COVID is everywhere again. Here’s what public health officials say you should do.

COVID-19 infections are on the rise again in Massachusetts in addition to flu and RSV cases.

And nearly four years after the world was seemingly shut down by the coronavirus, changing guidelines and new strains can make it confusing to know how best to avoid infection and what to do if your rapid test shows two lines. We asked two of the country’s top health officials to answer these common questions.

How prevalent is COVID in Massachusetts right now?

Wastewater continues to be one of the most reliable indicators of community levels of COVID-19. And by the end of December 2023, it’s not looking great.

“The concentration of COVID-19 in our local wastewater samples here in Boston is very high and continues to increase,” said Dr. Bisola Ojikutu, Boston’s Commissioner of Public Health and Executive Director of the Boston Public Health Commission. “In the last two weeks, we’ve seen about a 23% increase in our Boston samples.”

Another key metric that public health officials focus on is hospitalization rates.

“Our hospitals are overcrowded right now,” said Dr. Larry Madoff, medical director of the State Department of Public Health’s Bureau of Infectious Diseases and Laboratory Sciences. “Our hospitals are at or above capacity and there are waiting times in emergency rooms.”

This week, 16.7 percent of emergency room visits in the state were due to respiratory viral infections.

“That’s high,” Madoff said. “That’s as high as we’ve seen this season.”

So how do I avoid the disease?

One of the most important things you can do to protect yourself is to make sure you’re up to date on your COVID-19 vaccinations.

It’s probably a good idea to wear a mask, too.

“I know most people obviously don’t wear masks,” Ojikutu said. “However, masking is an important strategy that reduces the spread of respiratory viruses and can do so effectively if you mask appropriately when in crowded spaces.”

Do I really need another injection?

Probably, yes!

Statewide, only 18.1% of Massachusetts residents received the latest COVID-19 booster.

“If you have not been vaccinated since the end of August 2023, then you have not received the updated vaccine,” Madoff said.

In Boston, free vaccine clinics are available at the Bruce C. Bolling Building in Roxbury and at City Hall. More information is online here. Other vaccine locations can be found here.

What are the new variants of COVID?

One big reason to get vaccinated: The updated vaccine protects against newer variants of the virus, Madoff explained.

“The one that’s increasing the fastest is the one called JN.1,” he said. “Now all these variants are closely related to the omicron that was with us. And that’s good news because the updated vaccine continues to protect against these variants.”

JN.1 currently accounts for 44% of all COVID-19 cases in the United States. There is still limited data on this variant because it is so new, but the World Health Organization says it may be better able than previous variants to avoid previous immunity. Importantly, WHO has no reason to believe that this variant has a higher risk of causing severe disease.

Other common circulating variants are HV.1 and EG.5—also omicron relatives—although each has progressively reported fewer cases with the spread of JN.1.

Where can I get tested for COVID?

Rapid antigen tests are available at most pharmacies but are no longer covered by most insurance plans.

All households in the United States are eligible for four more free at-home tests from the federal government. The online order form for these free tests is here.

If I test positive, how long should I self-isolate?

These first five days are essential to stop the virus from spreading to others around you.

“And that means staying at home if at all possible and wearing a mask around household members,” Ojikutu said.

Many people will continue to test positive after the first five days. However, after that, if you have no symptoms or your symptoms improve, CDC guidelines suggest you can end isolation.

Until the 11th day, you should continue to wear a mask when you are among others indoors and in public places.

“[However]if someone tests negative on two separate home tests done approximately 48 hours apart, you can certainly remove the mask before the tenth day,” Ojikutu said.

What treatments are available for COVID?

If you are at least 50 years old or have an underlying health problem, you may be prescribed the antiviral treatment Paxlovid.

“Paxlovid is a very effective treatment,” Ojikutu said. “There was an almost 90% reduction in the risk of hospitalization and death in unvaccinated people in a clinical trial conducted by the NIH.”

COVID-positive patients can talk to their doctor about whether they should get a prescription for Paxlovid or get a free telehealth consultation from the state Department of Public Health.

Some patients may be frustrated that they do not qualify for a prescription for antiviral treatment. Madoff says there’s a reason it shouldn’t be prescribed to everyone.

“The purpose of Paxlovid and other antiviral treatments is not to make the disease go away, but to keep you out of the hospital and to keep you from dying from the disease,” he said. “And that’s what it’s been shown to do. And that benefit is really only for those who are at high risk of developing these complications.”

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