If you test positive for COVID-19, the most important first step is to stay home and away from others until your symptoms clear. Most people recover at home with rest and basic over-the-counter medicines. But some people qualify for prescription antiviral treatment that can prevent the illness from becoming severe, and the window to start it is narrow: within five to seven days of your first symptoms.
How Long to Stay Home
The current guidance treats COVID like other respiratory illnesses. Stay home and avoid contact with others until you’ve been symptom-free, including fever-free, for at least 24 hours without using fever-reducing medicines like acetaminophen or ibuprofen. This isn’t a fixed five-day clock anymore. Your symptoms set the timeline.
Once you feel better, wear a mask and limit close contact with others for at least five more days. You’re still potentially contagious during this period even if you feel fine. If you live with other people, try to sleep in a separate room if possible, use a separate bathroom if you have one, and keep shared spaces well ventilated by opening windows or running fans.
Who Should Seek Antiviral Treatment
If you’re 50 or older, or have certain underlying health conditions, you’re eligible for antiviral treatment that can significantly reduce your risk of hospitalization. The critical detail: you need to start treatment within five to seven days of your first symptoms. Don’t wait to see if you get worse. Call your doctor or a telehealth provider the same day you test positive.
The list of conditions that put you at higher risk is broader than many people realize. It includes:
- Diabetes (type 1 or type 2)
- Heart conditions (heart failure, coronary artery disease, possibly high blood pressure)
- Chronic lung disease (moderate-to-severe asthma, COPD, pulmonary hypertension)
- Obesity (BMI of 30 or higher)
- Overweight (BMI of 25 to 29.9)
- Cancer
- Chronic kidney disease at any stage
- Chronic liver disease
- Weakened immune system (from medication, organ transplant, or conditions like HIV)
- Pregnancy
- Smoking (current or former)
- Mental health conditions (including depression and schizophrenia spectrum disorders)
- Physical inactivity
- Neurological conditions (including dementia)
- Substance use disorders
Even if you’re not sure whether your condition qualifies, it’s worth calling. The prescribing decision is based on your provider’s overall assessment of your individual risk. People aged 12 and older (weighing at least 88 pounds) with mild-to-moderate symptoms and at least one risk factor generally qualify.
Managing Symptoms at Home
Most people with COVID have mild illness and recover without prescription treatment. Acetaminophen and ibuprofen both help with fever, body aches, and headache. Stay hydrated, rest, and monitor your symptoms. A sore throat, congestion, cough, fatigue, and mild body aches are all typical and usually resolve within a week or two.
Keep a thermometer handy and check your temperature a couple of times a day. If you have a pulse oximeter, use it. Oxygen levels at or above 95% are normal. A sustained reading below 92% is a reason to seek care.
Symptoms That Need Emergency Care
Most COVID infections stay mild, but certain warning signs mean you should get medical help immediately, not wait for a scheduled appointment. Go to the emergency room or call 911 if you experience:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in your chest
- New confusion or inability to stay awake
- Bluish lips or face
These signs can indicate that your oxygen levels are dropping or that the infection is affecting your heart or brain. They can develop suddenly, even several days into what seemed like a mild case.
When You Can Confidently Stop Isolating
Rapid antigen tests can help you gauge whether you’re still contagious. The FDA recommends two negative antigen tests taken 48 hours apart if you’ve had symptoms. If you never had symptoms but tested positive (say, from an exposure), you need three negative tests spaced 48 hours apart to be confident the infection has cleared.
A single negative rapid test isn’t fully reliable on its own, which is why the two-test (or three-test) approach matters. If your first test is negative but you still feel sick, you likely still have the virus. Wait 48 hours and test again.
What About Rebound After Treatment
Some people who take antiviral treatment notice their symptoms return a few days after finishing the course. This is sometimes called “Paxlovid rebound,” but it happens in untreated people too. A large CDC review found that rebound rates were roughly similar whether or not someone took antivirals: about 4.5% to 6.6% in one major study. Some smaller studies found higher rates in treated patients (10% to 14%), but randomized trial data showed nearly identical rebound rates in both groups (2.3% treated vs. 1.7% untreated).
If your symptoms come back after improving, treat it like a new round of illness. Stay home again until you’ve been symptom-free for 24 hours, and resume masking for five days after that. Rebound episodes are generally mild and haven’t been linked to hospitalization or death in the studies reviewed.
Work and Sick Leave
There is no federal law requiring private employers to provide paid COVID sick leave in 2024 or 2025. The emergency-era federal mandates have expired. Your options depend on your employer’s policies, your state’s laws, and your type of employment. Several states and cities still have their own paid sick leave requirements, so check your local labor department’s website.
Federal employees are in a different position. Agencies must grant sick leave when an illness like COVID prevents an employee from working. Federal workers can self-certify their absence, though agencies can require a medical certificate for absences longer than three days. Up to 240 hours (30 days) of advanced sick leave can be granted if the employee’s presence at work would jeopardize others’ health due to a communicable disease. For caregiving, up to 104 hours (13 days) can be advanced to care for a family member in the same situation.
Reducing Your Risk of Long COVID
Not everyone who gets COVID recovers quickly. Research from King’s College London identified three factors that predict who is most likely to develop lingering symptoms lasting weeks or months: older age, female sex, and a high number of different symptoms during the first week of illness. Their prediction model correctly identified about 69% of people who went on to develop long COVID. Higher BMI and a history of asthma also increased the risk, though no other underlying conditions showed a clear link.
You can’t control your age or sex, but getting antiviral treatment early (if you qualify) and resting fully during the acute phase are the most practical steps you can take. Pushing through symptoms to get back to work or exercise before you’ve truly recovered isn’t worth the tradeoff.