COVID-19 treatment and vaccine update thread

[Smoove_B]

No treatment or vaccine news, but an early release of a study published by the CDC's monthly journal Emerging Infectious Diseases is making the rounds this morning:

SARS-CoV-2 induces illness and death in humans by causing systemic infections. Evidence suggests that SARS-CoV-2 can induce brain pathology in humans and other hosts. In this study, we used a canine transmission model to examine histopathologic changes in the brains of dogs infected with SARS-CoV-2. We observed substantial brain pathology in SARS-CoV-2–infected dogs, particularly involving blood–brain barrier damage resembling small vessel disease, including changes in tight junction proteins, reduced laminin levels, and decreased pericyte coverage. Furthermore, we detected phosphorylated tau, a marker of neurodegenerative disease, indicating a potential link between SARS-CoV-2–associated small vessel disease and neurodegeneration. Our findings of degenerative changes in the dog brain during SARS-CoV-2 infection emphasize the potential for transmission to other hosts and induction of similar signs and symptoms. The dynamic brain changes in dogs highlight that even asymptomatic individuals infected with SARS-CoV-2 may develop neuropathologic changes in the brain.

Here's hoping we can do better...for the dogs.

[Blackhawk]

So... we should get our pericycles laminated?

[Max Peck]

If COVID-deniers are becoming progressively more brain-damaged as they are infected again and again, it would explain a lot of what is happening in the world.

[hitbyambulance]

https://www.seattletimes.com/nation-wor ... ong-covid/
https://www.nytimes.com/2023/10/16/heal ... tonin.html

Levy and Thaiss said they would be starting a clinical trial to test fluoxetine, a selective serotonin reuptake inhibitor often marketed as Prozac, and possibly also tryptophan.

“If we supplement serotonin or prevent the degradation of serotonin, maybe we can restore some of the vagal signals and improve memory and cognition and so on,” Levy said.

completely theoretical, but... after my bout with covid, short-term memory loss and brain-fog were among the few symptoms i did _not_ get. worth noting that i am currently on a daily dosage of Viibryd (vilazodone), which is an SSRI.

[Carpet_pissr]

Getting over my third round of Covid. No vaccine for me for 3 months.

I read up on this a bit since the wife just recently had Covid. From what I read, it was suggested that even those who had Covid recently get the new vax since apparently it introduces some new (antigens?) that you wouldn't normally have, even with a prior, recent infection.

Unrelated: she got it the other day, and it wiped her out for about a day and a half (as these vaccines have always done with her.) Me? Literally just a sore arm at the injection site for 48h tops...no symptoms whatsoever. I wonder what the difference is? Is how one responds to the vaccine any kind of health indicator? I'm worried I have no immune system!

Also, I need to say that I was critizing the CVS and Walgreens of the world upthread, wrt to allowing clients to schedule online, then not having vaccines when you show up for your appointment. This time, I had no problems either with me, or scheduling and getting the new vax for the rest of my family. So yay! (but my sister and niece did have a problem with this, again, so...)

[Daehawk]

I usually get my flu shot this month so Id toss a covid booster shot in as well. But with no car its hard to do either. But being home Im not out in the covid masses either. I think I can get the car repaired next month if I put it on my card.

Hope the freezer sells

[Kurth]

My wife got the latest COVID vac (+flu) yesterday afternoon. She started feeling shitty last night and has been in bed all day today.

My turn was supposed to be this week, but it keeps getting pushed back due to scheduling issues on my end.

Really just want to get it over with. Such a miserable experience every time I get that damn shot.

Then again, I’d rather that than the alternative.

[Daehawk]

Ive never had a reaction to all these covid shots. Yet. Hope I dont. Little soreness in my arm is all.

[Carpet_pissr]

Well, apparently the correlation between the vaccine and how your body responds has been studied, but it seems like they were just looking for "is it "working" in both those that DO react strongly vs those that don't" (the answer is yes, if you're curious).

"The current study appears to show that side effects from the vaccine and the antibody response it provokes might arise from different parts of a person’s immune system."

Not really sure what that means, but it seemed to be a conclusion, so I added it (I thought it was self-evident, but IANAD).

https://frederick.cancer.gov/news/lack- ... ot-working

Note I didn't actually read the study, just the linked article, so they may go into the WHY of how people react differently.

[Kraken]

My immune system even overreacts to insect bites, so vaccines always give me a good smackdown.

[Smoove_B]

Because the transition of the Fall 2023 Covid-19 vaccination to the private market has been going so well, get ready for the same to happen with paxlovid:

Today, the U.S. Department of Health and Human Services (HHS), announced that HHS and Pfizer have reached an agreement that extends patient access to Paxlovid, maximizes taxpayer investment, and begins Paxlovid’s transition to the commercial market in November 2023. This agreement builds on HHS and Pfizer’s strong partnership over the last three years that enabled the development, manufacture, and distribution of COVID-19 vaccines and therapeutics at a record pace.

HHS has consistently expressed a shared interest in jointly transitioning Paxlovid to the commercial market while ensuring that the United States taxpayer continues to receive fair and reasonable benefit from the HHS procurement of this product, with a focus on ensuring affordable access for beneficiaries in public programs like Medicare and Medicaid as well as for those who are uninsured. Per the agreement announced today, HHS and Pfizer will begin preparations for Pfizer to transition Paxlovid to the commercial market in November 2023.

Edited to now include price change speculation:

The price of the lifesaving Covid-19 medication Paxlovid is likely to rise next year for most patients as the United States continues to transition out of the emergency phase of the pandemic, sparking concerns among doctors that it will become less accessible.

Just as with Covid-19 vaccines this season, the antiviral – a combination of the drugs nirmatrelvir and ritonavir – will move from being available free to everyone through government purchases to a more traditional commercial marketplace for most patients at the end of this year, according to the US Department of Health and Human Services and drugmaker Pfizer.

The new price – the cost before insurance – hasn’t been set but is expected to be higher than the $530-per-course price paid by the US government.

...

One financial analyst who follows the company, Evercore ISI’s Umer Raffat, suggested that the price could go up three- to fivefold, to as much as $2,500 per course.

[Kraken]

Lordy, that's a lot of money. I'm sure the insurance companies will be fine with it.

I'm thankful that I was able to get Paxlovid for my two mild Covid infections and hope I'm at-risk enough to qualify for it again, should I need it.

[FishPants]

Got both shots yesterday at noon, I've had zero side effects.. I've now added Pfizer to my covid dance card (AZ and Moderna multiple times before that), so that's neat maybe the ontario government will send me a gold star.

Demand is high in my area for the shot, the Pharmacist said that I was the 20th shot she'd delivered so far, and I was in there at noon. Not even a sore arm this time which I usually got - but I'm wondering if it's because I've been around so much Covid on airplanes/office/friends/golf trip/people.. Honestly I'm in all kinds of closed unventilated spaces travelling around.

On another note a buddy of mine had his pops admitted to hospital and they couldn't figure out what was wrong, 5 days later they finally (!!) do a covid test and ends up he's dealing with serious Covid (on top of other health issues). He seems to be turning a corner now that they are dealing with the right issue; but I feel better knowing I got my shot when people are still getting ICUed with this variant.

[Punisher]

Got both shots yesterday at noon, I've had zero side effects.. I've now added Pfizer to my covid dance card (AZ and Moderna multiple times before that), so that's neat maybe the ontario government will send me a gold star.

Did you remember to yell UNO!!!? If not, you have to start all over.

[Blackhawk]

Because the transition of the Fall 2023 Covid-19 vaccination to the private market has been going so well, get ready for the same to happen with paxlovid:

Today, the U.S. Department of Health and Human Services (HHS), announced that HHS and Pfizer have reached an agreement that extends patient access to Paxlovid, maximizes taxpayer investment, and begins Paxlovid’s transition to the commercial market in November 2023. This agreement builds on HHS and Pfizer’s strong partnership over the last three years that enabled the development, manufacture, and distribution of COVID-19 vaccines and therapeutics at a record pace.

HHS has consistently expressed a shared interest in jointly transitioning Paxlovid to the commercial market while ensuring that the United States taxpayer continues to receive fair and reasonable benefit from the HHS procurement of this product, with a focus on ensuring affordable access for beneficiaries in public programs like Medicare and Medicaid as well as for those who are uninsured. Per the agreement announced today, HHS and Pfizer will begin preparations for Pfizer to transition Paxlovid to the commercial market in November 2023.

Edited to now include price change speculation:

The price of the lifesaving Covid-19 medication Paxlovid is likely to rise next year for most patients as the United States continues to transition out of the emergency phase of the pandemic, sparking concerns among doctors that it will become less accessible.

Just as with Covid-19 vaccines this season, the antiviral – a combination of the drugs nirmatrelvir and ritonavir – will move from being available free to everyone through government purchases to a more traditional commercial marketplace for most patients at the end of this year, according to the US Department of Health and Human Services and drugmaker Pfizer.

The new price – the cost before insurance – hasn’t been set but is expected to be higher than the $530-per-course price paid by the US government.

...

One financial analyst who follows the company, Evercore ISI’s Umer Raffat, suggested that the price could go up three- to fivefold, to as much as $2,500 per course.

It's a good thing they're not doing that, along with all of the delays and denials as the insurance companies figure out policies, right in the middle of the COVID busy season.

Oh, wait.

[Smoove_B]

New potential treatment for loss of taste and smell associated with infection:

New clinical-trial data suggest that an antiviral pill called ensitrelvir shortens the duration of two unpleasant symptoms of COVID-19: loss of smell and taste. The medication is among the first to alleviate these effects and, unlike other COVID-19 treatments, is not reserved only for people at high risk of severe illness.

Early in the pandemic, roughly 40–50% of people with COVID-19 experienced impaired smell or taste1. The antiviral drug molnupiravir speeds recovery of these senses2, but generally only the most vulnerable people can take it.

That is not true for ensitrelvir. In Japan, where it received emergency approval last year, the drug is available to individuals with mild to moderate symptoms, regardless of their risk factors. Its developer, Shionogi in Osaka, Japan, is continuing to conduct clinical trials of the drug, which has not yet been approved outside Japan.

...

Smell and taste problems are less prevalent now than they were at early stages of the pandemic3. “When the Omicron variants became dominant, the loss of taste and smell started to become less and less common,” says Amesh Adalja, an infectious-disease specialist at the Johns Hopkins Center for Health Security in Baltimore, Maryland. “But it still occurs, and it is a distressing symptom.”

Earlier this year, Shionogi reported that ensitrelvir shortens symptoms of COVID-19 by about a day — a standout trait, says Adalja. “What we’re trying to do is not just minimize severe disease, hospitalization and death, but also to minimize the disruption that an infection has on people’s activities.”

[Octavious]

Shionogi! Oh god they were my client many years ago. The way they treated the US office was hilarious. Their conference room was setup in a certain way and people had exact seats they had to sit in for conference calls or they would insult the Japanese office. That wasn't a fun client.

[Smoove_B]

Update on Paxlovid pricing:

Pfizer will price a five-day course of its Covid antiviral drug Paxlovid at $1,390 when the company starts to transition it to the commercial market later this year.

A company spokesperson on Wednesday confirmed the price, which was first reported by The Wall Street Journal. That list price, which is before rebates and other discounts to insurers and pharmacy benefit managers, is more than double the $529 the federal government paid for Paxlovid.

Note:

But health insurance plans will likely pay much less than the nearly $1,400 list price for Paxlovid, meaning patients will probably have small or no out-of-pocket costs. Pfizer also noted that it is working with payers to lower copays for patients.

And since everyone has health insurance we can just put this one to rest.

[gilraen]

I wonder if GoodRx and the like will include it in their discounts.

[LawBeefaroni]

Got my flu shot today. Was supposed to get the Covid shot too but they ran out in about 2 minutes.

They had 11 doses.


*shrug*

[coopasonic]

Got my flu shot today. Was supposed to get the Covid shot too but they ran out in about 2 minutes.

They had 11 doses.


*shrug*

My wife's hospital doesn't even have flu shots this year. She had to get it with the kids at the high school. The hospital has required and supplied flu shots every year as long as she has been there. Now, whatever, do what ya want and good luck.

[jztemple2]

Haven't been following this stuff for months, but now there is an updated Covid booster available from my pharmacy, but I have to sign up online. We got our last boosters a year ago. However, when I get there I find these two options:



We've had Moderna in the past, which do we sign up for? The wife and I are 70 and 73, if that makes a difference.

[LawBeefaroni]

Got my flu shot today. Was supposed to get the Covid shot too but they ran out in about 2 minutes.

They had 11 doses.


*shrug*

My wife's hospital doesn't even have flu shots this year. She had to get it with the kids at the high school. The hospital has required and supplied flu shots every year as long as she has been there. Now, whatever, do what ya want and good luck.

Still mandatory here.

Going to be some interesting flu seasons if more hospitals stop requiring it.

[Zaxxon]

Haven't been following this stuff for months, but now there is an updated Covid booster available from my pharmacy, but I have to sign up online. We got our last boosters a year ago. However, when I get there I find these two options:



We've had Moderna in the past, which do we sign up for? The wife and I are 70 and 73, if that makes a difference.

Spikevax is the trendy retail name for the Moderna jab.

[Zaxxon]

And to actually answer your question, I believe the tl;dr version is that either mRNA option (Moderna or Pfizer) are viewed as about equivalent in terms of efficacy. Novavax is a tier below, I believe.

[gilraen]

Our Costco wouldn't do COVID booster appointments online because (as I found out later) their website hasn't been changed to include Novavax. Like...okay? I called them to confirm that they had plenty of vaccines in stock so we were able to get both flu and COVID shots last week as walk-ins. Went with Comirnaty (Pfizer) but they did have all 3 available.

[hitbyambulance]

all three of my local pharmacies are booked out three weeks for vaccines and no walk-ins available...

[hitbyambulance]

Novavax is a tier below, I believe.

ehhhh....

"According to Lyke’s most recent study, the antibodies elicited by the new Novavax booster may have lasted a little longer than those produced after an mRNA vaccine. But Lyke says that’s not conclusive: by the time the study began early in 2022, many vaccinated people had recently been infected with Omicron or another dominant variant that’s good at avoiding the immune system. The infection gave their body a level of natural immunity that was difficult to distinguish from the vaccine’s effects.

Lyke says it is nearly impossible to directly compare different vaccines’ efficacy, given that people have had different exposures, infections and combinations of vaccinations. “I just don’t think we can run those trials anymore,” she says."

https://www.scientificamerican.com/arti ... ow-so-far/

[ImLawBoy]

all three of my local pharmacies are booked out three weeks for vaccines and no walk-ins available...

Have you tried pharmacies inside grocery stores? We had success there with shots for the kids.

[Smoove_B]

And to actually answer your question, I believe the tl;dr version is that either mRNA option (Moderna or Pfizer) are viewed as about equivalent in terms of efficacy. Novavax is a tier below, I believe.

To piggyback off comments by hitbyambulance, I would absolutely get a Novavax shot at this point if that was my only option. I don't want this to sound like I think it's an experiment (because it's not), but I am curious to see how the vaccine performs this coming winter - if we are able to "tease" out information related to people that had other vaccines first, people that had no prior vaccination history or illness history, etc...

The studies I'd been seeing right before it was released were hopeful it would have a "synergistic" impact with existing immunity, especially for those that only had been vaccinated and didn't have a wild exposure.

I guess we'll see.

[Zaxxon]

Cool.

[Smoove_B]

I'm really hopeful it increases vaccination coverage regardless as the lack of a "traditional" vaccine has been the rallying cry for the anti-spike protein crowd for 2+ years now. With Novavax widely (?) available, I'd hope those that have been resisting are more open to it.

[Smoove_B]

Not great:

We are approaching the end of October, and at least 10 million Americans have gotten the Fall 2023 Covid-19 vaccine. This amounts to ~3% of the eligible population (only 7% of nursing home residents). This is severely trailing typical flu vaccine coverage, just like last fall.

Note:

For those interested in nuance: Is this year trailing last year’s Covid-19 coverage too? Well, yes, as seen in the line above. But, we are comparing apples to oranges. The end of the public health emergency meant that states were no longer required to report vaccine uptake to the CDC, but some are still reporting. So, the 2023 numbers are the bare minimum. Models considering differential reporting show Covid-19 coverage is about the same as last year.

She goes into the reasons why our numbers might be so terrible, and they're all reasonable; I'm not sure which one is a driver or if they're all equally contributing.

*sigh*

[Max Peck]

I just got my flu and covid shots this morning. I'm on Team Spikevax again this year, so my record stands at 1 dose of Pfizer followed by 4 doses of Moderna's Finest.

Going by previous years, I can expect a mildly sore arm and a short bout of fever and chills sometime tonight.

The good news is that the pharmacy was booked solid for the day, so there is a healthy demand for the vaccination locally. That might be in part due to the fact that this week is the only one where appointments have been available at this pharmacy (which is just a 5 minute walk from my home). I had been putting off booking an appointment for a couple of weeks because I couldn't find any place that wouldn't be at least a couple hours round trip (apparently I live in the geographical center of a vaccine desert or something). If I hadn't checked on Sunday I probably would have missed out on the opportunity to get the shot locally.

[Blackhawk]

As mentioned elsewhere, I got mine (Moderna COVID + flu + Shingrix) a few days ago around noon. I started feeling a little light headed after about four hours, was 'sick' by that night, and felt like I had a bad cold the next day (mostly lightheadedness, congestion, some shivering, and fatigue.) By late that evening I was coming out of it (so about 30 hours after the shots), and by the next day I was fine with just a little bit of 'post cold' blah.

For reference, I had a similar response to last year's Moderna, and no response at all to the previous vaccinations/boosters. I've never had any response at all the flu vaccine when I still got it alone.

How much of this year's response was the Shingrix, I don't know - but it was more than zero.

[Isgrimnur]

I had been putting off booking an appointment for a couple of weeks because I couldn't find any place that wouldn't be at least a couple hours round trip (apparently I live in the geographical center of a vaccine desert or something). If I hadn't checked on Sunday I probably would have missed out on the opportunity to get the shot locally.

[Max Peck]

Spikevax 2023 (the XBB.1.5 variety) seems to pack less of a kick (for me) than the previous versions from Moderna. I had some fatigue and aches yesterday afternoon and evening, but no fever or chills. I had a decent night's sleep and feel fine again today aside from a bit of residual soreness around the injection site.

[Smoove_B]

Four more free tests available...

Ahead of the approaching holidays and a potential rise in cases this winter, the government is once again allowing households to order a fresh wave of four COVID-19 tests for free online.

The website, covidtests.gov, remains one of the last remaining ways Americans can secure free at-home rapid test after the end of the public health emergency last spring ended the requirement for insurance companies to cover eight tests per month.

Over the past three years, the return of winter has also brought a resurgence of COVID-19. According to modeling data from the Centers for Disease Control and Prevention, health officials are anticipating a similar number of hospitalizations this year as they saw last year, which topped nearly 45,000 per week at its peak.

The test ordering site relaunched last month, offering four tests per household, and will now offer an additional four tests per household for anyone who has already ordered -- or eight tests per household for anyone who hasn't placed an order yet this fall.

[gilraen]

...and ordered.

[Zaxxon]

Thanks for the heads-up.