It’s the holiday season! My favorite time of year. We are also in “epidemic” mode for our fall and winter respiratory season. We can take small steps in the “background” to minimize sickness and maximize family time. That is, if you want to maximize time with your family. ;) Here is an update on the latest on flu, RSV, and Covid-19.
Public health professional and expert explains the best practices and then states, "we don't do that anymore, because the tests are expensive" despite absolutely being able to afford it. If even the most informed and privileged people can't be bothered to test before an event (with a 39% chance of catching potential infection), then I guess no will. I will keep testing to protect others but jeeze that admission is depressing for any immunocompromised person.
Not that easy to understand it appears - hope someone can clarify. Oct 31 statement: "According to HHS, through the end of 2024, people who are uninsured and those who have Medicare or Medicaid coverage will continue to be able to get Paxlovid for free through a patient assistance program set up by Pfizer. That should mean that you pay nothing at the pharmacy counter." (https://www.verywellhealth.com/paxlovid-commercial-market-transition-8384418). A more clear statement would say what Part of Medicare covers it - if it's Part D (drugs at pharmacies), then you'd need Part D coverage unless the above statement is meant as an exception. The Medicare.gov statement seems even less helpful. It would be SO nice if official statements were reviewed by some typical consumers before publishing them.
Thank you. We have Medicare A, B, and D, so we should be okay. We are cautious and have so far been able to avoid Covid, but obviously that can change!
Medicare beneficiaries will not face cost-sharing requirements for certain covid pharmaceutical treatments, such as the antiviral Paxlovid, after May 11, as long as those doses were purchased by the federal government. Medicaid and the Children’s Health Insurance Program, meant for youngsters in working-class families, will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that, states may impose utilization limits and nominal cost-sharing.
Given that cost of Paxlovid is an issue, for those without access, what are your thoughts for clinicians on using metformin to reduce a patient's risk of developing long covid?
It obviously depends on the patient, but I am all for cheap, easy tools to help reduce the risk of long covid. That clinical trial was pretty darn clear. In other words, I would take it.
We took metformin (and Paxlovid) when we were infected this spring. The digestive symptoms from metformin took us by surprise, but switching to the extended release formula took care of the problem. Anyone who hopes to go straight to extended release should check their insurance formulary — once we had an issue, it was easy to switch and have it covered, but we had to try regular metformin first.
Thanks, useful information as usual. I had forgotten about the ventilation systems on airplanes. As we are flying home from Buenos Aires tomorrow, the reminder was timely. I had been wearing an N-95 end to end, but this suggests to me that I can switch over to a KN-95 once we're in flight.
1) Masks work on an "individual level", but there is somehow no evidence at all of them working at a population level (a population is comprised of individuals). This theory makes no sense. You continue to spread lies about masks.
2) Wearing properly fitted N95s is extremely uncomfortable and not at all practical for most people. And the evidence for even fitted N95s working to prevent viral infection is very weak.
3) Prior to 2020, I never heard any "experts" publishing pieces on how to avoid viruses at Thanksgiving. I never heard anyone telling people to celebrate outside.
4) I have a hard time believing the percentages in the survey you shared. When I go out in public (I live in a liberal metro area), I see maybe 1-2% of people wearing masks. Sometimes I see zero.
2. It is uncomfortable. The evidence is not weak, though. This is a physics question. Go to the post above, again.
3. We did, but people just weren't paying attention. It would be a shame to go back to pre-pandemic times, given how much we have learned over the past 4 years.
4. I have a hard time with that survey too, because I'm seeing the same. I think some of it has to do with social desirability bias in the survey.
Years ago we were exposed to ubiquitous cultural mask-wearing when we lived through a fall/winter/spring in Japan - where it's considered rude and "baka" to not wear a mask when you have even a light case of sniffles.
We got used to routinely wearing wearing masks in the pre-pandemic wildfires in northern California.
Currently I see about a third of our local population wearing masks in public - well over half among the elderly. (And local vaccine uptake is so high that there's been a shortage.) Our kid at UCLA tells us that the numbers are higher among students in public and classrooms, and they're still testing wastewater and offering antigen tests in vending machines.
It sounds to me like a dystopian nightmare in the parts of the country where ignorant ideologues insist that common sense measures to avoid infection are evidence of some vague but sinister govt/pharma conspiracy.
We stopped travelling for holiday get-togethers years ago because it's stressful - and too many stressed people in a small space is a recipe for selfishness, entitlement, rudeness, and bad behavior. During lockdown we embraced staying in touch with family and friends by frequent videochat - and for ourselves we are perfectly content to have made that - like masking, vaccinating, and voting in every election - a lifelong habit.
Katelyn, you do realize that he is one of the best 'supporters' you can have; very contrarian and hostile pronouncements are a sure way to get all your data confirmed in the minds of the public.
Paul, thanks for all the work you do to affirm Katelyn's work.
We have 80+ RCTs spanning decades and 3+ years of population-level data with no evidence of masks working. We have the gold-standard in medical evidence (Cochrane) saying the same thing that other pre-pandemic meta-analyses said (no evidence of efficacy).
I don't care about what you said in your carefully crafted narrative piece with confounded observational studies and a horribly constructed Bangladesh RCT (that still required data torturing to find a small effect). That is not quality evidence. Real-world data and RCTs are evidence. Lab studies and powerpoint charts/diagrams are not. If it "works" in a lab with a mannequin but not in the real world, then it doesn't work.
The narrative on masks completely flipped in late March/April 2020 based on nothing. There was no new "evidence" that was revealed. It went from "they don't work" to "they work and everyone needs to wear one." seemingly overnight. That right there tells you all you need to know. And everyone (you included) told people that cloth masks worked and would keep them (and others) safe. Now the narrative has moved to just fitted N95s.
you're reading the incorrect data, Paul; ask my granddaughter who is in grad school; she and her colleagues wear masks everyday in the lab because they're working with active pathogens; also JAMA just came out with a conclusive review of research pro masking; I have found many N95s that are comfortale--see Aaron Collins for reviews of breathability and fit
Thing is, if he'd said that he found masks uncomfortable, especially now that they aren't required, I'd have accepted that. Why he feels compelled to get into the weeds trying to prove masks are useless is beyond me. I *do* think that masks are important tools for both respiratory protection and source control, and wouldn't beat myself up if I occasionally decided against masking based on discomfort. Risk mitigation is never a purity test; it's a thing you make a good faith effort to do, in the moment, if it's practical.
One clear example of this overnight narrative shift is from Dr. William Schaffer, professor of medicine in the division of infectious diseases at Vanderbilt University. On March 4, 2020, he said this in a story published by Time.
“It seems kind of intuitively obvious that if you put something—whether it’s a scarf or a mask—in front of your nose and mouth, that will filter out some of these viruses that are floating around out there,” says Dr. William Schaffner, professor of medicine in the division of infectious diseases at Vanderbilt University. The only problem: that’s not likely to be effective against respiratory illnesses like the flu and COVID-19. If it were, “the CDC would have recommended it years ago,” he says. “It doesn’t, because it makes science-based recommendations.”
"It's clear that mask-wearing is absolutely fundamental to reducing contagiousness in the population, reducing spread, flattening that curve," said Dr. William Schaffner, an infectious disease doctor at Vanderbilt University Medical Center. "It does provide some measure of protection to me also, although that's smaller. Mostly I'm protecting you, and you wearing it, protecting me."
"What a load of BS." Ah: unintentional irony. Love it.
That little interchange was somewhat useful in the way it demonstrated someone the difference between a scientific POV (Dr. J) and someone proceeding from an ideological POV (that would be you). The former starts with evidence. The latter starts with intense belief and carefully choses or ignores evidence depending on conformance with belief.
The tone of the former tends to be calm and rational. The tone of the latter (at least in your case) tends to be strident, insulting, and angry. There is no disagreeing with you or posing other arguments. Anyone who isn't with you is against you. They are all fools, liars, and agents of Big Pharma and, for all I can tell, the Deep State.
I think it's rather a sign of extreme patience on Dr. J's side to bother responding to you at all. Most of us gave up a long time ago.
Paul like the CR article because he thinks it matches his ideology, of course. That's why he keeps bringing it up and ignoring any critical analysis of it. They guy is a broken record.
Interesting that there were parties who put significant $ into anti-masking campaigns. Cochrane walked back that awful p.o.s. (I'm not as polite as you) but it was also written under the influence of the Brownstone Institute, not a friend to publich health.
Cochrane has always been the gold standard but because they went against the mainstream narrative it is suddenly "junk". Yeah, ok. Cochrane came to the same conclusion that pre-pandemic systematic reviews arrived at, which is "no evidence that masks work" The best evidence is, of course, the last 3+ years of real-world data. And it's clear that masks failed.
Forget Cochrane, one can look at the individual RCTs themselves and come to the same conclusion that the WHO did in 2019, for example on page 18 of their "Non-pharmaceutical public health measures for mitigating the risk and impact ofepidemic and pandemic influenza"
Summary of evidence - Ten relevant RCTs were identified for this review and meta-analysis to quantify the efficacy ofcommunity-based use of face masks, including more than 6000 participants in total (42-47, 50, 68-70). Most trials combined face masks with improved hand hygiene, and examined the use of facemasks in infected individuals (source control) and in susceptible individuals. In the pooled analysis,although the point estimates suggested a relative risk reduction in laboratory-confirmed influenzaof 22% (RR: 0.78, 95% CI: 0.51–1.20, I2=30%, P=0.25) in the face mask group, and a reduction of8% in the face mask group regardless of whether or not hand hygiene was also enhanced (RR:0.92, 95% CI=0.75–1.12, I2=30%, P=0.40), the evidence was insufficient to exclude chance as anexplanation for the reduced risk of transmission. Some studies reported that low compliance inface mask use could reduce their effectiveness. A study suggested that surgical and N95 (respirator)masks were effective in preventing the spread of influenza
(71).OVERALL RESULT OF EVIDENCE ON FACE MASKS1. Ten RCTs were included in the meta-analysis, and there was no evidence that facemasks are effective in reducing transmission of laboratory-confirmed influenza
I really wish we could dropped the paxlovid label regarding "rebound". It's the natural history of a biphasic disease and is more properly called the inflammatory rebound reaction. Also happens, as mentioned, without paxlovid but also with other antivirals. Even if we accept that 1 in 5 get an inflammatory response, that's not that common in my books.
Has anyone asked the question, do we get "rebounds"? with other respiratory diseases? Yes, of course and we also need to examine if a course of any antimicrobials truly clears a antigen or does the immune system kicks in to complete.
Although in the case of Covid the rebound corresponds to something that (a) doesn't happen to everyone and (b) is pretty dangerous in its own right - it was often what ended up killing people in 2020.
From where I sit, as someone who experienced it, I just don't think it's relevant whether it's "natural". The whole point of a medicine is to stop as many adverse outcomes of a disease as possible. It's not hubris, or disrespectful to those who experienced Covid pre-Paxlovid, or too early, to work towards modifying/adapting/supplementing the official regimen to eliminate *all* symptoms and post-acute sequelae.
You are referring to the Cytokine Storm that comes along in the second week. When I use the term natural hisotry, I am referring to the natural course or natural phenomenon of a biphasic disease.
I was able to short circuit my rebound by starting a second ten day round of Paxlovid. As a result, during my entire course of my illness I was only symptomatic for two days - once in the beginning and once on Day 11.
And I still seroconverted. I checked.
Rebounding should not be written off as inevitable.
On Day 12 - the day after I restarted on Paxlovid - I had a serious leak in my living room ceiling, which I absolutely would not have been able to address if I'd been as symptomatic as I was on Day 11. That could easily have left me homeless.
I don't care about the "natural course" of the illness. The whole point of taking medication is to subvert that natural course. If we contented ourselves with "natural courses" we wouldn't have put people on the moon.
So, if anyone has any issues with how I self-managed my illness, they can bloody well keep it to themselves.
Thank you so much, Dr. Jetelina, for once again providing concise, clear, and timely information for the holidays. I hope you and your family have a wonderful Thanksgiving!
Thank you for this latest update. I also no longer test before I gathering, though I will test if I've just been at an event with a lot of people, and I'm going to see a vulnerable person. I was a panelist at our local science fiction convention over Veteran's Day weekend, and was glad that the con had a masking requirement for all programming spaces in the hotel. The only time I was unmasked was at lunch in the restaurant on Sunday--the tables were spread out, and ventilation seemed quite good.
I had been getting my limit of Covid tests when they were free in spring and keeping up with the changing expiration dates. And I got another batch in this most recent offer by the govt. I was not very amused to learn that the most recent ones sent by the govt had expiration dates sooner than any of the dozen or so I had gotten in the spring. I think they just wanted to clear out the warehouse.
They are almost certainly still good with the new expiration dates. The ones I received were already past the expiration dates on the box, but when I looked it up online, they were still good for several more months.
I feel like all of this is a lot less overwhelming if we take a step back and remember an important principle:
It's OK to skip things completely
Really. It is. I'd your friends and family truly love and care about you, then they'll get over it if you decide to forego the occasional holiday gathering.
I was supposed to fly to a memorial service for my uncle this weekend. After finding out that his daughter-in-law was going, despite having active Covid (and having exposed her husband and son, who would also be going) - I canceled my flight. If asked why, I'll just say "something came up." I don't really owe anyone more than that.
As always, clear, thoughtful, and yet pithy. And for the answers to commenters. I appreciate that. I need as little "noise" as possible in balancing my sources & deductions in the continuing pandemic. I'm really here to give a shout out to the emoticon about maximizing time with family. Truth is truth ;0)
I think at this point the government is just trying to get rid of all its at-home tests before they have to go in the trash. My latest delivery were 6 months past the expiration date when they arrived. I know those dates have been extended, but they don't last forever--seems like the gov ought to be sending people tests that will last a year or two!
Nice to see uncertainties clearly expressed. Happy Holidays and safe times to you all.
Thanks so much for this concise & informative update. Wishing your family a Happy Thanksgiving!
Public health professional and expert explains the best practices and then states, "we don't do that anymore, because the tests are expensive" despite absolutely being able to afford it. If even the most informed and privileged people can't be bothered to test before an event (with a 39% chance of catching potential infection), then I guess no will. I will keep testing to protect others but jeeze that admission is depressing for any immunocompromised person.
Does Medicare cover Paxlovid?
Not that easy to understand it appears - hope someone can clarify. Oct 31 statement: "According to HHS, through the end of 2024, people who are uninsured and those who have Medicare or Medicaid coverage will continue to be able to get Paxlovid for free through a patient assistance program set up by Pfizer. That should mean that you pay nothing at the pharmacy counter." (https://www.verywellhealth.com/paxlovid-commercial-market-transition-8384418). A more clear statement would say what Part of Medicare covers it - if it's Part D (drugs at pharmacies), then you'd need Part D coverage unless the above statement is meant as an exception. The Medicare.gov statement seems even less helpful. It would be SO nice if official statements were reviewed by some typical consumers before publishing them.
Thank you. We have Medicare A, B, and D, so we should be okay. We are cautious and have so far been able to avoid Covid, but obviously that can change!
We're preparing for travel and are taking Paxlovid with us just in case. My husband was not charged (medicare).
Medicare beneficiaries will not face cost-sharing requirements for certain covid pharmaceutical treatments, such as the antiviral Paxlovid, after May 11, as long as those doses were purchased by the federal government. Medicaid and the Children’s Health Insurance Program, meant for youngsters in working-class families, will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that, states may impose utilization limits and nominal cost-sharing.
Given that cost of Paxlovid is an issue, for those without access, what are your thoughts for clinicians on using metformin to reduce a patient's risk of developing long covid?
It obviously depends on the patient, but I am all for cheap, easy tools to help reduce the risk of long covid. That clinical trial was pretty darn clear. In other words, I would take it.
We took metformin (and Paxlovid) when we were infected this spring. The digestive symptoms from metformin took us by surprise, but switching to the extended release formula took care of the problem. Anyone who hopes to go straight to extended release should check their insurance formulary — once we had an issue, it was easy to switch and have it covered, but we had to try regular metformin first.
Thanks, useful information as usual. I had forgotten about the ventilation systems on airplanes. As we are flying home from Buenos Aires tomorrow, the reminder was timely. I had been wearing an N-95 end to end, but this suggests to me that I can switch over to a KN-95 once we're in flight.
1) Masks work on an "individual level", but there is somehow no evidence at all of them working at a population level (a population is comprised of individuals). This theory makes no sense. You continue to spread lies about masks.
2) Wearing properly fitted N95s is extremely uncomfortable and not at all practical for most people. And the evidence for even fitted N95s working to prevent viral infection is very weak.
3) Prior to 2020, I never heard any "experts" publishing pieces on how to avoid viruses at Thanksgiving. I never heard anyone telling people to celebrate outside.
4) I have a hard time believing the percentages in the survey you shared. When I go out in public (I live in a liberal metro area), I see maybe 1-2% of people wearing masks. Sometimes I see zero.
Thanks for your comments again, Paul. I'll give it to you, you are certainly consistent.
1. This is unfortunate, though, given I've written many times on why they work on an individual level and (may) work on a population level. In fact, you commented on this post a few months back. Not sure how better to explain it. Please let me know your question after reading this post again. https://yourlocalepidemiologist.substack.com/p/do-masks-work?utm_source=%2Fsearch%2Fdo%2520masks%2520work&utm_medium=reader2
2. It is uncomfortable. The evidence is not weak, though. This is a physics question. Go to the post above, again.
3. We did, but people just weren't paying attention. It would be a shame to go back to pre-pandemic times, given how much we have learned over the past 4 years.
4. I have a hard time with that survey too, because I'm seeing the same. I think some of it has to do with social desirability bias in the survey.
Years ago we were exposed to ubiquitous cultural mask-wearing when we lived through a fall/winter/spring in Japan - where it's considered rude and "baka" to not wear a mask when you have even a light case of sniffles.
We got used to routinely wearing wearing masks in the pre-pandemic wildfires in northern California.
Currently I see about a third of our local population wearing masks in public - well over half among the elderly. (And local vaccine uptake is so high that there's been a shortage.) Our kid at UCLA tells us that the numbers are higher among students in public and classrooms, and they're still testing wastewater and offering antigen tests in vending machines.
It sounds to me like a dystopian nightmare in the parts of the country where ignorant ideologues insist that common sense measures to avoid infection are evidence of some vague but sinister govt/pharma conspiracy.
We stopped travelling for holiday get-togethers years ago because it's stressful - and too many stressed people in a small space is a recipe for selfishness, entitlement, rudeness, and bad behavior. During lockdown we embraced staying in touch with family and friends by frequent videochat - and for ourselves we are perfectly content to have made that - like masking, vaccinating, and voting in every election - a lifelong habit.
Katelyn, you do realize that he is one of the best 'supporters' you can have; very contrarian and hostile pronouncements are a sure way to get all your data confirmed in the minds of the public.
Paul, thanks for all the work you do to affirm Katelyn's work.
We have 80+ RCTs spanning decades and 3+ years of population-level data with no evidence of masks working. We have the gold-standard in medical evidence (Cochrane) saying the same thing that other pre-pandemic meta-analyses said (no evidence of efficacy).
I don't care about what you said in your carefully crafted narrative piece with confounded observational studies and a horribly constructed Bangladesh RCT (that still required data torturing to find a small effect). That is not quality evidence. Real-world data and RCTs are evidence. Lab studies and powerpoint charts/diagrams are not. If it "works" in a lab with a mannequin but not in the real world, then it doesn't work.
The narrative on masks completely flipped in late March/April 2020 based on nothing. There was no new "evidence" that was revealed. It went from "they don't work" to "they work and everyone needs to wear one." seemingly overnight. That right there tells you all you need to know. And everyone (you included) told people that cloth masks worked and would keep them (and others) safe. Now the narrative has moved to just fitted N95s.
you're reading the incorrect data, Paul; ask my granddaughter who is in grad school; she and her colleagues wear masks everyday in the lab because they're working with active pathogens; also JAMA just came out with a conclusive review of research pro masking; I have found many N95s that are comfortale--see Aaron Collins for reviews of breathability and fit
Thing is, if he'd said that he found masks uncomfortable, especially now that they aren't required, I'd have accepted that. Why he feels compelled to get into the weeds trying to prove masks are useless is beyond me. I *do* think that masks are important tools for both respiratory protection and source control, and wouldn't beat myself up if I occasionally decided against masking based on discomfort. Risk mitigation is never a purity test; it's a thing you make a good faith effort to do, in the moment, if it's practical.
One clear example of this overnight narrative shift is from Dr. William Schaffer, professor of medicine in the division of infectious diseases at Vanderbilt University. On March 4, 2020, he said this in a story published by Time.
“It seems kind of intuitively obvious that if you put something—whether it’s a scarf or a mask—in front of your nose and mouth, that will filter out some of these viruses that are floating around out there,” says Dr. William Schaffner, professor of medicine in the division of infectious diseases at Vanderbilt University. The only problem: that’s not likely to be effective against respiratory illnesses like the flu and COVID-19. If it were, “the CDC would have recommended it years ago,” he says. “It doesn’t, because it makes science-based recommendations.”
https://time.com/5794729/coronavirus-face-masks/
This is a quote from him a couple months later.
"It's clear that mask-wearing is absolutely fundamental to reducing contagiousness in the population, reducing spread, flattening that curve," said Dr. William Schaffner, an infectious disease doctor at Vanderbilt University Medical Center. "It does provide some measure of protection to me also, although that's smaller. Mostly I'm protecting you, and you wearing it, protecting me."
https://www.wcax.com/content/news/Why-should-you-wear-a-face-mask-571163761.html
This is why trust is gone. What a load of BS.
"What a load of BS." Ah: unintentional irony. Love it.
That little interchange was somewhat useful in the way it demonstrated someone the difference between a scientific POV (Dr. J) and someone proceeding from an ideological POV (that would be you). The former starts with evidence. The latter starts with intense belief and carefully choses or ignores evidence depending on conformance with belief.
The tone of the former tends to be calm and rational. The tone of the latter (at least in your case) tends to be strident, insulting, and angry. There is no disagreeing with you or posing other arguments. Anyone who isn't with you is against you. They are all fools, liars, and agents of Big Pharma and, for all I can tell, the Deep State.
I think it's rather a sign of extreme patience on Dr. J's side to bother responding to you at all. Most of us gave up a long time ago.
The Cochrane Review on masks was a piece of junk and they know it. It was a failure for a publication that usually meets high standards.
Re: the utility of masks, I thought this multi-center post in JAMA was objective and enlightening. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811136
Paul like the CR article because he thinks it matches his ideology, of course. That's why he keeps bringing it up and ignoring any critical analysis of it. They guy is a broken record.
Interesting that there were parties who put significant $ into anti-masking campaigns. Cochrane walked back that awful p.o.s. (I'm not as polite as you) but it was also written under the influence of the Brownstone Institute, not a friend to publich health.
Cochrane has always been the gold standard but because they went against the mainstream narrative it is suddenly "junk". Yeah, ok. Cochrane came to the same conclusion that pre-pandemic systematic reviews arrived at, which is "no evidence that masks work" The best evidence is, of course, the last 3+ years of real-world data. And it's clear that masks failed.
Forget Cochrane, one can look at the individual RCTs themselves and come to the same conclusion that the WHO did in 2019, for example on page 18 of their "Non-pharmaceutical public health measures for mitigating the risk and impact ofepidemic and pandemic influenza"
https://www.who.int/publications/i/item/non-pharmaceutical-public-health-measuresfor-mitigating-the-risk-and-impact-of-epidemic-and-pandemic-influenza
4.3. Face masks
Summary of evidence - Ten relevant RCTs were identified for this review and meta-analysis to quantify the efficacy ofcommunity-based use of face masks, including more than 6000 participants in total (42-47, 50, 68-70). Most trials combined face masks with improved hand hygiene, and examined the use of facemasks in infected individuals (source control) and in susceptible individuals. In the pooled analysis,although the point estimates suggested a relative risk reduction in laboratory-confirmed influenzaof 22% (RR: 0.78, 95% CI: 0.51–1.20, I2=30%, P=0.25) in the face mask group, and a reduction of8% in the face mask group regardless of whether or not hand hygiene was also enhanced (RR:0.92, 95% CI=0.75–1.12, I2=30%, P=0.40), the evidence was insufficient to exclude chance as anexplanation for the reduced risk of transmission. Some studies reported that low compliance inface mask use could reduce their effectiveness. A study suggested that surgical and N95 (respirator)masks were effective in preventing the spread of influenza
(71).OVERALL RESULT OF EVIDENCE ON FACE MASKS1. Ten RCTs were included in the meta-analysis, and there was no evidence that facemasks are effective in reducing transmission of laboratory-confirmed influenza
old report; you're suffering from confirmation bias; Dr. Jetelina is very patient with you
Wow, your blood pressure OK?
He probably thinks blood pressure is a conspiracy by leftist woke Big Pharma as well.
Nah, it really is an evil experiment by Slobovian scientists to eradicate 'white' 'Mercans.
That's Lower Slobovia to you, buster! :-) It's right next to Pottsylvania.
I really wish we could dropped the paxlovid label regarding "rebound". It's the natural history of a biphasic disease and is more properly called the inflammatory rebound reaction. Also happens, as mentioned, without paxlovid but also with other antivirals. Even if we accept that 1 in 5 get an inflammatory response, that's not that common in my books.
Has anyone asked the question, do we get "rebounds"? with other respiratory diseases? Yes, of course and we also need to examine if a course of any antimicrobials truly clears a antigen or does the immune system kicks in to complete.
Although in the case of Covid the rebound corresponds to something that (a) doesn't happen to everyone and (b) is pretty dangerous in its own right - it was often what ended up killing people in 2020.
From where I sit, as someone who experienced it, I just don't think it's relevant whether it's "natural". The whole point of a medicine is to stop as many adverse outcomes of a disease as possible. It's not hubris, or disrespectful to those who experienced Covid pre-Paxlovid, or too early, to work towards modifying/adapting/supplementing the official regimen to eliminate *all* symptoms and post-acute sequelae.
You are referring to the Cytokine Storm that comes along in the second week. When I use the term natural hisotry, I am referring to the natural course or natural phenomenon of a biphasic disease.
https://www.pnas.org/doi/pdf/10.1073/pnas.2021128117
It still a major cause of death
https://pubmed.ncbi.nlm.nih.gov/36930516/
Please read Dr Griffin comments on Paxlovid.
https://twiv.s3.amazonaws.com/COVID+treatment+summary+11-24-2023.pdf
I was able to short circuit my rebound by starting a second ten day round of Paxlovid. As a result, during my entire course of my illness I was only symptomatic for two days - once in the beginning and once on Day 11.
And I still seroconverted. I checked.
Rebounding should not be written off as inevitable.
On Day 12 - the day after I restarted on Paxlovid - I had a serious leak in my living room ceiling, which I absolutely would not have been able to address if I'd been as symptomatic as I was on Day 11. That could easily have left me homeless.
I don't care about the "natural course" of the illness. The whole point of taking medication is to subvert that natural course. If we contented ourselves with "natural courses" we wouldn't have put people on the moon.
So, if anyone has any issues with how I self-managed my illness, they can bloody well keep it to themselves.
Thank you so much, Dr. Jetelina, for once again providing concise, clear, and timely information for the holidays. I hope you and your family have a wonderful Thanksgiving!
Thank you for this latest update. I also no longer test before I gathering, though I will test if I've just been at an event with a lot of people, and I'm going to see a vulnerable person. I was a panelist at our local science fiction convention over Veteran's Day weekend, and was glad that the con had a masking requirement for all programming spaces in the hotel. The only time I was unmasked was at lunch in the restaurant on Sunday--the tables were spread out, and ventilation seemed quite good.
Safe travels and happy Thanksgiving!
I had been getting my limit of Covid tests when they were free in spring and keeping up with the changing expiration dates. And I got another batch in this most recent offer by the govt. I was not very amused to learn that the most recent ones sent by the govt had expiration dates sooner than any of the dozen or so I had gotten in the spring. I think they just wanted to clear out the warehouse.
I am sure that is what they were doing, but that doesn't bother me. I would rather they get to people than get thrown out.
Well, it bothered me because they expired 3 weeks after I got 'em.
They are almost certainly still good with the new expiration dates. The ones I received were already past the expiration dates on the box, but when I looked it up online, they were still good for several more months.
No. I checked. They did not have an extended expiration date. They expired in October. I did use one but had to throw the other out.
I feel like all of this is a lot less overwhelming if we take a step back and remember an important principle:
It's OK to skip things completely
Really. It is. I'd your friends and family truly love and care about you, then they'll get over it if you decide to forego the occasional holiday gathering.
I was supposed to fly to a memorial service for my uncle this weekend. After finding out that his daughter-in-law was going, despite having active Covid (and having exposed her husband and son, who would also be going) - I canceled my flight. If asked why, I'll just say "something came up." I don't really owe anyone more than that.
Happy Thanksgiving to you and your sweet family!
We are still battling with the Covid conspiracy folks. Oh yeah!
Best to all that support science based research.
As always, clear, thoughtful, and yet pithy. And for the answers to commenters. I appreciate that. I need as little "noise" as possible in balancing my sources & deductions in the continuing pandemic. I'm really here to give a shout out to the emoticon about maximizing time with family. Truth is truth ;0)
Thank you so much as always! Happy Thanksgiving to you and your!
I think at this point the government is just trying to get rid of all its at-home tests before they have to go in the trash. My latest delivery were 6 months past the expiration date when they arrived. I know those dates have been extended, but they don't last forever--seems like the gov ought to be sending people tests that will last a year or two!