Robin Schoenthaler, MD
6 min readAug 23, 2023

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Dr Robin’s Covid Updates

Why do so many of us suddenly have Covid again?

We’re back with an uptick. So it’s back to basics.

Photo by Thom Milkovic on Unsplash

I’m a Boston-based cancer doctor and I’ve been writing weekly fact-based-no-blame-no-rumors-all-science-all-the-time essays about Covid-19 since March 2020. If you liked this and some of my other essays below, you can support both Medium and me here .

Since we’re having a bit of an increase in Covid infections — not a surge exactly, more like an uptick — I thought I would send out my first Covid missive in a while.

Just a little reminder about what this is: I am a cancer doctor who wrote a lot about Covid 2020–23 from my point of view as an oncologist who knows some stuff about statistics and epidemics and risk assessment and fear. I’m not an epidemiologist or infectious disease doc and I know nothing about Long Covid. But sometimes I like to write summaries about what is going on with Covid and try to tease out the facts from the fear and maybe put some of our experience and the headlines into perspective.

For a month or so we’ve been having an uptick in wastewater Covid — most places that measure Covid in our sewage have noticed a lot more (like 100% or 200% more) particles than earlier in the summer.

As you no doubt recall (and shudder remembering): as soon as we see more Covid in sewage, we will soon see an uptick in people with Covid.

Okay, let’s see how many times can I not use the word uptick.

Even though nothing is tracked very well anymore, some things are clear:

— First we had an increase in wastewater numbers.

— Then we had a trend up in wastewater numbers.

— Now we have started to see more cases in more places

— We started seeing more positives in asymptomatic people

— The ERs are seeing more people for Covid

— And now more people are being admitted to the hospital with Covid.

So now we have an uptick.

A few weeks ago this started to hit the press. A couple of weeks ago I myself started hearing more and more stories about friends getting diagnosed and getting their lives disrupted all over again. Now I’m hearing about friends and family every day.

Many but not all cases are related to travel. Many but not all are repeat infections. People who have had Covid before are getting it again.

People who were “Novids” — people who had never gotten Covid — are getting this one (and boy, are they annoyed). People who have been vaccinated can still get this kind of Covid but the vaccines still appear to do their job with this variant which is to keep you out of the hospital.

This uptick now clearly has the potential to have some kind of impact on our PERSONAL lives. It’s actually too early to guess whether it’s going to have an impact on our PUBLIC lives. I doubt very very much anything like travel restrictions or school closures will happen with this variant but who can possibly say?

The Covid virus that is making people sick is still a kind of Omicron called EG.5. It’s not a new Covid but it’s changed just enough so it’s making people sick and it’s making people contagious. It does not at this point appear to be making people sicker or die more. There’s also other variants in the pipeline but again, who can possibly say?

But what we do need to do is go back to the basics and review what we need to do if we get sick.

AIf you get respiratory symptoms (nose, throat, cough) or headache or GI symptoms or just feel ridiculously fatigued (or kids get pinkeye) you need to test and test again. It can take several days for these versions of Omicron to test positive.

B If you test positive and are over 50 (or have any medical issues whatsoever including depression, blood pressure, obesity, or are sedentary), call your doc and get Paxlovid.

Every single study that comes out on Paxlovid shows it helps keep people out of the hospital. It helps people die less. It helps shorten the disease. And it may (MAY!) help decrease the chances of Long Covid.

At the start of the pandemic we were all like “We need to be on lockdown until we have vaccines and good anti-virals and then we’ll be safer.” And our dreams came true (the science did save us) and now we have Paxlovid.

Paxlovid is precisely the kind of “anti-viral” we wanted — it helps decrease the amounts of Covid viruses in your body exactly like you need it to; it’s one of our Covid miracles.

It’s such a great drug! So why isn’t everybody taking it?

For some people it leaves a lousy taste in their mouth. One of the names for this symptom is “taste perversion” which I find hilariously funny because it makes me picture some guy wearing green plaid pants and purple shirts. This icky taste can last one dose, one day, or the whole time. For some people it helps to chew gum or suck on mints or candies but some people just need to tough it out and know the yuck factor will disappear.

A lot of people say, “Oh I’m not that sick, I’ll wait and see how I do.”

I have one response to that, just one: NO NO NO NO NO NO NO.

You do NOT want to wait to “see if you get worse.” Paxlovid is designed to KEEP YOU from getting worse. You have to take it early. If you are high-risk and you wait until you get worse, it may well be too late and boom, you’re super sick and in the hospital.

Another reason people don’t take it or get it is because of fear of “rebound.” This makes me a little insane as it’s really a “headline fear” and I hate “headline fears” with all my heart.

Covid is now associated with this scary headline name of “rebound” but the reality is “persistent symptoms after viruses” (which is what rebound means) have been around since the dawn of time.

We have all heard friends say, “I got a cold last summer and I went back to work and wham!! I ended up back in bed.” Or, “I had this nasty flu at Halloween and then I couldn’t stop coughing for the rest of the year.” It’s the same thing with Covid.

Persistent symptoms can happen after any virus and they can happen after Covid and they can happen whether you take Paxlovid or not.

The experts still feel the chances of rebound is low and the chances of helping you stay out of the hospital are high and if you are high risk it’s totally worth taking the Paxlovid.

A couple of different ER docs I’ve talked to have told me the one common denominator all their admitted patients have (they ones so sick with Covid they have to come into the hospital) is that they didn’t take Paxlovid.

So, especially if you’re older, and especially if you’re fragile (Hello, Aunt Gertrude): take the Paxlovid.

C Once you’ve got Covid, the CDC says stay home for five days after your first symptom. If negative you can leave home; if positive the CDC says you can go out with a mask although many choose to wait until they’re negative.

DShould you mask in general when you’re out? In crowded spaces, with strangers, when going home to immunocompromised or at-risk people? Sure. Are we going to have a mask mandate with this uptick? I doubt it.

E And what about the boosters and when to get them? Ahh, the 68 gajillion dollar question. As with most things the answer is “it depends.” A new more modern probably more targeted vaccine should be widely available in October. If you’re not terribly high-risk or you’ve had a recent vaccine or Covid infection, it’s reasonably safe to wait til then. If you’re higher-risk or have a job where you are with a lot of exposure and you haven’t had a shot in a while — well we are definitely in a uptick.

There, I said it again.

Photo by Jesse Echevarria on Unsplash

Here are some older pieces you may find helpful to read:

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Robin Schoenthaler, MD

Covid-Translator. Cancer doc: ~Three decades at MGH. Writer and storyteller: Moth Grand Slam Champion. Mom. www.DrRobin.org, @robinshome, robinshome2@gmail.com