I Have Contracted COVID: Details of My Date with SARS-CoV2

The skeptical cardiologist has contracted what the CDC would define as a “mild” case of COVID-19. Had I not received my second COVID vaccine booster recently my condition likely would be worse.

With the emergence of the more highly transmissible omicron variant it became clear in December (as noted by the AP) that all of us will have a date at some point with some variant of SARS-CoV-2:

“All of us have a date with omicron,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “If you’re going to interact with society, if you’re going to have any type of life, omicron will be something you encounter, and the best way you can encounter this is to be fully vaccinated.”

After receiving my fourth jab and returning to St. Louis to begin rounding on inpatient cardiology consults at SLU Hospital I have been very careful while in the hospital. I wear an N95 (Kimberly Clark) 99% of the time when in health care facilities.

Loosening Up

For two years I and the former eternal fiancee’ had been carefully and successfully avoiding COVID but lately based on our highly vaccinated state and the reduction in virulence of the new variants we had loosened up.

Outside the hospital I stopped wearing a mask except in rare cases. Last week after finishing inpatient rounding I went to several indoor events at which the vast majority of participants were unmasked. I realized I was increasing my chances of catching COVID-19 but given my super quadrivaccinated state and the seeming inevitability of avoiding the illness without living a cloistered and/or masked existence I felt ready for my date.

Monday night I attended an event at the Historic Schlafly Tap Work which I could not resist. It was a concert by the Ariana String Quartet on the Art of the Brew. Each piece the Quartet played was based on a Schlafly brew introduced by the beer maker’s brewmaster. Around 30 mostly un-masked beer and music loving individuals gathered in a medium-sized room in folding chairs scattered at nice intervals with really high ceilings to listen for about 90 minutes.

I judged this exposure as higher risk than I typically endure without a mask but Wednesday night at a medical dinner I attended I judged the risk as really high. We were all gathered in a small room (with the only door frequently shut) sitting right next to each other at a table. I began counting down the days until I could consider myself COVID-free.

Symptoms: Are they from COVID?

Unfortunately two days later in the after noon I began feeling very fatigued. The fatigue continued the next day accompanied by a mild scratchiness in my upper airway. the weakness and malaise became progressively worse as the day wore on. By mid-day I tried to take a walk and after two blocks was exhausted. I took a COVID rapid antigen test which was negative.

I thought about going for walk in park in afternoon but the process of getting ready for the walk exhausted me. I took the inhalers Advair and albuterol through the day as my chest felt heavy and congested along with shortness of breath that felt like asthma

COVID Contracted!

The next day, I awoke at 3 AM with intense sneezing and nasal congestion which intensified over the next hour and became associated with a particularly nasty headache. I took 30 mg of the decongestant pseudophed, a zicam tablet, my nasal steroid inhaler and ibuprofen. I couldn’t sleep so I watched an episode of Better Call Saul.

I retested myself again (15 hours after my initial negative test) for COVID and this time it was positive.

C which stands for control and rhymes with T which stands for Trouble with COVID

When I awoke later Sunday morning I felt pretty bad-extremely weak, bad headache, congested, chest tightness, shortness of breath on exertion. These symptoms worsened throughout the day and were accompanied by my first fever along with tachycardia in the evening.

To Take Paxlovid or Not?

In the morning I pondered whether to take Paxlovid. I wrote in detail about this very effective oral treatment for COVID-19, focusing on its drug-drug interactions here.

The FDA has an EUA for Paxlovid based on seeing an 89% reduction in the risk of hospitalization and death in a well done randomized clinical trial. It is free right now and it has efficacy against Omicron. It is indicated for:

nonhospitalized patients with mild to moderate COVID-19 aged ≥12 years and weighing ≥40 kg who are at high risk of disease progression;

I had all of the four factors in the above statement.

Mild, Moderate or Severe?

NPR published a nice article on the nuances of the terms mild, moderate and severe disease.

Basically as long your breathing/oxygenation is not impaired you are in the mild category but you can feel very horrible for multiple days and it won’t feel that mild.

So what does a mild case look like? A mild case could mean barely any symptoms and a quick return to feeling normal. But so-called mild cases aren’t always … well, mild. The National Institutes of Health guidelines for treatment categorize mild COVID as” [i]ndividuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell) but who do not have shortness of breath, dyspnea (difficult or labored breathing), or abnormal chest imaging.”

NPR.org

I checked my oxygen saturation, of course, multiple times (using my handy dandy Circul ring.) Early in the day of my diagnosis my O2 saturation was 98% and my pulse was 75 BPM. However late in the evening when I felt absolutely horrible and my temperature rose to 99.8 degrees* and my pulse to 104 BPM my oxygen saturation was hovering between 93 and 95%.

Earlier in the pandemic I wrote about pulse oximeters for home measurement of oxygen saturation, something I recommend for everyone. This NEJM graphic from 2020 emphasizes an O2 saturation of 94% as a differentiator of moderate from severe illness. Please note that treatment recommendations have changed dramatically in 2 years.

Because I am old (>65 years) I am automatically considered high risk.

Paxlovid On Board

Thus, when I decided to pull the trigger on Paxlovid and sent a my chart message to my internist I immediately received a call back from the covering nurse practitioner. By the time she called I had checked with various pharmacies on their Paxlovid supplies. Interestingly, there were none at Walgreen’s but they nicely referred me to a nearby CVS who had the drug.

Appropriately she asked about symptoms and test positivity. Most importantly she looked closely at the drugs I was taking for interactions with Paxlovid as these are (as I have written) legion.

I knew that she would ask me to stop taking the rosuvastatin I am taking. I was surprised when she told me that the inhaled Advair I take was also on the interaction list (more on that in another post.) The prescription was sent within 30 minutes to my local CVS. CVS requires that someone other than you pick up the prescription and that they come with a mask on.

Within 8 hours of my positive rapid antigen test I took my first dose (3 pills) of the Paxlovid. So far the only side effect has been a very strong metallic taste in my mouth. My daughter, the internist, indicates this is common. Thus far I have had none of the diarrhea that some experience as a side effect.

I am now midway through Day 3 of significant symptoms and feeling much better with no fever or headache. I began the Paxlovid 24 hours ago. Being a skeptical scientist I cannot say with certainty whether the improvement is due to a) tincture of time (i.e. the disease would have gotten better with or without the treatment b) Paxlovid or c) placebo.

I can say that I wish my date with COVID-19 had never happened and I fervently hope that I will have no further encounters.

Skeptically Yours,

-ACP

*N.B. for a great discussion on the normal temperature range I recommend my early pandemic post entitled ” In The Time of Coronavirus What Should Be Considered A Normal Temperature And What Is A Fever?

N.B The rapid antigen test I utilized was iHealth

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30 thoughts on “I Have Contracted COVID: Details of My Date with SARS-CoV2”

  1. I hate it that you were infected. Not only because I wouldn’t want you to be ill, but also because I too have been carefully and successfully avoiding it. I see a LOT of COVID victims in the wilds of pre-hospital care, and I’m discouraged you got it despite reasonable precautions.

    Reply
  2. That sounds like a pretty severe mild case, sort of like WInnie the Pooh asking Rabbit for a somewhat larger tiny bit of honey. Here’s hoping you get well soon.

    PS It’s all your fault for not participating in the Virgin Pulse wellness program.

    Reply
  3. My wife got COVID somewhere during her return from vacation in Ireland. Felt ill a couple of days after home. Tested positive on day five after the airports with a home test. (It took just a couple of minutes after the drops went in the test strip!) Confirmed positive at an urgent care clinic. There was that pesky weekend then. Got Paxlovid the Monday. Her experience was a bit milder than what you describe, but still knocked her low. Fine now. no sign of “long COVID”. . . yet.

    Me: I’m interesting. I’d gotten the 4th shot/2nd booster four days before she returned. We never took precautions with each other – no masks; no isolation.
    I never got it. No symptoms; no positives.
    The second booster can’t have acted that well that quickly, could it?

    Reply
    • Jeff,
      Did your wife use N95 well on the flight from Ireland? Was this post mask mandate?
      The time to positivity on the home RAT tests interests me. The first one positive one took >5 minutes to show positivity. I was so enthralled by Better Call Saul episode that I neglected to check it for about 30 minutes. When I realized I had forgotten I worried that I would have a missed the window but subsequently I note that these things stay positive for days. The second one taken the next day when I was feeling much better and post 2 doses of Paxlovid became positive within 30 seconds and was much more prominent than the first.
      The attack rate for family members has been listed at 35% or so. Unfortunately, my wife has developed symptoms and I’m anticipating her test will be positive today.
      My research on the second booster suggested I would be fully protected by day 12
      Dr. P

      Reply
      • My wife is 75. I’m 78. So, we’ve been very careful through this whole thing. We were both “fully” vaccinated at the time she left for an Irish month. We’ve done curbside pick-up for all shopping since early 2020. She wore her well fitted N-95s through airport, plane and airport. I guess that would constitute “loosening up” on her part. But Ireland was so safe. At the time.
        By attack I presume you mean 35% rate of infecting another family member. So low, even though these new variants are SO much more communicable? Do you know how often and how systematic genetic testing for variants is? What’s your variant?
        I’ve seen various seemingly wacky ideas bandied about, such as 0 blood type (mine!) will protect you. It doesn’t seem to have worked for this nasty common cold I have now. (Grandkids in daycare. OK, I guess that’s loosening too!) It’s getting so much harder to figure out what to believe, how to behave.
        Bold question: Do you have second thoughts about your recent loosening-up behavior considering that your wife now has it?

        Reply
        • My suspicion is the attack rate is higher with the newer variants.
          I’m totally unaware of personal genetic testing for variants.
          Interacting with grandkids in daycare seems to be a recipe for eternal URI and a need for never ending COVID testing.
          I have second thoughts about the loosening up when I was feeling really shitty. Now that I’m vastly improved not so much.
          As for the eternal beloved, did I say that she has it?
          In any event, she is in a much lower risk category, is trivaccinated and her job exposes her to travel and risk. We communicate constantly and transparently about possible exposures and were both ready to “loosen up” and were prepared for our respective dates with Rona.
          I’m going to write about quarantine issues which is my next adventure and spousal interaction is obviously a key part of that.
          Dr. P

          Reply
  4. I am so glad you are feeling better. I also live in St Louis and will put my mask on. Your “mild” case sounded miserable. Stay well

    Reply
  5. “I thought about going for walk in park in afternoon”

    Is breaking into Yorkshire grammar also now a symptom of COVID ?

    Reply
  6. It sounds as though you probably had multiple exposures over a short time period, and I would guess such would greatly increase chances of coming down with the disease. We’ve had over 40 cases since last December among residents in my CCRC (800+ in independent living) versus only 2 known cases prior to that with 99% reported vaccinated beginning Jan. 2021. I don’t know the percentage who have had both boosters – a very high percentage when CVS offered a booster clinic here last October. Those of us who elected to get our second boosters here got them last Friday, but many had theirs earlier. Our community began opening up a year ago and shut down a bit late following the first cases last December. Many residents are not wearing masks. So far I’m COVID free and more careful than most. Best wishes on a full recovery!

    Reply
  7. This is one of the best posts on the pros of getting vaccinated that I’ve seen and it has extreme credibility behind it. Thanks. I’ll forward it to my loved ones who are trying to commit suicide by default in not getting vaccinated.

    Reply
  8. I guess you’ve discontinued “awking” (per former eternal fiancee). Wishing you prompt and complete recovery. I had postponed my second booster, figuring that I don’t plan to fly until August. But I too have “loosened up”–went to 2 guitar recitals in the past month (the excellent Raphaella Smits and Johan Smith). I have also joined the guitar orchestra of my society–4 weekly rehearsals. Vaccine mandated, as are masks. Maybe I shouldn’t wait–I turn 70 tomorrow.

    Reply
    • Being a dentist and having people intimately breathing on me at work, I am ever faithful to masking up. I always wear a KN95 anytime I am indoors or in a crowd and wash my hands more times than I can remember, I received my 2nd booster last week and have not dined indoors since January of 2020. With all of that, I would not be surprised if I contract this latest variant since it is sweeping through the greater New York area at an unprecedented pace. Good luck with your recovery.

      Reply
      • Yeah, I’m a dentist too–though retired as of 12/2020. Was teetering at the edge and the pandemic (among other things) pushed me over–stay safe!

        Reply
      • Scott,
        thanks. Congratulations on avoiding your date with Omicron. I’ve only been to a dentist once since the pandemic and everyone was decked out as if in Hazmat suits. This pleased me, of course, as lying in a chair with mouth open feels particularly vulnerable.
        Dr P

        Reply
    • Steven,
      No awking because mere walking problematic. Will have to review CDC guidance on quarantining now that I am feeling up to it.
      Loosening up is nice. I can’t tell you how wonderful it felt to be sitting 10 feet from the 4 brilliant musicians in the Ariana String Quartet while they played Beethoven, Mozart and more modern pieces but there can be consequences.
      I haven’t flown since the mask mandate was lifted but I’m ready to do that.
      As far playing in the guitar orchestra, how could you resist?
      Dr P

      Reply
      • Guitar orchestras were a big deal around the turn of the 20th century (together with banjo and mandolin as well as mixed ensembles):
        https://en.wikipedia.org/wiki/BMG_movement
        The “orchestra” is run by a lovely young man (Phil Goldenberg) through the NYC Classical Guitar Society. He’s arranged ” Un Sonnet d’amour” from the Petit Suite of Samuel Coleridge Taylor for guitar in 4 parts.
        I’ve also finally started classical lessons after puttering around a mere 53 years. Got to keep the mind and fingers busy.
        Be well!

        Reply
  9. Happy to hear that you are feeling better. Thanks for sharing all the info about your Covid date. Get well soon!

    Reply

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