The last missive I wrote was right after Thanksgiving and things were relatively quiet. Not any more, not by a long shot. This month, with all the holiday visiting and the new JN.1 variant and the indoor time we now have tons and tons of cases, lots more hospitalizations and the death rate is inching up as well.
Covid crashed a lot of Christmases and it wasn’t pretty. People had to cancel trips because they found out they were positive and didn’t want to put Great Aunt Gertrude at risk. People went to go stay overnight at Grandma’s house but found out Grandma had Covid so they had to go stay at a hotel or eat Christmas dinner outside a closed bedroom door or on Facetime. People found out they were positive 12/20, stayed positive through 12/25, and there went all the Christmas parties and rituals and services. Sigh.
Everybody I know keeps trying to figure out “where they got it,” but the reality is contact tracing ended years ago. Now it’s everywhere and you can get it from anybody anywhere.
One of my new mottos is “Travel is the Devil” because with a lot of airport/hotel travel you have contact with oodles more people than usual and lots of folks bring Covid home from a trip. But it’s so pervasive right now you can absolutely get it near home as well. So no sense playing the blame game anymore.
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For most of us, this is a lousy illness that makes for a lot of inconvenience but usually we won’t end up in the hospital so there’s that.
But we can’t be casual — some people definitely are getting sick enough to end up needing hospital care.
Even if you’re vaccinated and consider yourself reasonably healthy, if you find yourself getting sick and sicker and in particular getting short of breath, you need to go to your doc or the ER.
We think fewer people who have received the newer vaccines end up in the hospital but it’s not universal. People who need Paxlovid and can take it within five days of first symptoms also usually don’t end up in the hospital — but not always.
(I know everybody is wondering if these vaccines and taking Paxlovid help decrease the chances of long-term Covid complications. While some studies seem pretty positive that vaccines and maybe Paxlovid help, others not so much. This uncertainty encourages scientists to keep studying the questions and is currently encouraging me to take both.)
These new vaccines are NEW vaccines (not boosters) targeting the newer variants and their relatives. The older vaccines were super helpful, but
a) they wear off, and
b) these new vaccines seem to be able to cover our newer variants.
The CDC continues to recommend that we all get these newer vaccines but I want to emphasize how important it seems to be for pregnant women as studies keep showing the new vaccines protect:
a) both the mom
b) and the baby.
So go get your shots! And flu, too – there’s a ton of Flu A around; and RSV if you’re older or younger and again definitely if you are pregnant.
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There’s been a lot of press about possible rebound and I’ve been hearing a TON of stories.
So far most scientific studies show similar rates of rebound (defined as testing positive and with symptoms) if you take Paxlovid or if you don’t, like 6-14%. A couple studies (like the little one from MGH) show higher rates with Paxlovid , like 20% v 2%.
These are hard studies to do for a bunch of reasons. Maybe people who take Paxlovid do more testing? Maybe sicker people take Paxlovid? Maybe some people get over Covid without Paxlovid and then a week later get “sinusitis” but don’t test and it never gets labeled rebound? It’s hard to tell.
But certainly there’s a lot of stories about rebound right now, both without but especially with Paxlovid.
It’s frustrating to not know exactly what is going on right now (do we need more Paxlovid? Earlier? Longer?) — and it’s equally frustrating that we won’t be able to know except in retrospect, when studies come out in some months. Past studies can’t help us here.
But this is how science always happens in infectious disease — we learn from scientific studies, but the studies are always about what happened “back then” and we can’t always be sure it’s applicable to now when the underpinnings (eg what variant is around) keep changing. We can hypothesize, we can theorize but right now have to extrapolate and watch and wait.
Right now it FEELS like a lot of rebound. It FEELS like positives are lasting more than ten days. It definitely FEELS like it takes longer for Covid patients to turn positive on the at-home antigen tests. My other current motto is “If you’re negative Day One of a cold or allergies or a sinus infection, you’re not TRULY Covid negative until a test is negative on Day Four (or Five).”
But we don’t yet have the data or the science about whether our FEELS are really FACTS.
We’ll see what the facts are when the science comes in. In a few months.
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In the meantime, it’s not at all unlikely that somebody in your family is going to get hit with Covid in the next month or so: this is a big surge.
So THIS is the time to mask in crowded spaces and think about ventilation and windows and try to be more protective of yourself and others.
It’s also time to plan ahead and not when you’re a feverish contagious mess.
You need some tests around for sure!
- Here’s a new program helps that helps you get two free Covid/flu test kits in certain situations (Medicare, VA, IHS, no insurance). It’s called Test to Treat Dot Org (all one word; I can’t include the link on FB).
- The US government is still sending out four tests for free via the USPS (you can google it). And keep trying. Sometimes they say no one month and yes the next.
Money can now be an issue with Paxlovid since the golden “Pandemic Era” when drugs were free has ended.
- The Test to Treat Dot Org website can help you get low or no-cost Paxlovid at your pharmacy if you qualify.
- There is also a corporate program to provide access to Paxlovid— google “paxlovid and access” or “PAXCESS” (cute) or just go to paxlovid dot iassist dot com
- There’s a program called visoryhealth dot com that some people have used for discounts
Given that Covid is fiercely in our faces once again, everybody’s pledge should be “I will not be on the hunt for Covid tests and Paxlovid in my nightgown at midnight while my nose is running all over CVS.”
It’s my kind of New Year’s resolution — very low bar, but the right one for now.