A sore throat can absolutely be the only symptom of a COVID-19 infection, especially with current circulating variants. The virus’s presentation has changed significantly since the start of the pandemic, moving away from the previously common severe respiratory distress, fever, and loss of smell or taste. Current variants often cause an infection that feels more like a common cold, where a sore throat is frequently the first or even the sole noticeable symptom. This shift in presentation means any new onset of throat discomfort should be treated with caution until a proper diagnosis is made.
The Evolving Role of Sore Throat as a Primary Symptom
The prominent role of sore throat is a direct result of both viral evolution and widespread human immunity. Earlier strains caused more severe disease, often triggering a systemic inflammatory response leading to symptoms like high fever and profound fatigue. Current variants, however, tend to replicate more efficiently in the upper respiratory tract, meaning the throat and nasal passages, rather than the lungs.
This concentration in the upper airway makes localized inflammation, such as a sore throat, a much more common and earlier feature of the infection. Studies report that a sore throat is now one of the most frequently reported initial symptoms, often occurring in over 60% of cases. In many instances, this throat irritation is the only sign before other symptoms, like a runny nose or cough, develop, if they appear at all.
Prior immunity from vaccination or a previous infection also plays a role in modifying the symptom profile. The immune system is better prepared to fight the virus, often resulting in a milder, more contained illness resembling a typical upper respiratory infection. This effective immune response prevents the infection from progressing to the lower respiratory tract, which caused the more severe symptoms seen previously. For some people, this reduced severity means the sore throat remains the most significant, and sometimes the only, indicator of infection.
Distinguishing COVID Sore Throats from Other Causes
A sore throat is a common complaint, making it difficult to distinguish a COVID-related case from other respiratory illnesses like the common cold, influenza, or strep throat. Without definitive symptoms, such as the severe body aches typical of the flu or the white spots often seen with bacterial strep throat, an accurate diagnosis is impossible based on feeling alone. The sensation of a COVID sore throat can vary widely, sometimes presenting as a mild scratchiness, or as an intense, sharp pain with recent variants.
A common cold rarely causes a high fever, while influenza and COVID-19 frequently share symptoms like fever, fatigue, and muscle aches. Since both COVID-19 and the flu are viral, antibiotics, which treat bacterial infections like strep throat, will not be effective for either. Without laboratory testing, even a healthcare provider cannot visually confirm the cause of the infection.
The only reliable way to differentiate a COVID-19 sore throat from one caused by another virus or bacteria is through testing. Since many of these illnesses circulate simultaneously, a sore throat should be a prompt for testing to ensure correct isolation and treatment decisions are made. Relying on the presence or absence of other symptoms, such as the loss of taste or smell, is no longer a sufficient method for ruling out a COVID infection.
Actionable Steps and Testing Guidance
If you develop a sore throat, even if it is the only symptom, immediately assume it could be transmissible and take steps to limit contact with others. Testing is the most practical step for confirming the cause, allowing you to follow appropriate public health guidance for isolation. Over-the-counter rapid antigen tests are a convenient first option, but they are less sensitive than laboratory-based molecular tests, especially early in the infection.
A negative result on a rapid test should be viewed with skepticism, as the test may not detect the virus until the viral load is higher. Public health recommendations advise repeat testing in this situation. If your first test is negative, perform a second rapid antigen test 48 hours later.
If the second test is also negative, but your symptoms persist, a third test 48 hours after the second is recommended, or you should consider getting a more sensitive molecular test, such as a PCR. While awaiting test results, or if you test positive, you should isolate to prevent spreading the infection, especially to individuals at high risk for severe illness. If your sore throat worsens, is accompanied by a high fever that does not respond to medication, or if you experience difficulty breathing, seek immediate medical consultation. A healthcare provider can determine if you are a candidate for antiviral treatments, which are highly effective when started early in the course of the illness.