July 22, 2024 – The summer COVID-19 bump is here, and growing, but there’s some relatively good news, too.
For many, the symptoms don’t last nearly as long as they once did. And some doctors are taking a more lenient approach to COVID testing – especially since tests are no longer free – saying they are OK with people who are mildly ill simply isolating until the symptoms go away.
So, can we view COVID 2024 as nothing more annoying than the common cold?
Not so fast, experts said. That’s misguided, incorrect, and potentially dangerous.
“We cannot assign COVID to the category of the common cold by any margin,” said William Schaffner, MD, a professor of infectious diseases at Vanderbilt University Medical Center in Nashville.
“Wishful thinking,” agreed Eric J. Topol, MD, editor-at-large of Medscape, WebMD’s sister publication, and a professor of molecular medicine and executive vice president of Scripps Research in La Jolla, CA. COVID, he said, is “still killing. The reason it’s tolerated much better is because of the immunity that has been built, but much wanes over time and the virus keeps evolving.”
Summer Bump: How Bad Is It?
In a CDC COVID update posted Friday, positive tests rose 12.6% for the week ending July 13, compared to an 11.4% increase the previous week. Hospitalizations for the week ending June 29 totaled 2.5 per 100,000 people, compared to 2.1 the previous week.
Four-plus years into the pandemic, disease experts have learned to expect at least two increases in cases each year, Schaffner said. Besides the summer bump, there’s typically a larger winter increase.
Who’s getting hospitalized now? Older people – those over 65 – and frail people, Schaffner said, along with those who are immune compromised, those with chronic conditions, and those either not up to date on COVID vaccination or those not vaccinated at all. In 2023-2024, more than 95% of those hospitalized with COVID had no record of receiving the latest vaccine.
Shorter Illnesses
Many people are getting mild infections, due to the evolving variants and population immunity, Schaffner said.
“The Omicron variants are not as serious as Delta, for example,” he said, “and we have population immunity.” According to the CDC, more than 98% of the U.S. population has some immunity from COVID due to vaccination, prior infection, or both.
While Omicron spreads easily, Schaffner said he has noticed brief illnesses, maybe 3 to 4 days of symptoms, for most who get infected now.
John Passantino, MD, CEO of OMNImedFL in Tamarac, FL, said most of his patients are reporting typical common cold symptoms, with a sore throat seeming to be a more common early symptom with recent variants. It has been a long time, he said, since he has seen patients with COVID get acute respiratory distress syndrome (ARDS), a serious lung condition that causes low blood oxygen and shortness of breath.
These days, “In general, I would say that patients who have COVID don’t know it because the symptoms are so mild and overlap with the common cold,” said Elena Christofides, MD, an endocrinologist in Columbus, OH.
“I think the experts are correct that herd immunity as well as the evolution of the virus is such that it has reached general population concerns similar to a cold. Sure, people can still get sick and/or hospitalized with it, but that had always been true even for all other respiratory viruses.”
For Mild Cases, a Changing Perspective on Testing
As illness patterns have changed, so have patients’ testing practices, doctors said.
“I haven’t heard of any of my patients bothering to get tested anymore as a result [of the milder symptoms],” Christofides said. And she’s OK with that, she said.
“With the sharp decline in severe cases,” Passantino said, “I am comfortable being more conservative, particularly with my low-risk patients. For them, if my recommendation is likely to be conservative management with rest, hydration, and over-the-counter medications, I see no benefit in testing.”
But, he said, shared decision-making is best, and he is always willing to review testing and treatment options with patients.
“I haven’t changed my recommendation [on testing], but my patients have changed their behavior,” said Linda Yancey, MD, director of infection prevention for Memorial Hermann Health System in Houston. Patients are much less likely to go buy a home test and use it, she said, and she accepts that.
“We cannot be in high alert, panic mode forever,” she said. She does counsel patients to stay home until symptoms clear up and to mask up if they go out in public.
The updated CDC recommendations say you can return to normal activities if after 24 hours your symptoms are improving and your fever, if you had one, is gone without you taking medication. For the next 5 days, follow other precautions such as masking when indoors.
Someday, COVID as a Cold?
Will COVID evolve eventually so someday, it will be more like a common cold virus? It’s often discussed among infectious disease experts, Schaffner said.
“We can wish,” he said, “but we can’t count on it.” There are crucial differences, he said. “The common cold doesn’t hospitalize anyone. The data continue to show that COVID among the hospitalized is more serious than the flu.”
