When President Joe Biden tested positive for COVID-19, he reported a runny nose, fatigue and a dry cough — “mild” symptoms common for this stage of the pandemic, but also for so much other stuff that doctors worry people might dismiss them as no big deal.
“How many times have you or your kid gotten a runny nose and you go on with your life?” said Dr. Panagis Galiatsatos, a Johns Hopkins Hospital pulmonologist and critical care physician who has been treating COVID-19 patients.
“You dismiss it as allergies and go on to infect others,” he said. “Someone around President Biden may have had a scratchy throat and didn’t think anything of it. My plea to everyone is to be diligent.”
The country is facing another wave of cases but most people aren’t getting severely sick, and Galiatsatos and others who treat or study COVID-19 fear a lot of infections are being treated as allergies or a minor cold or outright ignored because people need to go to work or want to vacation.
Even those concerned about the coronavirus may question when they need to test or stay home, and rapid tests that miss infections may fuel confusion.
Doctors say infections can make individuals sick and uncomfortable in the short and longer term and put vulnerable people in the community at risk. They also can give the virus more chances to evolve.
The official number of cases in Maryland is still far below the pandemic peak in January. But they began rising again in April, with more than 1,700 infections reported Friday by the Maryland Department of Health. That’s likely a vast undercount because people are not testing or are testing at home and not reporting results. There were 574 people reported hospitalized Friday, with about 50 adults and children in intensive care.
Experts say the good news is that vaccines, plus boosters and prior infections, still are working to keep people from severe illness. The dominant variant, BA.5, however, is extremely transmissible and lots of vaccinated people are getting reinfected or infected for the first time. Biden was vaccinated and boosted twice before he fell ill last week.
Symptoms have been largely consistent through the pandemic, with people developing a sore throat, cough, congestion, then a fever and aches and shortness of breath. Some people get a pounding heart, dizziness when standing or tummy issues. Fewer people are reporting loss of smell and taste from the latest variants.
“No one should think they have a cold and not COVID,” said Dr. David Marcozzi, incident commander for the 13-hospital University of Maryland Medical System’s COVID-19 response and medical adviser on COVID to Gov. Larry Hogan.
“If you’re sniffy, have a fever and sore throat, you should be testing to make sure it’s not COVID,” he said. “Test early and often.”
At-home rapid tests are recommended three to five days after exposure. If it’s negative even after symptoms arise, test again and even a third time, or get a more accurate PCR test performed in a lab. If you were exposed and have symptoms, assume you have COVID-19 and wear a well-fitting mask and distance yourself until symptoms subside, Marcozzi said.
Marcozzi said there are a lot more cases this summer than last, even though in warmer months more people tend to be outside where it’s safer. That shows the transmissibility of BA.5 and that people may be letting their defenses down too much.
That’s putting vulnerable people at risk; most of those hospitalized are over age 60 or with existing health conditions such as asthma, high blood pressure, diabetes or cancer. There are still several deaths a day from COVID-19 in Maryland.
The profile of who’s hospitalized is similar at Sinai Hospital in North Baltimore, Dr. Mark Goldstein, an emergency medicine physician, although he said the numbers are way down from January. There are five COVID-19 patients at Sinai, compared with 70 at the peak.
Patients now have fewer respiratory symptoms. They have nausea, aches and a poor appetite, and are admitted for dehydration that can lead to kidney dysfunction and other issues. It’s a problem magnified in seniors and people with chronic disease.
He cautioned, however, that an infection increases any person’s risk of related problems, including sudden death from a heart attack or stroke, in addition to long COVID.
“The disease is still unpleasant,” Goldstein said. “It’s not something you want to get. It’s also a burden here in terms of staffing. We consistently have people out with COVID.”
He said the antiviral medication Paxlovid is helping stem more serious disease. It was prescribed to Biden, who is at higher risk because he is 79.
Goldstein said the drug comes with side effects and shouldn’t be taken with certain medications. So, people should consult their doctor and have a plan for treatment before they are infected. If they need it, Maryland offers it at pharmacies under a “test to treat” program.
Goldstein noted the antiviral is different from one for influenza, and a bigger flu season is expected this fall after two seasons with few cases. He said that will make testing more important. The hospital has a test to differentiate among flu, COVID-19 and the respiratory virus RSV, common in children.
Galiatsatos, who also is a physician in Hopkins’ Post-COVID-19 Clinic, has been holding regular sessions with the community to answer coronavirus questions and offer advice. He’s found a typical BA.5 case starts with a runny nose and sore throat. A fever can last a day or two and a sinus headache and congestion can go on longer. A lingering cough with a lot of “gunk” coming out is also common. Children seem to get more gastrointestinal issues.
“The key is to keep the airways open,” said Galiatsatos, which may involve use of an asthma inhaler. “Avoid cough suppressants unless you have to give a Zoom talk or something, because the phlegm will just roar back because the lungs want it out.”
Ideally, people should stay home from work or school and rest until symptoms are gone and rapid tests are negative, but he said those with waning symptoms and no one to care for them are likely safe to go to the grocery with a well-fitting mask.
Call your doctor or head to the emergency room with trouble breathing, excessive dehydration or other more serious symptoms, he said.
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Managing long COVID-19 is trickier, with treatment typically case by case, said Dr. Andrea Levine, a pulmonary and critical care specialist at the University of Maryland Medical Center in Baltimore who runs a post-COVID-19 clinic.
“People are not getting that sick from the virus now, which is good, but so many people are getting it and getting reinfected,” she said. “Each subsequent infection increases the chance for ongoing symptoms. If you’re resigned to getting it over and over, it’s not a good strategy.”
The vaccine does appear to offer some protection against long COVID, she said, which means a lower proportion of people develop ongoing conditions now than earlier in the pandemic. The shear number of cases still means a lot of long COVID. It’s unclear who will get it, though research suggests it’s more common in women and older people.
Long COVID symptoms run the gamut from annoying to life altering. Levine treats a nurse used to being on her feet all day who now can only do telemedicine visits while laying down. Some people have really fast heart beats and end up needing implantable heart monitors. Many are fatigued and have “brain fog.” Others lose their hair, can no longer go for their daily run or get so dizzy they can’t work.
She said there are studies underway to better understand the range of conditions and how to treat them.
“Every single exposure is Russian roulette,” she said. “You can get sick and get long COVID.”
The defense, she said: get vaccinated, boosted and wear a mask.