To Vaccinate or Not---The Rat Flu Odyssey Continues

Update:

Latest jab Saturday at 4pm.
All good all day Sunday... until late Sunday night started feeling pretty unwell
Heebee Jeebees all night Sunday, runny nose, tight throat.
Wife got sick Monday morning, worse than me
Thinking I got something beyond the jab spending 30 minutes inside CVS Saturday Wife jabbed 2 weeks ago


Fast forward to this morning, day 3.. Both tested negative. Both still opting to stay home because it could still be the rona. Nasty whatever it is. FWIW we're both flu jabbed too. We're both still sick today. Testing again tomorrow night or Friday morning.

So serious question.. Paxlovid says take immediately wit h the onset of symptoms approved with a + COVID test.. Gut.. the home tests suck and don';t hit the + until day 4-5 most of the time now..

Yes, I know you can still get it with a little begging before you actually test +. Also can go get a better test. But, still a highly flawed system.. not by intent of course.

Rant over..

I’m still testing people every day for covid, about 30% are positive. Rest are other seasonal virus. I’d NEVER prescribe paxlovid for someone with a negative test, unless say their wife was confirmed positive.

Not every cold is Rona.

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Originally Posted by Trackhead

I’m still testing people every day for covid, about 30% are positive. Rest are other seasonal virus. I’d NEVER prescribe paxlovid for someone with a negative test, unless say their wife was confirmed positive.

Not every cold is Rona.

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The POINT is that the vast majority of people do NOT (rapid) test + until day 4-5 AFTER the onset of symptoms.. But, they recommend prescribing Pax at DAY ONE of the onset of symptoms. How do you reconcile that?

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Originally Posted by SumJongGuy

The POINT is that the vast majority of people do NOT (rapid) test + until day 4-5 AFTER the onset of symptoms.

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Is this actually true?

P.S. I just took my last dose of Paxlovid this morning. I feel great now other than an occasional cough. Hoping I don't get a rebound case.
In my case I tested positive with a rapid test the morning after I first felt symptoms (which was convenient because my new tests had just arrived in the mail).

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Originally Posted by SumJongGuy

The POINT is that the vast majority of people do NOT (rapid) test + until day 4-5 AFTER the onset of symptoms.. But, they recommend prescribing Pax at DAY ONE of the onset of symptoms. How do you reconcile that?

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N of one--I tested positive 36 hours after onset of sx--mild cold sx started one morning, tested neg that eve, positive the following eve when I started feeling worse. I didn't test at 24 hours.

This should settle it.

https://www.oregonlive.com/sports/20...source=twitter

Sent from my Pixel 7 Pro using Tapatalk

Quote:

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Originally Posted by SumJongGuy

The POINT is that the vast majority of people do NOT (rapid) test + until day 4-5 AFTER the onset of symptoms.. But, they recommend prescribing Pax at DAY ONE of the onset of symptoms. How do you reconcile that?

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Originally Posted by The AD

Is this actually true?

P.S. I just took my last dose of Paxlovid this morning. I feel great now other than an occasional cough. Hoping I don't get a rebound case.
In my case I tested positive with a rapid test the morning after I first felt symptoms (which was convenient because my new tests had just arrived in the mail).

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Originally Posted by old goat

N of one--I tested positive 36 hours after onset of sx--mild cold sx started one morning, tested neg that eve, positive the following eve when I started feeling worse. I didn't test at 24 hours.

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Here's what I saw documented. Several anectoctal cases at work and other folks I know..

At-home COVID-19 tests most accurate on day 4 of symptoms, study suggests retesting


^^^Trackehead^^^^ that's what I'm talking about..

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Originally Posted by SumJongGuy

The POINT is that the vast majority of people do NOT (rapid) test + until day 4-5 AFTER the onset of symptoms.. But, they recommend prescribing Pax at DAY ONE of the onset of symptoms. How do you reconcile that?

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I agree, last time I had covid was negative until day three. I reconcile by following FDA prescribing guidelines and prescribe to people with confirmed positive, not “I think I might have Covid because I have a sore throat and sinus congestion”.

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Originally Posted by Trackhead

I agree, last time I had covid was negative until day three. I reconcile by following FDA prescribing guidelines and prescribe to people with confirmed positive, not “I think I might have Covid because I have a sore throat and sinus congestion”.

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Do you tell them to come back and test again tomorrow? That would be the best thing for them to do no?? But that's more work for you, yes?

Give it a few years and Pax might have those indications added.. and a few more and it's OTC. Sucks that the optimal delivery window for efficacy doesn't jive with the realistic efficacy of the testing..

If someone is testing regularly during an illness (say every 12 hours) and they don’t turn positive until day 4+…well it would be interesting to study if this population still got benefit from a “late” start to paxlovid (assuming testing is done correctly) - if the virus is not showing up in secretions until day 4 does that imply a slowly increasing viral load that reaches the point of turning the test positive later than typical - and would paxlovid still confer significant and worthwhile benefit since that infection is “peaking” later.

Not saying this should be practice - but would be interesting info to study. Again it would need regular and high quality testing - wouldn’t make sense to have negative tests on day 1 and 2 and then not test until day 5 and then react to a positive test then because maybe that person would have been positive right after the second test.

I’m thinking out loud here - flame away if my ramblings aren’t logically sound.

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Originally Posted by SumJongGuy

Do you tell them to come back and test again tomorrow? That would be the best thing for them to do no?? But that's more work for you, yes?

Give it a few years and Pax might have those indications added.. and a few more and it's OTC. Sucks that the optimal delivery window for efficacy doesn't jive with the realistic efficacy of the testing..

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It will never be OTC, has too many med interactions and requires renal dosing.

If they test negative and really want Paxlovid, and might actually benefit, I leave it up to the patient if they want to test again. Paxlovid/covid visits take 5 minutes, it's not like they are complex or a lot of work like other patient complaints or issues. If they have another visit it is just another bill for them.

“Just another visit/bill” can add up to several hundred dollars.

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Originally Posted by stalefish3169

This should settle it.

https://www.oregonlive.com/sports/20...source=twitter

Sent from my Pixel 7 Pro using Tapatalk

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I really hope he feels the full wrath of the swifties And his paycheck is literally signed by the guy who owns Pfizer. But he’s an independent thinker and consummate little bitch. He really should’ve avoided big pharma and the industrial health complex to fix his achilles.

Sent from my iPad using TGR Forums

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Originally Posted by mcski

“Just another visit/bill” can add up to several hundred dollars.

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Yup. And for most people paxlovid isn’t going to be much benefit anyway.

Anecdotally speaking, this Covid vaccine had much easier side effects than the last 3 I’ve had. Basically just had a sore arm for two days and woke up day after feeling hungover that soon passed as the morning went on

I did have one family member tell me not to get it as they are seeing cardiac issues in some men after this vaccine but when I looked into it seems that cardiac risks are greater if you get Covid than if you get the vaccine. I didn’t look into that hard because I already got the vaccine so no going back now

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Originally Posted by SumJongGuy

Here's what I saw documented. Several anectoctal cases at work and other folks I know..

At-home COVID-19 tests most accurate on day 4 of symptoms, study suggests retesting


^^^Trackehead^^^^ that's what I'm talking about..

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If you read the actual study the study group had all tested positive at some point. They measured peak viral load and determined that it was highest on day 4. However, in order to determine that the patients all must have been diagnosed prior to day 4, so the study hardly shows that tests don't turn positive until day 4. A more valid study would have taken symptomatic patients from day 1 and tested them every day until they turned positive. I would certainly not wait until day 4 to test.

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Originally Posted by brutah

Anecdotally speaking, this Covid vaccine had much easier side effects than the last 3 I’ve had. Basically just had a sore arm for two days and woke up day after feeling hungover that soon passed as the morning went on

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What was your experience
the previous 3?

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Originally Posted by old goat

If you read the actual study the study group had all tested positive at some point. They measured peak viral load and determined that it was highest on day 4. However, in order to determine that the patients all must have been diagnosed prior to day 4, so the study hardly shows that tests don't turn positive until day 4. A more valid study would have taken symptomatic patients from day 1 and tested them every day until they turned positive. I would certainly not wait until day 4 to test.

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So if the 4 day average/peak holds true those folks would go through 3 tests if they start testing day 2.. and some would go through 4 if they decided to try again on the 5th day.. 4 is the peak of the curve so there were also people finally + at 5 and 6 too right? That's burning through a LOT of tests.. at $10 a pop. Uncle Sam only provides 4 for free if you happen to have them on hand. Not everyone has the money to do that. And you're supposed to be staying home right? Tests need to be better.. and cheaper..

Plus, it sounds like "some" providers are placing a lot more confidence on a day 2 or 3 test than reality is showing. You're negative at day 2-3 so it's just a sore throat and stuffy nose seasonal virus. Reality shows it very well could be COVID. Negative test at day 1-3 pretty much means NOTHING. Definitely doesn't mean NOT covid...

Did the double on Monday, runny nose and itchy eyes for 24 hours, good to go.

^^ and we tell our patients it’s possible the test is false negative. The test we use has a sensitivity of 92% and specificity of 98%.

There are respiratory panel tests we can use at some facilities that test for about 16 common respiratory viruses. They are rarely used because they are expensive and don’t change the treatment plan at all. If patients are curious, then we offer them.

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Originally Posted by summit

What was your experience
the previous 3?

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It was a 24-48 hr beat down…. About 12 hrs after the vaccine I would get body aches, felt cold, headache, just felt super shitty, and the usual sore arm and arm pit. I learned to schedule the vaccine mid morning so the initial onslaught of side effects would hit me while I was asleep. This one was cake walk in comparison

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Originally Posted by SumJongGuy

So if the 4 day average/peak holds true those folks would go through 3 tests if they start testing day 2.. and some would go through 4 if they decided to try again on the 5th day.. 4 is the peak of the curve so there were also people finally + at 5 and 6 too right? That's burning through a LOT of tests.. at $10 a pop. Uncle Sam only provides 4 for free if you happen to have them on hand. Not everyone has the money to do that. And you're supposed to be staying home right? Tests need to be better.. and cheaper..

Plus, it sounds like "some" providers are placing a lot more confidence on a day 2 or 3 test than reality is showing. You're negative at day 2-3 so it's just a sore throat and stuffy nose seasonal virus. Reality shows it very well could be COVID. Negative test at day 1-3 pretty much means NOTHING. Definitely doesn't mean NOT covid...

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No. The study group was people who tested positive. They tested positive on day 1, 2, 3 , 4 or whatever. THEN they started doing viral load tests. In order for them to say load was highest on day four there had to be significant numbers of patients who tested positive on the earlier days, otherwise how would they know that titers were higher on day 4 then on the earlier days. The only one saying don't test until day 4 is you. But yes, according to that study if you think you have covid you should test until you test positive or until day four, whichever is first. The CDC says wait 48 hours after the first negative test; I don't see anything magic about that--mainly a question of not going through too many tests. BTW the govt is mailing free tests again.

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Originally Posted by old goat

BTW the govt is mailing free tests again.

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Noted and mentioned above. We burned through all 4 of them between daughter's bout 2 weeks ago and ours this week. still need to test again.. The study was likely comparing the home rapid tests to the more thorough PCR tests. or whatever they were using to get those counts.. then only included the instances where it was eventually positive on the rapid test. That seems like a good way to measure and advise to me.

Concern 1... Not getting easy access to pax because home tests are not confirming the + quickly enough
Concern 2.. Burning through 3-4 tests trying to get that + confirmation so as to start the pax sooner rather than later.

Anybody gotten the new novavax booster yet? It looks like Costco’s throughout norcal are taking appts for novavax. Government website doesn’t list any other locations.

Covid has been snaking people left and right in my circles.

- couple friends just got it up in Bellingham.

- boss’s husband gets it while making an on-site visit in Boston.

- parents get it in Helena after running errands together at Costco.

Glad I grabbed the booster and flu vax last week. Ninja season for Covid

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Originally Posted by old goat

The only one saying don't test until day 4 is you.

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Yup. Though a recent TWiV update says some media sources are misinterpreting that study. As OG guessed, many in that study tested positive on day 1, 2, or 3. They recommended following the CDC's testing advice. I have lots of tests, so if I have a fever and feel like shit, I'll use one every 24-36 hours.

They also cover Paxlovid rebound. They strongly favor Paxlovid for people in certain groups because it's great at preventing bad outcomes. For most people at lower risk who qualify, it's also great at making them feel better, and they recommend that use too. They also say Paxlovid rebound is a myth/misinterpretaton - in controlled studies, takers had fewer symptoms on every day compared to controls. There were some cases where a taker went from no symptoms to e.g. cough on e.g. day 6, but this is still fewer symptoms than a control on the same day. Feel free to call it rebound, but it's sorta like the airbag that broke your nose while preventing worse injury.

Rebound includes more than just symptoms; I had a mild case, got on paxlovid by day 2, and felt fine thereafter. Upon completing the paxlovid, my continued testing response went through the roof (subjectively speaking: faster + bar development, stronger & darker color). Wife had the same experience.

I thought there were also published studies showing paxlovid reduced long covid potential, too. I can’t remember if they broke down the data by age.

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Originally Posted by S_jenks

- couple friends just got it up in Bellingham.

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Seemed like half the people I know in this town had it or were exposed over the last 2-3 weeks. Seeing lots of masks out there lately as well. Tough to get the updated vax too.

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Originally Posted by bodywhomper

Anybody gotten the new novavax booster yet? It looks like Costco’s throughout norcal are taking appts for novavax. Government website doesn’t list any other locations.

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Asked about Novavax when I got my (Pfizer) shot at Tahoe City CVS yesterday, they said they did’t have it yet but were expecting to get it any day now.

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Originally Posted by teledad

Asked about Novavax when I got my (Pfizer) shot at Tahoe City CVS yesterday, they said they did’t have it yet but were expecting to get it any day now.

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Thx!

Do You Have Covid, Flu or R.S.V.?

https://www.nytimes.com/2022/12/13/w...e=articleShare

Snippet:

“The flu, Covid and R.S.V. have symptoms that overlap — and also can look quite similar to those of the common cold, which is caused by a variety of viruses. You can develop a cough, fever, headache or runny or stuffy nose with any respiratory virus, said Dr. Michael Chang, an infectious disease specialist at Memorial Hermann Health System in Houston. But one way to differentiate among viral infections is to monitor how quickly your symptoms ramp up.

Symptoms of the flu come on quickly — often just one day after exposure to someone who was sick — and can be felt all over the body. People with the flu often describe feeling like they’ve been hit by a truck, Dr. Chang said. With colds, symptoms may take two or three days to appear and are much milder. Covid and R.S.V. have even longer incubation periods. It can take an average of five days from exposure to the coronavirus to the development of early Covid-19 symptoms, though newer variants may result in an active infection as soon as three days after exposure. R.S.V. takes about four to six days. With Covid and R.S.V., symptoms also build slowly: You may start out feeling sniffly, and then develop a cough or a headache the next day and a fever the next.”

——

The article - if you can access it - has more to it than what I quoted above.

It also has a checklist of symptoms you can click and info on what symptoms are most common in each type of infection (with all the obvious caveats that go with trying to define “typicsl” symptoms of a particular infection)

https://uploads.tapatalk-cdn.com/202...c808ab92ac.jpg

When I got sick I took Paxlovid the afternoon of day 2, felt better that night and completely well the next morning. No rebound.
When someone tests positive days after symptoms resolved, is that live virus or pieces of dead virus? I didn't retest.
I've only had covid once. The advantage of being antisocial.

Got another Covid booster yesterday, no symptoms.

If this doesn’t work I’m scheduling a bleach and sunshine enema for November

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Originally Posted by old goat

When I got sick I took Paxlovid the afternoon of day 2, felt better that night and completely well the next morning. No rebound.
When someone tests positive days after symptoms resolved, is that live virus or pieces of dead virus? I didn't retest.
I've only had covid once. The advantage of being antisocial.

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It’s live virus and if you are testing positive you’re likely infectious.

I had Covid a few weeks ago, got on Pax day one. It was pretty amazing. Went from feeling like absolute shit to almost normal in 24 hours. Tested negative by the end of the 5 day course. Three days later started getting some mild cold like symptoms and tested again. The line went positive before the control. Ended up positive for another 7 days and got pretty sick in the middle of it. Interestingly, the symptoms were completely different between the two. First round was sore throat, headache and chest congestion and the second was like an intensely bad head cold. The post Covid fatigue is legit. Just starting to feel rested now about three weeks out.

Wife was positive same time as me, got Pax, recovered and didn’t have rebound. YMMV

Day 5 of the big C and my body aches seem to be improving slightly. Contacted my Dr's office for paxlovid and they told me since I haven't been in over 3 years they need to run a complete workup before they can write a script. Why th fuck do they need to make shit so complicated?
Didn't go in and just been suffering old school style with the body aches for the most part. My wife and kid seem to have it worse than me.

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Originally Posted by ripvw

It’s live virus and if you are testing positive you’re likely infectious.


YMMV

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It's well documented that PCR can stay positive because of dead virus for a long time. It has been asserted that the same is not true for rapid tests--that they aren't sensitive enough. I couldn't find a study that actually tried to culture virus from people with positive rapid test 10 days out in a pubmed search; that doesn't mean there isn't one.

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Originally Posted by fatnslow

Day 5 of the big C and my body aches seem to be improving slightly. Contacted my Dr's office for paxlovid and they told me since I haven't been in over 3 years they need to run a complete workup before they can write a script. Why th fuck do they need to make shit so complicated?
Didn't go in and just been suffering old school style with the body aches for the most part. My wife and kid seem to have it worse than me.

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Complete workup? I would think a quick over the phone history for any changes in your health and a blood test for kidney function would be enough. Maybe a blood pressure check.
For non-medicare patients they've been allowing pharmacists to prescribe paxlovid based on a screening questionnaire.

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Originally Posted by old goat

It's well documented that PCR can stay positive because of dead virus for a long time. It has been asserted that the same is not true for rapid tests--that they aren't sensitive enough. I couldn't find a study that actually tried to culture virus from people with positive rapid test 10 days out in a pubmed search; that doesn't mean there isn't one.


Complete workup? I would think a quick over the phone history for any changes in your health and a blood test for kidney function would be enough. Maybe a blood pressure check.
For non-medicare patients they've been allowing pharmacists to prescribe paxlovid based on a screening questionnaire.

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Damn, wish I knew this since I know my pharmacist really well.

Not every pharmacist does this. I think you have to look up test and treat pharmacies.

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Originally Posted by fatnslow

Day 5 of the big C and my body aches seem to be improving slightly. Contacted my Dr's office for paxlovid and they told me since I haven't been in over 3 years they need to run a complete workup before they can write a script. Why th fuck do they need to make shit so complicated?
Didn't go in and just been suffering old school style with the body aches for the most part. My wife and kid seem to have it worse than me.

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This seems crazy. In WA you can call the Dept of Health and get a free telehealth appointment. You answer like 10 questions and then get a Pax script. My dad was visiting from out of state and got the 'Vid a couple months ago. He had a Pax script within 30 minutes of testing positive.

Got my SPIKEVAX (Terrible name btw) this week. No noticeable side effects other than a mildly sore arm.