Don't forget COVID-19: Why certain patients might be more likely to dismiss symptoms

Canadians are well-settled in offices and classrooms after the summer, bringing with them sore throats, coughs and sniffles, which many brush off as the annoyance of allergies or a pesky cold. The culprit could still easily be COVID-19.“It has settled into a pattern of seasonal and intermittent surges, but it’s presentation is increasingly indistinguishable from influenza, RSV and the common cold,” Dr. Samira Jeimy, associate professor of Clinical Immunology and Allergy in the Department of Medicine at Western University, wrote in an email to CHN. “For pharmacists, this means that vigilance is still necessary.”Watch for “razor blade sore throat”Among the current Omicron sub-variants, the most prevalent, according to Ontario public health, is the XFG variant, nicknamed ‘stratus’ by public health authorities. Twice as many cases of stratus have been confirmed as patients with the strain known as XFG.3 (or ‘nimbus’)—the second most prevalent subvariant appearing in Canada and across North AmericaWhile the new strains are generally presenting with similar symptoms as previous Omicron variations, it’s important to note that, since these variants replicate in the throat lining, the first symptom is often an extremely sore throat, or what WebMD and other medical sources are calling “razor blade sore throat."Cases on the uptickIn Canada, the number of COVID-19 cases has been gradually increasing since the end of August. For the week ending Sept. 13, 2025 the COVID-19 level was moderate at 9.6% (or 1,975) of laboratory confirmed detections. In comparison, the number of positive tests for influenza was 0.5% and for RSV 0.3%. Since Aug. 24, 2025, participating provinces and territories have reported 214 laboratory-confirmed respiratory viral outbreaks, mostly in long-term care homes and hospitals. Almost all outbreaks (99%) were associated with COVID-19.Importantly, 81.1% of Canadians have at least one COVID-19 vaccine, but only 3.9% of the population were vaccinated as per recommended Canadian immunization guidelines, according to data up to June 30, 2024. And only 18.2% of the population had received the updated XBB.1.5 COVID-19 vaccine. There are several reasons for decreasing COVID-19 vaccine coverage, including the change in risk perception since the start of the pandemic. “There are many people who now perceive COVID-19 as a few days of fever and a sore throat, without realizing that infections can be life threatening to them or those around them,” Shelly Bolotin, director for Vaccine Preventable Diseases at the University of Toronto and associate professor at the Dalla Lana School of Public Health and the Department of Laboratory Medicine and Pathobiology, wrote in an email to CHN. “Furthermore, misinformation about the vaccine has become more prevalent, and often spreads faster and more effectively than facts.”The importance of being vaccinated is not limited to high-risk groups, who are more likely than others to experience morbidity and mortality from COVID-19. “Even those who are not high risk, and don’t experience severe infection can be affected: if a COVID-19 wave occurs in the fall or winter concurrently with other respiratory viruses, like influenza and RSV, this could affect hospital capacity as a whole,” Bolotin says.There are also the long-term impacts of COVID-19 to consider. “Beyond the acute illness, even mild infections can leave a footprint in the form of long COVID, cardiovascular complications, or destabilization of chronic diseases,” says Jeimy.Pharmacists are uniquely positioned in communities to counsel patients about vaccination and harm reduction. And as COVID-19 transmission increases in the community, pharmacists play a crucial role in recognizing symptoms early and in determining if there is a need for testing, so that eligible patients can be prescribed time-sensitive antivirals. Pharmacists should keep top of mind that there may also be contraindications to taking antivirals, “COVID treatments carry complex drug-drug interactions, so the pharmacist’s role in guiding safe prescribing is irreplaceable,” Dr. Jeimy wrote.It's important for pharmacists also to be aware that patients with asthma or who are immunocompromised may not relate changes in their health to COVID. “A patient with asthma may assume that a new cough, chest tightness, or shortness of breath is ‘just their asthma’ acting up,” adds Dr. Jeimy. “That delay can cost them the window for testing and treatment, while in reality, COVID infection itself can worsen airway inflammation and trigger severe exacerbations.” “Immunocompromised patients are a different story: their symptoms may look deceptively mild at the outset because fever and strong inflammatory signs can be muted by their underlying immune deficit or their therapies,” said Dr. Jeimy . Fatigue, cough and subtle changes can be the only clues of COVID. “This is where pharmacists again make a difference: reminding patients that any change in their baseline, however slight, is a reason to test for COVID-19 and consider early treatment.”Says Dr. Jeimy: “The reason not to ‘forget’ COVID—regardless of what we would like to believe? The virus is still here, still interacting with other diseases and medications, and still capable of serious harm if dismissed too quickly.”And so when patients come into the pharmacy seeking help for a very bad sore throat, while Strep often immediately comes to mind, it’s important to also think ‘nimbus’ and consider testing for COVID-19.Read: Quebec follows Alberta’s move to stop offering COVID vaccine for free to most people

Don't forget COVID-19: Why certain patients might be more likely to dismiss symptoms

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