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

**bodywhomper** · 10-13-2023, 11:41 PM

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.

Thx!

**bennymac** · 10-14-2023, 01:27 AM

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)

**old goat** · 10-14-2023, 08:25 AM

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.

**JimmyCarter** · 10-14-2023, 08:29 AM

Got another Covid booster yesterday, no symptoms.

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

**ripvw** · 10-14-2023, 08:44 AM

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.

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

**fatnslow** · 10-14-2023, 09:32 AM

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.

**old goat** · 10-14-2023, 02:11 PM

Originally Posted by ripvw

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

YMMV

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.

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.

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.

**fatnslow** · 10-14-2023, 02:20 PM

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.

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

**old goat** · 10-14-2023, 07:28 PM

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

**Falcon3** · 10-14-2023, 07:57 PM

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.

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.

**Trackhead** · 10-15-2023, 07:44 AM

Originally Posted by old goat

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.

My thought on Paxlovid: if you have no common health issues that impair renal function (HTN, DM, elderly, etc), you don’t need your GFR checked before paxlovid. On the flip side, if you are healthy enough that the prescriber defers labs, the clinical benefit of Paxlovid is likely minimal.

**bennymac** · 10-15-2023, 01:16 PM

I’m sure this has been asked before and maybe we don't yet have the answer - but in a healthy young/middle aged adult - in whom paxlovid would only serve to potentially decrease severity of their mild symptoms (in what otherwise likely will be an uncomplicated and limited illness) - what is the thinking around decreasing risk of long covid?

Shit we can all put up with a week of feeling like ass - and taking paxlovid to maybe take the edge off some of the symptoms would have to be weighed against the risk (which seems minimal) and cost (and of course would have consider it there is a shortage of medications that then need to be saved for most at risk)

But if you said this med probably won’t do much for your symptoms and you’re probably gonna be over this in 7-10 days - but it decreases the risk of long covid by 10-15% I’d take it in a heartbeat.

**yeahman** · 10-15-2023, 01:20 PM

^^I would too but from everything I've read the factors influencing long covid are still very poorly understood.

**Trackhead** · 10-15-2023, 01:31 PM

Originally Posted by bennymac

But if you said this med probably won’t do much for your symptoms and you’re probably gonna be over this in 7-10 days - but it decreases the risk of long covid by 10-15% I’d take it in a heartbeat.

I wonder if Paxlovid is becoming the new Tamiflu? Per many summaries (Tamiflu), offers minimal reduction in the duration of symptoms. Maybe it's best given to those who might actually need it?
https://www.sciencedaily.com/release...0411091937.htm

**bobz** · 10-15-2023, 01:33 PM

I got my Covid booster yesterday. Woke up today feeling kind of shitty and with a headache. But that could be partly because I also woke up super early yesterday and ran a 5K (at race pace) before the vax. I'm at 24 hours now, and already feeling quite a bit better. Glad that's out of the way! Got flu vax 2 days earlier. I'll wait on the RSV until my annual physical doc has something to say about it.

**bennymac** · 10-15-2023, 01:36 PM

Originally Posted by Trackhead

I wonder if Paxlovid is becoming the new Tamiflu? Per many summaries (Tamiflu), offers minimal reduction in the duration of symptoms. Maybe it's best given to those who might actually need it?
https://www.sciencedaily.com/release...0411091937.htm

My point/question is have we determined who “actually needs Paxlovid” yet? With Tamiflu we have.

**Trackhead** · 10-15-2023, 01:40 PM

Originally Posted by bennymac

My point/question is have we determined who “actually needs Paxlovid” yet? With Tamiflu we have.

Agreed completely. Maybe 5yrs from now.

**bodywhomper** · 10-15-2023, 02:31 PM

There was a preprint in April describing reduction in long covid from taking paxlovid. My memory was that it was a relatively small study size. I thought there was a more recent study, but couldn’t find it with my quick search.

**ripvw** · 10-15-2023, 05:19 PM

Originally Posted by bennymac

My point/question is have we determined who “actually needs Paxlovid” yet? With Tamiflu we have.

The initial studies pretty much covered that. I don’t have the info in front of me, but my recollection is that for people at higher risk for moderate/ severe Covid, Pax reduced hospitalization by upwards of 90%. For people at lower risk there didn’t seem to be any clinical benefit. That said, from personal experience and those of family members, Paxlovid dramatically reduces symptoms. My wife went from nearly immobile in bed to feeling nearly normal 24 hours after starting her course.

As someone else mentioned, there have been a few pre prints that show benefits of Pax for long Covid, but jury is still out on that for sure.

**old goat** · 10-15-2023, 05:37 PM

Originally Posted by Trackhead

My thought on Paxlovid: if you have no common health issues that impair renal function (HTN, DM, elderly, etc), you don’t need your GFR checked before paxlovid. On the flip side, if you are healthy enough that the prescriber defers labs, the clinical benefit of Paxlovid is likely minimal.

I agree, but since I didn't know anything about his health I was suggesting the maximum workup that might be necessary--questionnaire and gfr.

It's easy to say that if you're low risk that it's fine to just ride out the symptoms for a week or two, but based on my experience of one, I would gladly take it to stop feeling like shit, although in my case I was in the high risk group. Best as I can tell the side effects and risks are similar to the OTC meds you might take for covid. Of course it's early and more serious side effects may pop up.

**Trackhead** · 10-15-2023, 05:47 PM

Originally Posted by old goat

I agree, but since I didn't know anything about his health I was suggesting the maximum workup that might be necessary--questionnaire and gfr.

It's easy to say that if you're low risk that it's fine to just ride out the symptoms for a week or two, but based on my experience of one, I would gladly take it to stop feeling like shit, although in my case I was in the high risk group. Best as I can tell the side effects and risks are similar to the OTC meds you might take for covid. Of course it's early and more serious side effects may pop up.

Agree on anecdotes and people feeling better quick. The second time I had covid I felt like ass for a couple weeks and really slow ski touring for two months (was that long covid?) Kinda felt like it but also probably had cancer then too and didn’t know it at the time.

So yeah, I’d be inclined to take it too. Last year with chemo I certainly was ready to.

**bodywhomper** · 10-15-2023, 06:07 PM

I believe that ^^ would be considered long covid.

Paxlovid rebound study: https://academic.oup.com/cid/article/77/1/25/7049992

Here’s the preprint that I mentioned: https://www.medrxiv.org/content/10.1....05.23288196v1

**frorider** · 10-15-2023, 06:24 PM

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.

I haven’t read much about Novavax but the govt line seems to be ‘hey it’s similar effectiveness as the mRNA vaccines, so now you have a choice, but we don’t really have anything to tell you that would make that decision easier so flip a coin’.

?

**old goat** · 10-15-2023, 07:29 PM

On the subject of covid studies in general--I don't put too much stock in single, unrepeated studies, which is virtually all of them. It takes time and multiple studies to get a clear picture. (And then there's the phenomenon of publication bias, which determines which studies get printed and which go into the round file.)

**bodywhomper** · 10-15-2023, 08:36 PM

And then there’s preprints, like the one that I posted.

Originally Posted by frorider

I haven’t read much about Novavax but the govt line seems to be ‘hey it’s similar effectiveness as the mRNA vaccines, so now you have a choice, but we don’t really have anything to tell you that would make that decision easier so flip a coin’.

?

My understanding: it’s a more traditional vax so PH peoples hope that people concerned with the mRNA vax will get novavax. Also, previous novavax covid vaxes supposedly had less reported side effects and longer durability (didn’t wane as quickly) compared to the mRNA vaxes.