COVID-19 Coronavirus Updates: Sunday / Monday, Dec. 26-27

Every patient I’ve seen with Covid that’s had a 3rd ‘booster’ dose has had mild symptoms.

By mild I mean mostly sore throat. Lots of sore throat. Also some fatigue, maybe some muscle pain.

No difficulty breathing. No shortness of breath.

All a little uncomfortable, but fine.

Most patients I’ve seen that had 2 doses of Pfizer/Moderna still had ‘mild’ symptoms, but more than those who had received a third dose.

More fatigued. More fever. More coughing. A little more miserable overall.

But no shortness of breath. No difficulty breathing.

Mostly fine.

Most patients I’ve seen that had one dose of J&J and had Covid were worse overall. Felt horrible. Fever for a few days (or more).

Weak, tired. Some shortness of breath and cough.

But not one needing hospitalization. Not one needing oxygen.

Not great. But not life-threatening.

And almost every single patient that I’ve taken care of that needed to be admitted for Covid has been unvaccinated.

Every one with profound shortness of breath. Every one whose oxygen dropped when they walked. Every one needing oxygen to breath regularly.

The point is you’re gonna hear about a LOT of people getting Covid in the coming days and weeks.

Those that have been vaccinated and got a booster dose will mostly fare well with minimal symptoms.

Those getting two doses might have a few more symptoms, but should still do well.

Those who got a single J&J similarly may have more symptoms, but have more protection than the unvaccinated (if you got a single dose of J&J, please get another vaccine dose—preferably Pfizer or Moderna—ASAP!)

But as I’ve witnessed in the ER, the greatest burden still falls on…

The unvaccinated. Those who haven’t gotten a single dose of vaccine.

They’re the most likely to need oxygen. They’re the most likely to have complications. They’re the most likely to get admitted. And the most likely to stay in the hospital for days or longer with severe Covid.



Rapid tests are important for managing this pandemic. But they require a nuanced understanding of what they are good for and how to best use them.

A common question is how accurate these tests really are. The data is now clear, including from my own research, that these tests are excellent at detecting people who are contagious. However, these tests do not always pick up the very earliest stages of an infection, before people develop symptoms, or the later stages of an infection, when symptoms have passed. But it’s important to understand that these very early and very late stages are when people are far less likely to be infectious and able to spread the virus to others…

So why is there still such rampant transmission of coronavirus in Britain, given that every person in the country has unlimited access to these tests?

Because rapid tests are excellent at confirming when a person is in a contagious stage of infection, but don’t perform well at identifying people in the very early stages of an infection, how they are used is incredibly important. People in Britain are encouraged to use these tests up to 24 hours before doing an activity. But having a negative rapid test does not necessarily mean that you are not infected with coronavirus. A negative test means you do not have levels of the virus that make you infectious at the very moment you took the test. This can change in a matter of hours if someone is in the early stages of an infection. That’s why you should not rely on a negative rapid test for a week’s worth of events…

… [L]eaders need to make sure people understand what a negative rapid test result means. You may not be infectious in that moment, but you may still have an infection and could be contagious later. It means you should still exercise caution to prevent spreading the coronavirus. If you want to maximize the benefits of rapid testing, take your test immediately before going out, not the day before.

The antiviral pills aren’t for everyone who gets a positive test. The pills are intended for those with mild or moderate COVID-19 who are more likely to become seriously ill. That includes older people and those with other health conditions like heart disease, cancer or diabetes that make them more vulnerable. Both pills were OK’d for adults while Paxlovid is authorized for children ages 12 and older.


Merck’s molnupiravir is not authorized for children because it might interfere with bone growth. It also isn’t recommended for pregnant women because of the potential for birth defects. Pfizer’s pill isn’t recommended for patients with severe kidney or liver problems. It also may not be the best option for some because it may interact with other prescriptions a patient is taking. The antiviral pills aren’t authorized for people hospitalized with COVID-19…


You’ll need a prescription first from a doctor or other authorized health worker. The U.S. government is buying the pills from Merck and Pfizer and providing them for free, but supplies will be limited initially. They’ll be shipped to states where they will be available at drugstores, community health centers and other places. Treatment lasts five days.

Some pharmacists may be able to administer a quick COVID-19 test and prescribe the pills all in one visit. They already do this in many states for flu or strep throat…


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