I finally got COVID

[+ FreshFluff]

I want to a party and let myself get peer pressured into taking off my N-95. Totally not worth it. Today, I tested positive for the first time. 

We’ll see how the symptoms go, but I'm more worried about long COVID and lingering symptoms than the immediate symptoms. I may feel differently when the symptoms worsen. There appears to be little research on whether Paxlovod is associated with decreased rates of COVID. I’m going to talk to my internist about this today.

[mike carey]

So sorry to hear that it caught up with you. Get well soon!

[+ Pensant]

This reminds us that Covid is still among us. I never contracted it (that I know of) and I haven’t exactly been a hermit over these past few years. I also don’t wear a mask anymore. I’ll probably get a few N95’s for my upcoming trip to Portugal, however.

[+ nycman]

14 hours ago, FreshFluff said:

There appears to be little research on whether Paxlovod is associated with decreased rates of COVID

 I think you meant to say….

There appears to be little research on whether Paxlovod is associated with
decreased rates of LONG COVID.

Correct?

There’s pretty good data on Paxlovid decreasing the severity of acute COVID.
Unfortunately, that early research was on unvaccinated patients.
Now that the vast majority of patients are vaccinated, and thus unlikely to 
get severely ill, regardless of what you do, it’s much harder to show a benefit.
In fact, Pfizer stopped enrollment in one of it’s studies because the baseline 
popultion wasn’t getting sick enough, and they risked showing that Paxlovid 
added no benefit in vaccinated patients. 

On long COVID? No real data and not much research being done with Paxlovid. 
In fact, Pfizer is doing no research at all on Paxlovid and long COVID. 

Edited September 1, 2022 by nycman

[+ FrankR]

14 hours ago, FreshFluff said:

I want to a party and let myself get peer pressured into taking off my N-95. Totally not worth it. Today, I tested positive for the first time. 

We’ll see how the symptoms go, but I'm more worried about long COVID and lingering symptoms than the immediate symptoms. I may feel differently when the symptoms worsen. There appears to be little research on whether Paxlovod is associated with decreased rates of COVID. I’m going to talk to my internist about this today.

Ugh. I am sorry you took an uninvited guest home.  Check in with us and let us know how you are managing.  Hope your symptoms are as mild as mine was when I picked it up in June. Vaccine seems to have done its job…kept me out of the hospital with mild flu like symptoms (team Pfizer here). Was able to keep working from home - after about a week I felt almost like my old self.
I did not take medication at all - not even NyQuill - symptoms were too mild.

No “long Covid” issues yet…  
Feel better soon! 

[Whitman]

@FreshFluff, I hope your case is a mild one and that you start to feel better sooner than you expect. That was my experience at the end of July when I tested positive for Covid after 2+ years of avoiding it. (I still have no idea how I got it. There was no unmasked group event, nothing that seemed the likely way it happened.)

Having been vaccinated and twice boosted (all Moderna), my 24 hours of feeling lousy involved flu-like aching, fatigue, head congestion and a fever (102), but no cough, no chest congestion, no trouble breathing. I only took the rapid test about 20 hours into it, and I was already feeling better a few hours later, and well enough to mow the lawn the next day. The head congestion lingered for several days, and it was 10 days before I had a negative rapid test, but--all in all--it wasn't too bad.

Take care of yourself. Wishing you the best with this.

[+ keroscenefire]

Feel better soon. Hopefully it's a very mild case for you.

[+ FreshFluff]

11 hours ago, nycman said:

 I think you meant to say….

There appears to be little research on whether Paxlovod is associated with
decreased rates of LONG COVID.

Correct?

There’s pretty good data on Paxlovid decreasing the severity of acute COVID.
Unfortunately, that early research was on unvaccinated patients.
Now that the vast majority of patients are vaccinated, and thus unlikely to 
get severely ill, regardless of what you do, it’s much harder to show a benefit.
In fact, Pfizer stopped enrollment in one of it’s studies because the baseline 
popultion wasn’t getting sick enough, and they risked showing that Paxlovid 
added no benefit in vaccinated patients. 

On long COVID? No real data and not much research being done with Paxlovid. 
In fact, Pfizer is doing no research at all on Paxlovid and long COVID. 

Yes, I meant long COVID. That's what I care about. As you say, I'm not that worried about being hospitalized. 

[+ FreshFluff]

Thanks, everyone. No fever but I didn't sleep at all last night and am very dehydrated. IV fluids were helpful. 

[Redwine56]

16 minutes ago, FreshFluff said:

Thanks, everyone. No fever but I didn't sleep at all last night and am very dehydrated. IV fluids were helpful. 

So @FreshFluff it seems as if you did go to the hospital after all to get the IV for hydration.  Just as well you did as that will lead to other problems.  I will make one comment about paxlovid.  Friends who have had COVID recently asked their doctor about it and the general consensus is that unless symptoms are truly severe, they'd rather not prescribe it.  Using the Prez & First Lady as an example, they were each given paxlovid when they first tested positive for COVID.  Then what happened?  They both had mild symptoms and eventually tested negative.  Then what happened?  A few days later they each tested positive.  From what I've gathered, paxlovid suppresses the immune system while lessening symptoms but then while body is trying to fight the virus, the COVID load returns and you test positive again.  No doubt if you have underlying conditions or older, your dr will prescribe it.  But in some ways, I believe it increases the period where you continue to rest positive.  Get well soon!  Here's wishing you all the best.

[+ sync]

38 minutes ago, FreshFluff said:

Thanks, everyone. No fever but I didn't sleep at all last night and am very dehydrated. IV fluids were helpful. 

[+ nycman]

2 minutes ago, Redwine56 said:

From what I've gathered, paxlovid suppresses the immune system while lessening symptoms but then while body is trying to fight the virus, the COVID load returns and you test positive again. 

I’m not aware of any data to suggest Paxlovid suppresses your immune system.

More likely, it suppresses the virus while you are taking it. If during that time
(5 days) your body hasn’t mounted a robust enough immune response, the 
virus will "rebound" and you can show symptoms again as well as swabbing 
positive again. 

The dreaded "swabbing positive again" is meaningless. What really matters
is clinical symptoms. Since few vaccinated people are dying, it’s hard to tell
the real importance of all this, but it’s most likely zero. 

[rvwnsd]

[+ bashful]

2 vacs., 2 boosters, and I got Covid in July.  Hit me like a truck.  Took Paxlovid, and symptoms mostly gone in a few days except for tiredness that lasted much longer.  Still have to some extent. 

What worries me is something someone called "Covid brain".  Just seems like, brain wise, I've aged more in a little while with more forgetfulness, and having to think about things that I need to do so I can remember to do them, or just not quite with it at some moments.

[Rudynate]

So sorry to hear this.  I hope you have a speedy recovery.

[+ Charlie]

8 hours ago, bashful said:

2 vacs., 2 boosters, and I got Covid in July.  Hit me like a truck.  Took Paxlovid, and symptoms mostly gone in a few days except for tiredness that lasted much longer.  Still have to some extent. 

What worries me is something someone called "Covid brain".  Just seems like, brain wise, I've aged more in a little while with more forgetfulness, and having to think about things that I need to do so I can remember to do them, or just not quite with it at some moments.

I have noticed those brain symptoms even though I have not had COVID (to my knowledge). Stress has a lot to do with them, and getting COVID after you have done everything to protect yourself is a stressor in itself.

[Rudynate]

I got so scattered and forgetful during the pandemic that it was scary.  I would ask my self "how can I work?  Not like this."  But I'm mostly back to normal.  That was a horrible thing we went through.

[+ FreshFluff]

8 hours ago, Charlie said:

I have noticed those brain symptoms even though I have not had COVID (to my knowledge). Stress has a lot to do with them, and getting COVID after you have done everything to protect yourself is a stressor in itself.

Exactly. I dined outdoors only, whether it was 32 or 90 degrees. And it was always about long COVID, as I was never really worried about severe symptoms. Really sicksvtk get it now, when the surge has receded. 

[Guest]

On 9/1/2022 at 6:20 PM, Redwine56 said:

... I will make one comment about paxlovid.  Friends who have had COVID recently asked their doctor about it and the general consensus is that unless symptoms are truly severe, they'd rather not prescribe it.  Using the Prez & First Lady as an example, they were each given paxlovid when they first tested positive for COVID.  Then what happened?  They both had mild symptoms and eventually tested negative.  Then what happened?  A few days later they each tested positive.  From what I've gathered, paxlovid suppresses the immune system while lessening symptoms but then while body is trying to fight the virus, the COVID load returns and you test positive again...

Jesus Christ. There are some seriously factually incorrect statements in that posting. Paxlovid comes in medication packets with two drugs. One is nirmatrelvir, which stops the virus from replicating (essentially like PrEP, but for SARS-CoV2 rather than HIV), and the other, while the other, ritonavir, although previously used as an HIV medication, in this case is simply used to keep the nirmatrelvir around longer by preventing the liver from breaking it down too quickly. Neither affects the immune system:

https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19#:~:text=The drug%2C developed by Pfizer,treatments%3B and it's cheaper than

"Paxlovid is an antiviral therapy that consists of two separate medications packaged together. When you take your three-pill dose, two of those pills will be nirmatrelvir, which inhibits a key enzyme that the COVID virus requires in order to make functional virus particles. After nirmatrelvir treatment, the COVID virus that is released from the cells is no longer able to enter uninfected cells in the body, which, in turn, stops the infection. The other is ritonavir, a drug that was once used to treat HIV/AIDS but is now used to boost levels of antiviral medicines. As a COVID-19 treatment, ritonavir essentially shuts down nirmatrelvir’s metabolism in the liver, so that it doesn’t move out of your body as quickly, which means it can work longer—giving it a boost to help fight the infection."

So basically, this medication clears the virus from your system for 5 days to actually help your body make antibodies without having to fight the virus at the same time. Although after 5 days, the virus will be free to replicate, by that time you should have made a ton of antibodies, so your symptoms will be few if any, and hopefully you won't be contagious even if the virus replicates. I don't understand how anyone could interpret the clearing of the virus as "suppressing the immune system," which would have the opposite effect. (As an aside, for some hospitalized patients, a different medication, i.e. dexamethasone, is used to suppress the immune system, but that's a completely separate/different treatment protocol.)

The studies on it were done in the pre-omicron era. Nevertheless, the studies showed a 89% reduction in complications with paxlovid:

" It had an 89% reduction in the risk of hospitalization and death in the clinical trial that supported the EUA, a number that was high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments."

Paxlovid does have a huge number of drug interactions (due to the ritonavir), but aside from that is a very safe drug to use. While supplies can't treat every single person who contracts the virus, it's indicated for anyone over 50 or with other conditions which increase risk. It's specifically indicated to be used early on in the illness, to prevent serious illness, not to treat serious illness. 

If any of you has had a health care professional who makes a statement such as "unless symptoms are truly severe, they'd rather not prescribe it," I suggest you change health care professionals, since that person has not been keeping up with the not overly-complicated literature on the virus.

Paxlovid should be prescribed as primary care. Once symptoms get severe, it's too late, and more dicey treatments, such as monoclonal antibodies and dexamethasone, will need to be used:

https://www.pnas.org/doi/10.1073/pnas.2119893119

I found it rather disconcerting that someone who didn't know what he was talking about gave the OP (and perhaps others) incorrect information, which may have dissuaded her (and/or others) from a safe and highly effective treatment  (barring drug interactions with the ritonavir). I would plead those who aren't up on the science to refrain from espousing "opinions" about stuff they think they've heard (or mis-heard).

Although it was not, of course, possible to study Paxlovid for the prevention of long COVID, which would have required several more months of study, since the WHO definition of long COVID means symptoms of over 3 months, it's difficult to imagine that reducing the viral burden wouldn't also reduce the risk of long COVID. If that's a concern (although Long COVID seems to be very rare with omicron), that would be an additional reason to take the Paxlovid.

Edited September 6, 2022 by Unicorn

[Guest]

https://www.covid19treatmentguidelines.nih.gov/management/clinical-management-of-adults/clinical-management-of-adults-summary/?utm_source=site&utm_medium=home&utm_campaign=highlights

Patient Disposition

Panel’s Recommendations

Does Not Require Hospitalization or Supplemental Oxygen

For All Patients: All patients should be offered symptomatic management (AIII). The Panel recommends against the use of dexamethasonea or other systemic corticosteroids in the absence of another indication (AIIb). For Patients Who Are at High Risk of Progressing to Severe COVID-19b Preferred therapies. Listed in order of preference: Ritonavir-boosted nirmatrelvir (Paxlovid)c,d (AIIa) Remdesivird,e (BIIa) Alternative therapies. For use ONLY when neither of the preferred therapies are available, feasible to use, or clinically appropriate. Listed in alphabetical order: Bebtelovimabf (CIII) Molnupiravird,g (CIIa)

 

Note that AIIa indicates a strong recommendation:
 

Recommendation Rating Scheme

Strength of Recommendation	Quality of Evidence for Recommendation
A:  Strong recommendation for the statement B:  Moderate recommendation for the statement 😄Weak recommendation for the statement	I: One or more randomized trials without major limitations  IIa: Other randomized trials or subgroup analyses of randomized trials  IIb: Nonrandomized trials or observational cohort studies  III: Expert opinion

 

I don't know why there's a happy face emoji where the C is supposed to be....

Edited September 6, 2022 by Unicorn

[+ bashful]

31 minutes ago, Unicorn said:

Paxlovid does have a huge number of drug interactions (due to the ritonavir), but aside from that is a very safe drug to use.

I had to stop taking Flomax (Tamsulosin) while I was taking Paxlovid.  

[Guest]

On 9/1/2022 at 5:46 PM, FreshFluff said:

Thanks, everyone. No fever but I didn't sleep at all last night and am very dehydrated. IV fluids were helpful. 

Were you throwing up? Usually fluids are only replaced IV when the GI tract isn't working properly, usually due to vomiting, though diarrhea can be severe enough that IV hydration is needed (cholera, for example). In general, if you're able to take fluids orally, it's safer to replace the fluids in that manner. Your body will regulate the amount of fluids and electrolytes it needs, instead of relying on the physician to make an educated guess as to the appropriate amount of fluid and electrolytes. Replacing fluids IV runs the risk of electrolyte imbalances and/or fluid overload, especially if the kidneys and/or heart aren't working well. Although rare, I have also seen two cases in which an IV resulted in patients getting reflex sympathetic dystrophy/chronic regional pain syndrome. It may be rare, but can be fairly devastating if it happens. 

[+ nycman]

7 hours ago, Unicorn said:

Although rare, I have also seen two cases in which an IV resulted in patients getting reflex sympathetic dystrophy/chronic regional pain syndrome. It may be rare, but can be fairly devastating if it happens. 

Ok, I’ll bite.

What’s the pathophysiology on that one?

Let’s assume, for the sake of argument, that "reflex sympathetic
dystrophy/chronic regional pain syndrome" is a real diagnosis.

[+ glutes]

[Guest]

2 hours ago, nycman said:

...What’s the pathophysiology on that one?...

I definitely don't purport to be an expert on this, fortunately rare, condition. There are plenty of places to look online if you're interested. Often, the affected limb will be visibly swollen, so I doubt patients are just making up symptoms.