What is mild COVID-19 anyway?

What is mild COVID-19 anyway?
Public health officials have repeatedly stressed that Omicron is milder than previous COVID-19 variants of late. So what exactly is mild COVID? (Photo credit: Andrea Piacquadio/Pexels)

In the days and weeks since Omicron was identified, British Columbia’s top doctor and other public health experts have stated repeatedly that this variant is milder than previous strains.

“We know now with this strain that even if you are fully vaccinated, you can get infected but it is a milder illness for most of those people,” said Dr. Bonnie Henry, the provincial health officer, during a press conference on Dec. 17.

The term mild or milder has been used frequently by public health experts, medical doctors in the media and in general communication when referring to the new variant, without much explanation about what that actually means.

So what exactly is mild COVID anyway?

When asked what Dr. Bonnie Henry’s definition of mild COVID was, a spokesperson for the Ministry of Health referred CHEK News to the BCCDC’s page on COVID-19 symptoms — a page that does not specifically lay out what mild COVID is.

However, Dr. Panagis Galiatsatos, an assistant professor at the Johns Hopkins School of Medicine, said the definition of mild COVID-19 from a medical perspective is fairly straightforward.

“Mild from a medical standpoint, it just means you weren’t hospitalized. It does not mean this virus won’t keep you bed-bound for days,” he told CHEK News. “So, mild from a medical standpoint means whether we have to send you to the hospital or not.”

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Calling Omicron milder from the perspective that it is less severe than previous variants is also somewhat misleading, according to Galiatsatos.

“The challenge was calling it milder is misleading, because if you have a lot more cases, you’re still going to get a lot more patients coming into the hospital. Sure, at lower rates maybe the Delta, but denominators, it’s all about the denominators.”

Galiatsatos also said mild symptoms aren’t something one should take lightly.

“It does not mitigate the symptoms people will feel, and that’s what I tell my patients. Mild symptoms may kick your butt and that has been the case for several patients that I  have where it has really been a doozy for them,” he said.

Dr. Baldev Sanghera, a family physician and medical director at Edmonds Urgent and Primary Care Centre in Burnaby, said symptoms of COVID-19 vary greatly and how sick one gets depends on a whole host of factors such as vaccination status, underlining health conditions, ethnicity and socioeconomic status.

“The majority of cases that we’re seeing that are considered mild, so not ending up in death and not ending up in hospitalization, and the majority of people tend to recover,” he said, later adding. “But there are plenty of cases where people initially had mild symptoms, but then ended up getting long COVID, which can be devastating.”

Sanghera explained some of the patients he has seen have had nothing more than just a dry cough while others have felt tired and weak, had headaches and nausea or lost their sense of smell and taste.

“We are seeing a full spectrum. I have seen really really mild conditions where the patient had a dry cough and recovered after a week,” he said. “I’ve had others who felt tired and weak, had a headache, nausea, loss of smell and taste but that cleared up within a week or two.”

Other patients with milder symptoms have had congestion, sinus pressure that has lingered for weeks, said Sanghera.

“It stuck around for two to four weeks,” he said. “It’s mild, but it’s a horrible thing to get over.”

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Sanghera said even mild symptoms can still have a significant impact on a person’s quality of life. He said one patient was an active and healthy woman in her 40s who experienced cold symptoms that later turned out to be the coronavirus.

“Prior to getting COVID, she was running 10K two times a week,” he said. “Now, she gets shortness of breath going up the stairs.”

Another patient, a woman in her 50s who was also active but had underlining conditions, continues to struggle with breathing as a result of becoming infected.

“She is having to catch her breath after walking more than a block,” Sanghera said.

Throughout the pandemic there has been no shortage of professional athletes, particularly of late as the virus works its way through various leagues including the NHL, who have tested positive for COVID-19 – or at the very least been placed into some kind of COVID-19 protocol – since the onset of the pandemic.

Many of those athletes who have tested positive, including Sidney Crosby, have either said themselves or their team has said publicly that their symptoms are mild.

Sanghera cautions people not to base the seriousness of COVID-19 on the experience of an athlete — or anybody else for that matter – because the virus affects everyone differently.

“Each person is different and your body’s response to COVID-19 is different. Your body’s immune system is different from someone else. This COVID virus causes a lot of inflammation in the body,” he said. “It’s not like any other respiratory virus that we have been exposed to in the past where you just get respiratory symptoms and that is it. COVID impacts the organs from an inflammatory point of view.”

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Are Omicron symptoms different from previous variants and are symptoms different based on vaccination level or status?

It is still too early to know if Omicron’s symptoms are completely different from other variants, but Sanghera said he has noticed a change in the type of symptoms people have been experiencing over the past week compared to a month ago.

“I can safely tell you that in the last week, the cases that we’re seeing are different than the ones that we were seeing two to three months ago,” he said.

The difference, according to Sanghera, is that fewer patients are complaining about a loss of smell and taste or having stomach issues than in the past and that the complaints now are related to breathing and congestion.

“We’re starting to see more of the upper airway, nasal congestion, sore throat, cough both dry and wet, shortness of breath. More wheezing, that kind of stuff we’re starting to see more about in the last week,” he said.

According to Health Canada’s website, common symptoms of COVID-19 include a new or worsening cough, shortness of breath or difficulty breathing, fever, chills and having a temperature equal to or more than 38 C. Other symptoms include fatigue or weakness, headache, loss of smell or taste, abdominal pain, diarrhea and vomiting and feeling “very” unwell.

Sanghera said he only knows whether his patients have tested positive for COVID-19 and is not informed about which variant they have, but noted that the change seems to be occurring as more and more people become infected with Omicron.

It’s also unclear whether symptoms are different based on how much vaccine or even the type of COVID-19 vaccine a person has received.

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However, Dr. Craig Spencer, an emergency room physician in New York City and the director of Global Health in Emergency Medicine at Columbia University Irving Medical Centre, suggested that there appears to be a difference in symptoms depending on the amount of vaccine a person has received. In a series of tweets on Dec. 26, he said all of the patients he has seen who had their third dose of vaccine had very 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,” he wrote on Twitter.

Spencer explained that patients with two doses of Pfizer or Moderna vaccine had mild symptoms too, but those symptoms were a bit worse than those who had their third dose. He also said those who had just a single dose of the Johnson & Johnson vaccine were far worse.

“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,” he wrote.

Galiatsatos said when it comes to unvaccinated individuals versus vaccinated individuals, those who have any kind of vaccination are far less likely to wind up in hospital or die.

“The vaccine, you should always remember, was meant not to prevent you from catching COVID, but to keep it mild and prevent it from becoming a severe disease,” he told CHEK News. “All my outpatients who were vaccinated against COVID, even though they caught it, it was maintained as mild COVID. The unvaccinated still are getting admitted into the hospital and at high rates.”

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Nicholas PescodNicholas Pescod

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