October 16, 2023

the more things change

Even though I’m a family doctor, I am an Infectious Disease (ID) doctor at heart. For several reasons, I chose Family Medicine as my career, mostly because I was 10 years older than my fellow med students and didn’t want to add on more years of training. I hoped to be able to work with HIV patients without needing the ID fellowship.

I was lucky and got my wish. Taking care of people with HIV taught me so much. As it turns out, so many diseases and conditions that I’ve taken care of are caused by infectious diseases after all. Things like gastric ulcers caused by Helicobacter Pylori and anal, cervical, and many oral cancers caused by HPV (Human Papilloma Virus), liver cancer caused by Hepatitis B and C. Other diseases may ultimately be found to be caused by infections. (Some of these are now preventable by immunizations, if only people weren’t afraid of vaccines. Another post is coming.)

It’s a big reason I look forward to hearing what’s presented at ID Week, the yearly conference for Infectious Disease doctors that presents new research that can change how we treat infections. I always learn something new.

This year, it was from a study about the peak of SARS-CoV-2 viral loads in COVID-19 infections. It shows how our own immunity is changing viral dynamics. When SARS-CoV-2 was a novel virus that we’d never met before, viral loads (the amount of virus detectable with testing) peaked just before or at the beginning of symptoms. Now the viral loads increase more gradually after symptoms start, rising in 1-4 days, peaking on the 4th and 5th day; compared to the flu with viral load that peak on the second day. This is why now so many people have negative tests when they test themselves at the start of symptoms. And why it’s important to re-test in 2-4 days if the first test is negative. This is because most of us now have some sort of immunity to the virus, either from infection or immunizations or both. That immunity helps keep the viral load lower. This is why the tests seem less sensitive. It also most likely means we are less infectious now before symptoms begin than people were at the beginning of the pandemic when lots of spread happened before people had symptoms.

We are learning more about Long COVID too and how to prevent it. One promising medication is metformin that is used to treat diabetes. I learned about an NIH-sponsored clinical trial that is still open, called ACTIV6. People can take other treatments like Paxlovid and still participate. The coolest part is that you can enroll in the study online, no travel needed. They will ship the meds to you. They have already studied other meds like ivermectin, fluticasone, montelukast, and fluvoxamine. Those arms are closed. They are hoping metformin can prevent long COVID and possibly Paxlovid rebound. Keep this opportunity in mind IF you were to catch COVID and want to contribute to science. We also know that Paxlovid can prevent Long COVID, but often it is not prescribed for a variety of reasons.

Long COVID is still baffling but some answers are starting to come, including a new theory that the virus Sars-CoV-2 lingers in the gut, depleting serotonin levels. This could be why fluvoxamine mentioned above showed promise in some studies, since it is an SSRI (selective serotonin reuptake inhibitor) that can help raise serotonin levels. This is used for treating depression and anxiety. Try this link to article in the New York Times to read it. Very interesting.

COVID is still out there. Most of us will do fine, some of us are more at risk. Get your updated booster. Look for an appointment through vaccines.gov. Wear a good mask if you or someone you are close to is at risk.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available. Thanks for reading.

Share this post if you know of others who may be interested. All links are listed at the bottom of this post.

A gentle reminder that I am now writing more regularly because I’ve committed to doing so by turning on Paid Subscriptions. Read about it here in this post: A Special Message. Most of my writing will remain free. Pay only if you wish to and are able to. The cost is $5/month, $50/year, $100 Founding Member, bonus is ability to post and other content. Think of it as tipping for a busker. Thanks to all who have paid already!

https://idweek.org/about-us/

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciad582/7285011

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext

https://blogs.jwatch.org/hiv-id-observations/index.php/an-october-id-and-non-id-link-o-rama/2023/10/08/

https://activ6study.org

https://www.nbcnews.com/health/health-news/paxlovid-may-prevent-long-covid-but-not-prescribed-rcna119737

https://www.nytimes.com/2023/10/16/health/long-covid-serotonin.html

https://www.vaccines.gov

Gift article link:

https://www.nytimes.com/2023/10/16/health/long-covid-serotonin.html?unlocked_article_code=ncPC0eCPZmhgRL-rFkS9ztJfb6ot8UR4HjkHDxn6TvaUStGSPrgOyBpyHhjx2Rui8HU_VHx5ijORUShq61eZK_frX8CeQU5060AoXCvfcTWG4nW-oRpthkMAXq7jAiWmDOuoC554-mgGtpeNRty2_Ykh598AU1FW63kTXGym3cTMIIGtyPkSvDycFslhia53af1JL50wfmdBWQUYpOulE7TwbeNKR6TvioRC9qgmp0W8Nhygx-hvpe5iKbPFW_uLtPTRdxo-xpxEdgpN443pktH_budk_lgln40VJ0TnaMGq__pJCe_cEuDF3W4HWyP8wIGDF8YvWkyRfkpG8A&smid=url-share