In vaccinated and boosted people, breakthrough Covid-19 cases can often be quite mild, akin to an annoying cold; these relatively manageable symptoms can result in infected people dismissing a slightly scratchy throat and perhaps forgoing testing. The “what is a symptom” question is also impacting those who do test positive, with new federal guidelines relying on symptoms as a deciding factor in whether you go back to work or stay home after testing positive for Covid-19 — especially for essential workers and those who don’t have paid time off.
In December 2021, the Centers for Disease Control and Prevention changed its recommendations for isolation after a positive test, with the number of days someone must isolate being largely dependent on the presence of symptoms. Now, people who test positive but do not develop symptoms must isolate for just five days; if they remain asymptomatic, they can end isolation after five days (but continue to wear a mask around others at home and in public for another five days).
To help you better understand what “counts” as a symptom, Vox spoke to three experts.
“No symptoms” means you feel your best
Defined by the CDC as “when a person is infected with a virus and will never feel any symptoms at all,” asymptomatic has become a catchall phrase for those who feel fine and aren’t exhibiting any of the common markers of Covid-19 — lack of taste or smell, dry cough, fever — but still test positive and appear to be capable of spreading the virus.
In the age of omicron, when symptoms can be almost imperceptible, asymptomatic means absolutely no sniffles, coughs, or aches of any kind. “Asymptomatic means you feel in your best shape ever,” says Jorge Salinas, an assistant professor of medicine and hospital epidemiologist at Stanford University. “You are doing great. You feel amazing, nothing bothers you.”
Because community transmission is so high right now, it’s best to assume you’ve been exposed to someone who has Covid-19 if you’ve been to a public place recently, Salinas says. Everyone should act as though they’ve come in contact with the virus and are potentially infected, and if anything feels off beyond your normal aches and pains (like your chronic lower back pain or regular migraines), you should consider it a symptom.
Tolerance for pain or illness varies from person to person — what one person considers a mild cold might feel like a more disruptive flu to another — and a little throat tickle may not ping as “sick” to you in ordinary circumstances. But these aren’t ordinary circumstances. No matter the severity, any cough, sneeze, headache, or body ache should be viewed as a symptom.
“What we often find in people who are vaccinated and get Covid is they think they are asymptomatic but when you talk to them, they have had a slight cough they thought was allergies, they had a little bit of a runny nose, they had a little bit of a sore throat,” says John D. Goldman, an infectious disease specialist at University of Pittsburgh Medical Center. “There are a lot of people who either truly have no symptoms or have such minor symptoms that they don’t think that they’re sick enough to have Covid.”
One part of the problem is that medical professionals struggle to offer more concrete guidelines on how to categorize “asymptomatic.” “Currently, there are no data available to define ‘asymptomatic,’ which can be different in different people, given that many have chronic respiratory symptoms as baseline, from congestive heart failure to allergies,” says Michael David, assistant professor of medicine and epidemiology in the Perelman School of Medicine at the University of Pennsylvania.
The key is to determine any differences between how you feel on your best days and right now. However, experts admit, this comparison is no simple task. If you typically have a runny nose after biking to work in the cold, it’s difficult to gauge whether today’s runny nose is normal or an indicator of something more serious. “If you really start thinking about it, we all have a little thing here and there,” Salinas says. “It is exceedingly difficult to really say that somebody’s asymptomatic.”
Make sure you know what Covid-19 symptoms can look like
Knowing the signs of Covid-19 is crucial to monitoring your own symptoms, or lack thereof. According to the CDC, symptoms of Covid-19 include fever, shortness of breath, cough, loss of taste or smell, fatigue, body aches, headaches, sore throat, congestion, nausea or vomiting, and diarrhea. Omicron symptoms tend to stray slightly, with data out of South Africa indicating that people with omicron experience a scratchy or sore throat, nasal congestion, dry cough, and muscle pain, including low back pain. Other experts have said to look out for a runny nose and/or headache.
It’s also wise to take note of the overall number of symptoms you’re experiencing. “The more symptoms you have, the more likely it’s a respiratory infection,” Salinas says. A combination of sore throat, headache, and sniffles is likely not a coincidence.
While monitoring how you feel day-to-day can help you catch symptoms as they emerge, ironically, by thinking too much about how you’re feeling, you could start tricking yourself into manifesting symptoms. The combination of anxiety and overthinking can lead you to magnify every little ache and pain, Salinas says. The only way to know for sure is to get tested; if you’ve already tested positive, the best way to gauge your symptoms is to re-test five days after first testing positive.
If you need meds to manage your symptoms, you have symptoms
Congestion that you’re treating with DayQuil or a headache that necessitates taking pain relievers is a red flag you’re experiencing a symptom, Goldman says. Not only are you feeling less than your best, you’re also hiding that crucial information from your family, co-workers, roommates — and yourself.
“If you’re masking the symptoms, you’re more likely to go to work, you’re more likely to do things that will spread the disease,” he says. “Taking Tylenol, doing something to deal with the symptoms is certainly not going to hurt you. It may just be that you go outside and you aren’t aware you’re sick and spread it to someone else.” He recommends getting tested to confirm (insurance companies must now pay for eight at-home tests a month per family member and Americans will soon be able to order free at-home tests) and doing everything you can to avoid others while you feel sick.
Continue to rely on tried-and-true mitigation methods
For people who think they may be experiencing symptoms but need to leave the house, the safest way to move about society requires wearing a high-quality mask around others, Salinas says, and isolating to the extent that you can. At this stage in the pandemic, Americans desperately need universal paid sick leave and free and easily accessible testing; until that happens, individuals will unfairly remain responsible for interpreting their symptoms as best they can.
Unless you’re able to regularly test, take note of how you’re feeling every day and continue to mask up in public settings. If you feel healthy without pain relievers and cold medicines, considering your own circumstances and history, you can safely assume you’re without symptoms, experts say. Anything less than your best means you should take every sniffle, ache, or cough seriously.