A scratchy or painful throat, medically termed pharyngitis, is a common symptom associated with respiratory illnesses, including COVID-19. As the virus that causes COVID-19, SARS-CoV-2, continues to circulate and mutate, the presentation of the infection has changed. This uncertainty arises because a sore throat is a broad symptom shared by many pathogens, making it difficult to determine the cause without specific testing. Understanding the typical presentation of this symptom within the context of current dominant variants is necessary for making informed health decisions.
Prevalence of Sore Throats in COVID-19 Cases
A sore throat is now one of the most frequently reported symptoms of a COVID-19 infection, particularly with the emergence of the Omicron variant and its sublineages. Early in the pandemic, symptoms like fever, cough, and loss of taste or smell were considered the primary indicators. However, symptom profiles have shifted, and current data shows a greater likelihood of upper respiratory complaints.
In studies comparing the Delta and Omicron variants, a sore throat was reported significantly more often by individuals infected during the Omicron wave. For example, data indicated that a sore throat was present in over 70% of Omicron cases, compared to around 60% or lower for Delta infections. This change is thought to be due to the newer variants replicating more efficiently in the upper respiratory tract, leading to localized irritation in the throat.
The symptom also tends to appear early in the course of the illness, often before more systemic symptoms develop. For individuals who are vaccinated or have previous immunity, the infection is typically milder and shorter in duration, and a sore throat can sometimes be one of the first, or even the only, noticeable complaint.
Differentiating Symptoms: COVID-19 vs. Other Respiratory Illnesses
While a sore throat is a recognized symptom of COVID-19, it is not exclusive and must be considered alongside other symptom clusters to distinguish it from other common ailments. Viral infections like the common cold, influenza, and even non-infectious conditions such as seasonal allergies can all cause pharyngitis. The common cold generally presents with a gradual onset, characterized by mild symptoms dominated by nasal congestion, a runny nose, and sneezing. A cold-related sore throat is typically mild and resolves quickly as the congestion clears.
Influenza, or the flu, usually causes a more rapid onset of symptoms and is often accompanied by high fever, severe body aches, and profound fatigue. While a sore throat is possible with the flu, the defining feature is the abruptness and intensity of the systemic symptoms, which are generally more debilitating than a typical cold. COVID-19 symptoms, conversely, can be highly variable, ranging from mild cold-like symptoms to severe respiratory distress.
A telling sign that may point toward COVID-19, though less common with newer variants, is the new or sudden loss of taste or smell. Systemic symptoms like fever, fatigue, and muscle aches are more probable with COVID-19 than with seasonal allergies. Allergies cause a scratchy throat primarily due to post-nasal drip, and are characteristically accompanied by itchy, watery eyes. Since symptoms overlap considerably, relying on a single symptom like a scratchy throat is unreliable for a definitive diagnosis.
When to Get Tested and Isolate
Given the overlap in symptoms between COVID-19 and other respiratory illnesses, getting tested is the only reliable way to confirm the cause of a scratchy throat and associated symptoms. If you develop a sore throat or any other symptom suggestive of a respiratory infection, testing immediately is recommended.
If your initial rapid test result is negative, it is advised to re-test approximately 48 hours later, as the viral load may have been too low for detection on the first day. Treatment for COVID-19, such as antiviral medications, is most effective when started shortly after symptoms begin, making prompt testing particularly important for individuals at higher risk of severe illness.
For isolation, public health recommendations emphasize staying home until you have been fever-free for a full 24 hours without fever-reducing medication and your other symptoms are generally improving. Once you return to regular activities, wear a high-quality mask when around others indoors for the next five days to minimize the risk of transmission. This guidance aligns the public health response for COVID-19 with that of other common respiratory viruses.
At-Home Relief Measures for Throat Discomfort
While waiting for test results or during recovery, several strategies can help manage the physical discomfort of a scratchy throat. Gargling with a mixture of warm water and salt can help reduce swelling in the throat tissues and temporarily relieve pain. Dissolve about half a teaspoon of table salt in eight ounces of warm water and gargle the solution several times daily.
Drinking warm beverages, such as caffeine-free tea with honey, can soothe the irritated lining of the throat. Honey functions as a natural cough suppressant and provides a coating effect, while warm liquids keep the throat moist. Sucking on lozenges or hard candies also stimulates saliva production, which naturally coats the throat and eases the scratchiness. Using a cool-mist humidifier in your bedroom at night can prevent the throat from drying out.