COVID-19 has changed, and the recommended ways to detect and treat it have changed as well.
Dr. Brandon Eilertson, an infectious disease physician with Kaiser Permanente, says the Centers for Disease Control and Prevention made “a big departure” from earlier practice in the spring when it stopped issuing separate guidelines for the coronavirus and grouped It with other respiratory viruses.
The move is “actually much more user-friendly,” the doctor says, because not everyone knows what they have — COVID, the flu, RSV — the moment they get sick, and people don’t always have access to tests.
Now, Eilertson says, the guidance is the same: Stay home for five days if you can. You can resume your routine when you’ve had 24 straight hours of feeling better and not having a fever without using any fever-reducing medicine. “If you don’t have access to a COVID test,” he says, “that’s a quick and dirty way to do it.”
He adds that you should wear a mask your first five days back in the world.
The latest variants — the so-called FLiRT variants — have gone from about 30 percent of cases to 70 percent in the past few months, and patients in those cases are more likely to be asymptomatic. The majority of transmission of these variants, Eilertson says, comes from “people who don’t even really know they’re sick or feel particularly sick.”
COVID-19 Virus Changing
The guidelines are changing, and the virus itself is changing. The reason: “Everyone at this point has been exposed to COVID or the vaccine,” Eilertson says. “There’s almost no one with no immunity of any kind.”
Even within the dominant Omicron variant, subtle mutations have made the virus “better at binding to the upper respiratory lining, and not as good at binding to the lower respiratory lining, down in the lungs,” Eilertson says. “Ever since we went from Delta to Omicron, people are not getting pneumonias from COVID anymore.”
That said, people are still getting very ill and dying. Pretty much everyone who is hospitalized for COVID-19 now is over 65 or immune-suppressed due to taking high doses of steroids, or receiving transplants, he says.
Those are the patients for whom Paxlovid is strongly recommended. Eilertson says if you’ve been keeping up on your vaccinations and you’re basically healthy, you don’t necessarily need it.
“We will give it to anyone who wants it. It is effective,” he says. “We’re happy to offer it, but it’s not as strong a recommendation.”
And while the early symptoms of the disease are pretty much the same — aches, fatigue, sore throat, fever, congestion, maybe a cough — people “aren’t for the most part having GI symptoms, loss of smell, brain fog,” Eilertson says. “Thankfully, we’re not really seeing that anymore.”
Similarly, long COVID “can still happen, but it’s really dropping off as we’ve gone into Omicron.”
Eilertson was also excited about the fact that the Food and Drug Administration last week approved the first flu/COVID-19 combined home test.
“That’s where we’re going to start heading,” he predicted, adding that the first such home tests might be able to detect respiratory syncytial virus or RSV, too. He says that would be a “huge advance” that would really help doctors give good advice.
He says the other good news is that the summer wave has been receding for a couple of months, and while there’s usually a late-winter wave of illness, he thinks most people will be prepared. “I’m very hopeful about that.”
In Virginia, overall respiratory illness activity in Virginia is low and COVID-19 emergency department visits are trending down. The state has had 61 deaths related to COVID-19, flu, and/or respiratory syncytial virus in the past six weeks. In the week that ended, Virginia had 1,742 positive COVID-19 lab reports.
Feature image by S.J. Objio
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