lab as part of a home collection kit. Or they can look on the DPH website for a testing site, where they can often receive testing for free.

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What is a good at-home COVID-19 test?

Solomon said all of the FDA-approved at-home COVID tests are “really useful” for people who have mild symptoms and are trying to decide whether to go to school or work.

He recommends antigen tests, which test for a protein on the surface of the virus. Antigen tests are “exactly what you need in this scenario” because they are a good marker of active infection, Solomon said.

“When used correctly, the antigen test can actually identify people who have a lot of active live virus, and those are the people who will be most infectious to others,” Solomon said.

How many people are getting tested in Massachusetts?

The state’s Department of Public Health has recorded a slight increase in testing this summer amid growing concerns around the spread of the Delta variant, and testing has also increased at the national level in recent weeks. Still, the number of tests hasn’t hit the heights seen before vaccines were rolled out.


Alexandra Chaidez can be reached at alexandra.chaidez@globe.com.