When Diarrhea Is More Serious Than You Think
Do I Have A Cold Or COVID? Does It Matter?
July 22, 2024 – The summer COVID-19 bump is here, and growing, but there's some relatively good news, too.
For many, the symptoms don't last nearly as long as they once did. And some doctors are taking a more lenient approach to COVID testing – especially since tests are no longer free – saying they are OK with people who are mildly ill simply isolating until the symptoms go away.
So, can we view COVID 2024 as nothing more annoying than the common cold?
Not so fast, experts said. That's misguided, incorrect, and potentially dangerous.
"We cannot assign COVID to the category of the common cold by any margin," said William Schaffner, MD, a professor of infectious diseases at Vanderbilt University Medical Center in Nashville.
"Wishful thinking," agreed Eric J. Topol, MD, editor-at-large of Medscape, WebMD's sister publication, and a professor of molecular medicine and executive vice president of Scripps Research in La Jolla, CA. COVID, he said, is "still killing. The reason it's tolerated much better is because of the immunity that has been built, but much wanes over time and the virus keeps evolving."
Summer Bump: How Bad Is It?
In a CDC COVID update posted Friday, positive tests rose 12.6% for the week ending July 13, compared to an 11.4% increase the previous week. Hospitalizations for the week ending June 29 totaled 2.5 per 100,000 people, compared to 2.1 the previous week.
Four-plus years into the pandemic, disease experts have learned to expect at least two increases in cases each year, Schaffner said. Besides the summer bump, there's typically a larger winter increase.
Who's getting hospitalized now? Older people – those over 65 – and frail people, Schaffner said, along with those who are immune compromised, those with chronic conditions, and those either not up to date on COVID vaccination or those not vaccinated at all. In 2023-2024, more than 95% of those hospitalized with COVID had no record of receiving the latest vaccine.
Shorter Illnesses
Many people are getting mild infections, due to the evolving variants and population immunity, Schaffner said.
"The Omicron variants are not as serious as Delta, for example," he said, "and we have population immunity." According to the CDC, more than 98% of the U.S. Population has some immunity from COVID due to vaccination, prior infection, or both.
While Omicron spreads easily, Schaffner said he has noticed brief illnesses, maybe 3 to 4 days of symptoms, for most who get infected now.
John Passantino, MD, CEO of OMNImedFL in Tamarac, FL, said most of his patients are reporting typical common cold symptoms, with a sore throat seeming to be a more common early symptom with recent variants. It has been a long time, he said, since he has seen patients with COVID get acute respiratory distress syndrome (ARDS), a serious lung condition that causes low blood oxygen and shortness of breath.
These days, "In general, I would say that patients who have COVID don't know it because the symptoms are so mild and overlap with the common cold," said Elena Christofides, MD, an endocrinologist in Columbus, OH.
"I think the experts are correct that herd immunity as well as the evolution of the virus is such that it has reached general population concerns similar to a cold. Sure, people can still get sick and/or hospitalized with it, but that had always been true even for all other respiratory viruses."
For Mild Cases, a Changing Perspective on Testing
As illness patterns have changed, so have patients' testing practices, doctors said.
"I haven't heard of any of my patients bothering to get tested anymore as a result [of the milder symptoms]," Christofides said. And she's OK with that, she said.
"With the sharp decline in severe cases," Passantino said, "I am comfortable being more conservative, particularly with my low-risk patients. For them, if my recommendation is likely to be conservative management with rest, hydration, and over-the-counter medications, I see no benefit in testing."
But, he said, shared decision-making is best, and he is always willing to review testing and treatment options with patients.
"I haven't changed my recommendation [on testing], but my patients have changed their behavior," said Linda Yancey, MD, director of infection prevention for Memorial Hermann Health System in Houston. Patients are much less likely to go buy a home test and use it, she said, and she accepts that.
"We cannot be in high alert, panic mode forever," she said. She does counsel patients to stay home until symptoms clear up and to mask up if they go out in public.
The updated CDC recommendations say you can return to normal activities if after 24 hours your symptoms are improving and your fever, if you had one, is gone without you taking medication. For the next 5 days, follow other precautions such as masking when indoors.
Someday, COVID as a Cold?
Will COVID evolve eventually so someday, it will be more like a common cold virus? It's often discussed among infectious disease experts, Schaffner said.
"We can wish," he said, "but we can't count on it." There are crucial differences, he said. "The common cold doesn't hospitalize anyone. The data continue to show that COVID among the hospitalized is more serious than the flu."
Dengue Fever Sufferers Explain What Happens When You Have The Deadly Illness
As Europe is currently battling a rise in cases of dengue fever cases, with an invasive mosquito species discovered in 13 EU countries, a victim has described what the illness feels like - and how hard it can be to spot it.
Reddit user u/divernire_10 reveals he contracted the bone-breaking disease in 2019, and that it was a "weird" experience, as he felt relatively fine until he was diagnosed.
"The day before the evening I started getting worse, I was feeling fatigued, thought I just over worked today", they wrote. "The same day around midnight, I was chills. But no fever.
"In the morning too, I had no fever at all but my BP [blood pressure] was so low, my head was spinning like crazy. Next day I felt better, after eating and drinking water well. Still no fever but had low BP. Next day much better, but still the low BP continued.
"And then I went to the hospital and was tested positive for dengue."
Dengue Fever: Doctor outlines signs and symptoms of infectionThe World Health Organisation (WHO) recently issued a warning that almost half of the world's population is now at risk of contracting dengue fever, with an estimated 100-400 million infections each year. According to The European Centre for Disease Prevention and Control (ECDC), climate change may be creating favourable conditions for the tiger mosquito, which is believed to be spreading the disease.
Severe dengue symptoms often appear after the fever has subsided. Individuals exhibiting these severe symptoms should seek immediate medical attention.
"My parents forced me to go to the hospital because I thought I was getting better", the Reddit user said. "Even when my platelet count was dropping in the hospital, I still felt almost fine. Had no fever the whole time at all.
"That is the reason why I'm writing this. You may feel like it's nothing. You may think it's some fatigue and low BP and you wait days to get it checked. Having mild to no fever at all makes you think it's not serious."
There is no specific treatment for dengue fever, but early detection and access to appropriate medical care can significantly reduce fatality rates from severe dengue.
The focus in treatment mainly relies on managing pain symptoms, as most people recover within one to two weeks. However, in rare cases, dengue can become severe and result in death.
Symptoms typically begin four to 10 days after infection and last for two to seven days. Those infected for the second time are at a higher risk of developing severe dengue.
Historic dengue vaccine programme launched in PhilippinesSymptoms of dengue may include:
Severe dengue symptoms often appear after the fever has subsided, and include:
Revisiting Tips To Prevent COVID-19 Infection As Long Island Cases Rise
With COVID-19 infections on the rise on Long Island and statewide, experts say the best way to avoid getting sick is still taking the latest vaccine. Credit: Houston Chronicle via AP / Melissa Phillip
When the virus that causes COVID-19 emerged in 2019, no one had protective immunity. Nearly five years later, most of the United States population has some immunity, either because of vaccination, infection or both. In most cases, COVID-19 illnesses now are less severe than in the early days of the pandemic.
But the coronavirus remains a public health threat, according to the Centers for Disease Control and Prevention. And on Long Island and statewide, positive tests for COVID-19 have been on the rise since late spring.
The CDC's recommendations — from how to prevent getting infected or passing the virus on to someone else, to symptoms and therapeutic treatments — remain largely the same.
How is the virus transmitted?The coronavirus that causes COVID-19 is still transmitted by airborne particles and droplets, according to the CDC. The risk of infection increases with close or prolonged contact with an infected person, especially in indoor or crowded settings.
How do I keep from becoming infected?The CDC has long recommended vaccination against the virus as the best way to prevent serious illness from COVID-19. Vaccination also provides some protection from initial infection. Avoiding close contact with others if infected, masking in crowded indoor spaces and hand washing can also prevent infection, the CDC says.
Do I need to vaccinate again?In most cases, yes, experts say. CDC recommendations call for everyone 6 months and older to get an updated 2024-2025 COVID-19 vaccine to protect against potentially serious complications of the disease this fall and winter. Getting an updated version of the vaccine is important because it will be better able to protect against new variants of the virus that causes COVID-19. Also, the protection from a vaccine declines over time. The updated COVID-19 vaccines will be available later this year from Moderna, Novavax, and Pfizer, most likely in September or October.
Dr. Bruce Farber, chief of epidemiology and public health with Northwell Health, recommended taking the vaccine as soon as it's available.
"It's a long time since we've had a vaccine — for many of us, it's going to be a year," he said. Because Long Islanders and Americans in general have done a "remarkably poor" job keeping up with vaccinations in recent years, he recommended signing up to take the flu vaccine at the same time as the one against COVID-19.
People with COVID-19 can be infectious from 1 to 2 days before and up to 8 to 10 days after symptoms begin, according to the CDC. The majority of transmission appears to occur during the early periods of infection, particularly in the 1 to 2 days before symptoms start and within the first few days of their onset.
Are the signs of COVID-19 infection the same?Yes. Symptoms include fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, loss of taste or smell, sore throat, nasal congestion or rhinorrhea, vomiting, diarrhea and skin rashes. However, not everyone infected experiences these symptoms.
Anyone with symptoms who is planning to attend a gathering or visit someone especially vulnerable to illness, like an elderly person or the very young or immunosuppressed, should take a COVID-19 test, experts said.
But test wisely, Farber said. "The rapid tests that we now rely on are no longer particularly good at diagnosing COVID, with these newer variants that are circulating," he said. A positive result still likely means infection, but false negatives are possible with rapid tests, also known as antigen tests. For that reason, especially if you have symptoms but negative results, "if you want to test reliably, you need to do a PCR." The PCR tests are generally administered by a health care professional and results take longer, but they offer what the CDC calls the "gold standard" of accuracy.
Do I still need to quarantine?Not necessarily. If you have COVID-19 symptoms, you should stay home until they improve, according to the CDC. But since March, the agency has advised that people can return to work and regular activities if their symptoms are mild and improving and it's been at least a day since they've had a fever. "If you go out, think about wearing a mask," said Dr. Sharon Nachman, division chief of pediatric infectious disease at Stony Brook Children's Hospital.
Dr. Aaron Glatt, chair of the Department of Medicine and chief of infectious diseases at Mount Sinai South Nassau hospital, said "you're probably contagious" if you test positive, even if you feel fine. At a minimum, Glatt said, consider the risk profile of the people you might be around and tell them you've been sick. Consider that "Most people won't want to be around you" if there's a chance you can get them sick too, he said.
Is exercise OK for someone infected?Start by exercising common sense, said Nachman. "If you have a fever, you should be home drinking fluids and taking it easy." If you have no fever, see how your body responds to walking up the stairs: "if you are air hungry or getting short of breath … then no exercise."
What about antivirals?Antiviral treatments like Paxlovid have been shown to reduce hospitalizations and deaths among older people and people with underlying health conditions when taken soon after COVID-19 symptoms start. But "for people who are under 60 and healthy, there's no evidence" to indicate their use, said Glatt.
Are COVID-19 infections in New York on the rise?The experts say yes. New York State testing data shows that positive tests have been on the rise statewide and Long Islandwide since late spring, though the latest Long Island rate of 16.9 cases per 100,000 people is well below the January high of 72.3. What's going on? "We are seeing new variants, and it's possible that our current variant is more infectious than the prior one," Nachman said. Also, she said, "People have lost some immunity to COVID over the last year, so perhaps they're a little more susceptible than last year." Changes in behavior like more socializing could also play a role, she said. However, "hospitalization rates and death rates are not up significantly," Farber said. "Most people are recovering very well."
Nicholas Spangler is a general assignment reporter and has worked at Newsday since 2010.
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