Aimee Seidman, MD, FACP
There have already been a surprising number of COVID infections this fall. Most people who acquire the disease develop symptoms 2 – 14 days after exposure. The majority develop symptoms after about 11 days.
People at high risk of complications include:
- Immunocompromising conditions or on immunosuppressive medications
- Chronic heart, lung, kidney or liver disease
- Diabetes
- Obesity (risk increases as BMI rises)
- Pregnancy or post-partum
- Neurologic conditions, such as stroke and dementia
- Disabilities such as Down’s syndrome
- Hematologic conditions such as sickle cell disease, thalassemia, myeloma
- Smoking
- Physical inactivity
- Substance use disorders
- Mental health conditions, such as mood disorders, schizophrenia
- Residence in a long-term care facility
- Age >65
Potential symptoms include fever, chills, cough, shortness of breath, fatigue, headache, sore throat, nasal congestion, new loss of taste or smell, or gastrointestinal symptoms such as nausea, vomiting, or diarrhea. Usually, patients have one or two of these.
Respiratory symptoms often start first, with others following. Shortness of breath suggests worsening disease. Some people, such as the high-risk patients listed above, can become seriously ill, be hospitalized, or even die. Over one million Americans died from COVID between 2020 and 2023. Between 2024 and 2025, 34,000 – 53,000 died in the United States. We don’t have statistics more recent than that.
Patients with COVID should get Paxlovid for symptomatic disease if they are at high risk for disease progression (see above list). Paxlovid must start within 5 days of onset of symptoms. In those with significant liver or kidney disease, the drug may be contraindicated or require dose adjustment. Symptoms can recur in 1 – 6 percent of patients after they resolve with Paxlovid treatment. People who are at average risk for severe disease may not need the drug at all. It should be determined on a case-by-case basis.
There are four COVID shots available for this season. Three are mRNA vaccines: Comirnaty (Pfizer), Spikevax (Moderna), and mNEXSPIKE (also Moderna). mRNA vaccines work by introducing a protein that prompts the virus to produce antibodies. The fourth, Nuvaxovid (Sanofi), is a protein-based vaccine that targets the spike protein on the virus’s surface. The CDC does not recommend one product over another. Nuvaxovid is a reasonable choice for patients who cannot or will not take the mRNA vaccines.
What are the potential side effects of the COVID vaccines? Most side effects are mild and short-lived: local (pain, redness, swelling) or systemic (fatigue, muscle aches, joint pain, chills, fever, nausea) reactions that usually resolve within a few days. The main serious risks are myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the pericardium). Myocarditis mostly occurs in young men (40 cases per million ages 12-29) and is usually mild. Pericarditis is even less common and is not limited to young men. Myocarditis and pericarditis can also be complications of COVID infection itself, so they can occur from either the vaccine or the infection.
We must weigh the risk of side effects against the risk of COVID infection to decide whether to Take the vaccine. For most people, the benefit of avoiding COVID far outweighs the potential side effects of the vaccine.
