Should I test for COVID-19 (Coronavirus Disease 2019) and influenza if I have symptoms of sneezing and congestion for 1 week?

Testing Recommendation for Sneezing and Congestion Lasting One Week

Yes, you should get tested for COVID-19, and testing for influenza may also be reasonable depending on local prevalence and clinical context. While sneezing and nasal congestion alone are less typical presentations of COVID-19 compared to fever and cough, these symptoms can occur with COVID-19, and testing is warranted given the duration and potential public health implications.

Rationale for COVID-19 Testing

COVID-19 can present with nasal congestion and upper respiratory symptoms, though these are less common than fever and dry cough. The most common COVID-19 manifestations are fever, weakness, and dry cough, but a small fraction of patients present with nasal congestion and runny nose 1. Your symptoms have persisted for one week, which aligns with the typical COVID-19 timeline where symptoms can evolve over 3-7 days 1.

Key Testing Considerations:

• The Infectious Diseases Society of America (IDSA) recommends testing symptomatic individuals suspected of having COVID-19 1
• For symptomatic individuals, either antigen testing or nucleic acid amplification testing (NAAT) is appropriate 1
• Antigen tests should ideally be performed within 5 days of symptom onset for optimal performance 1
• If an antigen test is negative but clinical suspicion remains, confirm with NAAT (PCR testing) 1

Rationale for Influenza Testing

Testing for influenza is reasonable, particularly if you are in a high-risk group or if influenza is circulating in your community. Upper respiratory symptoms like sneezing and nasal congestion are actually more characteristic of influenza than COVID-19 2, 3. Influenza patients demonstrate significantly higher rates of upper respiratory symptoms and otorhinolaryngological symptoms compared to COVID-19 patients 2.

Important Clinical Distinctions:

• Influenza typically presents with more prominent upper respiratory symptoms (runny nose, sneezing, sore throat) 2, 3
• COVID-19 more commonly presents with neurologic symptoms, diarrhea, and loss of taste/smell 2, 4
• Coinfection with both viruses is rare (approximately 0.54% in one series) but possible 5

Practical Testing Approach

Start with COVID-19 testing given the ongoing public health importance and potential for transmission:

1. Obtain a rapid antigen test or NAAT for COVID-19 1

   • Anterior nasal swab is acceptable and can be self-collected 1
   • Results guide isolation decisions and potential treatment

2. Consider influenza testing if:

   • You are at high risk for complications (elderly, immunocompromised, chronic medical conditions) 1
   • Influenza is known to be circulating in your community
   • You have had known exposure to influenza
   • Antiviral treatment for influenza would be considered (most effective within 48 hours of symptom onset)

3. If COVID-19 antigen test is negative but suspicion remains high:

   • Confirm with NAAT/PCR testing 1
   • Consider repeat testing 24-48 hours later if symptoms worsen or new symptoms develop 1

Common Pitfalls to Avoid

• Don't assume it's "just a cold" without testing - COVID-19 can present with mild upper respiratory symptoms alone 1
• Don't delay testing beyond 5 days of symptom onset - antigen test sensitivity decreases with time 1
• Don't ignore the possibility of coinfection - though rare, both viruses can occur simultaneously 5
• Don't rely solely on symptom type to rule out COVID-19 - while upper respiratory symptoms are less common, they do occur 1, 2

Isolation Considerations

Regardless of test results, practice appropriate precautions:

• Isolate from others, especially high-risk individuals, until you know your diagnosis 1
• COVID-19 patients require longer isolation periods and have higher transmission potential than initially symptomatic influenza patients 3, 6
• Even asymptomatic or mildly symptomatic individuals can transmit COVID-19 1