Your 13 year old artist is amazing--and so are you. I've thought about novavax soon and then mRNA too.
I had a dear relative contract Covid--likely during a physician visit in California--and where Kaiser does very well is that the on call physician took the time to figure out how to adjust medications and reduced the Paxlovid dose and the Kaiser pharmacy had it immediately (No PaxAssess nonsense.). They're still testing positive on day 12-13 and feeling discouraged, but I sent them the graph from YLE on peak viral load and infectiousness.
Boy, do I wish we were back in the dip of early June in Covidlandia. But we're not, and so I'm grateful to you and YLE (whose last email I somehow missed) to let us know that it's not only not seasonal, the peaks are really high.
Please tell the artist how talented she is and how beautiful her watercolors are. And thank you, thank you, thank you.
I too am seeing covid and as there are not too many other viruses out there, if you're having a sore throat, odds are it could be Covid.
Loved seeing that the sprays work, they used a polymer product from the UK and saline--so us neti pot people are doing a good job, and I swear by the carganeen sprays, if only to make me feel more confident. Personally use the Betadine brand.
Hi Jan! I’m humbled by your comments, and I will absolutely let the artist know! She gets that from her grandmother, and I’m tempted to ask for permission to use one of her grandmother’s paintings for a post soon!
I’m glad your family member seems to be recovering, and took Paxlovid. I don’t want to look back and regret I didn’t try, and that positivity is almost certainly inactivated viral remnants being cleared 🤞 I know this is controversial but as you know some people do a 10 day course.
I’m nostalgic for June too. Hard to countenance that we only get these brief valleys between surges, and it never really goes to zero. No wonder people choose to believe a different narrative of “back to normal.” It’s exhausting and takes a toll of its own to be mindful and careful.
Agree with the sore throat Covid until proven otherwise, and hard to prove 100% with rapid tests. Agree with your nasal spray strategy! Saline is hard for anyone to hate on. Thanks for stopping by :)
Oh that wasn't such a long article as you warned, Ryan. Two 100 meter tall stone pyramids were erected over in the next county while I speed-read it, but a third is only halfway up. The info you provided was very useful and actionable. The action I'm going to take is to grab a bottle of rotgut and drink myself into an apathetic stupor!
But seriously. This was a very fine tour d' horizon of the current state of knowledge and gives much support to the realization that the virus is still out there, still mutating, still capable of infecting millions and worse, leaving a significant percentage with Long Covid, an absolute misery I assure all and I know from experience. As you write, we should avail ourselves of all reasonable prophylactics and safeguards, including masking in higher transmission risk environments and keeping up with the booster shots. Sign me up for Novavax if it becomes available where I am.
That final Claude assisted speech was great! Thank you for this whole article and allowing my long response (the third pyramid just got completed while I was writing it)
😆 thanks Michael! Your comment stands as a great post all by itself, and I’m glad that this could be speed read. You must have some medical/scientific fluency which is great! The bottle of rotgut might not be evidence based, but there are times when drinking oneself into a stupor sounds about right!
I had to cut back on some links and articles, but since you mentioned the LC I’m going to send out a quick post soon highlighting a newish website I learned about that is collecting and presenting LC treatments and evidence for efficacy in real time. I hope for your continued recovery if still climbing back. Have a great weekend and thanks for the good humor!
Must echo Jan on the brilliance of your 13 year old artist’s watercolor—so accomplished, and such a deft depiction of the play of light throughout.
You, also, are not too shabby in your own sphere, to say the least! This is, as always, an excellent report, and I love your stump speech approach at the close. Thank you, as always, for keeping us up to date—and for cutting through the noise along the way.
Thanks Susan, will let the artist know! The last time I tried to do water colors I ended up destroying the paper in a sad collection of puddles and rolled up bits of paper fiber. I thought the stump speech was convincing, too, and I’m always ready to vote for hope and altruism ;)
Thank you, Dr. McCormick, for keeping our eyes focused on the truth about covid. As interesting and important as your well written article is, my eyes were also drawn to that lovely painting by your artist in residence. Nevermind a behavioral webpage for stress management! Her beautiful interpretation of this striking natural setting would be a perfect option to lift one out of their misery and relieve one's stress during an unwelcome bout with any virus. Thank you!
Thanks Sheila! I’m very happy to have her steal the show, especially when the show can drone on about a topic like Covid that even I am totally sick of! But the reality compels us to keep learning and trying to minimize harm. Hope you have a great weekend and thanks for stopping by :)
Agree that your 13 year old is very talented! And thank you for this article. Excellent! I have been seeing a lot of Covid though here in Seattle it seems to have peaked. I will be 4 months post-Covid in early September so I will wait for Moderna vaccine. I guess I have already been somewhat boosted by the new variant with my infection. Both of my Covid infections occurred a month post-vaccine so I am not sure what to make of that. I had just bought some Enovid (which I have been using off and on for a few years) and this article helps me justify the expense. Also, I remain a fan of Paxlovid and metformin despite the significant GI SE and I will continue to push it. I have a high school reunion in September but I won't go if I am not vaccinated. Many of my high school classmates are anti-vaxxers. Sigh.
Hi Donna thanks for sharing this. I have not tried Enovid but a few people really swear by it that I’ve talked with. I’ll use some azelastine nasal spray or saline, as I figure I benefit from the nasal symptom relief due to allergies anyway. I’m going to do a post about neomycin (neosporin) ointment intranasally for a quick shield in circumstances like the reunion and weddings. Always discouraging to hear of infections right after vaccinations- but hopefully kept the illness mild and reduced lingering problems? It’s a game of probabilities and inches, but no way to win by a shutout! Glad to hear your boots on the ground report that validates what they are saying about the peak and decline starting out west.
Want to see the neosporin post— it’s petrolatum based, right? We use bactoban, which is polyethylene glycol based in the nose all the time— just wondering about the vehicle and possible inhalation. Can’t wait to read it. Some internet searches indicate that the neomycin might be helpful. Interesting.
I am looking forward to hearing about neosporin! I do NOT want this again and my high school reunion does not fall into the category of "worth it to get Covid"! Four months post-Covid I still have some lingering cognitive effects or maybe I am just 67!! Thanks again!
I started college as an art major, got good grades for my work, but realized that I was being mechanical in my art vs passionate, and simply switched to a technical major because I didn't have the "it", talent. The 13 year old artist in residence does have "it". "It" doesn't define who one is or one's career, but life is richer with "it".
Aside from "that". Thank you. I share your posts with my wife, a retired infectious disease research nurse (almost no shoft work!), who finds them valuable, too.
Hi Jerry and I really appreciate this quote: "It" doesn't define who one is or one's career, but life is richer with "it". I think artists, musicians, and those who teach these subjects in schools would absolutely agree. As Americans I think we really strive to build marketable skills that pay the bills, which is necessary, but we shouldn’t give up those talents and hobbies that bring us joy and wealth of spirit. Please give my best to your wife, and she is always welcome to steer me back from anything her expertise would consider otherwise!
After graduating college, I moved out of state and left my darkroom equipment at my parents' house. After a few months, my best friend asked whether I was going to take it to my new city & I told him that I didn't plan to. So he took it all, carefully improved it, and went on to become an excellent photographer and skilled photo printer using the old fashioned chemical way. He's still at it, his photos having been used by dancers and models for their portfolios, his portraits and landscapes adorning the walls of his NYC condo by Columbia U. It helped him keep his sanity as he was getting his PhD in biomedical, and in his stressful early career, as he was coping w undiagnosed ADD. I just look on in wonder and awe. And I still tear when I encounter great art.
My wife's creative endeavor is our garden, and I'm fortunate to be able to relax in it.
Creativity is invaluable, and its contributions to people's lives is great. Its contributions to society is oftentimes hidden, as in my friend's case, but immeasurably great.
Agree with most of Fauci’s statements except this:
“…as you say, even though the air on planes is very, very good…”
The ventilation is demonstrably bad!
Glad to read Topol’s update as well, but I’m hearing a lot of experts like him and Daniel Griffin say some version of this:
“The vaccine boosters only last 4-6 months for protection from severe Covid,”
I think that’s poorly communicated. It’s not that we are ceasing to benefit from a durable protection against severe Covid that we achieved with our multiple vaccinations over these pandemic years (and prior infections) - it’s just that the protection gains from another shot are incremental, but are greater the longer it’s been since a dose or infection, right?
Yes, my husband and I do employ other mitigation methods, he is also a Novid.
I would be so grateful for the nasal spray for Covid, we definitely pull back from going out inside to crowded places during high infection times. It gets lonely and limiting!
Hi Bonnie - yes that would work better in terms of flushing stuff and I did cite a paper a while back that also found rinses were a bit better than saline sprays. Just be careful with slight Neti pot risks:
As always, rational, enlightening and comforting. Thank you. I sometimes get lost in the statistical “weeds”, but always “get” the bottom line. This post will be circulated to friends and family for their enlightenment. And the painting is so beautiful! I can say this with my official credential of “art critic”! My art teacher - I was 15 - said, during class critique of our works, “You really can’t paint, but you do give excellent critiques!!!
Hi Mary - sorry about the technical stuff, but I’m glad you get the gist and the bottom line is the most importantly part. I mostly include the study details so people know methods, absolute vs relative risk reductions, and stuff like that. Being a good critic is such a great skill, really. It’s so hard to give good feedback, it’s an art form in and of itself!
Ryan, no problem. My comment was not meant as a criticism, as I think it is very important that you include the scientific support for your “bottom line”. It is reassuring, and it also allows for trust. I am just getting “lazy” in my old age:)
OK, I'll return the favor with a long reply. (LOL) First, clearly, a proud dad showcasing his daughter's talent. I can clearly see why but keep it humble if you can (yeah, I know, a rather daunting task!)
So, about symptom resolution as a primary endpoint as used in influenza, I have mentioned that this should be a distant secondary endpoint. Second, comparing Corona viruses and Influenza viruses is bit like comparing apples and oranges (in my humble and naive opinion). Endpoints should be severity, hosp/ICU and death. Maybe include post acute sequelae. We've seen, while similar in clinical settings, are really different in many way. Postexposure prophylaxis approach works for many infectious diseases but not all. Also, likely that household contact have already been infected but turned into COVID-19. I didn't see this as negative for Paxlovid. One thing stood out for me was the ten day course was not really effective.
In my last post, you saw the pioneering study on nasal immunity and this could lead to useful vaccines/Tx interventions.
Another, shall we say, incredulous claim about masking is that it doesn't stop the virus but blocks O2. (sigh).
Great work as usual and nice to see from a clinician point. I know this is not easy work and seems that the inbox never seems to slow down. Wonder if your daughter would consider being a medical artist like Netter?
Disclaimer, I just realized that my "last post" was still in my draft box. Just posted it now. Back to the salt mines.
Hi KB! Thanks for these thoughts and avenues for further discussion. I’ll try to circle back for a more thorough reply, but suffice it to say I agree with your points here… and that asymptomatic Covid infection period in which people spread the virus to each other has always been the Achilles heel of this whole pandemic (plus some other unfortunate variables). For prophylaxis to even have a chance they should have tried a 24-48 hour window max, not the 96. Pfizer seems to shoot itself in the foot with their study designs re: paxlovid.
Another great jaunt through COVIDlandia - thanks Doc.
I wanted to share something interesting with you re: vaccines from the perspective of an existing COVID long hauler. Last summer, I emailed my functional medicine doctor, who is extremely well read on all the LC studies, to ask if he thought I should be considering getting any of the upcoming fall vaccines (COVID, flu, RSV). He responded that he could not in good faith recommend that any of his LC patients get any of the vaccines because we (medical science) just didn’t know enough by then about what they would do to an immune system that was already quite activated.
And then in July, I saw an immunologist for the first time at the behest of my infectious disease doc, due to mast cell activation syndrome that she was out of tools to treat. When I told her what my FMD said about the vaccines, she was nodding vigorously, and she said, “you are in the extremely small minority of patients for whom I’d agree with that advice.”
In addition to elevated serum tryptase, she found I have some low lymphocyte counts and last year, my ID doc was able to diagnose me with common variable immune deficiency.
So, while the vaccines might prevent LC in people who don’t already have it, it’s safe to say the jury is still out on whether we existing long haulers should be continuously vaccinated. A dear friend of mine took a huge step back after getting the Novavax jab last winter, after several rounds of the mRNA vaccines seemingly didn’t affect her at all. I myself had three mRNA shots in 2021-2022 and each one set me back for several weeks.
Lastly, I completely missed your daughter’s painting - thank goodness for the other comments here! I went back and saw it and was astonished that I missed something so beautiful. What a talent! 🤩
Hi Amy - this is such valuable testimony and case reporting, and it helps ground primary care docs like me to hear this counterpoint. It makes good sense and with your situation and the dear friend’s, it really is a roll of the dice. I back off pushing additional shots in these gray areas of risk. I also read a version of this comment in one of your posts that I was reading on the plane today while catching up on the email inbox. I’m so glad you are out there sharing your voice and experience and knowledge! It is a wonderful perspective and real.
Hi Arthur - metformin is by prescription only, as far as I know.
It’s a no brainer to try it at least, but GI side effects are common and intolerable for some. But metformin is considered the first line med for type 2 diabetes because of long track record of safety, effectiveness, and low cost. It should not cause hypoglycemia.
Here is a slightly cheesy illustration I made about the dosing regimen back in March, 2023. And the COVID-OUT trial has more specifics, I’ll find that link from a covidlandia post later, I think it was 2 months ago.
As usual, your article was great and is much appreciated. I also have a daughter with artistic talent and am impressed by yours's work. And the best part of that is that's it's undoubtedly so pleasurable to her that compliments aren't all that important.(although I imagine never unwelcome😁).
I do "take issue" with one of your comments here and I quote, "The much better news, at least as far as the CDC can still track this with more scant data reporting, is that weekly deaths are way down from the nightmarish days in which over 20,000 Americans were dying each week. Now it’s probably more like 300-400 a week". As far as I can see the CDC is still currently using the reporting system that relies on death certificates reported by states - reports which have Enormous Lags in the information and may even overlook Covid as a cause of death, leading to underreporting as well. In fact, I did a short test (wish I had saved the data I had used to illustrate this problem) which indicated that lags are so long - not just weeks but even months of data are being significantly revised due to updates. This makes recent reports on weekly deaths virtually meaningless. I got the information from the CDC website that you linked us too, but it was some time ago when I looked at it and it seems to no longer have the footnote that explains the source of the info and how/why it is lagged. I think it's very important to know this information, because, after all, the worst outcome of Covid is death. (although some might argue that long covid is worse - I don't know). But, the point of all this, is really to ask you if there is some new/different source that the CDC is using that is a more meaningful tool. It didn't look any different on the page you linked us too and you made note that there are the lags (which in their prior footnotes they minimized, based on my own review). But you also said that it doesn't look like we have more than 300-400 deaths a week now. I don't know how that conclusion could possibly be reached given the limitations on what they report. And I think the inaccuracy of that conclusion could be huge - in order of magnitude of many multiples, especially since we are talking about a very recent surge. The data (based on my "analysis") just won't/ don't support the numbers.
Sorry this comment seems "accusatory". Your information is so good and I appreciate it so much that I need to know if I am wrong in these conclusions (mainly because you have access to a better source of data). Thanks again for all you do for us.
DM - you make such great points here, and I think I need to go back and revise that section to reflect this uncertainty. So helpful thank you!
Off the top of my head it seems like a better metric for weekly deaths might be excess mortality, although there will certainly be a lag there as well. This would capture all the acute, subacute, and more distant but related deaths from this whole mess (although heat waves and other problems get baked in, too). Let me get back to you about this after doing a bit of research. Here is a quick resource on excess mortality; they categorize many different countries and subsets, too:
There are many difficulties with excess mortality as I’m sure you know. What should the baseline be is a tough one to deal with I think. And quite a while ago the CDC reworked its baseline to include deaths from Covid in the recent years after COVID began. This is justified by arguing that the baseline is not static and must be estimated using deaths from all causes. The circularity of this argument is obvious as is its undermining of “excess deaths”. The actuarial work you linked to here does that too, but acknowledges it unabashedly, unlike what the CDC did. I think that republishing the death data that is now reported- with numbers for earlier reporting periods being shown at earlier times to indicate just how long it takes and how much the reported numbers change over time might provide a somewhat useful too to see how much “current” reporting is likely to be understating the actual much more believable figure that may not be known for x months from now.
I haven't even read it yet but that painting by your "resident artist" is phenomenal!!! What an amazing talent. Please give her my hearty congratulations - I am in awe!
Your 13 year old artist is amazing--and so are you. I've thought about novavax soon and then mRNA too.
I had a dear relative contract Covid--likely during a physician visit in California--and where Kaiser does very well is that the on call physician took the time to figure out how to adjust medications and reduced the Paxlovid dose and the Kaiser pharmacy had it immediately (No PaxAssess nonsense.). They're still testing positive on day 12-13 and feeling discouraged, but I sent them the graph from YLE on peak viral load and infectiousness.
Boy, do I wish we were back in the dip of early June in Covidlandia. But we're not, and so I'm grateful to you and YLE (whose last email I somehow missed) to let us know that it's not only not seasonal, the peaks are really high.
Please tell the artist how talented she is and how beautiful her watercolors are. And thank you, thank you, thank you.
I too am seeing covid and as there are not too many other viruses out there, if you're having a sore throat, odds are it could be Covid.
Loved seeing that the sprays work, they used a polymer product from the UK and saline--so us neti pot people are doing a good job, and I swear by the carganeen sprays, if only to make me feel more confident. Personally use the Betadine brand.
Hi Jan! I’m humbled by your comments, and I will absolutely let the artist know! She gets that from her grandmother, and I’m tempted to ask for permission to use one of her grandmother’s paintings for a post soon!
I’m glad your family member seems to be recovering, and took Paxlovid. I don’t want to look back and regret I didn’t try, and that positivity is almost certainly inactivated viral remnants being cleared 🤞 I know this is controversial but as you know some people do a 10 day course.
I’m nostalgic for June too. Hard to countenance that we only get these brief valleys between surges, and it never really goes to zero. No wonder people choose to believe a different narrative of “back to normal.” It’s exhausting and takes a toll of its own to be mindful and careful.
Agree with the sore throat Covid until proven otherwise, and hard to prove 100% with rapid tests. Agree with your nasal spray strategy! Saline is hard for anyone to hate on. Thanks for stopping by :)
Oh that wasn't such a long article as you warned, Ryan. Two 100 meter tall stone pyramids were erected over in the next county while I speed-read it, but a third is only halfway up. The info you provided was very useful and actionable. The action I'm going to take is to grab a bottle of rotgut and drink myself into an apathetic stupor!
But seriously. This was a very fine tour d' horizon of the current state of knowledge and gives much support to the realization that the virus is still out there, still mutating, still capable of infecting millions and worse, leaving a significant percentage with Long Covid, an absolute misery I assure all and I know from experience. As you write, we should avail ourselves of all reasonable prophylactics and safeguards, including masking in higher transmission risk environments and keeping up with the booster shots. Sign me up for Novavax if it becomes available where I am.
That final Claude assisted speech was great! Thank you for this whole article and allowing my long response (the third pyramid just got completed while I was writing it)
😆 thanks Michael! Your comment stands as a great post all by itself, and I’m glad that this could be speed read. You must have some medical/scientific fluency which is great! The bottle of rotgut might not be evidence based, but there are times when drinking oneself into a stupor sounds about right!
I had to cut back on some links and articles, but since you mentioned the LC I’m going to send out a quick post soon highlighting a newish website I learned about that is collecting and presenting LC treatments and evidence for efficacy in real time. I hope for your continued recovery if still climbing back. Have a great weekend and thanks for the good humor!
Must echo Jan on the brilliance of your 13 year old artist’s watercolor—so accomplished, and such a deft depiction of the play of light throughout.
You, also, are not too shabby in your own sphere, to say the least! This is, as always, an excellent report, and I love your stump speech approach at the close. Thank you, as always, for keeping us up to date—and for cutting through the noise along the way.
Thanks Susan, will let the artist know! The last time I tried to do water colors I ended up destroying the paper in a sad collection of puddles and rolled up bits of paper fiber. I thought the stump speech was convincing, too, and I’m always ready to vote for hope and altruism ;)
Thank you, Dr. McCormick, for keeping our eyes focused on the truth about covid. As interesting and important as your well written article is, my eyes were also drawn to that lovely painting by your artist in residence. Nevermind a behavioral webpage for stress management! Her beautiful interpretation of this striking natural setting would be a perfect option to lift one out of their misery and relieve one's stress during an unwelcome bout with any virus. Thank you!
.
Thanks Sheila! I’m very happy to have her steal the show, especially when the show can drone on about a topic like Covid that even I am totally sick of! But the reality compels us to keep learning and trying to minimize harm. Hope you have a great weekend and thanks for stopping by :)
Agree that your 13 year old is very talented! And thank you for this article. Excellent! I have been seeing a lot of Covid though here in Seattle it seems to have peaked. I will be 4 months post-Covid in early September so I will wait for Moderna vaccine. I guess I have already been somewhat boosted by the new variant with my infection. Both of my Covid infections occurred a month post-vaccine so I am not sure what to make of that. I had just bought some Enovid (which I have been using off and on for a few years) and this article helps me justify the expense. Also, I remain a fan of Paxlovid and metformin despite the significant GI SE and I will continue to push it. I have a high school reunion in September but I won't go if I am not vaccinated. Many of my high school classmates are anti-vaxxers. Sigh.
Hi Donna thanks for sharing this. I have not tried Enovid but a few people really swear by it that I’ve talked with. I’ll use some azelastine nasal spray or saline, as I figure I benefit from the nasal symptom relief due to allergies anyway. I’m going to do a post about neomycin (neosporin) ointment intranasally for a quick shield in circumstances like the reunion and weddings. Always discouraging to hear of infections right after vaccinations- but hopefully kept the illness mild and reduced lingering problems? It’s a game of probabilities and inches, but no way to win by a shutout! Glad to hear your boots on the ground report that validates what they are saying about the peak and decline starting out west.
Want to see the neosporin post— it’s petrolatum based, right? We use bactoban, which is polyethylene glycol based in the nose all the time— just wondering about the vehicle and possible inhalation. Can’t wait to read it. Some internet searches indicate that the neomycin might be helpful. Interesting.
Found this: https://www.medicalnewstoday.com/articles/common-antibiotic-neosporin-may-shield-against-viral-respiratory-infections#Does-neomycin-boost-immune-response-in-people?
I am looking forward to hearing about neosporin! I do NOT want this again and my high school reunion does not fall into the category of "worth it to get Covid"! Four months post-Covid I still have some lingering cognitive effects or maybe I am just 67!! Thanks again!
Look what I found?? An article about how neomycin boosts nasal interferon: I think it's worth it.
https://www.medicalnewstoday.com/articles/common-antibiotic-neosporin-may-shield-against-viral-respiratory-infections#Does-neomycin-boost-immune-response-in-people?
Yup, that’s the one! Going to throw in my two cents, will love to hear yours!
I started college as an art major, got good grades for my work, but realized that I was being mechanical in my art vs passionate, and simply switched to a technical major because I didn't have the "it", talent. The 13 year old artist in residence does have "it". "It" doesn't define who one is or one's career, but life is richer with "it".
Aside from "that". Thank you. I share your posts with my wife, a retired infectious disease research nurse (almost no shoft work!), who finds them valuable, too.
Hi Jerry and I really appreciate this quote: "It" doesn't define who one is or one's career, but life is richer with "it". I think artists, musicians, and those who teach these subjects in schools would absolutely agree. As Americans I think we really strive to build marketable skills that pay the bills, which is necessary, but we shouldn’t give up those talents and hobbies that bring us joy and wealth of spirit. Please give my best to your wife, and she is always welcome to steer me back from anything her expertise would consider otherwise!
Thank you.
After graduating college, I moved out of state and left my darkroom equipment at my parents' house. After a few months, my best friend asked whether I was going to take it to my new city & I told him that I didn't plan to. So he took it all, carefully improved it, and went on to become an excellent photographer and skilled photo printer using the old fashioned chemical way. He's still at it, his photos having been used by dancers and models for their portfolios, his portraits and landscapes adorning the walls of his NYC condo by Columbia U. It helped him keep his sanity as he was getting his PhD in biomedical, and in his stressful early career, as he was coping w undiagnosed ADD. I just look on in wonder and awe. And I still tear when I encounter great art.
My wife's creative endeavor is our garden, and I'm fortunate to be able to relax in it.
Creativity is invaluable, and its contributions to people's lives is great. Its contributions to society is oftentimes hidden, as in my friend's case, but immeasurably great.
Did you read/hear the interview with Faust and Fauci: Fauci still masks and says "pick your spots and take Paxlovid"--
https://www.medpagetoday.com/special-reports/heavy-hitters/111295
And Eric Tool just wrote a where we are with Covid substack
https://open.substack.com/pub/erictopol/p/the-indomitable-covid-virus?r=6q5yk&utm_campaign=post&utm_medium=email
Nice!
Agree with most of Fauci’s statements except this:
“…as you say, even though the air on planes is very, very good…”
The ventilation is demonstrably bad!
Glad to read Topol’s update as well, but I’m hearing a lot of experts like him and Daniel Griffin say some version of this:
“The vaccine boosters only last 4-6 months for protection from severe Covid,”
I think that’s poorly communicated. It’s not that we are ceasing to benefit from a durable protection against severe Covid that we achieved with our multiple vaccinations over these pandemic years (and prior infections) - it’s just that the protection gains from another shot are incremental, but are greater the longer it’s been since a dose or infection, right?
Thank you so much for your Covidlandia updates! I learn so much from you!
I forgot about the Neosporin dab in the nose.
I look forward to your post on that soon.
Yes, Covid is high right now in So.Cal. I use Enovid, and so far I’m still a Novid.
Your updates and data help me navigate all this, so again my appreciation to you for ALL you do!!
And, please tell your 13 year old how fabulous her watercolor is!
Thanks Nancy! I really appreciate that. And if you haven’t pitched this line to the makers of Enovid yet, I think you could be onto a catchy jingle:
“I use Enovid, and so far I’m still a Novid.“
Of course to stay a Novid is getting harder and harder, but you obviously employ the other risk mitigation strategies quite expertly!
Yes, my husband and I do employ other mitigation methods, he is also a Novid.
I would be so grateful for the nasal spray for Covid, we definitely pull back from going out inside to crowded places during high infection times. It gets lonely and limiting!
I look forward to your Covidlandia posts. I have a question: can I substitute using a neti pot for the saline spray?
Hi Bonnie - yes that would work better in terms of flushing stuff and I did cite a paper a while back that also found rinses were a bit better than saline sprays. Just be careful with slight Neti pot risks:
https://www.fda.gov/consumers/consumer-updates/rinsing-your-sinuses-neti-pots-safe
As always, rational, enlightening and comforting. Thank you. I sometimes get lost in the statistical “weeds”, but always “get” the bottom line. This post will be circulated to friends and family for their enlightenment. And the painting is so beautiful! I can say this with my official credential of “art critic”! My art teacher - I was 15 - said, during class critique of our works, “You really can’t paint, but you do give excellent critiques!!!
Hi Mary - sorry about the technical stuff, but I’m glad you get the gist and the bottom line is the most importantly part. I mostly include the study details so people know methods, absolute vs relative risk reductions, and stuff like that. Being a good critic is such a great skill, really. It’s so hard to give good feedback, it’s an art form in and of itself!
Ryan, no problem. My comment was not meant as a criticism, as I think it is very important that you include the scientific support for your “bottom line”. It is reassuring, and it also allows for trust. I am just getting “lazy” in my old age:)
OK, I'll return the favor with a long reply. (LOL) First, clearly, a proud dad showcasing his daughter's talent. I can clearly see why but keep it humble if you can (yeah, I know, a rather daunting task!)
So, about symptom resolution as a primary endpoint as used in influenza, I have mentioned that this should be a distant secondary endpoint. Second, comparing Corona viruses and Influenza viruses is bit like comparing apples and oranges (in my humble and naive opinion). Endpoints should be severity, hosp/ICU and death. Maybe include post acute sequelae. We've seen, while similar in clinical settings, are really different in many way. Postexposure prophylaxis approach works for many infectious diseases but not all. Also, likely that household contact have already been infected but turned into COVID-19. I didn't see this as negative for Paxlovid. One thing stood out for me was the ten day course was not really effective.
Also have concerns about NO2 as this is a substance that is abused. https://www.acep.org/toxicology/newsroom/jun2021/nitrous-oxide-misuse-and-abuse/ However, the potential appears to be worth pursuing but, like anything else, has risks. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10913844/
In my last post, you saw the pioneering study on nasal immunity and this could lead to useful vaccines/Tx interventions.
Another, shall we say, incredulous claim about masking is that it doesn't stop the virus but blocks O2. (sigh).
Great work as usual and nice to see from a clinician point. I know this is not easy work and seems that the inbox never seems to slow down. Wonder if your daughter would consider being a medical artist like Netter?
Disclaimer, I just realized that my "last post" was still in my draft box. Just posted it now. Back to the salt mines.
Hi KB! Thanks for these thoughts and avenues for further discussion. I’ll try to circle back for a more thorough reply, but suffice it to say I agree with your points here… and that asymptomatic Covid infection period in which people spread the virus to each other has always been the Achilles heel of this whole pandemic (plus some other unfortunate variables). For prophylaxis to even have a chance they should have tried a 24-48 hour window max, not the 96. Pfizer seems to shoot itself in the foot with their study designs re: paxlovid.
Another great jaunt through COVIDlandia - thanks Doc.
I wanted to share something interesting with you re: vaccines from the perspective of an existing COVID long hauler. Last summer, I emailed my functional medicine doctor, who is extremely well read on all the LC studies, to ask if he thought I should be considering getting any of the upcoming fall vaccines (COVID, flu, RSV). He responded that he could not in good faith recommend that any of his LC patients get any of the vaccines because we (medical science) just didn’t know enough by then about what they would do to an immune system that was already quite activated.
And then in July, I saw an immunologist for the first time at the behest of my infectious disease doc, due to mast cell activation syndrome that she was out of tools to treat. When I told her what my FMD said about the vaccines, she was nodding vigorously, and she said, “you are in the extremely small minority of patients for whom I’d agree with that advice.”
In addition to elevated serum tryptase, she found I have some low lymphocyte counts and last year, my ID doc was able to diagnose me with common variable immune deficiency.
So, while the vaccines might prevent LC in people who don’t already have it, it’s safe to say the jury is still out on whether we existing long haulers should be continuously vaccinated. A dear friend of mine took a huge step back after getting the Novavax jab last winter, after several rounds of the mRNA vaccines seemingly didn’t affect her at all. I myself had three mRNA shots in 2021-2022 and each one set me back for several weeks.
Lastly, I completely missed your daughter’s painting - thank goodness for the other comments here! I went back and saw it and was astonished that I missed something so beautiful. What a talent! 🤩
Hi Amy - this is such valuable testimony and case reporting, and it helps ground primary care docs like me to hear this counterpoint. It makes good sense and with your situation and the dear friend’s, it really is a roll of the dice. I back off pushing additional shots in these gray areas of risk. I also read a version of this comment in one of your posts that I was reading on the plane today while catching up on the email inbox. I’m so glad you are out there sharing your voice and experience and knowledge! It is a wonderful perspective and real.
Thank you for reading and for validating my experience 🙏🏻
Ryan, is metformin available without a prescription for treating Covid?
It seems like a no brainer to take metformin since it reduces the risk of long COVID by 40% and Paxlovid only cuts the risk by 25%.
How long would you have to take it and how many days out from testing positive do you have to begin?
Hi Arthur - metformin is by prescription only, as far as I know.
It’s a no brainer to try it at least, but GI side effects are common and intolerable for some. But metformin is considered the first line med for type 2 diabetes because of long track record of safety, effectiveness, and low cost. It should not cause hypoglycemia.
Here is a slightly cheesy illustration I made about the dosing regimen back in March, 2023. And the COVID-OUT trial has more specifics, I’ll find that link from a covidlandia post later, I think it was 2 months ago.
Thanks for stopping in :)
https://mccormickmd.substack.com/p/how-to-prevent-long-covid
As usual, your article was great and is much appreciated. I also have a daughter with artistic talent and am impressed by yours's work. And the best part of that is that's it's undoubtedly so pleasurable to her that compliments aren't all that important.(although I imagine never unwelcome😁).
I do "take issue" with one of your comments here and I quote, "The much better news, at least as far as the CDC can still track this with more scant data reporting, is that weekly deaths are way down from the nightmarish days in which over 20,000 Americans were dying each week. Now it’s probably more like 300-400 a week". As far as I can see the CDC is still currently using the reporting system that relies on death certificates reported by states - reports which have Enormous Lags in the information and may even overlook Covid as a cause of death, leading to underreporting as well. In fact, I did a short test (wish I had saved the data I had used to illustrate this problem) which indicated that lags are so long - not just weeks but even months of data are being significantly revised due to updates. This makes recent reports on weekly deaths virtually meaningless. I got the information from the CDC website that you linked us too, but it was some time ago when I looked at it and it seems to no longer have the footnote that explains the source of the info and how/why it is lagged. I think it's very important to know this information, because, after all, the worst outcome of Covid is death. (although some might argue that long covid is worse - I don't know). But, the point of all this, is really to ask you if there is some new/different source that the CDC is using that is a more meaningful tool. It didn't look any different on the page you linked us too and you made note that there are the lags (which in their prior footnotes they minimized, based on my own review). But you also said that it doesn't look like we have more than 300-400 deaths a week now. I don't know how that conclusion could possibly be reached given the limitations on what they report. And I think the inaccuracy of that conclusion could be huge - in order of magnitude of many multiples, especially since we are talking about a very recent surge. The data (based on my "analysis") just won't/ don't support the numbers.
Sorry this comment seems "accusatory". Your information is so good and I appreciate it so much that I need to know if I am wrong in these conclusions (mainly because you have access to a better source of data). Thanks again for all you do for us.
DM - you make such great points here, and I think I need to go back and revise that section to reflect this uncertainty. So helpful thank you!
Off the top of my head it seems like a better metric for weekly deaths might be excess mortality, although there will certainly be a lag there as well. This would capture all the acute, subacute, and more distant but related deaths from this whole mess (although heat waves and other problems get baked in, too). Let me get back to you about this after doing a bit of research. Here is a quick resource on excess mortality; they categorize many different countries and subsets, too:
https://ourworldindata.org/grapher/excess-mortality-raw-death-count-single-series
And from an actuarial source:
https://www.actuaries.digital/2024/07/10/excess-mortality-in-first-three-months-of-2024-was-slightly-higher-than-predicted/
Thanks again, and I’m sure you are just as proud of your daughter’s talents as I am with mine!
There are many difficulties with excess mortality as I’m sure you know. What should the baseline be is a tough one to deal with I think. And quite a while ago the CDC reworked its baseline to include deaths from Covid in the recent years after COVID began. This is justified by arguing that the baseline is not static and must be estimated using deaths from all causes. The circularity of this argument is obvious as is its undermining of “excess deaths”. The actuarial work you linked to here does that too, but acknowledges it unabashedly, unlike what the CDC did. I think that republishing the death data that is now reported- with numbers for earlier reporting periods being shown at earlier times to indicate just how long it takes and how much the reported numbers change over time might provide a somewhat useful too to see how much “current” reporting is likely to be understating the actual much more believable figure that may not be known for x months from now.
Much appreciate your taking this “criticism” in the spirit in which it was intended. And let’s face we are lucky men in our “choice” of daughters
I haven't even read it yet but that painting by your "resident artist" is phenomenal!!! What an amazing talent. Please give her my hearty congratulations - I am in awe!
Thanks Gemma! We put these up on the fridge and they are a real mood boost. Her grandmother taught her most of her technique, no credit taken by me!