“Fever and cough symptoms?”
I have had a fever of 100 and cough with mucous along with headache and just feeling lousy for 4 days. I am taking antibiotics as given by the walk-in clinic. I took the home covid test and it was negative. I have been vaccinated. My oxygen level is 92. I am 5'10" and weigh 250.
Male | 64 years old
1 Answer
I apologize for this slightly delayed response to your blog question. I am super busy with my “day job.” I am even forced to limit responses to questions that I suspect, in all humility, that I am especially qualified to answer. My main medical interest during this “Year of the Plague” has been COVID 19.
***
Your symptoms with cough and fever and low O2 could be from the flu. Did the walk-in doc do a flu test?
Your symptoms could also be framing a readily treatable bacterial sinusitis with a bad bronchitis. If I had strongly suspected that--especially if I had heard wheezing in your lungs--I would have given you a Z-pack. It's not a great sinus antibiotic, but it is more protective of your lungs than most antibiotics are. (Zithromax also has some anti-viral properties that most docs probably don't know about.) However, I am guessing that your doctor didn't hear wheezing, or pneumonia crackles, since you didn't mention that he or she also prescribed an inhaler
For now, I am not able to second guess your walk-in provider. I cannot rule out a bacterial (or even fungal) component of your illness, and it is distinctly possible that it is what we doctors call a URI, i.e., a so-called Upper Respiratory Infection with a complicating feature of bronchitis headed toward becoming a Lower Respiratory Infection (again, a good reason for trying Z-pack).
A blog post obviously does not facilitate a more specific determination of what is going on in your case. It does occur to me, however, that your problem might be only viral. (By a convention of medical terminology, by the way, the term URI is reserved for presumably virus-only infections.) URIs are usually self-resolving, but in some cases they are stubbornly slow to resolve. The “Standard of Care” is for the provider who can’t make a bacterial diagnosis is to give you general advice and to suggest mainly over-the-counter meds and essentially just to urge you to wait and see how things unfold in your case. You will either improve or you won’t improve. You might actually get worse, of course.
Doctors often just make educated guesses. They try one med or another based on shrewd guesswork.
An in-person follow-up visit with a regular provider, if it becomes necessary, would ordinarily be the key to your provider’s management of your case according to the Standard of Care.
***
Now, if you have you do have a URI--again, only viral--the possibilities get kind of gnarly--because COVID 19 itself starts as a URI. What I am ultimately saying is that, based on the limited info that you have given me, you have to consider the possibilty that you do have a COVID 19 infection with a false negative test thus far. I have seen this happen.
I appreciate the fact that your blog inquiry suggests that you are inclined to believe that it’s not COVID-19, and you are probably correct about that. However, following are some medical facts that we ought to think about:
In the first place, your vaccinated status definitely does not mean that you surely don’t have a COVID 19 infection as the present cause of your fever and cough and low oxygen. You probably already realize that (as seen in the fact that you went to the trouble of taking the home test for COVID 19!). The truth is that the currently available COVID vaccines rank among the least effective vaccines we have ever distributed. (Some of the flu vaccines in recent years have been pretty low in efficacy, but the COVID vaccines are especially discouraging.) It turns out that our COVID vaccines don’t even meet the FDA standards set for the required efficacy for any vaccine being deployed. The standard for approving the use of a given vaccine is 50% efficacy against getting the infection during an epidemic wave. The last figures I recall being published for our vaccines’ protection against getting the COVID 19 infection ranged from only 36% to only 42%. The Delta variant appears to be blowing right past the vaccines pretty often.
This is why the CDC has even admitted that the vaccines are not meaningfully slowing the spread of the infections. The mantra that the unvaccinated folks are the super-spreaders is more than a little dubious. It turns out that several of the world’s countries having the HIGHEST percentages of ALREADY FULLY VACCINATED citizens have recently been seeing startling INCREASES in the number of new cases per hundred thousand of population. One such country is Ireland—a nation with a much higher vaccination percentage than most of the nations in the world. Ireland’s New Case stats have been pretty awful in recent weeks. What makes Ireland’s situation even weirder is that Ireland has one county that has achieved an astonishing vaccination coverage of 98.8% of adult citizens—the highest of all the counties in Ireland—and yet that very county has recently recorded the highest number of new cases of any county in Ireland.
We have been unable to account for this mess, but something is going haywire. Our public health agencies and our media have doubled down on booster shots and started pushing for the vaccination of little kids and are even trying to mandate full vaccination of practically everyone in the U.S.—including even people who clearly do not need it. (Contrary to what we sometimes hear, the natural immunity that a COVID 19 survivor has is both long-lasting and potent in preventing re-infection. Something like 90 studies around the world have shown this.
By way of a full, medically open-minded disclosure, I need to be sure to mention an evidently real benefit for our currently available vaccines: It is pretty clear that the person who gets fully vaccinated and then winds up with a breakthrough infection has a dramatically improved prognosis for the course of his disease. (This is nothing for the anti-vaxxers to scoff at even if some of their other concerns about the vaccines need to be honestly addressed.)
How can this be so? How can a vaccine be pretty poor in the usual (i.e., standard) matter of vaccine efficacy yet be pretty good in slowing down the disease when it breaks through? I have ideas of my own, but they are beyond the scope of this email. What I mainly want to say is that your home test result could have been a FALSE negative. There is no cause for alarm here, but I want you to realize that the home test might not reveal the presence of a genuinely ongoing COVID 19 infection for the (possible? likely?) reason that you have at least a partial (vaccination-induced) immunity that is currently suppressing the virion count far enough to put that count below the so-called “detection limit” of the home test. I would specifically point out that we do see a fair number of false negatives with the home tests (and with the quicky tests of the same type used in most hospital Emergency Departments). A follow-up PCR is much more sensitive and thus almost certain to reveal the COVID 19 breakthrough infection that the home test missed.
One of the sharp hospitalists where I am currently working has pointed that a positive home test is obviously to be believed, whereas a negative test for a patient with COVID 19 symptoms is not necessarily to be trusted. One of our ED doctors has declared that if the array of COVID 19 symptoms are present, then we have to assume we have a COVID 19 case on our hands unless and until a PCR test comes back negative. That’s just good medicine.
In short, the point of my unabashedly speculative discussion about the vaccine is that the partial benefits of the vaccine might also screw up the home test. This would tend to make “super-spreaders” out of vaccinated individuals who are pretty sure they just have a “bad cold.”
***
Finally, if you are still sick by the time you read this belated response to your original inquiry, you should at least go to a good Family Practice clinic or Urgent Care to see a provider. If you are terribly sick (e.g. badly short of breath), please go straight to an Emergency Department. If you haven't gotten a flu test, you need to get one. If that is negative, you definitely need a PCR test for COVID 19
Good luck and stay safe
Edwin McClelland, M.D.
***
Your symptoms with cough and fever and low O2 could be from the flu. Did the walk-in doc do a flu test?
Your symptoms could also be framing a readily treatable bacterial sinusitis with a bad bronchitis. If I had strongly suspected that--especially if I had heard wheezing in your lungs--I would have given you a Z-pack. It's not a great sinus antibiotic, but it is more protective of your lungs than most antibiotics are. (Zithromax also has some anti-viral properties that most docs probably don't know about.) However, I am guessing that your doctor didn't hear wheezing, or pneumonia crackles, since you didn't mention that he or she also prescribed an inhaler
For now, I am not able to second guess your walk-in provider. I cannot rule out a bacterial (or even fungal) component of your illness, and it is distinctly possible that it is what we doctors call a URI, i.e., a so-called Upper Respiratory Infection with a complicating feature of bronchitis headed toward becoming a Lower Respiratory Infection (again, a good reason for trying Z-pack).
A blog post obviously does not facilitate a more specific determination of what is going on in your case. It does occur to me, however, that your problem might be only viral. (By a convention of medical terminology, by the way, the term URI is reserved for presumably virus-only infections.) URIs are usually self-resolving, but in some cases they are stubbornly slow to resolve. The “Standard of Care” is for the provider who can’t make a bacterial diagnosis is to give you general advice and to suggest mainly over-the-counter meds and essentially just to urge you to wait and see how things unfold in your case. You will either improve or you won’t improve. You might actually get worse, of course.
Doctors often just make educated guesses. They try one med or another based on shrewd guesswork.
An in-person follow-up visit with a regular provider, if it becomes necessary, would ordinarily be the key to your provider’s management of your case according to the Standard of Care.
***
Now, if you have you do have a URI--again, only viral--the possibilities get kind of gnarly--because COVID 19 itself starts as a URI. What I am ultimately saying is that, based on the limited info that you have given me, you have to consider the possibilty that you do have a COVID 19 infection with a false negative test thus far. I have seen this happen.
I appreciate the fact that your blog inquiry suggests that you are inclined to believe that it’s not COVID-19, and you are probably correct about that. However, following are some medical facts that we ought to think about:
In the first place, your vaccinated status definitely does not mean that you surely don’t have a COVID 19 infection as the present cause of your fever and cough and low oxygen. You probably already realize that (as seen in the fact that you went to the trouble of taking the home test for COVID 19!). The truth is that the currently available COVID vaccines rank among the least effective vaccines we have ever distributed. (Some of the flu vaccines in recent years have been pretty low in efficacy, but the COVID vaccines are especially discouraging.) It turns out that our COVID vaccines don’t even meet the FDA standards set for the required efficacy for any vaccine being deployed. The standard for approving the use of a given vaccine is 50% efficacy against getting the infection during an epidemic wave. The last figures I recall being published for our vaccines’ protection against getting the COVID 19 infection ranged from only 36% to only 42%. The Delta variant appears to be blowing right past the vaccines pretty often.
This is why the CDC has even admitted that the vaccines are not meaningfully slowing the spread of the infections. The mantra that the unvaccinated folks are the super-spreaders is more than a little dubious. It turns out that several of the world’s countries having the HIGHEST percentages of ALREADY FULLY VACCINATED citizens have recently been seeing startling INCREASES in the number of new cases per hundred thousand of population. One such country is Ireland—a nation with a much higher vaccination percentage than most of the nations in the world. Ireland’s New Case stats have been pretty awful in recent weeks. What makes Ireland’s situation even weirder is that Ireland has one county that has achieved an astonishing vaccination coverage of 98.8% of adult citizens—the highest of all the counties in Ireland—and yet that very county has recently recorded the highest number of new cases of any county in Ireland.
We have been unable to account for this mess, but something is going haywire. Our public health agencies and our media have doubled down on booster shots and started pushing for the vaccination of little kids and are even trying to mandate full vaccination of practically everyone in the U.S.—including even people who clearly do not need it. (Contrary to what we sometimes hear, the natural immunity that a COVID 19 survivor has is both long-lasting and potent in preventing re-infection. Something like 90 studies around the world have shown this.
By way of a full, medically open-minded disclosure, I need to be sure to mention an evidently real benefit for our currently available vaccines: It is pretty clear that the person who gets fully vaccinated and then winds up with a breakthrough infection has a dramatically improved prognosis for the course of his disease. (This is nothing for the anti-vaxxers to scoff at even if some of their other concerns about the vaccines need to be honestly addressed.)
How can this be so? How can a vaccine be pretty poor in the usual (i.e., standard) matter of vaccine efficacy yet be pretty good in slowing down the disease when it breaks through? I have ideas of my own, but they are beyond the scope of this email. What I mainly want to say is that your home test result could have been a FALSE negative. There is no cause for alarm here, but I want you to realize that the home test might not reveal the presence of a genuinely ongoing COVID 19 infection for the (possible? likely?) reason that you have at least a partial (vaccination-induced) immunity that is currently suppressing the virion count far enough to put that count below the so-called “detection limit” of the home test. I would specifically point out that we do see a fair number of false negatives with the home tests (and with the quicky tests of the same type used in most hospital Emergency Departments). A follow-up PCR is much more sensitive and thus almost certain to reveal the COVID 19 breakthrough infection that the home test missed.
One of the sharp hospitalists where I am currently working has pointed that a positive home test is obviously to be believed, whereas a negative test for a patient with COVID 19 symptoms is not necessarily to be trusted. One of our ED doctors has declared that if the array of COVID 19 symptoms are present, then we have to assume we have a COVID 19 case on our hands unless and until a PCR test comes back negative. That’s just good medicine.
In short, the point of my unabashedly speculative discussion about the vaccine is that the partial benefits of the vaccine might also screw up the home test. This would tend to make “super-spreaders” out of vaccinated individuals who are pretty sure they just have a “bad cold.”
***
Finally, if you are still sick by the time you read this belated response to your original inquiry, you should at least go to a good Family Practice clinic or Urgent Care to see a provider. If you are terribly sick (e.g. badly short of breath), please go straight to an Emergency Department. If you haven't gotten a flu test, you need to get one. If that is negative, you definitely need a PCR test for COVID 19
Good luck and stay safe
Edwin McClelland, M.D.
