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

[stalefish3169]

This should settle it.

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

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[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?

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).

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.

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..

[Trackhead]

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?

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”.

[SumJongGuy]

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”.

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..

[bennymac]

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.

[Trackhead]

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..

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.

[mcski]

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

[altacoup]

This should settle it.

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

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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.

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[Trackhead]

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

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

[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

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

[old goat]

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..

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.

[summit]

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

What was your experience
the previous 3?

[SumJongGuy]

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.

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...

[buttahflake]

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

[Trackhead]

^^ 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.

[brutah]

What was your experience
the previous 3?

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

[old goat]

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...

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.

[SumJongGuy]

BTW the govt is mailing free tests again.

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.

[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.

[S_jenks]

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

[LongShortLong]

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

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.

[PB]

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.

[bodywhomper]

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.

[Ted Striker]

- couple friends just got it up in Bellingham.

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.

[teledad]

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.

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.