At age 68, I will get my second updated Covid vaccine in about a month (5 months after my first). The last 2 times I went to Europe, I got vaccinated 2 weeks in advance. Despite a lot of caution, I still got Covid both times (2023, 2024). This time I will get vaccinated a month in advance and see how it goes. My spouse just came back from Europe (10 hour flight AND FORGOT TO MASK). I wasn't with him to remind him and he said no one else was wearing a mask (🙄). Thankfully, it has been 4 days and he is symptom free (I may let him back in the house!) I did not divorce him but I was pretty worried for a few days. I still mask under many circumstances but I am more lax than even last year. THANKS AS ALWAYS! We will get through the next 4 years but we will suffer.
Well, don't hold me to it, but I remain an optimist. I believe we will begin to mobilize a fight. I have been protesting injustice and stupidity for over 50 years and I am not stopping now!
Hi Donna! I'm glad no divorce pending, but if he gets sick perhaps sleeping in another bedroom for a week+ would be fair ;)
I really hope your European vacation goes well, and the timing of the shot (and even more importantly the waves) works out this time. We mask in the planes and in museums, and so far that seems to work out pretty well. But increasingly letting our guards down with restaurants as that's certainly part of the fun.
With all the disruption at the FDA/CDC, I’m not expecting new approvals for COVID medications— like the promising one from Shinogi. I just hope that we still have access to vaccines in the future. Not being hyperbolic. Thank you for being such a great communicator/person/physician.
And sharing the work of your talented daughter— it’s so beautiful.
Thank you Jan, and I also thought this latest watercolor was jaw dropping! I'll extend your compliments to the artist. And yes, I'm certainly concerned about regressive policies and intentional mismanagement at FDA/CDC. Shinogi's ensitrelvir should have approved here long ago. Now it will be forgotten. Thank you for being such a great communicator/person/physician, too!
Thanks for sharing that wonderful work of your kiddo. Better frame it!
Interesting the Ab intranasal in China but given the political stat of affairs? I did make a note about azvudine last January (2024) and glad to see progress. We need to continue to develop antivirals. Still wondering about Xocova (Ensitrelvir). Heard any news?
You did see the Japanese researchers develop peptide preventing COVID
Posted in Under the Cover of the Petri Dish and I did mention you might be adding this to your nasal spray list. Looking at Influenza too. Still needs to undergo trials but could be useful in the future? (Yeah, I know, seems everything is in limbo.)
As far as the flu vaccine, I think that the rationale is preventing co-infections and chimeric viruses. Both infecting a cell are capable of replication in the cell.
Even though COVID is lower than past winter season, sounds like you're busy with all the respiratory fun. What's up with Flu?
Like the bullet point summary and keep up the great work!
Hi KB - and thanks again for following all this stuff. I missed the late January Japanese peptide announcement, so I've added it to the queue for review next month. Thanks in advance! Do you think I should start and end with with the bullet point summaries?
Intriguing question, maybe this could be a poll conducted with your subscribers. For me, it would be either start or end, not both. I am not expecting anything on the peptides for a long while but quite interesting.
I'm so grateful for your comment, Carole. I swear writing this has done more to stave off professional burnout than 100 hollow "wellness initiatives." It's 5% lemonade stand side hustle, 95% labor of love. Let's all keep trying to avoid despair and retreat, instead doubling own on the values and people and truths we hold dear.
Another terrific update from you, thank you so much. So pleased to see you have many new subscribers, too. Well-earned, and I hope the trend continues. It certainly should! Oh, let me not forget! Another SENSATIONAL artwork. Wow! Can a museum exhibit be far behind? Please give the in-resident artist molto applause.
I read your comment to my daughter, and she very much appreciated it! I've been trying to get her to start a little business, maybe greeting cards or prints with some of her artwork. A museum would be so cool! Why don't they have a museum of children's art somewhere!?! We should get on that in our free time...
Oh, that is lovely to hear. I thought of her work, and her grandmother’s (do I have that right?) today, as we went to see the Caspar Friedrich exhibit at the Met. His depictions of landscapes, like your artists in residence, were luminous and delicate.
The ramifications of the new administration's assault on the public health system are enormous. Under the flimsy guise of promoting American prosperity by silencing or dismantling agencies responsible for the same, they are steering us toward an enormous public health crisis. Trump/Musk - making America sick again.
Yes, Michael, and the throughline goes back all the way to FDR... probably back to the beginning of human civilization... Social programs and the middle class matter little to the ultra-rich and corporations, who are the overlords of the current project 2025 cataclysm.
We knew it was coming; presently they harnessed anti-wokeism and turned us crabs in a bucket against each other.
Dr, Ryan, if one takes Metformin for diabetes, would it still have the salutary effects against Covid, or would the dosage need to be increased? Not that I expect get it; I’m still, luckily, a Novid.
Hi Mim - yes, studies have definitely shown that people with diabetes who already take metformin have better Covid outcomes. I can get you links to studies if you want, but it's definitely been seen. I don't think any comparison of dosing has been studied, but in the trials specifically using metformin as treatment of Covid (in non-diabetics), the chosen dosing was a taper up from 500mg day one, 500mg twice daily days 2-5, and 500mg in AM 1,000mg in PM for days 6-14. I think! Best regimens still to be determined though, and taper up on this schedule might produce too may GI side effects for some. When I did this I felt totally fine (n=1)
I agree about the painting, will relay this to my daughter :)
Thanks so much for addressing the immune system damage question — it’s one I’ve really been trying to understand recently. I always hear in the more cautious circles that covid damages the immune system… might it be more accurate that covid *CAN* the immune system?
Also, I want to point out that the N=113 and the two studies referenced in the Sick Times piece are likely fully (or at least mostly) among unvaccinated patients based on data collection timeframes and pub dates. Not sure what to make of that information when making risk assessments for 2025, especially for those of us who are several shots deep at this point… (your posts have encouraged me to keep up with them, even when pandemic fatigue makes me question the value) Any thoughts? 🙂
Hi KM, thanks for a great question. I would agree that, as with everything it seems, there is a continuum. With so many variables in this equation it is hard to consistently predict who will have immune system dysfunction versus damage versus not much of anything. The risk factors are pretty well established but are not deterministic, so like you, I bend the variables in the equation to my advantage when I can... staying up to date with vaccinations helps unless someday proven otherwise, avoiding infections when possible and to a personal choice of social penalty tolerance, treating when sick, etc. Gray areas drive people crazy, myself included, and that cognitive dissonance drives many to cults of personality who claim easy, one-size-fits-all answers!
Really appreciate the insightful summary and interpretations as always. I'm very curious to see where the research goes on covid and immune deficiency.
Thanks again for a wonderful summary. And my condolences for the shitshow of a dumpster fire that's happening in America with the government at the moment.
Thank you Zhong. I hope the vast swath of ocean between us keeps our shitshow dumpster fire from catching over there... although I know this pendulum swing is world wide.
The resident artist strikes again - simply beautiful!
Great post to kick off the year, doc. Just to add that Yale is still in the midst of its Paxlovid/long COVID study which I believe involved a 15 day course. Akiko Iwasaki is the immunologist heading that up.
Thanks Amy! Will extend your compliments, it's still a little thrill for her.
And please do keep us up to date if you hear anything first about the 15 days course. I think much of it will depend on when it is started, and in what subset of long Covid patients as you know how the pathophysiological mechanisms vary among affected people. Akiko for president! Or at least HHS head ;)
One question: your statement (under immune dysfunction) that sometimes COVID is just a cold and sometimes isn’t…can you say more about that? I have been under the impression in my internet and newsletter “travels” that multiple reinfections are considered playing with fire, both from a long COVID perspective and from a down-the-line organ damage perspective, even if a particular acute re-infection FEELS quite mild. There have also been recent studies about viral fragments being found in the meninges, kidneys, and gut biome. I just don’t see how anyone can ever declare COVID as “just a cold.” Thoughts?
Adding my thanks for your work here. I’m tickled and nodding in recognition that the artist-in-residence has established their art work signature. Very important, those signatures!
I have a quick question - is it okay if I share your original "politicization of healthcare" article?
Also, your resident artist continues to astound me!! What a beautiful picture. I hope she loves what she does and will keep expressing herself and sharing her precious gift with the world. It makes me think of the old Dostoyevsky quote, "the world will be saved by beauty", (and of course by truth - thank you for that!).
Share at will thank you Gemma. Anything I put out there I am assuming will be public domain at this point, and if used against us by some gestapo social policing then we will have already lost. But there are too many of us left to leave just yet. I think?
Love the Dostoyevsky quote - the world will be saved by beauty. Love that. I hope so.
Sometimes I think I should just switch over to writing poetry and publishing her paintings and call it a day :)
Would LOVE that prophylactic nasal spray, but the way things are going am not counting on it being available here 😭
Agreed. International cooperation is being destroyed. Many crucial medications are made in China. Watch out for that.
At age 68, I will get my second updated Covid vaccine in about a month (5 months after my first). The last 2 times I went to Europe, I got vaccinated 2 weeks in advance. Despite a lot of caution, I still got Covid both times (2023, 2024). This time I will get vaccinated a month in advance and see how it goes. My spouse just came back from Europe (10 hour flight AND FORGOT TO MASK). I wasn't with him to remind him and he said no one else was wearing a mask (🙄). Thankfully, it has been 4 days and he is symptom free (I may let him back in the house!) I did not divorce him but I was pretty worried for a few days. I still mask under many circumstances but I am more lax than even last year. THANKS AS ALWAYS! We will get through the next 4 years but we will suffer.
Thank you for saying we will get through the next 4 years. I've really been wondering...
Well, don't hold me to it, but I remain an optimist. I believe we will begin to mobilize a fight. I have been protesting injustice and stupidity for over 50 years and I am not stopping now!
Sure hope so.
Hi Donna! I'm glad no divorce pending, but if he gets sick perhaps sleeping in another bedroom for a week+ would be fair ;)
I really hope your European vacation goes well, and the timing of the shot (and even more importantly the waves) works out this time. We mask in the planes and in museums, and so far that seems to work out pretty well. But increasingly letting our guards down with restaurants as that's certainly part of the fun.
I know you know the score and have a great plan!
He did not get sick! YAY! We flew to San Diego yesterday and he wore the mask. 😎
With all the disruption at the FDA/CDC, I’m not expecting new approvals for COVID medications— like the promising one from Shinogi. I just hope that we still have access to vaccines in the future. Not being hyperbolic. Thank you for being such a great communicator/person/physician.
And sharing the work of your talented daughter— it’s so beautiful.
Thank you Jan, and I also thought this latest watercolor was jaw dropping! I'll extend your compliments to the artist. And yes, I'm certainly concerned about regressive policies and intentional mismanagement at FDA/CDC. Shinogi's ensitrelvir should have approved here long ago. Now it will be forgotten. Thank you for being such a great communicator/person/physician, too!
Thanks for sharing that wonderful work of your kiddo. Better frame it!
Interesting the Ab intranasal in China but given the political stat of affairs? I did make a note about azvudine last January (2024) and glad to see progress. We need to continue to develop antivirals. Still wondering about Xocova (Ensitrelvir). Heard any news?
You did see the Japanese researchers develop peptide preventing COVID
19 infections
https://www.japantimes.co.jp/news/2025/01/23/japan/science-health/peptide-prevention-covid-19/?utm_source=substack&utm_medium=email
Posted in Under the Cover of the Petri Dish and I did mention you might be adding this to your nasal spray list. Looking at Influenza too. Still needs to undergo trials but could be useful in the future? (Yeah, I know, seems everything is in limbo.)
As far as the flu vaccine, I think that the rationale is preventing co-infections and chimeric viruses. Both infecting a cell are capable of replication in the cell.
Even though COVID is lower than past winter season, sounds like you're busy with all the respiratory fun. What's up with Flu?
Like the bullet point summary and keep up the great work!
Hi KB - and thanks again for following all this stuff. I missed the late January Japanese peptide announcement, so I've added it to the queue for review next month. Thanks in advance! Do you think I should start and end with with the bullet point summaries?
Intriguing question, maybe this could be a poll conducted with your subscribers. For me, it would be either start or end, not both. I am not expecting anything on the peptides for a long while but quite interesting.
I am so grateful when you write. I also admire your clear way of summarizing results from diverse sources. You make such a difference in many lives.
Agree 💯💯💯
I'm so grateful for your comment, Carole. I swear writing this has done more to stave off professional burnout than 100 hollow "wellness initiatives." It's 5% lemonade stand side hustle, 95% labor of love. Let's all keep trying to avoid despair and retreat, instead doubling own on the values and people and truths we hold dear.
As always, Ryan, a great update.
Thank you for all you do.
Another terrific update from you, thank you so much. So pleased to see you have many new subscribers, too. Well-earned, and I hope the trend continues. It certainly should! Oh, let me not forget! Another SENSATIONAL artwork. Wow! Can a museum exhibit be far behind? Please give the in-resident artist molto applause.
I read your comment to my daughter, and she very much appreciated it! I've been trying to get her to start a little business, maybe greeting cards or prints with some of her artwork. A museum would be so cool! Why don't they have a museum of children's art somewhere!?! We should get on that in our free time...
Oh, that is lovely to hear. I thought of her work, and her grandmother’s (do I have that right?) today, as we went to see the Caspar Friedrich exhibit at the Met. His depictions of landscapes, like your artists in residence, were luminous and delicate.
The ramifications of the new administration's assault on the public health system are enormous. Under the flimsy guise of promoting American prosperity by silencing or dismantling agencies responsible for the same, they are steering us toward an enormous public health crisis. Trump/Musk - making America sick again.
Yes, Michael, and the throughline goes back all the way to FDR... probably back to the beginning of human civilization... Social programs and the middle class matter little to the ultra-rich and corporations, who are the overlords of the current project 2025 cataclysm.
We knew it was coming; presently they harnessed anti-wokeism and turned us crabs in a bucket against each other.
Read this if you are looking for an emetic:
https://www.npr.org/2025/02/06/nx-s1-5288145/trump-anti-trans-executive-order
Thanks again for the information!
The painting is superb.
Dr, Ryan, if one takes Metformin for diabetes, would it still have the salutary effects against Covid, or would the dosage need to be increased? Not that I expect get it; I’m still, luckily, a Novid.
Hi Mim - yes, studies have definitely shown that people with diabetes who already take metformin have better Covid outcomes. I can get you links to studies if you want, but it's definitely been seen. I don't think any comparison of dosing has been studied, but in the trials specifically using metformin as treatment of Covid (in non-diabetics), the chosen dosing was a taper up from 500mg day one, 500mg twice daily days 2-5, and 500mg in AM 1,000mg in PM for days 6-14. I think! Best regimens still to be determined though, and taper up on this schedule might produce too may GI side effects for some. When I did this I felt totally fine (n=1)
I agree about the painting, will relay this to my daughter :)
Thanks so much for addressing the immune system damage question — it’s one I’ve really been trying to understand recently. I always hear in the more cautious circles that covid damages the immune system… might it be more accurate that covid *CAN* the immune system?
Also, I want to point out that the N=113 and the two studies referenced in the Sick Times piece are likely fully (or at least mostly) among unvaccinated patients based on data collection timeframes and pub dates. Not sure what to make of that information when making risk assessments for 2025, especially for those of us who are several shots deep at this point… (your posts have encouraged me to keep up with them, even when pandemic fatigue makes me question the value) Any thoughts? 🙂
Hi KM, thanks for a great question. I would agree that, as with everything it seems, there is a continuum. With so many variables in this equation it is hard to consistently predict who will have immune system dysfunction versus damage versus not much of anything. The risk factors are pretty well established but are not deterministic, so like you, I bend the variables in the equation to my advantage when I can... staying up to date with vaccinations helps unless someday proven otherwise, avoiding infections when possible and to a personal choice of social penalty tolerance, treating when sick, etc. Gray areas drive people crazy, myself included, and that cognitive dissonance drives many to cults of personality who claim easy, one-size-fits-all answers!
thanks for holding the nuance! makes sense to me!
Really appreciate the insightful summary and interpretations as always. I'm very curious to see where the research goes on covid and immune deficiency.
Thanks again for a wonderful summary. And my condolences for the shitshow of a dumpster fire that's happening in America with the government at the moment.
Thank you Zhong. I hope the vast swath of ocean between us keeps our shitshow dumpster fire from catching over there... although I know this pendulum swing is world wide.
The resident artist strikes again - simply beautiful!
Great post to kick off the year, doc. Just to add that Yale is still in the midst of its Paxlovid/long COVID study which I believe involved a 15 day course. Akiko Iwasaki is the immunologist heading that up.
Thanks Amy! Will extend your compliments, it's still a little thrill for her.
And please do keep us up to date if you hear anything first about the 15 days course. I think much of it will depend on when it is started, and in what subset of long Covid patients as you know how the pathophysiological mechanisms vary among affected people. Akiko for president! Or at least HHS head ;)
That would be a DREAM! Alas…
One question: your statement (under immune dysfunction) that sometimes COVID is just a cold and sometimes isn’t…can you say more about that? I have been under the impression in my internet and newsletter “travels” that multiple reinfections are considered playing with fire, both from a long COVID perspective and from a down-the-line organ damage perspective, even if a particular acute re-infection FEELS quite mild. There have also been recent studies about viral fragments being found in the meninges, kidneys, and gut biome. I just don’t see how anyone can ever declare COVID as “just a cold.” Thoughts?
Adding my thanks for your work here. I’m tickled and nodding in recognition that the artist-in-residence has established their art work signature. Very important, those signatures!
I noticed that too! Adorable.
Thank you!
I have a quick question - is it okay if I share your original "politicization of healthcare" article?
Also, your resident artist continues to astound me!! What a beautiful picture. I hope she loves what she does and will keep expressing herself and sharing her precious gift with the world. It makes me think of the old Dostoyevsky quote, "the world will be saved by beauty", (and of course by truth - thank you for that!).
Share at will thank you Gemma. Anything I put out there I am assuming will be public domain at this point, and if used against us by some gestapo social policing then we will have already lost. But there are too many of us left to leave just yet. I think?
Love the Dostoyevsky quote - the world will be saved by beauty. Love that. I hope so.
Sometimes I think I should just switch over to writing poetry and publishing her paintings and call it a day :)
Maybe one day. 😊