We're four years into the COVID-19 pandemic, and by this point, most Americans have had the coronavirus at least once. But when the virus comes for us (again), it can still feel just as alarming as our first bouts.

Here's a guide to what COVID looks like now and how to treat it.

Symptoms

The most common COVID symptoms haven't changed much since the start of the pandemic, and they remain consistent for the latest dominant variant, JN.1, said Dr. Soniya Gandhi, the associate chief medical officer at Cedars-Sinai Medical Center in Los Angeles. They include fatigue, sore throat, congestion, runny nose, headache, body aches and cough.

"All or any of those in isolation can still be COVID," Gandhi said.

Some people may develop conjunctivitis, also known as pink eye, or experience gastrointestinal issues, such as nausea, vomiting and diarrhea, but those symptoms are rarer. Anecdotally, experts said, one of the most notable symptoms early in the pandemic — the loss of taste and smell — also appears to be less common these days.

"The biggest change is that people are having milder symptoms overall," said Dr. Amanda Casto, an acting assistant professor of allergy and infectious diseases at the University of Washington. That's because virtually everyone has some preexisting immunity from vaccines, a prior infection or both.

While COVID is mild for most people, it can be dangerous and even fatal for some. Data from the Centers for Disease Control and Prevention indicated that, as of mid-February, more than 21,000 people were hospitalized with COVID, and there had been roughly 10,000 COVID-related deaths in 2024.

Severe illness is a lot less prevalent now than during the first few years of the pandemic, "but we're still seeing it," said Dr. Stuart Ray, a professor in the division of infectious diseases at Johns Hopkins Medicine in Baltimore. The people who are getting sickest tend to be those with compromised immune systems and underlying health conditions, such as heart disease, diabetes or lung problems. Adults over age 65 are also at higher risk for severe infections.

Since mild COVID can look like a cold or the flu, it's important to test yourself if you have symptoms or have had a known exposure, Gandhi said. Knowing what you have can affect your treatment and how long you isolate from others. The CDC currently recommends isolating for five days after a positive test and wearing a mask for five days after that.

Treatment

The antiviral pill Paxlovid is very effective against severe COVID, reducing the risk of death by 73% if taken within the first five days of an infection, according to a preliminary study conducted by the National Institutes of Health. Experts urged people who are high-risk to contact their doctors about getting a prescription as soon as they have symptoms or test positive.

"If you're elderly or you have comorbidities, before you even get worse, you should already seek medical care," said Dr. Bernard Camins, the medical director for infection prevention at the Mount Sinai Health System in New York. "Your health care provider will then evaluate you if you're a candidate for antivirals."

Paxlovid isn't recommended for everyone. It can interact with several medications, including common ones used to lower blood pressure or prevent blood clots, and it's also not advised for people with severe kidney disease. If you can't take Paxlovid, the drug remdesivir could be an option, but it has to be delivered intravenously, so it's less convenient and harder to obtain.

Paxlovid also doesn't appear to provide much benefit to young, healthy adults whose risk of severe infection is low, so it isn't broadly recommended for those groups.

For most people, COVID symptoms can be managed at home and treated like any other respiratory illness, with an emphasis on rest and staying hydrated. "If you have congestion or cough, you're losing more fluids than you normally would," Casto said. "So I would definitely recommend that people stay on top of fluid."

If you have a fever or body aches, take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). You can also take over-the-counter cold and flu medicines with decongestants or cough suppressants, although the experts didn't recommend them strongly because they don't work for everybody and can cause drowsiness.

When to seek medical care

If you're experiencing shortness of breath — meaning you can't catch your breath or are taking quick and shallow breaths — it's important to seek medical attention right away.

"The thing that I worry most about is the breathing," Casto said. "That's the most concerning sign, because people can get" worse really quickly. If you're having trouble breathing, she advised going to the emergency room rather than to your doctor or an urgent care clinic. Experts also said you should see a provider if you experience confusion or chest pain.

If your symptoms don't improve after several days, or improve and then regress, it could be a sign you have a secondary infection such as pneumonia, Casto said. In that case, or if you're concerned about your symptoms at all, don't hesitate to call your doctor.