Omicron anecdata?

[wathe]

29 minutes ago, Elona said:

Re Paxlovid: I got it because I tend to get hit hard by upper respiratory infections. I think if you are similar or if you have risk factors, you should take it. You can only get it if you have at least one risk factor. (Smoker or former smoker, diabetes, cancer, high blood pressure, heart issues, there may be others I am not remembering.) For me, it didn't shorten my illness. For the 5 days that I was on it, it helped a lot - my heart rate returned to normal, my sore throat went away, sinus pressure was relieved, etc. But when the course was done I went downhill in terms of energy and lung congestion. I was basically in bed for 2 weeks. I do very much feel it helped keep things manageable and from getting really bad. I am glad I took it, but the side effects were awful and wouldn't have been worth it if I just had typical cold symptoms and no risk factors.

Rebound of covid symptoms post-paxlovid is definitely something we are seeing and is getting attention.  I don't think anyone is quite sure what to make of it yet.

[Kanin]

3 hours ago, YaelAldrich said:

I have been tired as of late about every stupid possible symptom of COVID and trying to stay one step ahead of the virus. Guess I get a little break now?

 

I guess so! Yay...?

[Kanin]

2 hours ago, JennyD said:

As of this morning my DS14 finally turned negative (his Day 10 after 1st positive test).  DH is on Day 8 and still positive, although not as strongly as before.  I'm strongly positive on Day 5. 

How is everyone feeling?

[Corraleno]

48 minutes ago, wathe said:

 

I personally wouldn't seek paxlovid unless I were unvaccinated with risk factors  or immunecompromised.  I'm sceptical.  I think this drug is benefitting from a lot of spin and hopium. 

The paxlovid trial EPIC-HR was conducted on unvaccinated individuals with at least one risk factor, who had not previously had covid,  during the delta wave.  That's the only cohort for whom we have evidence of benefit.  There are legitimate criticisms of the trial: Pharma-funded and Pharma-run, modified intention to treat analysis (with no explanation for why it was modified), disease-specific hospitalization instead of all-cause hospitalization as part of the composite end-point, failure to publish secondary endpoints, trial stopped before full enrolment reached ---  all of these are tweaks that may serve to exaggerate the true efficacy.  One of my Canadian EM colleagues has written a very good critique.

Interim analysis of the standard risk trial (EPIC-SR) has been communicated by Pfizer by press release.  Primary endpoint of symptom alleviation was not met, and the secondary endpoint of hospitalization and death did not meet statistical significance.  This trial included unvaccinated people with no risk factors and vaccinated people with at least one risk factor -  the population to whom we are prescribing the most paxlovid.

The Ontario Science table has crunched numbers and come up with a risk table that captures those who are at 5% or greater risk of hospitalization or death from covid, and advises prescribing to that population.  I think that even this is not warranted by evidence, since risk of hospitalization from covid =/= paxlovid efficacy in preventing hospitalization, and many of the higher risk patients are at increased risk of harm from paxlovid because of all the meds they take , poor kidney function etc.  OST has also published their rationale.  

My anecdotal experience as a person who prescribes this drug and does follow up:

The list of drug interactions is long and many are potentially very serious.  

Paxlovid makes people feel crummy. IME, about 20% of patients don't tolerate it and stop taking it. (This is much higher than the 2% reported in the trial).  

100% of my patients have had dysgeusia (bad taste in mouth), much higher than the 20% reported in the trial.  Lots of nausea, vomiting, diarrhea, onset within a few hours.  Hard to tease out how many feel worse because of covid, of course, but the symptom progression for paxlovid seems pretty distinctive, and goes away when they stop taking it.  

Bottom line:  I'm sceptical.  The population on whom the drug was trialed successfully mostly no longer exists (unvaccinated, covid-naive, delta).   Independent replication of efficacy is needed.  I think that we will find that EPIC-HR has over-estimated the benefit and underestimated the harm of paxlovid.  We'll see.  Based on current evidence, I wouldn't take it, and wouldn't recommend it to my 70-something triple vaxxed healthy parents.

 

 

This is so helpful, I really appreciate you taking the time to type all that out!

[mommyoffive]

Pfizer vaccine: Three-dose Covid-19 vaccine produces strong immune response in young children, Pfizer and BioNTech say | CNN

[YaelAldrich]

2 hours ago, Elona said:

Re Paxlovid: I got it because I tend to get hit hard by upper respiratory infections. I think if you are similar or if you have risk factors, you should take it. You can only get it if you have at least one risk factor. (Smoker or former smoker, diabetes, cancer, high blood pressure, heart issues, there may be others I am not remembering.) For me, it didn't shorten my illness. For the 5 days that I was on it, it helped a lot - my heart rate returned to normal, my sore throat went away, sinus pressure was relieved, etc. But when the course was done I went downhill in terms of energy and lung congestion. I was basically in bed for 2 weeks. I do very much feel it helped keep things manageable and from getting really bad. I am glad I took it, but the side effects were awful and wouldn't have been worth it if I just had typical cold symptoms and no risk factors.

 

2 hours ago, wathe said:

 

I personally wouldn't seek paxlovid unless I were unvaccinated with risk factors  or immunecompromised.  I'm sceptical.  I think this drug is benefitting from a lot of spin and hopium. 

The paxlovid trial EPIC-HR was conducted on unvaccinated individuals with at least one risk factor, who had not previously had covid,  during the delta wave.  That's the only cohort for whom we have evidence of benefit.  There are legitimate criticisms of the trial: Pharma-funded and Pharma-run, modified intention to treat analysis (with no explanation for why it was modified), disease-specific hospitalization instead of all-cause hospitalization as part of the composite end-point, failure to publish secondary endpoints, trial stopped before full enrolment reached ---  all of these are tweaks that may serve to exaggerate the true efficacy.  One of my Canadian EM colleagues has written a very good critique.

Interim analysis of the standard risk trial (EPIC-SR) has been communicated by Pfizer by press release.  Primary endpoint of symptom alleviation was not met, and the secondary endpoint of hospitalization and death did not meet statistical significance.  This trial included unvaccinated people with no risk factors and vaccinated people with at least one risk factor -  the population to whom we are prescribing the most paxlovid.

The Ontario Science table has crunched numbers and come up with a risk table that captures those who are at 5% or greater risk of hospitalization or death from covid, and advises prescribing to that population.  I think that even this is not warranted by evidence, since risk of hospitalization from covid =/= paxlovid efficacy in preventing hospitalization, and many of the higher risk patients are at increased risk of harm from paxlovid because of all the meds they take , poor kidney function etc.  OST has also published their rationale.  

My anecdotal experience as a person who prescribes this drug and does follow up:

The list of drug interactions is long and many are potentially very serious.  

Paxlovid makes people feel crummy. IME, about 20% of patients don't tolerate it and stop taking it. (This is much higher than the 2% reported in the trial).  

100% of my patients have had dysgeusia (bad taste in mouth), much higher than the 20% reported in the trial.  Lots of nausea, vomiting, diarrhea, onset within a few hours.  Hard to tease out how many feel worse because of covid, of course, but the symptom progression for paxlovid seems pretty distinctive, and goes away when they stop taking it.  

Bottom line:  I'm sceptical.  The population on whom the drug was trialed successfully mostly no longer exists (unvaccinated, covid-naive, delta).   Independent replication of efficacy is needed.  I think that we will find that EPIC-HR has over-estimated the benefit and underestimated the harm of paxlovid.  We'll see.  Based on current evidence, I wouldn't take it, and wouldn't recommend it to my 70-something triple vaxxed healthy parents.

 

 

Thank you both for your candid explanations of Paxlovid!

I had the online consultation. Because I'm on another antiviral drug for my chronic hepatitis B she said it wasn't a great idea to go on Paxlovid. Too stressful on the kidneys. 

I have a good number of friends in my age group who have gotten it. All have had some side effects; especially the bad taste in mouth. Some have had the rebound as well. 

The PCR results for the DH and kind came back - all negative. My husband is still symptomatic though; the kids aren't. Guess we will try again tomorrow?

[AmandaVT]

11 hours ago, YaelAldrich said:

Is it worth getting Paxlovid? It's easy to get an appointment and test to treat where I am. Still minor symptoms - sore throat, sinus type pressure. I'd rather be done sooner than later to take care of people that need a healthy person. I'm aware of the side effects and that there might be rebound.

I think so - I got it and noticed my (very mild) symptoms abating within a few hours. I tested negative on day 5 and had no rebound symptoms or positive tests. Only side effect I had was a horrid taste in my mouth for a few hours after each dose.

[AmandaVT]

7 hours ago, Spryte said:

For those of you testing positive, how long after exposure or symptoms (whichever date you know) did it take for you to test positive?

I hope you all feel better soon!

I don't know when I was exposed because I think my school is a covid pool right now, but I noticed watery eyes and a runny nose on a Friday, it was a bit worse on Saturday and I tested on Sunday morning. 

[mommyoffive]

[Elona]

4 hours ago, wathe said:

Rebound of covid symptoms post-paxlovid is definitely something we are seeing and is getting attention.  I don't think anyone is quite sure what to make of it yet.

I have a strong sense that if I had been able to take it for 7-10 days it would have worked. It didn't feel so much like rebound, as like I just didn't get fully better before I ran out. My Covid symptoms abated quite rapidly when I was on it, and I felt like I was almost totally better. But the horrible, acrid taste in my mouth was nearly intolerable by the end and I don't know that I could have withstood it for another five days. I also had some gastrointestinal issues. I suspect that you are correct about hype and spin playing a role here. Nevertheless, it did help me and I am glad I had access to it. Hopefully a better alternative will come out eventually. I hope that non-biased studies are conducted soon, but I read that the manufacturer was withholding the drug from those who wanted to run studies. I found that especially suspect.

Edited May 23, 2022 by Elona

[Elona]

58 minutes ago, AmandaVT said:

Only side effect I had was a horrid taste in my mouth for a few hours after each dose.

That is very lucky. I had it for ten full hours after each dose. It was truly awful.

[historically accurate]

8 hours ago, Spryte said:

For those of you testing positive, how long after exposure or symptoms (whichever date you know) did it take for you to test positive?

I hope you all feel better soon!

Don't know exposure date, but I got cold symptoms on Friday the 13th. Tested negative on Saturday the 14th, negative on Monday the 16th, and positive on Thursday the 19th. I might have tested positive on Wednesday if I hadn't been trying to limit my use of tests because I was so tired I didn't want to go buy more. I'm still testing positive as of today (still have nasal congestion, but no other symptoms currently). 

[JennyD]

3 hours ago, Kanin said:

How is everyone feeling?

We're all doing well, thanks!  The teens are completely recovered and testing negative.  DH (day 9) is still testing positive but feels largely OK, a little tired.  I (day 5) feel almost entirely fine but am still testing strongly positive. 

The family member doing the worst right now is DS11, who has not been sick but has endured two weeks of disruption and isolation.  He is a remarkably even-tempered kid but is clearly reaching his limit.  

 

[ScoutTN]

On 5/22/2022 at 12:31 PM, JennyD said:

Oh I am sorry, Yael!  We are just emerging from our own personal Covid extravanganza -- everyone except my youngest wound up catching it, and my fingers are still crossed that he manages to stay negative.  

We tried REALLY hard to isolate to the extent possible in our house, moving sick people into separate rooms at the first sign of illness, opening windows and running air purifiers, etc., but ultimately it was not all that successful.  We did manage to stretch it out enough so that we were not all sick at once, which would have been a nightmare -- by the time I went down DS17 was mostly recovered and could handle things.  

FWIW we each felt genuinely horrendous for about 24-36 hrs (sore throat and low-grade fever, but also just feeling really bad) and then gradually became less sick and more stuffy.   So far my teens, at least, have tested positive well after their symptoms ended.  DS17 tested positive for a full 9 days and DS14 is still testing (faintly) positive on his 9th day, today.  DH and I aren't even bothering to test because we are still mildly symptomatic.

Also FWIW, the only thing i felt even remotely like eating was ice cream.  

Hugs to you all, refuah shleimah (get well soon)!!

 

 

Any clue where you caught it?Hope you are all feeeling much better soon!

[JennyD]

26 minutes ago, ScoutTN said:

Any clue where you caught it?Hope you are all feeeling much better soon!

DS17 had a known exposure at a musical performance.  He was wearing a mask but obviously they're not magic.  Nobody else caught it, though, so it's also possible he caught it at an AP test.  Kids were definitely going to those sick.

[Spryte]

Can anyone refresh my memory? What were the first symptoms of Omicron B.1.1.529, generally? Was the the first Omicron variant?

The one surging now seems often to start with a sore throat, but was the last one more of a cough at the outset? I don’t recall sore throat figuring so obviously in every report of symptoms, so it must have been something else.

It’s all running together.

[YaelAldrich]

Today in addition to the sore throat I feel a little bit tight in the chest with a intermittent dry cough and runny nose.  Achy muscles and eyes.

[Shoeless]

22 hours ago, DinCO said:

I’m so sorry to hear that!  Can you reschedule for a few weeks from now when she is feeling better?  You should definitely try to get together to celebrate your birthday… it is a big deal and I’m sorry your DH isn’t being more understanding.

I don't know. MIL may or may not be visiting now, which is a whole other thing. 

I really don't know if I want to restart arguing about travel, and to be honest, I no longer feel like celebrating. I'd rather the day pass un-noted if I can't go on my trip. 

[freesia]

48 minutes ago, Spryte said:

Can anyone refresh my memory? What were the first symptoms of Omicron B.1.1.529, generally? Was the the first Omicron variant?

The one surging now seems often to start with a sore throat, but was the last one more of a cough at the outset? I don’t recall sore throat figuring so obviously in every report of symptoms, so it must have been something else.

It’s all running together.

My dd who had Omicron in January started with a sore throat. I remember encouraging her to test bc if the sore throat bc it seemed to be a common starting symptom at that point. So whatever variant was around in January. 

[Spryte]

2 hours ago, YaelAldrich said:

Today in addition to the sore throat I feel a little bit tight in the chest with a intermittent dry cough and runny nose.  Achy muscles and eyes.

My FIL said Mucinex seemed to help a bit with the chest tightness, if you have that on hand. Hope it gets better soon!

[Laura Corin]

6 hours ago, Spryte said:

Can anyone refresh my memory? What were the first symptoms of Omicron B.1.1.529, generally? Was the the first Omicron variant?

The one surging now seems often to start with a sore throat, but was the last one more of a cough at the outset? I don’t recall sore throat figuring so obviously in every report of symptoms, so it must have been something else.

It’s all running together.

This compares BA1 to BA2 https://youtu.be/RvcvNRXmlrA

Graph at minute 6.47.

 

 

Edited May 24, 2022 by Laura Corin

[YaelAldrich]

Feeling better today. No more sore throat. Still have that dry cough with nasal/post nasal drippiness and stuffed up feeling but haven't lost my taste nor smell . Slept pretty well last night as well (thank you benadryl!). 

[KSera]

15 hours ago, Spryte said:

Can anyone refresh my memory? What were the first symptoms of Omicron B.1.1.529, generally? Was the the first Omicron variant?

The one surging now seems often to start with a sore throat, but was the last one more of a cough at the outset? I don’t recall sore throat figuring so obviously in every report of symptoms, so it must have been something else.

It’s all running together.

I recall sore throat becoming one of the most prominent symptoms starting with the original omicron. It’s always been a symptom for some people, since the original variant (my potential infection before there was widespread testing started with a horrendous sore throat, so I payed a lot of attention to whether or not sore throat was a symptom). Definitely seemed to shift to being one of the most common with omicron. Runny nose and/or congestion seem to be common right now as well. 

[mommyoffive]

Just a quick poll.  If you have kids 5-11 are you boosting them now?  Why or why not?

[kokotg]

18 minutes ago, mommyoffive said:

Just a quick poll.  If you have kids 5-11 are you boosting them now?  Why or why not?

Mine already got his. The data on effectiveness for the original two doses was so discouraging that I wasn't even really considering him vaccinated without the booster (I think it was 12% against infection, 48% against hospitalization). 

[Spryte]

25 minutes ago, mommyoffive said:

Just a quick poll.  If you have kids 5-11 are you boosting them now?  Why or why not?

Yes. DH is traveling to areas with high transmission all summer, quarantining upon returns, but it’s adding a layer of risk. DD11 is high risk for complications, anyway, so I’d probably opt for it even without the travel.

I think the booster is a pretty important component to effective vaccination.

If she were not high risk, and if our personal family risk level was staying the same — I might delay if she had a 12th birthday coming soon, but none of that applies … so we are boosting today.

[maize]

1 hour ago, mommyoffive said:

Just a quick poll.  If you have kids 5-11 are you boosting them now?  Why or why not?

I will, but not sure when. My kids in that age range have all had covid as well as two shots; I've heard some recommend waiting until fall for the booster so their immunity is high going into winter.

[maize]

31 minutes ago, Spryte said:

Yes. DH is traveling to areas with high transmission all summer, quarantining upon returns, but it’s adding a layer of risk. DD11 is high risk for complications, anyway, so I’d probably opt for it even without the travel.

I think the booster is a pretty important component to effective vaccination.

If she were not high risk, and if our personal family risk level was staying the same — I might delay if she had a 12th birthday coming soon, but none of that applies … so we are boosting today.

If they turn twelve I guess they would get the higher dose booster?

I'll have to think about that one. I have a son turning twelve this summer. 

[KSera]

8 minutes ago, maize said:

If they turn twelve I guess they would get the higher dose booster?

I'll have to think about that one. I have a son turning twelve this summer. 

They do. That would definitely play into my planning if any of mine had summer birthdays. I really think Pfizer used too low of a dose so I would want that higher one.

I keep going back and forth on mine, because we have so little exposure right now and will have more in the fall. However, it’s so rampant here right now and we have our youngest under five, and are working so hard to keep it out of the house. I was leaning toward waiting a little while, to extend protection toward Fall, but the reminder above about how low effectiveness of just two doses were for this age group makes me think again.

[mommyoffive]

2 hours ago, kokotg said:

Mine already got his. The data on effectiveness for the original two doses was so discouraging that I wasn't even really considering him vaccinated without the booster (I think it was 12% against infection, 48% against hospitalization). 

did he just get his?  How did it go?

How old is he?  I am so on the fence as to what to do with my 11 year that is why I am asking age.

Edited May 24, 2022 by mommyoffive

[mommyoffive]

2 hours ago, Spryte said:

Yes. DH is traveling to areas with high transmission all summer, quarantining upon returns, but it’s adding a layer of risk. DD11 is high risk for complications, anyway, so I’d probably opt for it even without the travel.

I think the booster is a pretty important component to effective vaccination.

If she were not high risk, and if our personal family risk level was staying the same — I might delay if she had a 12th birthday coming soon, but none of that applies … so we are boosting today.

I have an 11 year who will turn 12 after summer.  I don't know what to do for them.  Let me know how the shot goes for her.

[mommyoffive]

2 hours ago, maize said:

I will, but not sure when. My kids in that age range have all had covid as well as two shots; I've heard some recommend waiting until fall for the booster so their immunity is high going into winter.

I would wait until fall if we had it.  But to our knowledge we havent.  

[mommyoffive]

1 hour ago, KSera said:

They do. That would definitely play into my planning if any of mine had summer birthdays. I really think Pfizer used too low of a dose so I would want that higher one.

I keep going back and forth on mine, because we have so little exposure right now and will have more in the fall. However, it’s so rampant here right now and we have our youngest under five, and are working so hard to keep it out of the house. I was leaning toward waiting a little while, to extend protection toward Fall, but the reminder above about how low effectiveness of just two doses were for this age group makes me think again.

I am conflicted on my 11 year old who will turn 12 right after summer.  ARGH. I really think having the higher does would be better.

[kokotg]

18 minutes ago, mommyoffive said:

did he just get his?  How did it go?

How old is he?  I am so on the fence as to what to do with my 11 year that is why I am asking age.

He's just 9, so we didn't have that on the cusp of 12 dilemma. He got it on Saturday, and it went fine--sore arm the next day but nothing else, which was the same as with the first 2 for him.

[Terabith]

My in laws decided that my oldest's high school graduation is too big a covid risk.  (Graduating class has fewer than 20 students, so we're not talking about thousands of people.)  Totally understand.

But they're currently at a Community Band Concert, in a high school auditorium along with five hundred of their closest friends.  

[Catwoman]

4 hours ago, Terabith said:

My in laws decided that my oldest's high school graduation is too big a covid risk.  (Graduating class has fewer than 20 students, so we're not talking about thousands of people.)  Totally understand.

But they're currently at a Community Band Concert, in a high school auditorium along with five hundred of their closest friends.  

I would be livid about that! 

[Mom_to3]

I wish they'd approve Moderna for the 6-17 year olds already. Higher dose.

[Ausmumof3]

 

[Spryte]

DD was boosted today. First under 11 yr old to be boosted at our local health department, and they were excited to see her. 
 

So far, no side effects. She had temp 102 after her second shot, so I’m hoping this time is easier!

[mommyoffive]

A note... and Q&A boosters for 5-11 year olds (substack.com)

[Spryte]

Small update on DD11’s booster experience — she’s got temp 101 this am, a sore arm, and feels like a small marble is lodged in her armpit.

[Ausmumof3]

https://www.bostonglobe.com/2022/05/24/metro/people-who-rebound-with-covid-19-after-paxlovid-may-be-highly-contagious-new-studies-suggest/?camp=bg:brief:rss:MSN&rss_id=MSN_rss_brief
 

Pavloxid rebound cases potentially infectious for longer 

[mommyoffive]

MPX State of Affairs: May 26 - by Katelyn Jetelina (substack.com)

[mommyoffive]

Long COVID affects more older adults; shots don't prevent it (yahoo.com)

[mommyoffive]

Researchers Find a Pathway to Prevent COVID Infection (medscape.com)

Multivalent 9-O-Acetylated-sialic acid glycoclusters as potent inhibitors for SARS-CoV-2 infection (uclouvain.be)

[JennyD]

2 minutes ago, mommyoffive said:

Researchers Find a Pathway to Prevent COVID Infection (medscape.com)

Multivalent 9-O-Acetylated-sialic acid glycoclusters as potent inhibitors for SARS-CoV-2 infection (uclouvain.be)

Well that is all very exciting!

I am still testing very, very faintly positive on Day 8, so I am hopeful that today will be my last day in isolation.  Still a bit congested but otherwise feel fine.

I genuinely do not know what to do about a booster for DS11.  He's the only one of us who never got sick or tested positive.  He briefly had a sore throat one evening that was gone the next morning, so it certainly seems possible that he just fought it off.   I'm no longer worried about him being a vector for the rest of us -- at least not for the next couple of months -- but obviously I'd like him to have as much protection as possible for his own sake.

I'm leaning towards waiting until the fall, but I guess I'll ask the pediatrician.  

[YaelAldrich]

Woke up yesterday and did a sniff test and failed! I freaked out because that's the real reason I have been so cautious. I cook based on smell and taste and everything goes cattywampus when I can't smell or taste. They slowly started to come back all throughout that day thank G-d! Still down to a drippy post nasal thing with a cough. Happened again this morning but I'm smelling things again.

[YaelAldrich]

30 minutes ago, JennyD said:

Well that is all very exciting!

I am still testing very, very faintly positive on Day 8, so I am hopeful that today will be my last day in isolation.  Still a bit congested but otherwise feel fine.

I genuinely do not know what to do about a booster for DS11.  He's the only one of us who never got sick or tested positive.  He briefly had a sore throat one evening that was gone the next morning, so it certainly seems possible that he just fought it off.   I'm no longer worried about him being a vector for the rest of us -- at least not for the next couple of months -- but obviously I'd like him to have as much protection as possible for his own sake.

I'm leaning towards waiting until the fall, but I guess I'll ask the pediatrician.  

I got my 12yo and 15yo boosted very recently. I'm very glad because of my unluckiness. So far so good. 

[Corraleno]

1 hour ago, mommyoffive said:

MPX State of Affairs: May 26 - by Katelyn Jetelina (substack.com)

That's a really good, thorough explanation of the current state of affairs with monkeypox. Reading that it's already mutated further/faster than would be expected for a DNA virus is not reassuring! 

[Catwoman]

1 hour ago, YaelAldrich said:

Woke up yesterday and did a sniff test and failed! I freaked out because that's the real reason I have been so cautious. I cook based on smell and taste and everything goes cattywampus when I can't smell or taste. They slowly started to come back all throughout that day thank G-d! Still down to a drippy post nasal thing with a cough. Happened again this morning but I'm smelling things again.

What a relief! That must have been scary!