Enter the omicron sore throat, which is now among the chief complaints of people diagnosed with COVID-19. With omicron (and specifically its most most contagious version, BA.5) having displaced delta as the predominant variant, “it’s important for us to update our thinking about the most common symptoms,” says Panagis Galiatsatos, MD, an assistant professor of medicine and a pulmonary and critical care doctor at Johns Hopkins Medicine in Baltimore. What have experts learned about omicron sore throat, and what does it mean for people who are vaccinated and those who aren’t? Here are seven things to keep in mind if your throat starts hurting, and advice on how to get the pain relief you need. In a review of data from the U.K.-based Zoe Health survey, which compared delta and omicron symptom complaints, researchers found that a sore throat and a hoarse voice were among the top omicron symptoms. The analysis found that loss of taste and smell was less common with omicron than with delta, occurring in fewer than 1 in 5 people. Cough and sore throat also topped the list of most common symptoms in a U.K. national report released on September 30, 2022, with loss of smell, loss of taste, and shortness of breath less prevalent. Keep in mind that according to the data in both the survey and the report, many people infected with omicron don’t have a sore throat — or any symptoms at all. “It’s a predominant early symptom,” says Dr. Weisenberg, “but not every patient with omicron follows the same symptom pattern.”
2. Omicron Appears to ‘Live’ More in the Upper Airway and Less in the Lungs Than Earlier Variants
Unlike delta, omicron is more likely to populate the upper respiratory system. “This is a shift from earlier variants that replicated in the lower respiratory tract, in the lungs,” Dr. Galiatsatos says. This may be due to omicron’s many mutations, he suggests. This variant has approximately 50 mutations, around 30 of which have been identified on the spike protein — the part that attaches to human cells. Omicron’s prevalence in the upper airways may explain why it is more likely than earlier variants to cause a scratchy or sore throat as well as a runny or stuffy nose. There were some upper respiratory symptoms in delta and the other earlier variants, but not like we’re seeing with omicron, Galiatsatos says. The new location is part of what makes omicron so contagious, he adds. “If the virus is hanging out in the upper respiratory system, it’s probably easier for infected people to breathe it out, and easier to spread from person to person,” Galiatsatos says. “Keep in mind the COVID-19 vaccine isn’t meant to protect you from those symptoms — it’s really meant to protect you from severe disease,” he says. Weisenberg seconds that: “The main difference between the vaccinated and boosted and the unvaccinated is that the risk of severe disease is much higher in the unvaccinated.” Craig Spencer, MD, an assistant professor and emergency medicine physician at the Columbia University Medical Center in New York City, frequently tweets about what he sees while treating COVID-19 patients in the ER. In his experience, unvaccinated people tend to have more severe symptoms or a more dangerous course of COVID-19, whereas vaccinated and boosted patients who get COVID-19 typically have mild symptoms. “By mild I mean mostly sore throat. Lots of sore throat. Also some fatigue, maybe some muscle pain. No difficulty breathing. No shortness of breath. All a little uncomfortable, but fine,” Dr. Spencer tweeted as the first wave of omicron began to hit the United States in December 2021. In his dealings with patients, Galiatsatos has found that symptoms like sore throat and runny nose tend to linger for a longer period in individuals who aren’t vaccinated. “I’ve had unvaccinated patients have these symptoms for 10 to 14 days, whereas for vaccinated people they’re usually doing much better within a week,” he says. The good news is that, in general, symptoms of omicron seem to go away faster than those of earlier variants, especially in people who are vaccinated and boosted. A study published in April 2022 in The Lancet found that in individuals with three vaccine doses, omicron symptoms went away after about four days, compared with almost eight days in people who had a delta-era infection. In people who received only the initial vaccine series with no booster, symptoms lasted roughly eight days from omicron, compared with a little more than nine days from delta.
4. Sore Throats Aren’t Always Due to Omicron
COVID-19 aside, throat pain may also be due to the common cold, flu, or strep throat, according to Mayo Clinic. Unfortunately, there’s no way to know what kind of infection you have without testing, according to R. Scott McClelland, MD, MPH, a professor of medicine, epidemiology, and global health and a clinical attending physician in infectious diseases at UW Medicine in Seattle. “Even a specialist in infectious disease can’t determine that,” he says.
5. If You Have a Sore Throat, It’s Safest to Assume It’s COVID-19
Although many of us have been trained to think of a sore throat as no big deal (as children, we were usually shipped off to school unless we also had a fever), COVID-19 requires a change of mentality. People who have any flu- or cold-like symptoms should assume they have COVID-19 “until proven otherwise,” said Chicago’s Department of Public Health commissioner, Allison Arwady, MD, in a Facebook Live interview in January 2022. “Even if it’s a sore throat, no matter what it is,” said Dr. Arwady. “I’ve told my own staff this, it’s what I do myself … if you are sick, even a little bit sick, stay home. More true than ever right now because [if you’re] sick, even a little bit sick, until proven otherwise with a test — that’s COVID. That’s how we treat it, that’s how you should treat it.”
6. Over-the-Counter Pain Relievers and Home Remedies Can Help Your Sore Throat
There’s no medicine that can cure a COVID-19 sore throat, but there are things you can do to reduce your discomfort, says Galiatsatos. “For symptom relief, it’s appropriate to take a pain reliever — acetaminophen does a great job. It’s also important to stay well hydrated,” he says. Home remedies may also help. Gargling with salt water or drinking warm water or tea mixed with honey or warm water with lemon juice can all relieve pain, according to Penn Medicine. If your symptoms are mild or moderate but you’re at high risk of developing severe illness, drugs such as Paxlovid (nirmatrelvir and ritonavir) can help keep you out of the hospital. You’ll need to begin taking the medication within five days of the onset of symptoms like sore throat — the sooner, the better.
7. Taking an At-Home Test to See if That Sore Throat Is COVID-19? Follow the Instructions That Come With Your Test
The CDC recommends testing as soon as symptoms develop or, if you don’t have symptoms, at least five days after exposure to someone with COVID-19. That should give ample time for the body to develop a viral load that can be detected by a test, according to the agency. If your first test is positive, there’s no need to take another test; assume the result is correct and that you have COVID-19. But if you have symptoms or a known exposure and you get a negative result, you should test again 48 hours after the first negative test, for a total of at least two tests, per U.S. Food and Drug Administration (FDA) guidance. At-home COVID-19 test manufacturers emphasize the importance of following instructions precisely in order to get an accurate result. But in the omicron era, some people — including some infectious disease experts — are “hacking” the kits by swabbing not just their nostrils, as directed, but also their throats. In some countries, including Canada, people who suspect they have COVID-19 can purchase at-home testing kits (PDF) that analyze a sample from both the nose and the throat. In the United States, the only FDA-approved at-home antigen tests use a nasal swab. Because of potential safety issues and concerns about inaccurate results, among other worries, the FDA issued this tweet in January 2022: “Please don’t go sticking that #COVID19 testing swab down your throat. Use swabs as instructed: via the nose.” In a September 2022 update, the American Academy of Pediatrics echoed that guidance, stating that “there are no robust data suggesting that oral samples should be preferred over nasal samples for any SARS-CoV-2 variant” (SARS-CoV-2 is the COVID-19 coronavirus),” and that people should collect samples according to the instructions that come in the box with the test.
