From a listener question: The renal dose of Paxlovid should only be given to patients who have documented kidney function issues. Some doctors prescribe it to anyone older than 65, but Dr. Griffin says it’s better to give the full dose of #Paxlovid unless really warranted.

#TWiVTLDR 9/9

A small study showed that people with #LongCOVID do not have reactivated Epstein-Barr virus in their blood. Dr. Griffin wants to reframe this, since some of his long COVID patients do have reactivated EBV, but some do not. It’s certainly true it’s not causative, but it also highlights the fact that a blood test for long COVID is still a ways off.

#TWiVTLDR 8/

Another thing that doesn’t help with #COVID disease progression - Conestat A (ConA) a recombinant human C1 inhibitor, which generally affects inflammation. They even stopped the study early because of how useless it was.

#TWiVTLDR 7/

Taking 100mg of fluvoxamine 2x a day (an SSRI mostly used for OCD treatment) does not help people recover faster from mild to moderate #COVID. Apparently a bunch of people really thought this would work, because it was a thing that people told each other to take for COVID recovery. Sorry, it doesn’t work!

#TWiVTLDR 6/

The middling results of using COVID convalescent plasma (given to #immunocompromised ppl who can’t take anything else) may be down to timing - if you give it late, it doesn’t have much of an effect. Also, the vast majority given plasma were also on steroid drugs at the time, which may have affected the plasma’s impact. (You take steroids to reduce inflammation from hyperactive immune response.) It emphasizes the importance of giving #COVID convalescent plasma in first week.

#TWiVTLDR 5/

…Both Drs. Griffin and Racaniello point out how “odd” this is, and question how you’re going to measure “rebound” if nobody goes to zero to rebound from? The study did find that people who took #Paxlovid have fewer symptoms and lower viral load than untreated, so it should still help with transmission. And observe that symptom rebound is a separate thing from viral rebound. So Paxlovid should really be prescribed for everyone with #COVID who is high risk.

#TWiVTLDR 4/

And another Paxlovid “rebound” study, comparing #COVID patients of similar health histories that were treated or untreated with #Paxlovid. To start, they really broaden the definition of “rebound” so that 20% of the untreated group would qualify as having “rebound.” Many people in both treated and untreated groups still report having at least 1 COVID symptom even after day 15 (70%). Also, only about 20% of people in both groups were testing negative on PCR tests by day 10…

#TWiVTLDR 3/

A VA study found that people taking immunosuppressive drugs (so, #immunocompromised) for organ transplants, rheumatoid arthritis, inflammatory bowel disease (IBD), or psoriasis are still somewhat likely develop severe COVID-19 even if they’ve been vaccinated. 22.7% of organ transplant recipients are likely to get severe #COVID, 12.8% of rheumatoid arthritis patients, 6.9% of IBD patients, and 7.3% of psoriasis patients. And Paxlovid helped a lot.

#TWiVTLDR 2/

The hosts also discuss how some doctors avoid prescribing Paxlovid for nonsensical reasons, like #rebound symptoms being worse than nontreated COVID (they aren’t) and preventing transmission during rebound (uhh, #Paxlovid is an antiviral and should help with that...??). There also aren’t any indications that anyone taking Paxlovid has ever transmitted COVID onwards.

#TWiVTLDR 7/7