Tested positive for flu during the holidays? Here’s what you should do

By Jacqueline Howard, CNN

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

Flu activity is already rising across the country. In the week ending December 13, roughly 4% of visits to health care providers were for respiratory illnesses, and nearly 10,000 patients were hospitalized with influenza, according to the latest data from the US Centers for Disease Control and Prevention, released Friday. So far, three children already have died from flu-related causes this flu season.

Those numbers mean the virus may be closer to home than many families realize. Holiday gatherings could include someone just recovering from the flu, or someone beginning to feel sick. Should they still show up to open presents on Christmas morning? How long should a visit be postponed before heading to grandma’s to bake cookies?

As flu cases climb, here are the flu-related rules families should know this holiday season.

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

There are several over-the-counter flu tests 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 experience 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, Dr. Pamela Lindor, a pediatrician at Bluebird Kids Health in Jacksonville, Florida, said in an email.

While 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.

Testing is key because once it is determined which respiratory illness you have, you can then receive 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.

At what point 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 flu 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, for 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 not spread 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 said. “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 for gatherings?

Some people who have symptoms or fever might be tempted to still visit family or open Christmas gifts with loved ones, as long as they wear a mask, but Schaffner still warned 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?

While someone with flu should take precautions to isolate themselves and not expose others, 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 they are not yet 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 may travel home for Christmas to visit their grandfather. The next day, after they have already visited their grandfather, 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 once you test positive for flu and experience 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.

“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.

“That’s a holiday present to you and to everyone else around you,” he 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.”

Lindor said that overall, the best way to avoid having the flu disrupt family gatherings during the holidays is “for all family members to get their flu vaccine early in the flu season each year.”

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