Why COVID 'Razor Blade' Sore Throat Hurts So Bad

WebMD

4 hours ago

June 26, 2025 – The new COVID-19 variant that now makes up about a third of U.S. COVID cases has a signature symptom: a painful sore throat that feels like "razor blades."
"This 'razor blade sore throat' was reported as a common symptom in China," where the variant first emerged in May, said Matthew S. Kelly, MD, MPH, chief of infectious diseases in the Pediatrics Department at the University of Arkansas for Medical Sciences. It's also been widely reported in other countries, including the U.S., as the variant has spread worldwide.
Why Does This Sore Throat Hurt So Much?
NB.1.8.1 – or Nimbus – is a subvariant of Omicron, the dominant COVID variant since late 2021. Omicron variants tend to cause more throat problems than the virus's earliest forms.
In the past few years, infectious disease specialist Peter Chin-Hong, MD, has seen more and more COVID patients with sore throats.
"Even before this variant, sore throat has been reported in up to 70% of patients with COVID, and it can be severe," said Chin-Hong, a professor at the University of California, San Francisco.
One possible explanation is that as the virus evolves, our body's response to it changes too.
COVID viruses bind to ACE2 receptors, found on the surface of cells. Cells in the upper airway (nose, throat) have more ACE2 receptors than those in the lower airway and lungs do – making them prime targets for Omicron variants, which bind to these receptors more strongly. Research suggests that of all the variants circulating now, Nimbus binds to ACE2 receptors the most.
Once the virus reaches those cell receptors in and around your throat, your immune system – likely primed by past infections, vaccination, or both – kicks into overdrive to keep the virus at bay. Cue inflammation, fluid buildup, redness, and swelling.
"Symptoms of the sore throat are not from the virus itself," said Chin-Hong. "They are from the inflammatory reaction to the virus."
Another possibility: A COVID sore throat might feel worse today than it did earlier in the pandemic, because the original virus had more severe systemic symptoms, diverting attention from individual ones like a sore throat, said Chin-Hong.
What Works for a Sore Throat?
Anti-inflammatory drugs."[Data shows that] the most effective thing for sore throat is systemic therapy," said Chin-Hong. Think over-the-counter pain relievers such as ibuprofen. If pill swallowing is painful, try a liquid form, he said.
Numbing agents, like throat sprays and lozenges with benzocaine, can be effective for short-term relief. Just don't ignore the package directions because misuse can be dangerous. "You're just trying to dull the pain for a couple of days when it's at its worst," said Kelly.
Menthol lozenges. Menthol affects nerve activity in the throat, causing a mild numbing effect for a short time.
Warm or cold liquids. No high-quality studies exist for these interventions, but many doctors still recommend hot tea and soup, or ice chips and ice pops. "This is sort of where medicine crosses over into: What seems to work for you? What did your mom do?" Kelly said.
Here's what not to do:
Don't beg your doctor for antibiotics. "Viruses are the most common cause of sore throat," said Chin-Hong – and antibiotics only work against bacterial infections. Plus: "Overprescribing antibiotics is bad for the microbiome and for increasing the risk of thrush and yeast infections."
Don't assume steroids are a quick fix. "Sometimes people try to reach for steroids for pain associated with sore throat," said Chin-Hong, but steroids can have an immune-suppressive effect. In one 2025 study, people who took a corticosteroid for mild or moderate COVID had longer-lasting symptoms than those who took a nonsteroidal anti-inflammatory instead. They were also more likely to be hospitalized.
Don't apply pressure. You may have seen TikTok influencers touting "throat massage" techniques for a sore throat. Your neck is rich with delicate blood vessels and tissues that can be easily damaged with too much pressure, Kelly said. Leave massaging to trained experts.
What Should You Do if You Have a Sore Throat?
Take an at-home COVID test. (They still work for new variants.) If the test is positive, you can ask your doctor whether you're a candidate for an antiviral medication to help you recover faster. If it's negative, retest in 24 hours to confirm. When throat pain is your only symptom, it can take a few days before nasal swab tests can detect the virus, said Chin-Hong.
Watch for symptoms that get worse, which could mean you have a severe bacterial infection or abscess. See a doctor if:
Throat pain is much worse, compared to other symptoms.
It's the worst sore throat you've ever had.
You notice signs of a throat obstruction, such as hoarseness, drooling, or trouble breathing.
Your doctor might do a throat culture for strep. If it's positive, you'll likely be prescribed antibiotics to keep the infection from spreading. "We want to prevent bad stuff down the road, like heart disease, rheumatic fever, or kidney disease," said Chin-Hong.
Should You Worry About Nimbus?
While U.S. cases are still relatively low, "this could lead to a summer surge or a surge in the next couple of months," said Kelly. Now's a good time to get a booster vaccine, particularly if you're 65 or older or have a chronic medical condition, he said. The COVID vaccines available now were formulated to target Omicron variants.