Covid-19 Remains a Dangerous Illness
This year the Centers for Disease Control (CDC) expects 125,000 Americans will have died from Covid 19 in 2022. 1 out of 8 people dying is under the age of 65. The risk of dying is 20 times higher in the unvaccinated than in those vaccinated and boosted.
Flu, RSV or Covid?
With Respiratory Syncytial Virus and influenza already present across the United States, people with Covid 19 are delaying seeking care because of the overlapping symptoms.
It becomes a slippery slope. The Respiratory Syncytial Virus rarely kills an adult, and influenza still has a preponderance among the elderly. Patients with Covid 19, while having similar onsets, still tend to crash on day two and day three. I relate the patient’s story to illustrate what happens when the quicksand grabs you.
A cautionary tale
On Day Zero, he was at a dinner celebrating the end of pickleball season with about 20 other adults. No one wore masks, and since the weather had recently turned cold, the windows were closed, and the ventilation system was not adding much fresh air.
Day Three, his first symptoms were a runny nose and sore throat. He felt well enough to go to work, but during the day developed some discomfort breathing, went home, and contacted his doctor. His wife, who works in healthcare, had already stocked the house with home tests for influenza and Covid 19 and RSV for visiting grandchildren.
He ran the tests. The result for Covid-19 was positive.
He had an extensive history of coronary artery disease and occasional arrhythmias. Though not 65, he was at high risk. Covid-19 has a predilection for inflaming the heart.
Since it was in the first five days of the illness, his doctor called in an order for Paxlovid, a fingertip pulse oximeter, and a digital thermometer. He told him to cut his arrhythmia medicine by 50%, rest, consume fluids, take acetaminophen, and restrict his activities.
His doctor also instructed him to warm his hands before checking his blood oxygen and to avoid hot or cold liquids before taking his temperature. If his blood oxygen drops below 93, he should go to the hospital.
By Day Five, he had a nasty cough, painful breathing, a temperature of 100°F, and his blood oxygen dropped from 97 to 94. More worrisome, his pulse rate had fallen from its usual 55 to 36.
His doctor stopped all his antiarrhythmic medicines. The patient said he was not any worse walking up and down the stairs. His doctor reassured him that he should be turning the corner, but if his pulse rate dropped or he got short of breath, his wife should drive him to the hospital.
By Day Eight, he had finished the Paxlovid, had normal oxygen, no fever, and minor aches and pains.
On Day Ten, his nasal antigen test turned negative, and he was back on all his medicines.
On Day 14, his face erupted in hives, he developed a persistent cough that interfered with finishing a sentence, and muscle aches. He did not have a fever and his blood oxygen was normal. His nasal antigen was again positive indicating he was contagious.
This timing is typical for Paxlovid rebound. This was worse than most cases. He went to the Urgent Care Center and received prednisone, antibiotics, and antihistamines. He felt significantly better within 24 hours, but his nasal antigen stayed positive for four more days.
He had all his vaccinations and booster shots. He lived at one end of the house while his wife lived at the other, and she did not become ill.
We are entering the season when people congregate indoors for meetings, meals, holidays, travel, and entertainment. The newest variant of Covid-19 — BQ.1.1. — Is highly infectious and can avoid immunoglobulin treatments and infect people previously infected with other strains.
In New York City, in two weeks, this new variant went from less than 1% of infections to 30% of infections. It can be asymptomatic until it meets a susceptible host — either the elderly, the medically compromised, or the very young for whom there is no vaccination.
The same rules apply for this winter as last winter. Avoid crowded spaces or wear a mask when in one. Being outdoors or using ventilation indoors is also an effective preventative.
Remember that you can spread Covid-19, influenza, or Respiratory Syncytial Virus even if you are asymptomatic. Be cautious when visiting the elderly, infirm, or babies.
You will find differing advice at state health departments, city health departments, and the Centers for Disease Control. His entire episode lasted three weeks, and could have turned out much worse.