As the Omicron variant of COVID-19 surges around the country, we’re seeing increases in infections, even among people who’ve been fully vaccinated and have what are called breakthrough infections. As case counts surge, so does demand for testing. As an infectious diseases expert and a hospital epidemiologist, here’s what you should know about when to get a COVID-19 test, what kind you should use, what to do if you can’t get one at all and why it’s still important to get vaccinated and boosted.

Who Should Get Tested for COVID-19?

If you are experiencing any symptoms that the Centres for Disease Control and Prevention (CDC) has identified for COVID-19, you need to get tested.

• What are the symptoms of COVID-19? People with COVID-19 can have mild symptoms to severe illness. Symptoms can appear two to 14 days after being exposed to the virus. Symptoms can include cough, shortness of breath or difficulty breathing, fever or chills, muscle or body aches, sore throat, headache, nausea or vomiting, diarrhoea, runny nose or stuffy nose, fatigue, recent loss of taste or smell. Children have similar symptoms to adults and generally have mild illness.
• In certain situations, it is recommended that you to be tested if you do not have symptoms if you are a health care worker, first responder, congregate care facility resident or staff (includes nursing homes, assisted living facilities, managed residential communities, correctional institutions), homeless, or living in communities at high risk. Some of these situations include being exposed to someone with COVID-19 without adequate protection or detection of asymptomatic spread during an outbreak.

When Should I Get A COVID-19 Test?

• You have COVID-19 symptoms. It is especially important if you are at higher risk of severe illness to get a test so you can access treatment earlier.
• You are at higher risk of severe illness and have been recently exposed to someone with COVID-19. Early diagnosis means you can access treatment earlier.
• You are a household contact or have had a high or moderate risk exposure to someone with COVID-19. This will help you know if you have COVID-19 sooner.

You do not need to test or self-isolate if you have had COVID-19 and have finished self-isolating in the last 12 weeks unless you have symptoms. If you are at higher risk of severe illness and have any new symptoms after you have finished self-isolating, you should get a PCR test (nose and throat swab). You should talk to your doctor as your doctor may also recommend a test for other respiratory viruses such as influenza.

Who is at Higher Risk of Severe Illness?

• People aged 60 years and older
• Pregnant women
• People with obesity, diabetes, serious cardiovascular disease, chronic lung disease (including severe asthma requiring hospitalisation in last 12 months), severe chronic liver or kidney disease, active cancer or who are immunocompromised
• Some people with a disability including those with a disability that affects their lungs, heart or immune system
• Residents of aged care and disability care facilities
• People aged 18 years and older who are unvaccinated

Older age is a risk factor for serious illness, particularly when combined with significant underlying health conditions.

What COVID-19 Test Should I Get?

If you are at higher risk of severe illness you should get a PCR test as they are more accurate. There are early treatments available for COVID-19 such as antiviral medication that can work best if they are taken within 5 days from when your symptoms start. If you can’t get a PCR test result quickly, do a rapid antigen test while you wait for the PCR test result. If you are at higher risk of severe illness, plan ahead. Speak to your doctor now about antiviral or other early treatment for COVID-19 so you understand your options if you test positive.

If you are not at higher risk of severe illness, do a rapid antigen test unless you have arrived from overseas and have COVID-19 symptoms, or your doctor tells you to have a PCR test. If you are an international arrival, you should monitor closely for symptoms of COVID-19 after arrival. If you develop symptoms, get tested for COVID-19 and self-isolate until you receive a negative result. If your symptoms have started within 14 days of arriving in Australia, a PCR test is preferred. Specific testing advice is available for residents of aged care facilities. Speak to your residential aged care provider if you have questions.

What Do I Do with the Results?

PCR tests

• If you have a positive PCR test result, even if you don’t have symptoms, you have COVID-19. You must follow the advice for people testing positive to COVID-19 and managing COVID-19 safely at home.
• If you have a negative PCR test result you do not currently have COVID-19. If you have been recently exposed to a person with COVID-19, you need to continue to follow the self-isolation advice for people exposed to COVID-19 as you may still be developing the infection.
• Some pathology providers test for multiple viruses and may send you test results for Respiratory Syncytial Virus (RSV), influenza and COVID-19 at the same time.

I’m Vaccinated and Boosted. Why did I Still Get COVID-19?

COVID-19 vaccines and boosters are hugely valuable. In addition to providing protection from the virus, vaccines and boosters reduce the chances of serious illness, hospitalization and death. But people can still get infected when they’re fully vaccinated and boosted. This may be because the vaccine’s protection has decreased over time or because a new variant (like the Omicron variant) is better at getting around the vaccine’s protective properties.

COVID-19 infections in fully vaccinated people are called breakthrough infections, which usually result in milder symptoms versus infections in the unvaccinated. Your body’s memory B cells and T cells, which developed after your vaccine, respond quickly to stop the infection and prevent severe damage. Immunocompromised people may not have strong B cell- and T cell-immunity even after vaccination, so they remain at higher risk. If you are immunocompromised and have a breakthrough infection, you should contact your doctor even if you only have mild symptoms.

Unvaccinated people don’t have existing antibodies or memory B cells or T cells waiting to fight off COVID-19, so they have to start their immune response from scratch if they become infected. Infections typically cause more damage to their organs and tissues, which can lead to complications like having low oxygen levels, as well as problems with the lungs, kidney and heart. Unvaccinated individuals are also much more likely to need intensive care support or have lingering symptoms known as long COVID-19.

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Do COVID-19 Booster Shots Offer Added Protection against The Omicron Variant?

Boosters offer the best protection from catching Covid, but they aren’t perfect. Scientists are still gathering data on the effectiveness of vaccines against Omicron, but existing data show people who are vaccinated and boosted have additional protection and are less likely to be hospitalized than those who are unvaccinated