COVID-19 treatment and vaccine update thread

[Blackhawk]

So, Wise Oracle, is this a 'be in line on opening day' vaccine, or is this a 'wait until later in the season to extend protection further into next year' vaccine?

[Smoove_B]

As someone that hasn't been vaccinated since Labor Day weekend of 2022, I will be there ASAP to get the next round of vaccinations. My philosophy now is that it's better to have current/recent protection than to try and time the vaccine (like is recommended for flu) for seasonal exposure. While there does seems to be seasonal risk associated with COVID-19, the summer surge we're seeing now in parts of 'merica is demonstrating the once a year vaccination strategy is going to be a bit dicey.

I'd need to confirm, but I believe the current data suggests protection after vaccination is strongest for 8-10 weeks after your shot and there's just no way I'm waiting until November to get one - especially with a child still in school. My equations might change in the Fall of 2024, but right now it's all hands on deck. I'd rather be boosted and then diminished headed into winter where I can better control my exposures than continuing to roll the dice for another 90 days and hope I can dodge the virus for a total of ~15 months between shots.

[Blackhawk]

Thank you, wise one. Your words shall be heeded.

[stessier]

Oddly good news. My last shot was October last year, so I'm looking Forward to the next one.

Oh wise Oracle, I'm due for my shingles vaccine - any concern getting it next week could delay my eligibility for the COVID-19 shot.

[Smoove_B]

I wish I could provide better, generalized advice for everyone but public health as we knew it is now dead, imho. Making decisions that work best for you (and your immediately family) seems to be the only option we have as humanity circles the drain.

[Smoove_B]

Oh wise Oracle, I'm due for my shingles vaccine - any concern getting it next week could delay my eligibility for the COVID-19 shot.

Generally speaking, vaccinations don't contraindicate providing additional vaccinations; there's no reason you can't get multiple vaccines at once. I believe the only vaccination they're currently advising to not offer at the same time is MPox.

I guess that *could* change when they make their final COVID-19 vaccination recommendations, but I would tend to doubt it. Either way, I'm having a hard time imagining you'd be ineligible for a COVID-19 vaccination based on a shingles vaccination next week. As someone that never had the chicken pox, shingles isn't on my list of concerns, but I think you're smart for proactively getting the shot. I've known quite a few adults over the last decade (mainly older family members) that had shingles and they said it was more painful than they imagined.

[stessier]

Oh wise Oracle, I'm due for my shingles vaccine - any concern getting it next week could delay my eligibility for the COVID-19 shot.

Generally speaking, vaccinations don't contraindicate providing additional vaccinations; there's no reason you can't get multiple vaccines at once. I believe the only vaccination they're currently advising to not offer at the same time is MPox.

I guess that *could* change when they make their final COVID-19 vaccination recommendations, but I would tend to doubt it. Either way, I'm having a hard time imagining you'd be ineligible for a COVID-19 vaccination based on a shingles vaccination next week. As someone that never had the chicken pox, shingles isn't on my list of concerns, but I think you're smart for proactively getting the shot. I've known quite a few adults over the last decade (mainly older family members) that had shingles and they said it was more painful than they imagined.

Thanks. Yeah, I had chicken pox as a kid and one of the guys who works for me got shingles about a month ago. It presented as a rash inside his mouth - he went to the dentist thinking he needed a root canal. Nope! Took him days before he could eat normal food again - he said it was brutal. So that moved the shot way up on my list.

[Smoove_B]

Dear lord, I didn't realize you could get shingles in your mouth! I've only heard from people that had it on their torso and they said it was hell on earth!

[Blackhawk]

Dear lord, I didn't realize you could get shingles in your mouth! I

No kidding. My god, the splinters!

[Zarathud]

COVID-19 free after attending GenCon. I’ll get the next round of shots.

[Isgrimnur]

Dear lord, I didn't realize you could get shingles in your mouth! I

No kidding. My god, the splinters!

I get the shakes just thinking about it.

[Victoria Raverna]

That's correct. I don't know if they'll say anyone over the age of 60 can walk into a pharmacy and get the shot while anyone under 60 will need documentation / recommendation from a doctor.

At this point I don't believe there's any reason to suspect another round of vaccinations could cause harm. The issue (and why they wouldn't recommend them, imho) is because of the little evidence they're providing any benefit - specifically lowering rates of death in people under a specific age (65? 60?).

What follows then is whether or not the pharmaceutical industry will be interested in regularly producing a vaccine that will only be given to people over the age of 65. I'm not being conspiracy-theory minded here, it's a reality. If they can't make money vaccinating a fraction of people, they'll need incentives to do it - money from the government. Pneumococcal vaccine is given to infants and people over the age of 65. Shingles vaccine for people over 50. There aren't any vaccines that are only for people 65+...

Unless they're all dying off by now, according to 2021 estimate there are over 50 millions people in US that is over 65 years old. Still a big market.

[disarm]

Dear lord, I didn't realize you could get shingles in your mouth! I've only heard from people that had it on their torso and they said it was hell on earth!

Shingles can be a really big deal depending on the location and severity. One of the worst places is affecting your trigeminal nerve, which covers part of your face your eyes. It's possible to get shingles lesions on your eye that can cause permanent damage and vision loss. It's also important to treat shingles quickly to minimize the chances of developing post-herpetic neuralgia, a condition where you experience chronic (sometimes lifelong) nerve pain in the distribution affected by shingles. Both of those conditions are rare, but the possibility is why you shouldn't mess around with shingles. The vaccine is very important, but it's equally as important to seek treatment as soon as you suspect you might be starting an outbreak.

[Smoove_B]

Get your sHingles vaccinations folks!

Back on topic, an interesting update from Dr. Topol regarding a possible cause for Long Covid - "sick" mitochondria, via a new study. I fully appreciate that his detailing might be a bit too much, but if you liked basic biology in high school (and can remember back that far), possibly recall that your mitochondria are the source of your force powers. Just kidding, they are the "powerhouse" of your cells, providing energy:

It turns out the virus binds directly to essential mitochondrial proteins, suppressing mitochondrial gene expression (both nuclear-encoded and mitochondria-encoded), inducing mitochondrial energy production dysfunction and activation of the immune response (innate immunity, spelled wrong, top right, in their Figure below).

...

The autopsy samples provided evidence that this disruption of mitochondrial genes and function was occurring in many organs throughout the body, especially the heart, but also the liver, kidneys, and lymph nodes. Even after clearance of the virus, there was evidence of chronic OXPHOS inhibition. The authors point out: “The irreversible inhibition of visceral mitochondrial transcription could also contribute to the multisystem symptoms of Long Covid.”

There's lots more details, but it's certainly a potentially encouraging study as it suggests a way to possibly treat some of the people suffering.

He also shared a bit about how the $1.15 billion that was provided to the NIH resulted in exactly zero therapies for Long Covid, which is unfortunate (to say the least). STAT News details where all the money went and overwhelmingly it was put towards an observational study to catalog people with symptoms. Only a fraction (15% of the funding) went towards clinical trials - seeing if Paxlovid helped (it didn't).

He notes we're really behind with research on this and the problems are continuing to grow. For all the progress we made with the original vaccine, to completely fumble the follow-up with treatments for chronic complications is a real gut-punch.

EDIT: Fret forgive me

[Punisher]

Get your singles vaccinations folks!

But what if I'm already married?

[RunningMn9]

There's lots more details, but it's certainly a potentially encouraging study as it suggests a way to possibly treat some of the people suffering.

Anything in there for people coming up on Day 700 of a 101 degree fever?!

[Smoove_B]

Anything in there for people coming up on Day 700 of a 101 degree fever?!

I check every day for news and information. Every. Day.

I have provided what I've learned, but nothing in the way of an actual, tangible solution. I'm guessing that lies with a ME/CFS specialist that is seeing people suffering from Long Covid.

FWIW, my guess is on vagus nerve damage and/or immune dysregulation. Neither are great.

[coopasonic]

Get your singles vaccinations folks!

But what if I'm already married?

All the more reason to avoid the singles!

[Smoove_B]

Just waiting for the conspiracy reporting about the mice:

Moderna's updated COVID-19 vaccine provided a "significant boost" in people's neutralizing antibody levels against the latest omicron SARS-CoV-2 subvariants circulating in the US, that is, EG.5 and FL.1.5.1, according to a press release from the company.

...

Moderna, which was reporting its takeaway from preliminary clinical trial data, did not release additional details of the study, including the number of trial participants or the relative increase of neutralizing antibody levels. But the announcement aimed to ease concerns about whether the fall booster will adequately match this season's variants.

...

"These new results, which show that our updated COVID-19 vaccine generates a robust immune response against the rapidly spreading EG.5 and FL.1.5.1 strains and reflects our updated vaccine's ability to address emerging COVID-19 threats," Moderna President Stephen Hoge said in the press release.

The shots were designed against the previously reigning omicron subvariant, XBB.1.5. In June, an advisory panel for the Food and Drug Administration determined that a shot aimed at an XBB variant, particularly XBB.1.5, was the best choice for the 2023-2024 season.

[Smoove_B]

Not a surprise but it's always good to have the data:

The report, published Monday in the medical journal Hypertension, found that more than 1 in 5 patients who were hospitalized with Covid-19 – and over 1 in 10 who were not – had been diagnosed with high blood pressure six months later. Compared with people who had influenza, another upper respiratory virus, those hospitalized with Covid-19 were over twice as likely to develop hypertension.

...

In the new study, the researchers looked at the medical records of over 45,000 Covid-19 patients and nearly 14,000 influenza patients in the Bronx borough of New York City between 2020 and 2022. Before their viral infection, none of the patients had a history of hypertension. At a six-month follow-up appointment, the researchers then tracked which ones had new diagnoses of the heart condition.

Across the board, people who were hospitalized with Covid-19 were diagnosed with hypertension at about twice the rate of those who were not: About 21% of hospitalized Covid-19 patients were hypertensive, compared with 11% who were not hospitalized.

Of the hospitalized Covid-19 patients, more than 1 in 5 developed hypertension during their time in the hospital, while actively infected with Covid-19, despite having no history of high blood pressure.

However, in comparison with patients who were infected with the flu, Covid-19 patients had worse blood pressure outcomes.

Of note:

“Given the sheer number of people affected by COVID-19 compared to influenza, these statistics are alarming and suggest that many more patients will likely develop high blood pressure in the future, which may present a major public health burden,” Dr. Tim Duong, a study author and professor of radiology at the Albert Einstein College of Medicine, said in a news release.

But scientists are unsure how the Covid-19 virus might trigger new-onset high blood pressure. The study theorizes that the coronavirus could infect heart cells and disrupt blood pressure regulation or that acute kidney injury – a common complication during Covid-19 hospitalization – might contribute to hypertension.

The report also noted that most of the people in the study came from communities with low socioeconomic status, which might have increased their risk of developing high-blood pressure. Risk factors linked with poverty, including stress and reduced access to healthy food, might have raised rates of hypertension.

[Smoove_B]

Another big study released today, covering a 2-year follow up on people suffering with PASC after a COVID-19 infection.

I'm guessing it's going to (eventually) make it into more popular media - and presented in a much easier format to process and if I see that, I'll share. However, there's a few very important things to note. First, the cohort they're studying is once again from a veteran's database. Overwhelmingly then the population being studied is (1) male and (2) older. Clinical data tells us that it's actually middle-aged women that seem to be at highest risk for complications following a COVID-19 infection, so already there's a mismatch between data sources.

Second, the population being studied for 2 year follow up is made up of people that were part of that "first wave" of infections. We're in a different world now - new variants and post-vaccination. No one has any idea if this first group is typical for that first wave or predictive for all future waves.

Going through the methodology and analysis is above my pay grade, but it's an insanely rigorous examination of 80 different conditions that people reported experiencing after a COVID-19 infection. This table might be the best to look at (you can see they're all organized by organs or systems affected) and you'll note the RR (relative risk) is highest for :

• Myocarditis
  Pulmonary embolism
  Myopathy
  Hypoxemia

Those are double-digit associations, but there are plenty that are still significant (RR > 3).

Anyway, it's good information and something that should give us all pause.

EDIT: And here's an article in Fortune that's a bit easier to follow.

[Kraken]

Ima ask my doc about the covid connection to blood pressure when I see him on Wednesday. I never had high pressure in my life until my last two checkups, and I had covid twice last year. Could very well be connected. Not that it would make any difference in treatment, probably, but I'll ask him what he knows about it.

[em2nought]

In the mouth? I think I'll go ahead and pay for the shingles vaccine instead of waiting until I get around to forming a relationship with the VA.

[stessier]

So from this article, a few questions (most likely for Smoove) - is there a long term plan for monitoring in the US? Who is in charge of it? Is such a plan unique or is it something pretty normal - like don't we already do this with flu?

Part of the reason there is so little data on BA.2.86 is that there is relatively little data on circulating variants in general. In early 2022, at the height of pandemic genomic surveillance, scientists worldwide submitted nearly 100,000 coronavirus genetic sequences per week to the public genomic database (GISAID). In the past month, however, weekly GISAID submissions have averaged around just 5,000.

In the US, the Centers for Disease Control and Prevention has likewise seen a perilous drop in monitoring. In early 2022, the agency collected data from nearly 100,000 COVID-19 tests per week. Now, amid a summer wave with test positivity on the rise again, the test volume is just 40,000. And the agency only has enough genomic surveillance data to estimate variant prevalence for three of the country's 10 health regions.

In October of last year, as experts were wary of a winter wave of COVID-19, Maria Van Kerkhove, WHO's technical lead for COVID-19, warned in a press briefing that the surveillance landscape had "changed drastically."

"The number of sequences that the world and our expert networks are evaluating has dropped by more than 90 percent since the start of the year. That limits our ability to really track each of these [omicron subvariants]," she said at the time.

But things have only gotten worse since then. In October 2022, for instance, scientists submitted over 20,000 coronavirus sequences per week to GISAID, compared with the current average of around 5,000.

[Smoove_B]

It's few issues, but really just one - money. The CDC would likely have been the agency that was coordinating the testing, possibly through the NIH or with a 3rd party lab system. However, once the Public Health Emergency was declared over and Congress cut the legs out from under the pandemic budget, surveillance options vaporized.

This isn't any different than anything else related to public health, which is why my peers have been sounding an alarm for over a year now - that we're in big f-ing trouble. Money for all things related to public health (not just COVID-19) has been yanked from federal all the way down to local levels. It's the most insane response to a global pandemic I could possibly imagine. Historically public health has gone through up and down cycles; what's happening now is unprecedented.

As far as I know, this is the current plan:

U.S. airports are visited by more than 1 billion travelers each year.

Travelers are an important population to consider when tracking new and emerging infectious diseases because they move from place to place quickly and can spread pathogens across borders.

Strategic biosurveillance at airports enables timely detection of SARS-CoV-2 variants and other pathogens of public health importance.

The CDC has partnered with private labs with the little money they could spare to set up random kiosks at various high-traffic airports in the United States. They are accepting volunteers - people that just randomly walk up to the table - for submission sampling. Identifying information is not maintained. Likely it's an ID number, point of origin and destination (city, state).

We (the CDC) absolutely already does genomic surveillance for other illnesses. For the foodborne illness outbreaks, the genomic surveillance is helpful in figuring out how and where it likely started. The issue for COVID-19 is the size and scope. Despite what you might have heard, the pandemic rages on and so to try and stay on top of things it would require a substantial budget and operational team (for all the administrative elements as well). Apparently we've decided that it's no big deal anymore so all subsequent decisions follow that directive.

Again, what's happening is unprecedented. My only explanation at this point is that government and private industry are gambling against PASC (Long Covid) - taking a chance that it's no big deal and that in another 5-10 years there won't be millions of disabled people. It's really the only guess I have left at this point.

Sorry that's a bit long.

[Smoove_B]

Not a treatment or vaccine update, but this is the first I'm seeing this reported:

In a sign that scientists still don’t fully understand how some COVID-19 variants manage to evade the immune system, a new Ontario study has found that retirement- and long-term-care home residents infected during the first Omicron wave were 20 times more likely to get reinfected by the virus than those who avoided a prior infection.

The surprising finding by researchers at McMaster University runs counter to the prevailing wisdom that a previous COVID infection affords protection against future infections, at least in the older adults who participated in the study.

[Unagi]

Maybe the people that have managed to avoid infection are just 20 times more likely to avoid infections - and those that suck at it, are bound to keep sucking at it?

[Smoove_B]

Maybe? It wouldn't be the first time we discover that a virus does something that makes future infections (even from other agents) more likely.

One of the most unique—and most dangerous—features of measles pathogenesis is its ability to reset the immune systems of infected patients. During the acute phase of infection, measles induces immune suppression through a process called immune amnesia. Studies in non-human primates revealed that MV actually replaces the old memory cells of its host with new, MV-specific lymphocytes. As a result, the patient emerges with both a strong MV-specific immunity and an increased vulnerability to all other pathogens.

[LordMortis]

Maybe the people that have managed to avoid infection are just 20 times more likely to avoid infections - and those that suck at it, are bound to keep sucking at it?

That what I read at first glance. Those distancing and masking and avoiding gatherings and public transit and eating out three years later are likely still not getting infected like those who have been ignoring everything for three years straight. The surprise to me would be if that wasn't the case. Otherwise I would think about traveling and eating and lingering and going to an indoor gathering and....

Of course, you confirm my bias, so you must be wise.

[Smoove_B]

Big article in Nature yesterday about the new BA.2.86 variant:

To many scientists, the emergence of BA.2.86 is reminiscent of the early days of the Omicron variant in late 2021, when scientists in southern Africa noticed a weird-looking lineage that quickly went global. “There’s a little bit of déjà vu all over again,” says Adam Lauring, a virologist and infectious-disease physician at the University of Michigan in Ann Arbor, whose lab identified one person infected with BA.2.86.

Successive COVID-19 waves and booster vaccine roll-outs mean global immunity to SARS-CoV-2 is higher and broader than ever, and most scientists do not expect BA.2.86 to have the same impact as Omicron’s arrival. “There’s good reason to think it won’t be like the Omicron wave, but it’s early days,” Lauring adds.

I was reading some general commentary online (the viral scientist community) and they largely seem to be in agreement. Namely, that the coming weeks are going to help make things much clearer.

Some info:

Many of BA.2.86’s changes are in regions of the spike protein targeted by the body’s potent infection-blocking, or neutralizing, antibodies, says Bloom, who posted a preliminary analysis of the variant last week. For this reason, there is a good chance that the variant will be able to escape some of the neutralizing antibodies triggered by previous infections and vaccine boosters.

Another feature of BA.2.86 that has scientists paying attention is its geographical distribution. None of the cases seem to be linked — including three infections in Denmark that were detected in different parts of the country. This suggests that variant may already be fairly widespread, says Bloom. “It’s got to have been transmitting a fair amount.” The UK Health Security Agency said that there is a case in a person with no recent travel history, “suggesting a degree of community transmission within the UK”.

Of note:

Bloom says that he is especially interested in seeing the extent to which BA.2.86 can evade neutralizing antibodies triggered by a recent infection with a variant called XBB.1.5, because the latest COVID-19 booster vaccines are based on that variant’s spike sequence. “If something like [BA.2.86] became widespread. I think you’d want to start thinking about updating the vaccine,” says Bloom.

Is it time to crack each other's heads open and feast upon the goo inside?

“I don’t think anybody needs to be alarmed by this,” stresses Bloom. “The most likely scenario is that this variant fizzles out, and in a month, nobody other than people like me even remember that it existed.”

Even if BA.2.86 becomes widespread and proves adept at dodging neutralizing antibodies — which looks likely based on its set of spike mutations — other forms of immunity are likely to keep most people from getting seriously ill if they are infected, Bloom adds.

[Smoove_B]

On the "seasonality" of Covid-19:

To most people on the planet, the Covid-19 pandemic is over. But for many scientists who have been tracking the largest global infectious disease event in the era of molecular biology, there is still a step that the virus that caused it, SARS-CoV-2, hasn’t yet taken. It has not fallen into a predictable seasonal pattern of the type most respiratory pathogens follow.

...

It’s been widely expected that SARS-2 will ease into that type of a transmission pattern, once human immune systems and the virus reach a sort of detente. But most experts STAT spoke to about this question said that, so far, the virus has not obliged. Their views differ on the margins. Some expect seasonality to set in soon while others don’t venture to guess when the virus will settle into a seasonal pattern.

...

Questions posed over SARS-2’s lack of seasonality aren’t purely academic. Knowing when to expect a disease is critical for health care labor force planning. The tsunami of RSV-infected babies struggling to breathe in the late summer and early fall of 2022 was made worse by the fact that hospitals weren’t as prepared as they could have been; they normally see RSV peaks in the winter months. Likewise, knowing when to expect SARS-2 surges helps the Food and Drug Administration and the Centers for Disease Control and Prevention time the rollout of Covid booster shots. The protection against infection generated by the vaccines wanes quickly, so giving them too soon or too late would undermine the efficacy of this countermeasure.

Van Kerkhove thinks waning immunity in the population is the reason for the periodic swells of transmission. Protection against severe disease — whether induced by infection, vaccination, or the two combined — appears to hold up reasonably well. But when it comes to SARS-2, protection against basic infection is short-lived. That’s not a surprise given what’s known about the four human coronaviruses that predate the arrival of SARS-2. A study in the Netherlands that followed healthy volunteers for more than 35 years found that people can be reinfected with human coronaviruses within about a year after infection, and sometimes after a mere six months. With SARS-2, there are reports of intervals that are shorter still.

[Kraken]

I asked my doc about my blood pressure and preceding covid infections. He shrugged and said "could be." Whatever triggered my mild but persistent hypertension is academic, since it won't affect treatment protocols. Ima start a new pill for that tomorrow.

[Victoria Raverna]

I asked my doc about my blood pressure and preceding covid infections. He shrugged and said "could be." Whatever triggered my mild but persistent hypertension is academic, since it won't affect treatment protocols. Ima start a new pill for that tomorrow.

Maybe just coincidence, now my average blood pressure is higher than what it was before COVID-19 infection.

Or maybe because I'm older now.

[Kraken]

I asked my doc about my blood pressure and preceding covid infections. He shrugged and said "could be." Whatever triggered my mild but persistent hypertension is academic, since it won't affect treatment protocols. Ima start a new pill for that tomorrow.

Maybe just coincidence, now my average blood pressure is higher than what it was before COVID-19 infection.

Or maybe because I'm older now.

A study came out last week saying (IIRC) that about 25% of those who were hospitalized for covid, and 10% of those who had mild cases, have elevated blood pressure a year later. That's in line with my experience.

[Smoove_B]

Americans had undiagnosed and unmanaged elevated BP before the pandemic. We now have a situation where a significant number of people have been added to that list, putting them at increased risk for all kinds of problems.

Your doctor didn't care because most doctors don't care about prevention - they're focused on treating the problem that already exists. Hopefully you can take a pill and be fine. I've been on BP meds for almost a decade now.

[Kraken]

Hopefully you can take a pill and be fine. I've been on BP meds for almost a decade now.

That's the hope. I'll know in a few weeks. Took my first one this morning and felt a little lightheaded when I got a couple of miles into my walk. Might have to take that pill after I exercise.

Oh wait, this isn't the I'm Old thread. Sorry, carry on.

[ImLawBoy]

Four days into the new school year, and . . . girl twin has COVID! It's her second time. So far everyone else is negative, but we'll keep an eye on things.

[Blackhawk]

Oof, that sucks, especially with everything else going on for you right now. Be careful, and be safe.

[Smoove_B]

I am sorry to hear it as well. Not really great news on the vaccination either; the earliest they're meeting is 9/12 to sign off on it. Once again, they're at least a month+ behind the latest surge with this effort:

"What are they waiting for? They need to step up their game now, and get the booster out ASAP to the public," said Dr. Hugh Cassiere, director of critical care services at South Shore University Hospital, part of Northwell Health in New York.

..,.

Officials maintain that they are working fast enough and carefully enough to ensure that the mid-September rollout of the boosters will be effective.

"Our goal is to release and recommend the vaccine so that it can coincide as much as possible with the peak of the season," Dr. Nirav Shah, CDC's principal deputy director, said in an interview.

The peak in Covid spread, Shah and others guess, may occur in November or December.

"Theoretically, if you vaccinate a lot of people too early, and their immunity wanes even by a couple of percentage points, the peak of the season could have far more significant consequences."

"There's an art to it, as well as a science," Shah said.

When so few people actually voluntarily vaccinate, trying to time the release feels pointless.

Remember:

Even if the first shots are given as soon as CDC Director Dr. Mandy Cohen signs off on them, it could be an additional two weeks for people to develop full protection.

I guess we'll see how things look on 10/1 and armchair QB whether or not it was a good idea.

[hitbyambulance]

and now it's my turn - just blew (or dripped) positive this morning. i kinda knew i had it before the test result returned positive - i had pretty much ALL the classic symptoms and it really couldn't be mistaken for anything else - it didn't feel like any kind of illness i've ever had before. going to see if i can get on Paxlovid since i qualify