COVID-19

COVID-19, the common term which encompasses many SARS-CoV-2 variants is characterized by a spectrum of ailments from allergy or cold like symptoms to fatal organ failure.

Individuals are typically infected and contagious 3 – 5 days before they begin having symptoms. 

COVID-19 Common Symptoms:

• runny nose
• sore throat*
• headache*
• body aches
• fever, chills
• cough
• nausea, vomiting or diarrhea
• shortness of breath* (often 4- 8 days after initial symptoms begin)
• loss of smell and taste*

*Italicized COVID symptoms may be more pronounced and bothersome than the common cold or Flu and suggestive of COVID-19. (May see references 1,2 below.)

Severe Illness Symptoms:

Go to the nearest ER for:

• chest pain
• activity limiting shortness of breath, inability to speak in full sentences
• decrease in normal oxygen levels (pulse ox) < 92%
• heart rate increased and sustained at > 110 beats per minute
• decrease in normal blood pressure range to < 100/70
• altered mental status or confusion
• falling

Treatment 

Individuals at high risk for developing severe illness with COVID-19 may be candidates for antiviral medication.

The current preferred anti viral treatment is Paxlovid, (Nirmatrelvir-ritonavir) a combo drug in a dose pack which may need to be dose adjusted for kidney function. Paxlovid is not recommended as safe for everyone related to several possible drug interactions with daily medications (discuss ALL of of your current medications with your doctor before taking).

• For individuals age > 50 who are not high risk, but who are unvaccinated, antiviral treatment is recommended. 
• For individuals who are high risk and vaccinated, antiviral treatment is still recommended. 
• Antiviral medications are not indicated for individuals who do not meet high risk criteria for progression to severe disease. 
• Antiviral treatment is also not recommended for individuals who test positive but do not have any symptoms.

There are multiple medications available now for treatment, discuss with your doctor which one is best and may be most appropriate for you. 

A Mention

Recent studies are finding the antiviral, Paxlovid, does not seem to reduce the risk of developing long COVID, (3) as previously hoped. The study was published in the Journal of Medical Virology on January 4th, 2024 (4).

Risk Factors for Progression to Severe Illness with COVID-19:

• Pregnancy
• Age > 65
• Obesity
• Diabetes
• Lung disease
• Cancer
• Cardiac disease
• Kidney disease
• Liver disease
• Brain disease
• Disabilities
• HIV, Hepatitis B, Hepatitis C
• Smoking
• Organ or stem cell transplant recipient

Influenza

Individuals are typically infected and contagious 2 – 4 days before they begin having symptoms. 

Influenza Common Symptoms:

• fever, chills
• dry cough
• body aches
• fatigue
• sore throat
• runny nose
• Headache

Treatment 

• Antiviral influenza treatment is recommended within 48 hours of symptom onset in high risk individuals to reduce the duration of illness. 
• Antiviral influenza treatment is also recommended within 48 hours of symptom onset for those dwelling among others (for example, large households, dormitories, senior living communities) in efforts to reduce the likelihood of transmission. 

Influenza Exposure Prophylaxis

Antiviral influenza prophylactic therapy is recommended for those without symptoms but who have been in close contact with an individual who developed the flu. Post exposure prophylaxis ought to be initiated within the first 48 hours after exposure.

References

1. Centers for Disease Control and Prevention. (2023, October 26). Symptoms of COVID-19. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

2. Mayo Clinic. (2023, October 26). Coronavirus disease 2019 (COVID-19) – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963

3. University of California, San Francisco. (2024, January 4). Study finds Paxlovid treatment does not reduce risk of long COVID. Retrieved from https://www.ucsf.edu/news/2024/01/426906/study-finds-paxlovid-treatment-does-not-reduce-risk-long-covid

4. Durstenfeld, M. S., & Peluso, M. J. (2024). Association of nirmatrelvir for acute SARS-CoV-2 infection with subsequent Long COVID symptoms in an observational cohort study. Journal of Medical Virology, 96(3), 456-464. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.29333