Tested positive for flu this holiday season? Here’s what you should do

By Jacqueline Howard, CNN

(CNN) — As millions of Americans hit the road or took to the skies for the holidays, another seasonal traveler is picking up speed: influenza.

The US Centers for Disease Control and Prevention estimates that there have been at least 7,500,000 illnesses, 81,000 hospitalizations and 3,100 deaths from flu this season, according to an update published Tuesday with data through December 20. At least eight children have died from flu this season.

Those numbers mean the virus may be closer to home than many families realize. Holiday gatherings could easily have included someone just recovering from the flu or someone beginning to feel sick. Should they still show up to the New Year’s Eve party? How long should a visit be postponed before heading back to school or work?

As flu cases climb, here are the flu-related rules that families should know.

If I’m having symptoms, when should I take a flu test?

Several over-the-counter flu tests are available in the United States, and they can be taken at home as a nasal swab, similar to Covid-19 tests.

Many doctors recommend taking a test as soon as you notice symptoms – “particularly if you’re a person in a high-risk group,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center.

“Those persons are people who are age 65 and older, anyone who has a chronic underlying medical condition, if you’re immune-compromised, if you’re a pregnant person and very young children,” he said. “Those are all people who are in high-risk, and once they have symptoms, that’s the time to get tested, because we would have antivirals available to help keep you out of the hospital.”

Flu symptoms usually start suddenly with fever, chills, headache, body aches and fatigue, said Dr. Pamela Lindor, a pediatrician at Bluebird Kids Health in Jacksonville, Florida.

Although you should quickly start treatment and avoid exposing others when you test positive for flu, “if the over the counter test is negative but your symptoms are severe, consider getting a more accurate test from your doctor or urgent care center,” she said in an email.

Testing is key because once it’s determined which respiratory illness you have, you can get the appropriate treatment, Schaffner said.

“Flu is not the only illness we’re concerned about. Maybe you have Covid, and if you have Covid, we have another medication that could help keep you out of the hospital,” he said.

When should I take antiviral medications for flu?

Flu antiviral drugs, such as Tamiflu or Xofluza, are prescription medications, and they work best when started early, ideally within two days after symptoms begin.

“For the flu, if you are ill, the sooner you begin the antiviral, the more effective it is,” Schaffner said. “There is the 48-hour rule. That is, for it to be maximally effective, you have to initiate treatment within the first 48 hours after you get symptoms. But even after 48 hours – and this is especially true for high-risk people – you can still have some modulating effect of the antivirals.”

If I test positive, how long should I avoid contact with others?

As soon as someone starts to show symptoms, they should stay home and avoid contact with other people to avoid spreading the virus.

“You’re capable of transmitting the influenza virus the day before you get symptoms,” Schaffner said. “But nonetheless, wear a mask and avoid other people in your family as much as possible until your symptoms start to abate and you’ve had no fever for 24 hours without using Tylenol.”

According to the CDC, people can return to their normal activities when, for at least 24 hours, they have not had a fever without using fever-reduction medication and their overall symptoms are improving.

“This will usually be at least 4-5 days,” Lindor wrote. “Flu is most contagious starting the day before symptoms develop and continuing for about one week.”

If I’m wearing a mask, can I still be around people?

Some people who have symptoms or fever might be tempted to get together with others or go about their usual routines as long as they wear a mask. Schaffner still warns against it.

“If you’ve developed symptoms, I think you’ve got to stay home,” Schaffner said.

“Even if you say, ‘Well, I have these symptoms, but I’ll wear a mask.’ Yes, that will reduce the chance of spreading but not reduce it to zero. And guess what? It’s very hard to eat and drink with a mask on,” he said. “So you will indeed be exposing people. And when you get to family members, even when you wear that mask, they’ll be hugging and kissing. These are very close circumstances, so you’ve got to restrain yourself and separate yourself, otherwise you are very much in danger of becoming a dreaded spreader.”

What should household members do if someone else in the home tests positive?

Someone with flu should take precautions to isolate themselves and not expose others, but there are important steps their household members also can take to reduce their risk of getting sick.

“Good handwashing is very important to prevent spread,” Lindor said. “Common surfaces in the house should be disinfected.”

Can I take antivirals to prevent getting sick?

Some doctors may prescribe antiviral medications to people who have been exposed to someone with flu but who are not showing signs or symptoms themselves, especially if that person is in a high-risk group.

“Tamiflu can be prescribed to people who have been exposed to the flu, and is usually taken for 7-10 days to prevent infection,” Lindor said. “Xofluza can also be used prophylactically, and only one dose is needed, for adults and children 5 or older.”

For example, a 22-year-old college student travels home to visit their grandfather. The next day, they test positive for the flu.

“Their grandfather is obviously in a high-risk group. Should the grandfather take Tamiflu for five days? That’s not a bad idea,” Schaffner said. “In that circumstance, it could very well avert the influenza infection.”

When do I know whether to go to the hospital?

It’s important to stay in contact with your doctor if you test positive for flu and have worsening symptoms, especially if you are in a high-risk group, Schaffner said.

And with your doctor, “have those discussions about when it is that you need to go to the hospital,” he said. “But difficulty breathing, coughing up blood, really feeling terrible, temperatures of 103 or higher – all of those things are indicators that you really need medical attention.”

Some other “warning signs” that may require urgent medical attention include “dehydration, chest pain, lethargy, mental status changes, seizures or severe weakness,” Lindor said. “Confusion, behavior changes, or high persistent fever for over 3 days also warrant urgent medical attention.”

Is it too late to get a flu shot?

There is still time to receive your seasonal flu shot if you haven’t already.

“It’s not too late to get your flu shot,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It doesn’t guarantee you won’t get flu. It doesn’t guarantee that you still won’t get sick, but it surely is a big improvement on what the otherwise outcome could be, of either being seriously ill or dying.”

The CDC recommends that everyone 6 months and older get a flu vaccine each season, but vaccination rates have been decreasing in recent years. Data suggests that only about 17% of children and 23% of adults had gotten their seasonal flu vaccine by the end of November.

“For all those people out there who are still well, if you haven’t been vaccinated, please get the vaccine. Don’t linger,” Schaffner said.

“There’s more than one kind of influenza virus out there, and the vaccine helps prevent serious disease due to three different types of influenza virus.”

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