Doctors say they are having more and more difficulty distinguishing Covid from allergies or colds, even if hospitalizations are increasing.
Past features of the illness, such as a dry cough or loss of taste or smell, have become less common. Instead, doctors are seeing milder disease, mostly concentrated in the upper respiratory tract.
“It’s not the same typical symptoms that we were seeing before. There’s a lot of congestion, sometimes sneezing, usually a mild sore throat,” said Dr. Erick Eiting, vice president of emergency medicine operations. at downtown Mount Sinai in New York. The city of York.
The sore throat usually comes first, he says, followed by congestion.
The Zoe COVID Symptom Study, which collects data on self-reported symptoms in the UK via smartphone apps, documented the same trend. Its results suggest that sore throats became more common after the omicron variant became dominant in late 2021. Loss of smell, on the other hand, became less prevalent and the rate of hospitalizations decreased compared to summer and in fall 2021.
Doctors now describe a clearer and more consistent pattern of symptoms.
“Almost everyone I saw had very mild symptoms,” Eiting said of his urgent care patients, adding: “The only way we knew it was Covid was because let us test them.”
How do the symptoms of Covid evolve?
Although three doctors interviewed said Covid usually starts with a sore throat these days, they gave different descriptions of the severity.
Dr. Grace McComsey, associate dean of clinical and translational research at Case Western University, said some patients described “a burning sensation like they’ve never had, even with strep in the past.” .
“Then as soon as the congestion appears, it seems like the throat gets better,” she said.
In addition to congestion, doctors say, some patients experience headaches, fatigue, muscle aches, fever, chills or post-nasal drip that can lead to coughing — although coughing is not a main symptom.
McComsey said fatigue and muscle pain usually last a few days, while congestion can sometimes last a few weeks.
She estimated that only about 10 to 20 percent of her Covid patients now lose their sense of taste or smell, compared to about 60 to 70 percent at the start of the pandemic.
Eiting said he also hasn’t been experiencing much diarrhea lately — a more common symptom in the past.
For the most part, doctors said, few patients require hospitalization — even those who show up in emergency rooms — and many recover without needing the antiviral pill Paxlovid or other treatment.
“Especially since July, when this recent mini-surge began, young people who experience upper respiratory symptoms – cough, runny nose, sore throat, fever and chills – go home 99% of the time with health care. support,” said Dr. Michael. Daignault, an emergency room doctor at Providence Saint Joseph Medical Center in Burbank, California.
Why Covid seems milder now
Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, attributed the mild symptoms seen by doctors to immunity from vaccines and previous infections.
“Overall, the severity of Covid is much lower than it was a year and two years ago. It’s not because the variants are less robust. It’s because immune responses are higher,” Barouch said.
Other doctors believe that omicron itself also changed the presentation of Covid symptoms, as some studies showed that early versions of it were not as effective as previous variants at infecting the lungs.
The most common subvariant currently circulating is EG.5, followed by a strain called FL.1.5.1. Together, these two appear to be leading to an increase in Covid infections, although scientists are also monitoring BA.2.86, a variant with a large number of mutations that appears very different from previous versions of omicron. Although cases of BA.2.86 are increasing in the United States, it is not one of the major circulating variants.
Barouch said the new booster shots should be effective against these three strains and others.
Who is hospitalized?
The United States is seeing about 19,000 Covid-related hospitalizations per week, according to the Centers for Disease Control and Prevention. The weekly average increased by approximately 80% from the beginning of August to the beginning of September.
Hospitalization rates are highest among people aged 75 and older, followed by babies younger than 6 months and adults aged 65 to 74. Most people hospitalized with Covid since January had not received a bivalent booster, according to the CDC.
Older people in particular may see their immunity wane if they have not been infected or vaccinated recently, Daignault said.
“That is why the priority should be to vaccinate this particular group of patients with the fall booster,” he said.
Daignault said emergency rooms generally don’t see the shortness of breath, low oxygen levels or viral pneumonia that have led some patients to be put on oxygen tubes or ventilators in the past.
Instead, he said, typical Covid patients hospitalized in Burbank are older and suffer from dehydration, loss of appetite, weakness or fatigue.
What does long Covid look like now?
A study published this month found that long-term Covid rates declined once the omicron became the dominant variant. Researchers aren’t sure if milder illness contributed to this trend or if population immunity is largely to blame.
But McComsey — principal investigator of the National Institutes of Health’s RECOVER initiative, which studies long Covid — said she’s still seeing new cases of long Covid. A rapid heart rate and exercise intolerance are among the most common persistent symptoms, she said.
Each reinfection carries a risk of long Covid, McComsey added, so she doesn’t think people should ignore the current rise in infections.
“What we’re seeing in long-term Covid clinics is not just the older strains continuing to be symptomatic and not getting better – we’re also adding to that number with the new strain,” McComsey said . “That’s why I don’t take this new wave any less seriously.”