COVID case numbers are climbing again this September, with infections growing across most US states and wastewater levels high in many of them. What has changed is not just the amount of virus but the way it announces itself. The symptom most people still screen for, losing taste and smell, is now uncommon. Two others have taken its place. If you are trying to work out what you have, this is what the current wave looks like.
Several descendants of the Omicron family are sharing the season rather than one variant sweeping the board. Recent surveillance puts SW.2 in front at roughly a fifth of cases, followed by XFG.1.1 and RW.1.1, with BA.3.2 accounting for a meaningful share and showing up in wastewater across more than thirty states.
The practical implication of a mixed field is that no single symptom list will fit everyone. What follows is the pattern clinicians are seeing most often, not a rule.
A severe sore throat. Patients describe it as razor-like, sharp enough to make swallowing genuinely unpleasant, and it is often the first thing they notice. It is frequently worse than the cough.
Stomach upset. Nausea, diarrhoea and general gastrointestinal misery are turning up far more than most people expect from a respiratory virus, and they lead a lot of people to assume food poisoning.
Around those two, the familiar list still applies: fever, chills, body aches, headache, fatigue, congestion and a runny nose.
Early in the pandemic, losing taste and smell was close to diagnostic. It is now reported far less often. The virus has changed in ways that appear to affect the tissue involved differently, and populations now have layers of immunity from vaccination and previous infection that shape how illness presents.
The practical consequence is worth stating directly: you cannot rule out COVID because you can still smell your coffee. A lot of people are doing exactly that this autumn.
If you are in a group at higher risk of severe illness, meaning older adults, people who are immunocompromised, pregnant, or living with heart, lung, kidney or metabolic conditions, testing early is what makes antiviral treatment possible, because those treatments work best when started within the first days of symptoms.
Two timing notes that save wasted tests. A rapid test taken on the first day of symptoms is often negative even when you are infected; if symptoms continue, repeat after 24 to 48 hours. And because flu and COVID are circulating together with overlapping symptoms, a negative COVID test does not mean you do not have something worth treating.
If you are unsure what your symptoms add up to, a structured symptom check will take you through the questions a clinician would ask and tell you whether this looks like something to manage at home.
The 2026-2027 COVID vaccine formula is a monovalent XFG vaccine, updated to be closer to what is actually circulating. Eligibility and access rules differ by country and have changed more than once, so check what applies where you are rather than assuming last year's rules hold.
If you have recently had COVID, there is usually a recommended interval before vaccination. Ask rather than guess, because the interval has changed over time.
Infectiousness generally begins a day or two before symptoms and is highest in the first few days after they start. Current guidance in most places is built around symptoms rather than a fixed number of days: stay home while you are feeling unwell and until you have been fever-free for 24 hours without medication, then take precautions such as masking and avoiding vulnerable people for several days afterwards.
Some people continue to test positive for a week or more after feeling better. A faint line on a rapid test late in the illness is not the same level of risk as a strong line on day two, but if you are visiting someone frail or immunocompromised, it is a reason to wait or to mask.
Most people recover fully. A minority develop symptoms that persist for months, most commonly fatigue that is out of proportion to activity, breathlessness, brain fog and a racing heart on standing.
Two things are worth knowing. Vaccination appears to reduce the risk, which is a benefit separate from avoiding acute illness. And pushing hard through the recovery period, returning to full work and full exercise while still exhausted, is associated with a worse course. Coming back gradually is not indulgent, it is the safer approach.
If fatigue is still dominating your life weeks after the infection cleared, that is a reason to see a doctor rather than to wait longer, because several treatable conditions, including anaemia, thyroid problems and iron deficiency, look very similar and are worth ruling out.
Seek urgent care for difficulty breathing or breathlessness at rest, chest pain or pressure, confusion or difficulty waking, bluish lips or face, an inability to keep fluids down, or a marked deterioration after a period of improvement.
Be alert too if you live with a long-term condition and your usual baseline shifts: a person with heart failure whose breathlessness changes, or someone with diabetes whose glucose readings become erratic during an infection, needs advice sooner than an otherwise healthy person with the same temperature.
Rest genuinely matters, and so does fluid, particularly with the gastrointestinal presentation that is common this wave. Paracetamol or ibuprofen will help fever and aches if they are suitable for you. For a sore throat this severe, warm drinks, lozenges and salt-water gargles are modest but real help.
Return to activity gradually. Pushing back to a full schedule the moment the fever breaks is a reliable way to extend the tail of fatigue.
COVID is rising this autumn with a mixed field of variants, and the presentation has shifted: a severe sore throat and stomach upset are doing the work that loss of taste and smell used to do. Do not rule it out because your sense of smell is intact. If you are at higher risk, test early enough for treatment to be an option, and check what this season's updated vaccine means for you.
This article is for general education and is not a substitute for professional medical advice. Variant patterns and vaccine recommendations change; check current guidance from your local health authority.
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