No beautiful watercolor this month in Covidlandia? As always, your summaries are so good and so appreciated.
I did remember where I read that vaccinated people shed less: it was a WaPo article about the summer surge and Peter Hotez said he’s more comfortable at a medical conference because he assumes more people are vaccinated, with regard to picking your spots to be less cautious.
I just read Mary Trump’s Substack article about getting her first case of COVID at the DNC despite masking.
The desire to return to “normal” and the stigma surrounding masks and precautions is just so strong. As summer ebbs, I’m not thrilled about moving indoors without open windows. But I too will pick my spots.
The mask laws are just ridiculous and dangerous. No viral season coming up in the locations soon? As if the stigma wasn’t already sky high?
I just had a transplant patient get remdesivir via the ED , a first for me— 3 outpatient visits/ infusions after their COVID diagnosis. I do wish we had more therapeutics in our toolbox.
Hey Jan, sorry the artist in residence was too busy being a kid right now to provide an illustration! That will be reflected in her allowance 😉 JK
Good call on the WaPo article, and I certainly do feel more comfortable around people who are up to date with vaccines for that reason.
The mask laws are spiteful and mean… but when viewed in the broader political context are just part of the authoritarian mentality. Americans need to resist that regardless of political party, right?
Will have to see about the remdesivir via ER, makes sense for patients that can’t take Paxlovid and are high risk like the one you described. Haven’t had that option since my institution stopped doing this via infusion center. Thanks for adding your thoughts as always!
Agree the mask laws are beyond reason and logic. It's a patellar reflex aka knee jerk response to protesting people wearing masks. A lot of people wore masks on Jan 6th but where was the outcry then?
That’s true. No insurrectionists should be able to wear a mask while insurrecting😏 a mask is also a stark, jarring reminder that Covid can still hurt us individually, and many who want to enforce the contrary fiction see the mask as an inconvenient truth to stamp out.
Yet another great round-up! I so appreciate the time and effort and intelligence (!) you expend, in your already jam-packed schedule, to put these together. I always look forward to them.
In reading about the JAMA Health Forum findings, I was interested to note in the conclusion that “However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.” An important area of public health that was missed, by Democratic administration decision-makers, was to recognize and include in judgments made on mitigation measures the impact of school-closings on child social development and learning, family stress, and so much more, in determining public policy. Yes, there was a great deal unknown, but my sense is there wasn’t much, if any, effort to take these issues into account. With 20-20 hindsight, it would have been far better to leave the schools open and focus on masks, vaccines, and ventilation. (It’s not that the information wasn’t out there about how to make schools a lot safer: listening to folks like Linsey Marr and Joseph Allen much earlier on would have helped quite a lot.)
In my “travels” around the internet, I see a lot of commentary from frustrated parents who do not feel, and I think appropriately so, that their concerns about school-closings were taken into account. This has unfortunately led, for many, to broader distrust in all the mitigation strategies used—and not just among those on the more conservative side of the aisle. Indeed, the folks I personally am seeing express this frustration are liberals. Allied to this, it’s a terrible shame, and even worse, as you note, that we have not learned from past mistakes: “The authors argue that despite previous pandemic preparedness plans, the U.S. is showing similar weaknesses in testing, surveillance, and coordination between agencies and levels of government.”
While I do agree that public policy matters, I think it will not serve us well to cast these issues in a partisan way. In particular, our Democratic leaders need to do much better at acknowledging the mistakes that were made, and demonstrate lessons learned, rather than doubling down. For all our sakes, we need to listen first, engage one another based on respect, and work together to improve, no matter what our party politics may be. (And I am writing here as a life-long Democrat, just to be clear!)
Thanks Susan, and like you said in hindsight if everyone bought in and put their kids in quality masks/respirators we could have really knocked this down early and kept kids in school. I’ve learned that N95s work as they have not failed me in smalll examining rooms with Covid+ patients and airplanes full of coughing people during waves yet 🤞
This article from Jonathan Howard MD from back in 2022 is still right on target:
“We know what happened in the real-world. What would have happened had schools remained open without any mitigation measures?
One obvious answer, is that nearly all children would have gotten COVID, as would everyone they live with, and most school employees. Despite early hopes that schools were magically immune to the spread of COVID, subsequent research revealed the unsurprising news that the virus spreads quite well in schools, especially those without any mitigation measures.
How then would the unmitigated spread of COVID affected children, none of whom were vaccinated?
The vast majority would have been just fine, thankfully. However, in the real world, the CDC COVID Data Tracker reports that over 1,850 children have died of COVID. This number would have been higher had 60-70 million unvaccinated children contracted the virus over several months time in 2020. It’s reasonable to assume that several thousand children would have died had no mitigation measures been taken.
Death is not the only bad outcome from COVID. In the real world, around 150,000 children have been hospitalized with COVID. Some were very sick, needing mechanical ventilation in the ICU. Neurological complications are not uncommon in hospitalized children. Rarely, they have needed amputations or had strokes. Over 9,000 children had MIS-C and most of these children go to the ICU. 74 children have died of MIS-C. The vaccine has drastically lowered the risk of these rare, but grave outcomes. Many thousands more children would have been hospitalized or developed MIS-C had no mitigation measures been taken at the pandemic’s start.”
Mmm, not that keen on Howard’s approach. Yours is a lot better. It need not have been the binary Howard describes. Instead, perhaps if parental concerns had been taken to heart more, a resolution could have been found by which to keep schools open with appropriate mitigations, like those you describe, in place. Howard seems more to be throwing down the gauntlet, daring folks who want schools open to do all the lifting about how to make that possible safely. At least that’s how I read him.
Fair enough! Agree with you. Binaries get us into trouble. I think he is often fending off some pretty extreme “let it rip” types so a dash of nuance in that piece would have had broader appeal. And always feel free to disagree here!
You know, thinking about your observation “Binaries get us into trouble,” I can actually think of choices that are binary, but even then, while it may not be easy, I think it’s possible to address concerns that might arise out of making what is the necessary choice. There is a great book, “Getting to Yes,” about handling negotiations, that speaks to this. Anyway, I am just thinking aloud here; please don’t feel you need to respond.
Even saying “binaries get us into trouble” gets us into trouble! We’re getting a bit meta on this thread but I think it might yet lead to the meaning of life 😁
Congratulations for a nice summary from the Covidlandia. Spousal unit brought me a Weirdlandia t-shirt. This has been weird and strange 4 years.
Agree that semaglutide (wegovy) is not likely to be a treatment. So, to add to my note (https://substack.com/@kb501/note/c-67406044), Adipose Tissue is rich in ACE2, Cytokines and TNF-α. SARS-CoV-2 really kick start the inflammatory response in said organ (https://www.nature.com/articles/s41574-022-00778-0). My posit is, reduction in Adipose Tissue triggered by semaglutide, reduces the risks. Especially in cytokine storm (a major cause of death) and it is a known major comorbidity.
I understand spending a little less time on COVID but I don't think other ID or syndrome would be much less of a bear. I went down that road because of more knowledgeable folks like yourself can keep us up to date. Still, cannot resist that occasional shining object. :-)
Thanks KB! I’ll need to check out those Weirdlandia shirts 😆
I suspect you are totally right about the mechanism underlying the Glp 1 benefit we see, and there was another study out last month that I didn’t include but that confirmed obesity is a risk factor for not only more severe illness, but also more likely to catch a case.
Yeah I caught that article too . This was brought at the local Saturday Market here. I see it's available on EBay. https://www.ebay.com/itm/326085138053
Got the Moderna shot Friday. We believe. My husband and I remain Covid-free. My goal is not to never get the disease, but rather to die with the fewest cases possible. We mask, avoid crowds, and try to avoid people obviously coughing in public. If some officer of the law want to arrest this 80 year old for wearing a mask, bring it on. I can't wait to talk to the judge about the people I personally know with long Covid who can't complete a sentence or remember what you just told them. On getting back to normal. Whose normal? Ain't no such thing except in statistics, it's called an average, and judging from average around here, well, not my cuppa tea.
Hi Manuiwa, I respect your variation on the “if I get Covid I want it to be worth the exposure.” Dying (and living before that) with the fewest cases is a good mantra, especially at 80 when the toll can be even harder to compensate for. Let me know if you’re ever in that courtroom defending your right to protect yourself. I practice in Jersey, and I’ll bring My Cousin Vinny!
I think this was more like a 5th grade teacher actually with some of the tone sounding too young. AI chat still feels novel, but I could do a better job with the satire… next one, time permitting!
Hello & thanks much for the summary. I’m >65 & immunocompromised so I mask indoors but still want to live life. Two friends treated me to spa massage; I wore mask entire time, enjoyed massage. They caught Covid, I did not.
I had last Novavax booster in late April before late May trip to Europe ( wore mask airports & planes ). Great trip, no Covid. We have a Florida trip & cruise in late October so plan to get Novavax again in mid-September & and again 4 months later. I’ve now got neosporin & cue tips, just in case.
Are you suggesting *both* Paxlovid & Metformin for Covid infections? I know PCP will give me Pax but I’ll have to give her the studies on metformin, unsure if she’ll prescribe both. I *really* want to avoid long Covid & doing what I can to eliminate the virus ASAP makes so much sense, especially with under-achieving immune system.
Thank you kindly for continuing to take Covid seriously & sharing your knowledge.
Hi Sally and thanks for sharing these quick vignettes- hard not to be convinced by the spa day especially!
Seems like you are gaming this well, and I hope your winning streak remains unbroken. As i have said before I really enjoy not getting sick on planes anymore. It ruins so many vacations.
I’ve been increasingly offering Paxlovid and metformin concurrently, and I know at least one of my partners offers this, too. I warn people about additive GI side effects potentially, and to only titrate up as tolerated. I would say that 75% can. Ironically just talked with a patient today who took both together and did great, no complaints of side effects even. Also no long covid for what that’s worth.
I don’t think the combination has been officially studied though, so there’s a degree of uncertainty, but no one is scared of prescribing metformin in other contexts such as first line treatment for type 2 diabetes. It’s considered safe and well tolerated in those familiar situations. I believe there are “longevity” trials using it too .Best of luck!
Thanks Ryan as always for the great summary. We just got back from a 2 week WWII tour to the N. Marianas, Japan, and Honolulu. Consisted of 9 people flying, taking public transportation, trains, planes, taxis, buses, and one round trip ferry ride. We had local guides travel with us too. 7 of us, masked when it made sense when traveling and in crowded spaces like museums. My husband and I had COVID previously, as another couple, and were determined not to get it again. The others were a retired dentist and two retired police detectives. The one that did not mask were a retired physician and a well traveled person interested in history. Since we’re over 70, we got the old booster, which was 4 months beyond the last booster. I carried N95 masks, enough to give to people who wanted them and test kits. I also took along a recommended nasal spray. I took my ARANET4. Hardly anyone masks, even in Japan. No one ended up with COVID in our group, although I ended up with a wicked jet lag and some irregularity (constipation, ha) because of the horrid heat and humidity. We did a lot of outdoor touring and walking, so days of being dehydrated. It is possible to stay safe with precautions and luck. We were probably lucky to not encounter someone with a high viral load in an a place with poor air circulation. Stay safe Ryan and everyone.
Hi Susan, what a cool trip! It must have been a burden to carry and plan all that extra gear and precaution, but in my opinion absolutely worth it to keep experiencing the adventure of your trip and to keep avoiding Covid when you can. I have some family members who just got back from a Mexico trip and half their tour got Covid and had to isolate and then go home, missing the best part of the trip. Family members timed their boosters and a few other precautions that seemed to help. FOMO can be a good motivator in addition to
health risks, right?
And constipation definitely haunts trips to hot locations in different time zones that screw up our circadian rhythms! Thanks for stopping in and wishing you well, too.
Thanks Donna, can you believe I cut out a bunch too?! Word count still hit >3,000 which any editor would tell me is bad… but the occasional long form here seems to work 😬
Shocked shoCKED !SHOCKED! it is illegal to wear a mask in parts of this country!
O! say does that star-spangled Banner yet wave,
O'er the Land of the free and the home of the brave?
There is no 'Land of the Free' and certainly no 'home of the brave' if a bunch of ignorant cultural warriors are allowed to sicken/kill people in their quest for self aggrandizement and lust for power.
GEORGE 'going to jail-former volleyball star, Wall St exec-Holocaust family-NYU Grad' SANTOS represented people in Nassau County so maybe I should not be sooo shocked?!?!
May the legislators get the Long Covid they deserve.
The shocks just keep coming, don’t they?! I hope our democracy can keep absorbing them but it has been George Foreman body blows for the past decade or two. And that makes so much sense about Santos representing said district. How could they vote for that guy? I guess this is how. Thanks for dropping in!
Yeah, as a Texan who moved to NY many years ago, I was shocked NY ended up with the first anti mask law on the books in the country. As an immunocompromised person, I should not be burdened to show proof of my need to mask. Infuriating!
Exactly Sistr: HOW do you prove you are immunocompromised? Carry around your medical records from an immunologist? 'Here is my Long Covid card'...'my Chronic Fatigue card'...'my transplant card'? There is no such card.
Well I'm going to try and get a Nobsbac from Costco. Thanks for the pointer, Ryan.
I think I am on 9 shots and boosters now since 2020. I will keep taking them so long as available-them to take or me to take them.
But I had the distinct unfortune to catch one of the earliest strains in April 2020 and to get long Covid with all the classic sequelae. Now, my life span has been shortened I'm afraid and I'm already over 75.
It sometimes feels futile to continue with my masking or to continue getting boosters. I really don't think the virus can do any more damage to me than it has already done. But I will continue
There's a silver lining. Shortening my life as it has, the virus has made me treasure life more and made each day more poignant. In that sense it gave me a gift.
Well I certainly hope it has not shortened your life, but i personally understand the sentiment of gratitude after health setbacks. Stay hopeful if you can
I got Novavax last fall and this January after multiple mRNA vaccines. Trying to find it was an adventure (CVS was especially weird), and I ended up in Rite Aid both times. I am glad to see they are offering single dose pre-filled syringes this time. I have no doubt some of the weirdness and hesitation to carry it had to do with 5 dose vials that had to be wasted if no one else wanted the other 4 doses in the vial (along with the cost falling on the providers/pharmacy.) I had a multi-day close exposure after my 2 Novavax and no infection. I’m immunocompromised, so I consider that a victory even if only anecdotal. I’m still sitting at 1 infection last August (from my mom, after years of working in the hospital during pandemic peak!) but it was a 3 week affair that almost ended in a hospital stay so I’d rather not repeat it!
Good to hear about this, I’ll keep an eye out for Novavax locations as a lot of my patients (especially who experience more side effects with mRNA) ask about this. Was your reaction to Novavax easier to handle, too?
Must have been quite scary and unpleasant to almost end up in the hospital. When we talk about hospitalizations for any illness, we have to think just how bad someone is feeling/doing to head over to the hospital. No one wants to be there, for many reasons! And very good point about the 5 dose vials versus the single, should facilitate things much better. Thanks for this!
My kiddos are back in school, and our schools are so worried about attendance/state funding/state report cards that their guidance is “come to school sick as long as you are not vomiting and not running a fever.” My kiddos masked every day of school in KN95s for two solid years; we stopped asking that of them for the 2023-2024 school year. The mental toll of being the sole maskers overrode any health benefits the masks were providing. Anecdotally, one kiddo got Flu B, and the other had perfect attendance. I feel less optimistic this year. But,one can hope. It is a terrible time to parent, as my kids missed out on so many normal things that they saw their friends doing in 2021 and 2022. They will never get that time or those experiences back. So, we risk more than I would like because I have given up on some accounts.
Still hoping for better data on nose sprays because, anecdotally, I believe them to be helpful.
That (1/35) I picked up from twitter (J.P. Weiland and the Mitigation Group I linked to). It does build in a 10 day period of illness I think, based on my back of a napkin calculation.
If we go with a shorter contagious period of 7 days, then it's *only* 1 out of every 50 people estimated. Not making me feel any better! Best of luck with kids back to school.
I’m 73, female, white, a healthy weight, and have had Long Covid for four years (got it spring 2020). Current symptoms: exhaustion, PEM, dizziness. I must pace myself carefully. My life is quite limited. I’m vaccinated annually. I mask when I leave home and eat outside at restaurants.
You write that “it sucks to be careful, and it sucks to not be careful.” What are your thoughts regarding the upcoming holidays for a person like me?
Hi Adrienne, and thank you for your comment and story. I have quite a few patients and some friends with very similar experiences right now. I have very complicated thoughts for all of us during the holidays. It feels cruel to me to avoid friends and family, especially over the holidays... but when rates are very high and people are forced indoors with bad ventilation, often with kids who are sick with something like 50% of the time, it can often feel not worth the risk of permanent worsening of symptoms/LC. There really is no one-size-fits all people or situations. I implement the protective measures I can, but do take risks when I figure the risk of getting Covid is socially worth it. In the "reading room" section of my site I have collected some evergreen articles I've written about my approach in case you want some deep dive ideas, from ventilation to nasal sprays. Best of luck.
FYI: I went to my 50th high school reunion last weekend. It was a packed room with zero extra ventilation (some A/C)--100° outside, so that was appreciated. I used the neosporin trick and somehow did not get Covid! I suspect that my Covid infection 4 months prior helped. I will put off my updated Covid vaccine until October. Thanks as always.
That’s awesome! Love the anecdote and feedback. I’m sure the recent infection and hopefully the nasal modulation helped. I’ve been to 2 big school events for my daughter, and going to a bat mitzvah this weekend. Doing a bit of the “regimen” myself. So far so good.
Just saw patient with flu B this morning on rapid antigen testing. Surprised me.
No beautiful watercolor this month in Covidlandia? As always, your summaries are so good and so appreciated.
I did remember where I read that vaccinated people shed less: it was a WaPo article about the summer surge and Peter Hotez said he’s more comfortable at a medical conference because he assumes more people are vaccinated, with regard to picking your spots to be less cautious.
I just read Mary Trump’s Substack article about getting her first case of COVID at the DNC despite masking.
The desire to return to “normal” and the stigma surrounding masks and precautions is just so strong. As summer ebbs, I’m not thrilled about moving indoors without open windows. But I too will pick my spots.
The mask laws are just ridiculous and dangerous. No viral season coming up in the locations soon? As if the stigma wasn’t already sky high?
I just had a transplant patient get remdesivir via the ED , a first for me— 3 outpatient visits/ infusions after their COVID diagnosis. I do wish we had more therapeutics in our toolbox.
Thank you for helping us navigate.
Hey Jan, sorry the artist in residence was too busy being a kid right now to provide an illustration! That will be reflected in her allowance 😉 JK
Good call on the WaPo article, and I certainly do feel more comfortable around people who are up to date with vaccines for that reason.
The mask laws are spiteful and mean… but when viewed in the broader political context are just part of the authoritarian mentality. Americans need to resist that regardless of political party, right?
Will have to see about the remdesivir via ER, makes sense for patients that can’t take Paxlovid and are high risk like the one you described. Haven’t had that option since my institution stopped doing this via infusion center. Thanks for adding your thoughts as always!
Agree the mask laws are beyond reason and logic. It's a patellar reflex aka knee jerk response to protesting people wearing masks. A lot of people wore masks on Jan 6th but where was the outcry then?
That’s true. No insurrectionists should be able to wear a mask while insurrecting😏 a mask is also a stark, jarring reminder that Covid can still hurt us individually, and many who want to enforce the contrary fiction see the mask as an inconvenient truth to stamp out.
Yet another great round-up! I so appreciate the time and effort and intelligence (!) you expend, in your already jam-packed schedule, to put these together. I always look forward to them.
In reading about the JAMA Health Forum findings, I was interested to note in the conclusion that “However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.” An important area of public health that was missed, by Democratic administration decision-makers, was to recognize and include in judgments made on mitigation measures the impact of school-closings on child social development and learning, family stress, and so much more, in determining public policy. Yes, there was a great deal unknown, but my sense is there wasn’t much, if any, effort to take these issues into account. With 20-20 hindsight, it would have been far better to leave the schools open and focus on masks, vaccines, and ventilation. (It’s not that the information wasn’t out there about how to make schools a lot safer: listening to folks like Linsey Marr and Joseph Allen much earlier on would have helped quite a lot.)
In my “travels” around the internet, I see a lot of commentary from frustrated parents who do not feel, and I think appropriately so, that their concerns about school-closings were taken into account. This has unfortunately led, for many, to broader distrust in all the mitigation strategies used—and not just among those on the more conservative side of the aisle. Indeed, the folks I personally am seeing express this frustration are liberals. Allied to this, it’s a terrible shame, and even worse, as you note, that we have not learned from past mistakes: “The authors argue that despite previous pandemic preparedness plans, the U.S. is showing similar weaknesses in testing, surveillance, and coordination between agencies and levels of government.”
While I do agree that public policy matters, I think it will not serve us well to cast these issues in a partisan way. In particular, our Democratic leaders need to do much better at acknowledging the mistakes that were made, and demonstrate lessons learned, rather than doubling down. For all our sakes, we need to listen first, engage one another based on respect, and work together to improve, no matter what our party politics may be. (And I am writing here as a life-long Democrat, just to be clear!)
The US had the longest school closure, only South Korea where they were more skilled at remote learning was longer.
I’ve read that “ better to close bars and open schools “, and that the strong national teachers union was behind health policy around schools.
I read “Lessons from the COVID War” https://www.hachettebookgroup.com/titles/covid-crisis-group/lessons-from-the-covid-war/9781541703803/?lens=publicaffairs
Mistakes were made on many fronts.
Thanks Susan, and like you said in hindsight if everyone bought in and put their kids in quality masks/respirators we could have really knocked this down early and kept kids in school. I’ve learned that N95s work as they have not failed me in smalll examining rooms with Covid+ patients and airplanes full of coughing people during waves yet 🤞
This article from Jonathan Howard MD from back in 2022 is still right on target:
https://sciencebasedmedicine.org/was-closing-schools-a-mistake/
“We know what happened in the real-world. What would have happened had schools remained open without any mitigation measures?
One obvious answer, is that nearly all children would have gotten COVID, as would everyone they live with, and most school employees. Despite early hopes that schools were magically immune to the spread of COVID, subsequent research revealed the unsurprising news that the virus spreads quite well in schools, especially those without any mitigation measures.
How then would the unmitigated spread of COVID affected children, none of whom were vaccinated?
The vast majority would have been just fine, thankfully. However, in the real world, the CDC COVID Data Tracker reports that over 1,850 children have died of COVID. This number would have been higher had 60-70 million unvaccinated children contracted the virus over several months time in 2020. It’s reasonable to assume that several thousand children would have died had no mitigation measures been taken.
Death is not the only bad outcome from COVID. In the real world, around 150,000 children have been hospitalized with COVID. Some were very sick, needing mechanical ventilation in the ICU. Neurological complications are not uncommon in hospitalized children. Rarely, they have needed amputations or had strokes. Over 9,000 children had MIS-C and most of these children go to the ICU. 74 children have died of MIS-C. The vaccine has drastically lowered the risk of these rare, but grave outcomes. Many thousands more children would have been hospitalized or developed MIS-C had no mitigation measures been taken at the pandemic’s start.”
Mmm, not that keen on Howard’s approach. Yours is a lot better. It need not have been the binary Howard describes. Instead, perhaps if parental concerns had been taken to heart more, a resolution could have been found by which to keep schools open with appropriate mitigations, like those you describe, in place. Howard seems more to be throwing down the gauntlet, daring folks who want schools open to do all the lifting about how to make that possible safely. At least that’s how I read him.
Fair enough! Agree with you. Binaries get us into trouble. I think he is often fending off some pretty extreme “let it rip” types so a dash of nuance in that piece would have had broader appeal. And always feel free to disagree here!
You know, thinking about your observation “Binaries get us into trouble,” I can actually think of choices that are binary, but even then, while it may not be easy, I think it’s possible to address concerns that might arise out of making what is the necessary choice. There is a great book, “Getting to Yes,” about handling negotiations, that speaks to this. Anyway, I am just thinking aloud here; please don’t feel you need to respond.
Even saying “binaries get us into trouble” gets us into trouble! We’re getting a bit meta on this thread but I think it might yet lead to the meaning of life 😁
Congratulations for a nice summary from the Covidlandia. Spousal unit brought me a Weirdlandia t-shirt. This has been weird and strange 4 years.
Agree that semaglutide (wegovy) is not likely to be a treatment. So, to add to my note (https://substack.com/@kb501/note/c-67406044), Adipose Tissue is rich in ACE2, Cytokines and TNF-α. SARS-CoV-2 really kick start the inflammatory response in said organ (https://www.nature.com/articles/s41574-022-00778-0). My posit is, reduction in Adipose Tissue triggered by semaglutide, reduces the risks. Especially in cytokine storm (a major cause of death) and it is a known major comorbidity.
I understand spending a little less time on COVID but I don't think other ID or syndrome would be much less of a bear. I went down that road because of more knowledgeable folks like yourself can keep us up to date. Still, cannot resist that occasional shining object. :-)
Thanks KB! I’ll need to check out those Weirdlandia shirts 😆
I suspect you are totally right about the mechanism underlying the Glp 1 benefit we see, and there was another study out last month that I didn’t include but that confirmed obesity is a risk factor for not only more severe illness, but also more likely to catch a case.
Keep Covidlandia weird💪
Yeah I caught that article too . This was brought at the local Saturday Market here. I see it's available on EBay. https://www.ebay.com/itm/326085138053
I love that they “put a bird on it” 😆
PS
Ever noticed a fair number of novids are getting the first case of COVID-19 these days? KP.3.1.1 is rapidly overtaking the other KPs.
Yes, absolutely seeing this in my little practice. So contagious, and so many people not testing and then exposing others at will…
Got the Moderna shot Friday. We believe. My husband and I remain Covid-free. My goal is not to never get the disease, but rather to die with the fewest cases possible. We mask, avoid crowds, and try to avoid people obviously coughing in public. If some officer of the law want to arrest this 80 year old for wearing a mask, bring it on. I can't wait to talk to the judge about the people I personally know with long Covid who can't complete a sentence or remember what you just told them. On getting back to normal. Whose normal? Ain't no such thing except in statistics, it's called an average, and judging from average around here, well, not my cuppa tea.
Hi Manuiwa, I respect your variation on the “if I get Covid I want it to be worth the exposure.” Dying (and living before that) with the fewest cases is a good mantra, especially at 80 when the toll can be even harder to compensate for. Let me know if you’re ever in that courtroom defending your right to protect yourself. I practice in Jersey, and I’ll bring My Cousin Vinny!
Some grammatical issues with the AI responses, if I may:
https://www.merriam-webster.com/grammar/all-right-or-alright-which-is-correct
I prefer “all right” in all cases.
It uses way too many exclamation points.
On the other hand, it can sort of be excused since its audience is eighth graders.
Very good, human derived grammatical points.
I think this was more like a 5th grade teacher actually with some of the tone sounding too young. AI chat still feels novel, but I could do a better job with the satire… next one, time permitting!
I rather like exclamation marks! Keep them coming!
Uninflected communication is a bit like robotic data transfer
Hello & thanks much for the summary. I’m >65 & immunocompromised so I mask indoors but still want to live life. Two friends treated me to spa massage; I wore mask entire time, enjoyed massage. They caught Covid, I did not.
I had last Novavax booster in late April before late May trip to Europe ( wore mask airports & planes ). Great trip, no Covid. We have a Florida trip & cruise in late October so plan to get Novavax again in mid-September & and again 4 months later. I’ve now got neosporin & cue tips, just in case.
Are you suggesting *both* Paxlovid & Metformin for Covid infections? I know PCP will give me Pax but I’ll have to give her the studies on metformin, unsure if she’ll prescribe both. I *really* want to avoid long Covid & doing what I can to eliminate the virus ASAP makes so much sense, especially with under-achieving immune system.
Thank you kindly for continuing to take Covid seriously & sharing your knowledge.
Hi Sally and thanks for sharing these quick vignettes- hard not to be convinced by the spa day especially!
Seems like you are gaming this well, and I hope your winning streak remains unbroken. As i have said before I really enjoy not getting sick on planes anymore. It ruins so many vacations.
I’ve been increasingly offering Paxlovid and metformin concurrently, and I know at least one of my partners offers this, too. I warn people about additive GI side effects potentially, and to only titrate up as tolerated. I would say that 75% can. Ironically just talked with a patient today who took both together and did great, no complaints of side effects even. Also no long covid for what that’s worth.
I don’t think the combination has been officially studied though, so there’s a degree of uncertainty, but no one is scared of prescribing metformin in other contexts such as first line treatment for type 2 diabetes. It’s considered safe and well tolerated in those familiar situations. I believe there are “longevity” trials using it too .Best of luck!
https://www.npr.org/sections/health-shots/2024/04/22/1245872510/a-cheap-drug-may-slow-down-aging-a-study-will-determine-if-it-works
Will write a post on this someday soon
Thanks Ryan as always for the great summary. We just got back from a 2 week WWII tour to the N. Marianas, Japan, and Honolulu. Consisted of 9 people flying, taking public transportation, trains, planes, taxis, buses, and one round trip ferry ride. We had local guides travel with us too. 7 of us, masked when it made sense when traveling and in crowded spaces like museums. My husband and I had COVID previously, as another couple, and were determined not to get it again. The others were a retired dentist and two retired police detectives. The one that did not mask were a retired physician and a well traveled person interested in history. Since we’re over 70, we got the old booster, which was 4 months beyond the last booster. I carried N95 masks, enough to give to people who wanted them and test kits. I also took along a recommended nasal spray. I took my ARANET4. Hardly anyone masks, even in Japan. No one ended up with COVID in our group, although I ended up with a wicked jet lag and some irregularity (constipation, ha) because of the horrid heat and humidity. We did a lot of outdoor touring and walking, so days of being dehydrated. It is possible to stay safe with precautions and luck. We were probably lucky to not encounter someone with a high viral load in an a place with poor air circulation. Stay safe Ryan and everyone.
Hi Susan, what a cool trip! It must have been a burden to carry and plan all that extra gear and precaution, but in my opinion absolutely worth it to keep experiencing the adventure of your trip and to keep avoiding Covid when you can. I have some family members who just got back from a Mexico trip and half their tour got Covid and had to isolate and then go home, missing the best part of the trip. Family members timed their boosters and a few other precautions that seemed to help. FOMO can be a good motivator in addition to
health risks, right?
And constipation definitely haunts trips to hot locations in different time zones that screw up our circadian rhythms! Thanks for stopping in and wishing you well, too.
Thanks Ryan. Wish we’d have free N95 masks and test kits for everyone. And some good public health education.
Thank you! A lot to unpack and I will re-read when I get the chance.
Thanks Donna, can you believe I cut out a bunch too?! Word count still hit >3,000 which any editor would tell me is bad… but the occasional long form here seems to work 😬
Will give everybody a break or a quick one next!
Oh I appreciate the long posts -- but want to give it the time.
Shocked shoCKED !SHOCKED! it is illegal to wear a mask in parts of this country!
O! say does that star-spangled Banner yet wave,
O'er the Land of the free and the home of the brave?
There is no 'Land of the Free' and certainly no 'home of the brave' if a bunch of ignorant cultural warriors are allowed to sicken/kill people in their quest for self aggrandizement and lust for power.
GEORGE 'going to jail-former volleyball star, Wall St exec-Holocaust family-NYU Grad' SANTOS represented people in Nassau County so maybe I should not be sooo shocked?!?!
May the legislators get the Long Covid they deserve.
Thanks for the great update! :-)
The shocks just keep coming, don’t they?! I hope our democracy can keep absorbing them but it has been George Foreman body blows for the past decade or two. And that makes so much sense about Santos representing said district. How could they vote for that guy? I guess this is how. Thanks for dropping in!
Yeah, as a Texan who moved to NY many years ago, I was shocked NY ended up with the first anti mask law on the books in the country. As an immunocompromised person, I should not be burdened to show proof of my need to mask. Infuriating!
Exactly Sistr: HOW do you prove you are immunocompromised? Carry around your medical records from an immunologist? 'Here is my Long Covid card'...'my Chronic Fatigue card'...'my transplant card'? There is no such card.
Well I'm going to try and get a Nobsbac from Costco. Thanks for the pointer, Ryan.
I think I am on 9 shots and boosters now since 2020. I will keep taking them so long as available-them to take or me to take them.
But I had the distinct unfortune to catch one of the earliest strains in April 2020 and to get long Covid with all the classic sequelae. Now, my life span has been shortened I'm afraid and I'm already over 75.
It sometimes feels futile to continue with my masking or to continue getting boosters. I really don't think the virus can do any more damage to me than it has already done. But I will continue
There's a silver lining. Shortening my life as it has, the virus has made me treasure life more and made each day more poignant. In that sense it gave me a gift.
Well I certainly hope it has not shortened your life, but i personally understand the sentiment of gratitude after health setbacks. Stay hopeful if you can
I got Novavax last fall and this January after multiple mRNA vaccines. Trying to find it was an adventure (CVS was especially weird), and I ended up in Rite Aid both times. I am glad to see they are offering single dose pre-filled syringes this time. I have no doubt some of the weirdness and hesitation to carry it had to do with 5 dose vials that had to be wasted if no one else wanted the other 4 doses in the vial (along with the cost falling on the providers/pharmacy.) I had a multi-day close exposure after my 2 Novavax and no infection. I’m immunocompromised, so I consider that a victory even if only anecdotal. I’m still sitting at 1 infection last August (from my mom, after years of working in the hospital during pandemic peak!) but it was a 3 week affair that almost ended in a hospital stay so I’d rather not repeat it!
Good to hear about this, I’ll keep an eye out for Novavax locations as a lot of my patients (especially who experience more side effects with mRNA) ask about this. Was your reaction to Novavax easier to handle, too?
Must have been quite scary and unpleasant to almost end up in the hospital. When we talk about hospitalizations for any illness, we have to think just how bad someone is feeling/doing to head over to the hospital. No one wants to be there, for many reasons! And very good point about the 5 dose vials versus the single, should facilitate things much better. Thanks for this!
My kiddos are back in school, and our schools are so worried about attendance/state funding/state report cards that their guidance is “come to school sick as long as you are not vomiting and not running a fever.” My kiddos masked every day of school in KN95s for two solid years; we stopped asking that of them for the 2023-2024 school year. The mental toll of being the sole maskers overrode any health benefits the masks were providing. Anecdotally, one kiddo got Flu B, and the other had perfect attendance. I feel less optimistic this year. But,one can hope. It is a terrible time to parent, as my kids missed out on so many normal things that they saw their friends doing in 2021 and 2022. They will never get that time or those experiences back. So, we risk more than I would like because I have given up on some accounts.
Still hoping for better data on nose sprays because, anecdotally, I believe them to be helpful.
Thank you Ryan, as always, for these updates. The more collective amnesia there is, the more I appreciate your posts. (Also, 1/35? WOW.)
Thanks Catherine :)
That (1/35) I picked up from twitter (J.P. Weiland and the Mitigation Group I linked to). It does build in a 10 day period of illness I think, based on my back of a napkin calculation.
If we go with a shorter contagious period of 7 days, then it's *only* 1 out of every 50 people estimated. Not making me feel any better! Best of luck with kids back to school.
I’m 73, female, white, a healthy weight, and have had Long Covid for four years (got it spring 2020). Current symptoms: exhaustion, PEM, dizziness. I must pace myself carefully. My life is quite limited. I’m vaccinated annually. I mask when I leave home and eat outside at restaurants.
You write that “it sucks to be careful, and it sucks to not be careful.” What are your thoughts regarding the upcoming holidays for a person like me?
Hi Adrienne, and thank you for your comment and story. I have quite a few patients and some friends with very similar experiences right now. I have very complicated thoughts for all of us during the holidays. It feels cruel to me to avoid friends and family, especially over the holidays... but when rates are very high and people are forced indoors with bad ventilation, often with kids who are sick with something like 50% of the time, it can often feel not worth the risk of permanent worsening of symptoms/LC. There really is no one-size-fits all people or situations. I implement the protective measures I can, but do take risks when I figure the risk of getting Covid is socially worth it. In the "reading room" section of my site I have collected some evergreen articles I've written about my approach in case you want some deep dive ideas, from ventilation to nasal sprays. Best of luck.
FYI: I went to my 50th high school reunion last weekend. It was a packed room with zero extra ventilation (some A/C)--100° outside, so that was appreciated. I used the neosporin trick and somehow did not get Covid! I suspect that my Covid infection 4 months prior helped. I will put off my updated Covid vaccine until October. Thanks as always.
That’s awesome! Love the anecdote and feedback. I’m sure the recent infection and hopefully the nasal modulation helped. I’ve been to 2 big school events for my daughter, and going to a bat mitzvah this weekend. Doing a bit of the “regimen” myself. So far so good.
Just saw patient with flu B this morning on rapid antigen testing. Surprised me.
Ugh! Don't want an early flu year. THANKS again for the neosporin hack!