Metformin may help prevent Long COVID
March 8, 2023 10:59 AM Subscribe
"I don’t use the term “breakthrough” lightly." The latest Ground Truths from Eric Topol discusses a new randomized, placebo-controlled trial of metformin, with a 42% reduction of subsequent Long Covid in participants who received metformin compared to the placebo group.
More in this preprint at the National Institutes of Health.
In the popular press: Trying to Stop Long COVID Before It Even Starts, Katherine J. Wu, The Atlantic
From Eric Topol's Ground Truths piece, A break from Covid waves and a breakthrough for preventing Long Covid:
More in this preprint at the National Institutes of Health.
In the popular press: Trying to Stop Long COVID Before It Even Starts, Katherine J. Wu, The Atlantic
From Eric Topol's Ground Truths piece, A break from Covid waves and a breakthrough for preventing Long Covid:
I don’t use the term “breakthrough” lightly. Besides Paxlovid, that I initially wrote about in 2021 here, and the new anti-obesity drugs here, I’m reluctant to go there. But to see such a pronounced benefit in the current randomized trial of metformin, in the context of it being so safe and low cost, I’d give it a breakthrough categorization. Another way to put it, that unless or until there are data to the contrary, if I got Covid, I’d take metformin for 2 weeks at the doses used in this trial.
I wonder if there's been any research on fasting as either a preventative measure or treatment for long COVID.
posted by drstrangelove at 11:19 AM on March 8, 2023
posted by drstrangelove at 11:19 AM on March 8, 2023
I haven't gotten Covid yet, but these firsthand Long Covid stories scare the hell out of me.
posted by gottabefunky at 11:31 AM on March 8, 2023 [27 favorites]
posted by gottabefunky at 11:31 AM on March 8, 2023 [27 favorites]
I was just reading somewhere today that Metformin depletes b12. But probably 2 weeks of b12 depletion is no big deal for most people.
posted by aniola at 11:32 AM on March 8, 2023 [3 favorites]
posted by aniola at 11:32 AM on March 8, 2023 [3 favorites]
a 42% reduction of subsequent Long Covid in participants who received metformin compared to the placebo group.
I look forward to the responses from those insisting that LC is just mass hysteria.
I was just reading somewhere today that Metformin depletes b12. But probably 2 weeks of b12 depletion is no big deal for most people.
posted by aniola
IIRC that is only an issue for long term use.
posted by Pouteria at 11:48 AM on March 8, 2023 [2 favorites]
I look forward to the responses from those insisting that LC is just mass hysteria.
I was just reading somewhere today that Metformin depletes b12. But probably 2 weeks of b12 depletion is no big deal for most people.
posted by aniola
IIRC that is only an issue for long term use.
posted by Pouteria at 11:48 AM on March 8, 2023 [2 favorites]
So interesting, points towards a completely unanticipated mechanism.
When I get covid, hoping I can convince my PCP or someone to get me metformin.
posted by Dashy at 11:49 AM on March 8, 2023 [1 favorite]
When I get covid, hoping I can convince my PCP or someone to get me metformin.
posted by Dashy at 11:49 AM on March 8, 2023 [1 favorite]
Metformin suppresses some interleukin inflamatory processes. Some portion of long covid could be persistant inflamation.
posted by anecdotal_grand_theory at 12:00 PM on March 8, 2023 [9 favorites]
posted by anecdotal_grand_theory at 12:00 PM on March 8, 2023 [9 favorites]
Also, as an aside, when people tell me they havent had covid yet, i ask them if they have been tested weekly since march of 2020. They haven't.
I'm glad they haven't had symptomatic covid. I still try to remind people that they can carry and spread covid without having symptoms themselves. Something like 1/3 of covid infections are that way.
as for long covid, it joins a noble list of real things that initially get described as hysteria. Indeed, the best way to know a condition is real is when doctors assume its hysteria.
posted by anecdotal_grand_theory at 12:04 PM on March 8, 2023 [12 favorites]
I'm glad they haven't had symptomatic covid. I still try to remind people that they can carry and spread covid without having symptoms themselves. Something like 1/3 of covid infections are that way.
as for long covid, it joins a noble list of real things that initially get described as hysteria. Indeed, the best way to know a condition is real is when doctors assume its hysteria.
posted by anecdotal_grand_theory at 12:04 PM on March 8, 2023 [12 favorites]
Also, as an aside, when people tell me they havent had covid yet, i ask them if they have been tested weekly since march of 2020. They haven't.
Some of us who have never had COVID yet didn't effectively leave our houses for a year and a half until we were fully vaccinated, and even in March 2023 do not eat indoors in restaurants, do not shop in grocery stores, and still wear N95/KN95 masks when going indoors in other places.
I'm happy to put cash money on a bet that I haven't had asymptomatic COVID, thank you very much.
posted by tclark at 12:10 PM on March 8, 2023 [79 favorites]
Some of us who have never had COVID yet didn't effectively leave our houses for a year and a half until we were fully vaccinated, and even in March 2023 do not eat indoors in restaurants, do not shop in grocery stores, and still wear N95/KN95 masks when going indoors in other places.
I'm happy to put cash money on a bet that I haven't had asymptomatic COVID, thank you very much.
posted by tclark at 12:10 PM on March 8, 2023 [79 favorites]
Idk, I did all those things and I got symptomatic COVID last year, so it's not at all a sure thing.
posted by BungaDunga at 12:14 PM on March 8, 2023 [34 favorites]
posted by BungaDunga at 12:14 PM on March 8, 2023 [34 favorites]
Something like 1/3 of covid infections are that way.
This is one of those stats/facts that’s presumably a moving target, with which I stopped keeping up a while ago, but I’ve been under the impression that presymptomatic spreading is a very big driver of transmission - indeed that the peak of viral shedding is from a couple days before the onset of symptoms to a couple days after - but that true asymptomatic carriers are likely smaller, though nonzero contributors.
As I said don’t know how that’s held up post-Omicron, though, with higher transmissibility, faster turnaround and a greater number of mild cases in general.
posted by atoxyl at 12:14 PM on March 8, 2023 [4 favorites]
This is one of those stats/facts that’s presumably a moving target, with which I stopped keeping up a while ago, but I’ve been under the impression that presymptomatic spreading is a very big driver of transmission - indeed that the peak of viral shedding is from a couple days before the onset of symptoms to a couple days after - but that true asymptomatic carriers are likely smaller, though nonzero contributors.
As I said don’t know how that’s held up post-Omicron, though, with higher transmissibility, faster turnaround and a greater number of mild cases in general.
posted by atoxyl at 12:14 PM on March 8, 2023 [4 favorites]
i ask them if they have been tested weekly since march of 2020
I don't think the quick test is good enough to answer this question anyways.
Cochrane Institute
"In people with confirmed COVID-19, antigen tests correctly identified COVID-19 infection in an average of 73% of people with symptoms, compared to 55% of people without symptoms...In people who did not have COVID-19, antigen tests correctly ruled out infection in 99.6% of people with symptoms and 99.7% of people without symptoms."
So if you got a negative test without ever having COVID, that's 99.7. But if you've got an asymptomatic case, that's only 55%.
posted by The_Vegetables at 12:16 PM on March 8, 2023 [4 favorites]
I don't think the quick test is good enough to answer this question anyways.
Cochrane Institute
"In people with confirmed COVID-19, antigen tests correctly identified COVID-19 infection in an average of 73% of people with symptoms, compared to 55% of people without symptoms...In people who did not have COVID-19, antigen tests correctly ruled out infection in 99.6% of people with symptoms and 99.7% of people without symptoms."
So if you got a negative test without ever having COVID, that's 99.7. But if you've got an asymptomatic case, that's only 55%.
posted by The_Vegetables at 12:16 PM on March 8, 2023 [4 favorites]
I look forward to the responses from those insisting that LC is just mass hysteria.
Well for those people, this treatment reduces mass hysteria 40% vs a placebo, which is an even bigger breakthrough, right?
posted by aubilenon at 12:17 PM on March 8, 2023 [8 favorites]
Well for those people, this treatment reduces mass hysteria 40% vs a placebo, which is an even bigger breakthrough, right?
posted by aubilenon at 12:17 PM on March 8, 2023 [8 favorites]
I did all those things and I got symptomatic COVID last year, so it's not at all a sure thing.
Oh, it's definitely not a sure thing, and I'm extremely grateful for being fortunate to have not gotten it, but I'm not going to presume there's a significant chance I've had an asymptomatic case just because.
Besides, even if I would lose the bet I'm willing to make, my continuing precautions in public would protect others as much as myself.
posted by tclark at 12:19 PM on March 8, 2023 [6 favorites]
Oh, it's definitely not a sure thing, and I'm extremely grateful for being fortunate to have not gotten it, but I'm not going to presume there's a significant chance I've had an asymptomatic case just because.
Besides, even if I would lose the bet I'm willing to make, my continuing precautions in public would protect others as much as myself.
posted by tclark at 12:19 PM on March 8, 2023 [6 favorites]
Well for those people, this treatment reduces mass hysteria 40% vs a placebo, which is an even bigger breakthrough, right?
No, these results don't describe treatment of long COVID, it's prevention of long COVID via treatment during COVID infection.
posted by entropone at 12:19 PM on March 8, 2023 [2 favorites]
No, these results don't describe treatment of long COVID, it's prevention of long COVID via treatment during COVID infection.
posted by entropone at 12:19 PM on March 8, 2023 [2 favorites]
I guess instead of "reduces" I should have said "prevents"
posted by aubilenon at 12:20 PM on March 8, 2023 [1 favorite]
posted by aubilenon at 12:20 PM on March 8, 2023 [1 favorite]
These firsthand Long Covid stories scare the hell out of me.
Dianna Cowern is in very poor shape atm.
posted by CynicalKnight at 12:29 PM on March 8, 2023 [11 favorites]
Dianna Cowern is in very poor shape atm.
posted by CynicalKnight at 12:29 PM on March 8, 2023 [11 favorites]
Lol I literally just said it loud to my phone "the fuck?! metformin??" I only know of it as a diabetes drug. Does anyone have a sense of why it was in this trial at all?
My partner has had covid for almost two weeks now, between the initial bout and Paxlovid rebound. He is isolating so the kids and I don't get sick, and I am nearing the end of my rope solo parenting like this. I'm getting a feeling that researchers have concluded there isn't much more money to be made treating covid now that Paxlovid exists, but anyone who's been through this rebound scenario can tell you it's not a perfect drug and there's definitely room for improvement. Right now he isn't severely ill but he's still testing strongly positive. We are all ready for this to be over.
posted by potrzebie at 12:37 PM on March 8, 2023 [5 favorites]
My partner has had covid for almost two weeks now, between the initial bout and Paxlovid rebound. He is isolating so the kids and I don't get sick, and I am nearing the end of my rope solo parenting like this. I'm getting a feeling that researchers have concluded there isn't much more money to be made treating covid now that Paxlovid exists, but anyone who's been through this rebound scenario can tell you it's not a perfect drug and there's definitely room for improvement. Right now he isn't severely ill but he's still testing strongly positive. We are all ready for this to be over.
posted by potrzebie at 12:37 PM on March 8, 2023 [5 favorites]
Has Metformin been tested for those who already have Long COVID? To see what it does?
I got presumed COVID in early March 2020, and have had mild ME/CFS since then. I'm also getting evaluated for POTS in a couple of weeks. I tried getting into a couple of Long COVID studies, but the hard thing was that I don't have a positive test from that March. My doctor's office wasn't testing anyone what hadn't been in Wuhan, China, and when I finally got a test? All of the symptoms had passed, and it was negative.
posted by spinifex23 at 12:52 PM on March 8, 2023 [1 favorite]
I got presumed COVID in early March 2020, and have had mild ME/CFS since then. I'm also getting evaluated for POTS in a couple of weeks. I tried getting into a couple of Long COVID studies, but the hard thing was that I don't have a positive test from that March. My doctor's office wasn't testing anyone what hadn't been in Wuhan, China, and when I finally got a test? All of the symptoms had passed, and it was negative.
posted by spinifex23 at 12:52 PM on March 8, 2023 [1 favorite]
Dianna Cowern is in very poor shape atm.
I'm so glad she has such a great support circle (like Simone Giertz, who is no stranger to having her life completely disrupted by health issues). It's heartrending what she's going through.
posted by Lentrohamsanin at 1:01 PM on March 8, 2023 [3 favorites]
I'm so glad she has such a great support circle (like Simone Giertz, who is no stranger to having her life completely disrupted by health issues). It's heartrending what she's going through.
posted by Lentrohamsanin at 1:01 PM on March 8, 2023 [3 favorites]
I got presumed COVID in early March 2020, and have had mild ME/CFS since then. I'm also getting evaluated for POTS in a couple of weeks. I tried getting into a couple of Long COVID studies, but the hard thing was that I don't have a positive test from that March. My doctor's office wasn't testing anyone what hadn't been in Wuhan, China, and when I finally got a test? All of the symptoms had passed, and it was negative.
This is pretty much my daughter's story to a T, except that she's been to several clinics and been in several studies after referrals from our family doctor, even though she's never had a positive test. Pretty much all of them have just been like *shrug* though, after the study is over. She's sees a cardiologist who's great and put her on beta blockers for her insane racing heartbeat and a few other meds for nausea/brain fog stuff like that. But it's been basically a fever every night since March 2020, can't stand up long enough to brush her teeth, has a wheelchair to go further than the end of the block. All manner of other weird and awful symptoms. Ice packs, blue-tinted glasses, whatever food doesn't gross her out that week. Well-meaning friends send her "hopeful" LONG COVID IS REAL! articles about this or that study or research! about micro clotting or whatever the latest thing is, (which inevitably have a sad person looking out a window as the featured picture.) She's on disability because she can't work, after catching this right after graduating university. Her social media is filled with people she knows going to concerts and YAY BACK TO NORMAL and it fucking sucks. She used to be in chat groups with other Long Covid sufferers at the beginning but she ended up leaving after the first year because new people would come in all "I have this and this symptom, when do you start feeling better?" and it became too sad to just say "never."
posted by chococat at 1:11 PM on March 8, 2023 [23 favorites]
This is pretty much my daughter's story to a T, except that she's been to several clinics and been in several studies after referrals from our family doctor, even though she's never had a positive test. Pretty much all of them have just been like *shrug* though, after the study is over. She's sees a cardiologist who's great and put her on beta blockers for her insane racing heartbeat and a few other meds for nausea/brain fog stuff like that. But it's been basically a fever every night since March 2020, can't stand up long enough to brush her teeth, has a wheelchair to go further than the end of the block. All manner of other weird and awful symptoms. Ice packs, blue-tinted glasses, whatever food doesn't gross her out that week. Well-meaning friends send her "hopeful" LONG COVID IS REAL! articles about this or that study or research! about micro clotting or whatever the latest thing is, (which inevitably have a sad person looking out a window as the featured picture.) She's on disability because she can't work, after catching this right after graduating university. Her social media is filled with people she knows going to concerts and YAY BACK TO NORMAL and it fucking sucks. She used to be in chat groups with other Long Covid sufferers at the beginning but she ended up leaving after the first year because new people would come in all "I have this and this symptom, when do you start feeling better?" and it became too sad to just say "never."
posted by chococat at 1:11 PM on March 8, 2023 [23 favorites]
This is great! Metformin is commonly prescribed for pregnant people with gestational diabetes (why I'm familiar with it.)
posted by freethefeet at 1:15 PM on March 8, 2023
posted by freethefeet at 1:15 PM on March 8, 2023
Never happier to be a type 2 diabetic.
posted by Halloween Jack at 1:24 PM on March 8, 2023 [7 favorites]
posted by Halloween Jack at 1:24 PM on March 8, 2023 [7 favorites]
I've been taking about twice this dose of metformin for years with no side effects (some people do have them, as I understand it gives you the shits, better than LC IMHO), I do get a B12 shot about once a year.
Metformin has been touted as a wonder drug for a bunch of things over the past few years, I suspect the jury is still out for many of them, and this is just one study, and it obviously needs to be repeated. On the other hand metformin is incredibly cheap - that whole dose against covid costs ~$5, and for those who tolerate it benign (so few downsides for taking it).
Interestingly some coverage of this study indicates that some of the placebo people got invermectin .... and results were no different from placebo (I can't find a reference so maybe not a real thing)
posted by mbo at 1:30 PM on March 8, 2023
Metformin has been touted as a wonder drug for a bunch of things over the past few years, I suspect the jury is still out for many of them, and this is just one study, and it obviously needs to be repeated. On the other hand metformin is incredibly cheap - that whole dose against covid costs ~$5, and for those who tolerate it benign (so few downsides for taking it).
Interestingly some coverage of this study indicates that some of the placebo people got invermectin .... and results were no different from placebo (I can't find a reference so maybe not a real thing)
posted by mbo at 1:30 PM on March 8, 2023
Oh wait, the ivermectin data is right there in the NiH link, I just can't spell 'ivermectin')
posted by mbo at 1:42 PM on March 8, 2023
posted by mbo at 1:42 PM on March 8, 2023
Dang, I was hoping this was about treatment for LC, not prevention. If you have to take the meds within a short time period of symptomatic covid, it's a similar schedule to paxlovid, which people haven't been taking in the amounts they probably should.
Testing facilities are being closed down, sick pay for covid is being removed, at home testing will cost money. And based on the people I know who have gotten covid recently, they're probably going to just ignore the (usually mild) symptoms because the risks of LC are downplayed. They're not going to test or quarantine as it would cost them time and money. We're not even counting the people who lie about having it. And if no one bothers to find out if it's actually covid, they're certainly not going to go out and seek the medication for it.
posted by meowzilla at 1:47 PM on March 8, 2023 [7 favorites]
Testing facilities are being closed down, sick pay for covid is being removed, at home testing will cost money. And based on the people I know who have gotten covid recently, they're probably going to just ignore the (usually mild) symptoms because the risks of LC are downplayed. They're not going to test or quarantine as it would cost them time and money. We're not even counting the people who lie about having it. And if no one bothers to find out if it's actually covid, they're certainly not going to go out and seek the medication for it.
posted by meowzilla at 1:47 PM on March 8, 2023 [7 favorites]
One interesting finding - in the study population, participants who were vaccinated (primary series, boosters not assessed) had no change in their long COVID risk if they took metformin compared to placebo. The long COVID risk difference from vaccination looks very similar in magnitude to the metformin (6.6% long COVID in vaccinated participants, 10.5% in unvaccinated).
posted by quadrilaterals at 1:58 PM on March 8, 2023 [12 favorites]
posted by quadrilaterals at 1:58 PM on March 8, 2023 [12 favorites]
FWIW, I and a group of covid-conscious friends have been getting ourselves a supply of Enovid, a nitric oxide nasal spray, as a way to reduce the chances of infection from exposure. Nitric oxide was already being used as a broad-spectrum antibacterial, and more recently studied as a broad-spectrum antiviral agent. A method was found to package it as two liquids that form nitric oxide gas when mixed and that's what Enovid is. It's in phase-3 studies in multiple countries and is approved for sale in a few others, including Israel, where it was developed. In addition to reducing the chances of infection, a more recent study showed that as a post-infection treatment, detectable viral load was reduced to a small fraction as the control group. Hopefully this will show use in prevention of LC. I'm not associated with the product at all, but I've been finding it reassuring to be able to use it immediately after being in a situation that I find too "people-y" for my comfort.
posted by WaylandSmith at 2:01 PM on March 8, 2023 [8 favorites]
posted by WaylandSmith at 2:01 PM on March 8, 2023 [8 favorites]
Some of us who have never had COVID yet didn't effectively leave our houses for a year and a half until we were fully vaccinated, and even in March 2023 do not eat indoors in restaurants, do not shop in grocery stores, and still wear N95/KN95 masks when going indoors in other places.
I'm happy to put cash money on a bet that I haven't had asymptomatic COVID, thank you very much.
I don't think anyone is impugning your precautions. The choices we make in response to Covid are heavily moral in the way they affect others, but the actual getting of Covid or not is entirely amoral; if you come up on the wrong side of the statistical likelihood, the virus doesn't care whether you did the right thing. The suggestion that you may have had Covid does not imply that you haven't been making real sacrifices to protect yourself and others.
posted by dusty potato at 2:06 PM on March 8, 2023 [22 favorites]
I'm happy to put cash money on a bet that I haven't had asymptomatic COVID, thank you very much.
I don't think anyone is impugning your precautions. The choices we make in response to Covid are heavily moral in the way they affect others, but the actual getting of Covid or not is entirely amoral; if you come up on the wrong side of the statistical likelihood, the virus doesn't care whether you did the right thing. The suggestion that you may have had Covid does not imply that you haven't been making real sacrifices to protect yourself and others.
posted by dusty potato at 2:06 PM on March 8, 2023 [22 favorites]
I got Covid in Dec 2021, fairly mild as I had Moderna + a booster at the time. I've been on metformin for PCOS/pre-diabetes (The PCOS is not helping a family history) since 2019. The only long covid symptom I've had was the loss of smell (and only certain scents), but it's slowly coming back. So the metformin might be why I only lost my smell.
posted by tlwright at 2:57 PM on March 8, 2023
posted by tlwright at 2:57 PM on March 8, 2023
Me: You can be infected and not know it
People: No, i would know if i had been infected and not known it.
And Scene!
Thank you commentors for indulging my little derail about the difference between " i never had symptoms" vs "i never had/spread covid". It is airborne, retains viabilty on surfaces dozens of hours including on cheese/meats and warm food. So if someone tells you they've avoided air and food for 3 years, draw your own conclusion.
Back to Metformin. Metformin has shown effectiveness for weightloss in humans and life-extension in animal models. The prior hypothesis if mechanism were that uncontrolled/high blood sugar is bad and inflammatory thus lowering it is good. But metformin also directly interferres with interleukins, the inflammatory signaling proteins.
And, as noted above, its affordable. This is v good news if the result is replicated and then expanded to trials in those with Long Covid already.
posted by anecdotal_grand_theory at 3:52 PM on March 8, 2023 [7 favorites]
People: No, i would know if i had been infected and not known it.
And Scene!
Thank you commentors for indulging my little derail about the difference between " i never had symptoms" vs "i never had/spread covid". It is airborne, retains viabilty on surfaces dozens of hours including on cheese/meats and warm food. So if someone tells you they've avoided air and food for 3 years, draw your own conclusion.
Back to Metformin. Metformin has shown effectiveness for weightloss in humans and life-extension in animal models. The prior hypothesis if mechanism were that uncontrolled/high blood sugar is bad and inflammatory thus lowering it is good. But metformin also directly interferres with interleukins, the inflammatory signaling proteins.
And, as noted above, its affordable. This is v good news if the result is replicated and then expanded to trials in those with Long Covid already.
posted by anecdotal_grand_theory at 3:52 PM on March 8, 2023 [7 favorites]
From Topol's article, "There are about 15% of Americans (more than what many people think or have been led to believe), based on all the serologic data available, who never had Covid and are relying on their vaccines/boosters to avoid their first infection."
posted by SoundInhabitant at 4:19 PM on March 8, 2023 [8 favorites]
posted by SoundInhabitant at 4:19 PM on March 8, 2023 [8 favorites]
I've had four negative nucleocapsid tests.
I'm relying on my behavior more than boosters to avoid infection. I mask diligently. I carry a personal HEPA filter. I have not flown since 2019. We do not eat indoors around other pieholes.
But yeah, if some internet rando is sure, then you must know better than me.
posted by Dashy at 4:37 PM on March 8, 2023 [6 favorites]
I'm relying on my behavior more than boosters to avoid infection. I mask diligently. I carry a personal HEPA filter. I have not flown since 2019. We do not eat indoors around other pieholes.
But yeah, if some internet rando is sure, then you must know better than me.
posted by Dashy at 4:37 PM on March 8, 2023 [6 favorites]
Same, Dashy.
Now to throw out this text entry box. It's completely worn out from all the stuff I've typed into it and deleted.
posted by tigrrrlily at 4:51 PM on March 8, 2023 [4 favorites]
Now to throw out this text entry box. It's completely worn out from all the stuff I've typed into it and deleted.
posted by tigrrrlily at 4:51 PM on March 8, 2023 [4 favorites]
So if someone tells you they've avoided air and food for 3 years, draw your own conclusion.
I've entirely avoided Covid, being able to synthesise all of my body's necessary nutrients entirely through sunlight and rainwater
posted by Merus at 4:59 PM on March 8, 2023 [3 favorites]
I've entirely avoided Covid, being able to synthesise all of my body's necessary nutrients entirely through sunlight and rainwater
posted by Merus at 4:59 PM on March 8, 2023 [3 favorites]
I have long covid after something like 2-3 bouts and infections before the Moderna dose and perhaps an additional 1-2 times after.
Even though it's very clear I've had covid and I have had basically all of the buffet of symptoms except for death, I never had any of my covid tests test positive whether PCR/lab or quick home tests.
At this point I'm effectively disabled to the point that it's like I had a stroke or brain tumor. I'm easily half or less as smart or quick as I was before covid. I'm exhausted all the time and have maybe 25% or less of my energy or endurance. Mild exercise and exertion can wreck me for days afterwards and cause huge flare ups. I've been dealing with significant speech and language aphasia like totally spacing out on grammar or vocabulary or dealing with slurred verbal speech like I'm drunk even when I'm well rested and stone cold sober.
I really wish there was some kind of protocol or treatment for LC at this point but after a year plus of tests, diagnostic imaging and eliminating other major things like brain cancer or other chronic diseases there's... basically nothing and no treatment available and I don't know what to do but hang on and take it easy and rest as much as I can.
I don't even know where I'm going with all of this except to overshare with my internet family and also maybe to say - yeah, don't get long covid and anything that can help people not get long covid needs to become a protocol and standard.
posted by loquacious at 5:02 PM on March 8, 2023 [45 favorites]
Even though it's very clear I've had covid and I have had basically all of the buffet of symptoms except for death, I never had any of my covid tests test positive whether PCR/lab or quick home tests.
At this point I'm effectively disabled to the point that it's like I had a stroke or brain tumor. I'm easily half or less as smart or quick as I was before covid. I'm exhausted all the time and have maybe 25% or less of my energy or endurance. Mild exercise and exertion can wreck me for days afterwards and cause huge flare ups. I've been dealing with significant speech and language aphasia like totally spacing out on grammar or vocabulary or dealing with slurred verbal speech like I'm drunk even when I'm well rested and stone cold sober.
I really wish there was some kind of protocol or treatment for LC at this point but after a year plus of tests, diagnostic imaging and eliminating other major things like brain cancer or other chronic diseases there's... basically nothing and no treatment available and I don't know what to do but hang on and take it easy and rest as much as I can.
I don't even know where I'm going with all of this except to overshare with my internet family and also maybe to say - yeah, don't get long covid and anything that can help people not get long covid needs to become a protocol and standard.
posted by loquacious at 5:02 PM on March 8, 2023 [45 favorites]
I've entirely avoided Covid, being able to synthesise all of my body's necessary nutrients entirely through sunlight and rainwater
Weird, I've been going with constricting my anus 100 times a day.
posted by loquacious at 5:03 PM on March 8, 2023 [12 favorites]
Weird, I've been going with constricting my anus 100 times a day.
posted by loquacious at 5:03 PM on March 8, 2023 [12 favorites]
loquacious, I'm so sorry that all has happened to you and is still going on. Ugh, ugh, ugh. Here's a hug if you'd like one.
I don't know if anyone's eligible for paxlovid if they're not testing positive, but is it something you might be able to bring up with your doctor?
Could Paxlovid treat long Covid? Major new study aims to find out, NBC News
Study suggests Paxlovid eases long-COVID symptoms, Minnesota Center for Infectious Disease Research & Policy News
It may be a long shot, but it might be worth at least asking about.
Meanwhile, here's another hug, which may not help either but hopefully won't hurt.
posted by kristi at 5:15 PM on March 8, 2023 [4 favorites]
I don't know if anyone's eligible for paxlovid if they're not testing positive, but is it something you might be able to bring up with your doctor?
Could Paxlovid treat long Covid? Major new study aims to find out, NBC News
Study suggests Paxlovid eases long-COVID symptoms, Minnesota Center for Infectious Disease Research & Policy News
It may be a long shot, but it might be worth at least asking about.
Meanwhile, here's another hug, which may not help either but hopefully won't hurt.
posted by kristi at 5:15 PM on March 8, 2023 [4 favorites]
Anecdote from a friend who is one of my more conscientious friends who has been avoiding high risk situations except this one time when she's made to go on international work travel and subsequently picked up Covid: she went to the one of the national response centres we still have open and was prescribed paxlovid and she said that it left a metallic taste in her mouth. she's still having some symptoms and her antigen tests are a mixed bag on a daily basis.
Hoping this study mix it out of preprint and can be replicated. All my friends who had a bout were vaccinated but it seemed like all of them had some form of long-term respiratory issues that lasted for a few months at least.
posted by cendawanita at 7:28 PM on March 8, 2023 [1 favorite]
Hoping this study mix it out of preprint and can be replicated. All my friends who had a bout were vaccinated but it seemed like all of them had some form of long-term respiratory issues that lasted for a few months at least.
posted by cendawanita at 7:28 PM on March 8, 2023 [1 favorite]
in the study population, participants who were vaccinated (primary series, boosters not assessed) had no change in their long COVID risk if they took metformin compared to placebo.
This is important from a public health perspective, because, in a real-world context, persuading someone who hasn't even gotten their primary series to test and seek pharmaceutical treatment (which can cause some GI distress, right?) within a short timeframe is going to be difficult. This discovery (if it holds up, I am begging everyone to remember what a preprint is) may be more useful for illuminating the mechanisms of damage in the affected population.
(I don't understand why the far edge of the pro-mitigation wing devolves into wishing catastrophe on people. It's both a serious ethical failure and exactly the opposite of what persuades others. But that's a side note.)
posted by praemunire at 8:51 PM on March 8, 2023 [2 favorites]
This is important from a public health perspective, because, in a real-world context, persuading someone who hasn't even gotten their primary series to test and seek pharmaceutical treatment (which can cause some GI distress, right?) within a short timeframe is going to be difficult. This discovery (if it holds up, I am begging everyone to remember what a preprint is) may be more useful for illuminating the mechanisms of damage in the affected population.
(I don't understand why the far edge of the pro-mitigation wing devolves into wishing catastrophe on people. It's both a serious ethical failure and exactly the opposite of what persuades others. But that's a side note.)
posted by praemunire at 8:51 PM on March 8, 2023 [2 favorites]
in a real-world context, persuading someone who hasn't even gotten their primary series to test and seek pharmaceutical treatment (which can cause some GI distress, right?) within a short timeframe is going to be difficult
Isn’t that also the ivermectin/hcq demo, though? One might suggest, only semi-jokingly, that the key is to convince people that They don’t want you to have metformin (which after all is a cheap generic!)
Not jokingly at all, I think people who are specifically vaccine-hesitant but willing to take a short course of something else are a real group. I think the politicization of the whole idea of being concerned about long COVID might be an obstacle for some in that group but again not everyone.
posted by atoxyl at 9:09 PM on March 8, 2023 [5 favorites]
Isn’t that also the ivermectin/hcq demo, though? One might suggest, only semi-jokingly, that the key is to convince people that They don’t want you to have metformin (which after all is a cheap generic!)
Not jokingly at all, I think people who are specifically vaccine-hesitant but willing to take a short course of something else are a real group. I think the politicization of the whole idea of being concerned about long COVID might be an obstacle for some in that group but again not everyone.
posted by atoxyl at 9:09 PM on March 8, 2023 [5 favorites]
One member of our family came down with Covid in December 2021, but the rest of us managed to avoid it (just been vaccinated - probably had something to do with it) then - and until now.
But over the past month, we've all managed to come down with it. It was "bad cold" symptoms and I couldn't even convince anyone to take a Covid test. But I managed to get it last, took the test, and wah-lah. Covid.
The reason I'm bothering to write this down is to get everyone on board with their Paxlovid plan.
Paxlovid is super effective but you must take it within the first few days of becoming sick. Officially that is the first 5 days, but the sooner the better.
Most people eligible for Paxlovid (in the U.S.) can get it by going to a pharmacy (CVS or Walgreens, etc), or via a telemedicine appointment, and simply showing or telling about your positive test results.
However . . . as I found out, if your medical situation is complex at all, they might not be able to do it. This is a bit of a problem, as it is exactly the people with medically complex situations who are going to need Paxlovid most of all.
Anyway, by the time I got to Day 2 of Covid and had my positive test, it was very, very clear this was not going well. It was "only" cold and flu symptoms, but they were very, very heavy. I was sleeping about 23.5 hours per day, and blood oxygen was already below 95 (on literally Day 2).
So I started working on getting a Paxlovid prescription. I'll leave out the details, but it took 36 hours of calling, calling, calling, telemedicine appointments, screwups galore, my one doctor who should have known best said "no prescription," etc etc etc.
36 hours later I finally had the prescription in hand. And what do you know: 3 hours later, 100% turnaround in symptoms.
I've taken a few antivirals before, and frankly, my expectation of them is very low. But in this case - this stuff really works. I highly recommend it if you get Covid and can get ahold of it.
Part of my point though is that you've got to have a plan to get it, and get it in time. When the time comes, you're always going to be surprised, you're always going to be feeling terrible, you're always going to not have the help you really want or need, and (assuming you're in the U.S.) the terrible U.S. health care system is bound to do its best to get in your way as much as possible.
This article has suggestions for getting lined up with Paxlovid. CDC Paxlovid overview. Talk to your primary care physician about this in advance. If you're in one of the judgement areas for eligibility (specifically, lower kidney or liver function) make sure your labs are current a couple of times per year - no one is going to want to send you in for new labs the first day after you come down with covid.
Also there are two other helpful treatments if Paxlovid doesn't work out for you - Molnupiravir and Remdesivir (info on both of those on the CDC page.) Despite what you may have heard, both of these are actually quite helpful, especially if started early on - as with Paxlovid, the sooner the better. Remdesivir is given by IV, which is something of an impediment. But if you're in any kind of Covid high-risk group, either of these could be a literal lifesaver. And if you talk to your physician ahead of time and figure out that Paxlovid isn't going to work for you, then getting one or the other of these lined up is well worthwhile.
However - this is, again, a thing you are going to have to talk about with your physician ahead of time. No one around here acted like they had ever even heard of Molnupiravir and Remdesivir.
(But they've heard of ivermectin. Hooray.)
posted by flug at 10:17 PM on March 8, 2023 [22 favorites]
But over the past month, we've all managed to come down with it. It was "bad cold" symptoms and I couldn't even convince anyone to take a Covid test. But I managed to get it last, took the test, and wah-lah. Covid.
The reason I'm bothering to write this down is to get everyone on board with their Paxlovid plan.
Paxlovid is super effective but you must take it within the first few days of becoming sick. Officially that is the first 5 days, but the sooner the better.
Most people eligible for Paxlovid (in the U.S.) can get it by going to a pharmacy (CVS or Walgreens, etc), or via a telemedicine appointment, and simply showing or telling about your positive test results.
However . . . as I found out, if your medical situation is complex at all, they might not be able to do it. This is a bit of a problem, as it is exactly the people with medically complex situations who are going to need Paxlovid most of all.
Anyway, by the time I got to Day 2 of Covid and had my positive test, it was very, very clear this was not going well. It was "only" cold and flu symptoms, but they were very, very heavy. I was sleeping about 23.5 hours per day, and blood oxygen was already below 95 (on literally Day 2).
So I started working on getting a Paxlovid prescription. I'll leave out the details, but it took 36 hours of calling, calling, calling, telemedicine appointments, screwups galore, my one doctor who should have known best said "no prescription," etc etc etc.
36 hours later I finally had the prescription in hand. And what do you know: 3 hours later, 100% turnaround in symptoms.
I've taken a few antivirals before, and frankly, my expectation of them is very low. But in this case - this stuff really works. I highly recommend it if you get Covid and can get ahold of it.
Part of my point though is that you've got to have a plan to get it, and get it in time. When the time comes, you're always going to be surprised, you're always going to be feeling terrible, you're always going to not have the help you really want or need, and (assuming you're in the U.S.) the terrible U.S. health care system is bound to do its best to get in your way as much as possible.
This article has suggestions for getting lined up with Paxlovid. CDC Paxlovid overview. Talk to your primary care physician about this in advance. If you're in one of the judgement areas for eligibility (specifically, lower kidney or liver function) make sure your labs are current a couple of times per year - no one is going to want to send you in for new labs the first day after you come down with covid.
Also there are two other helpful treatments if Paxlovid doesn't work out for you - Molnupiravir and Remdesivir (info on both of those on the CDC page.) Despite what you may have heard, both of these are actually quite helpful, especially if started early on - as with Paxlovid, the sooner the better. Remdesivir is given by IV, which is something of an impediment. But if you're in any kind of Covid high-risk group, either of these could be a literal lifesaver. And if you talk to your physician ahead of time and figure out that Paxlovid isn't going to work for you, then getting one or the other of these lined up is well worthwhile.
However - this is, again, a thing you are going to have to talk about with your physician ahead of time. No one around here acted like they had ever even heard of Molnupiravir and Remdesivir.
(But they've heard of ivermectin. Hooray.)
posted by flug at 10:17 PM on March 8, 2023 [22 favorites]
finally some good news about diabetes
posted by klangklangston at 10:56 PM on March 8, 2023 [5 favorites]
posted by klangklangston at 10:56 PM on March 8, 2023 [5 favorites]
(Minor side note: it’s the borrowed-from-French word “voilà”.)
posted by eviemath at 12:16 AM on March 9, 2023 [4 favorites]
posted by eviemath at 12:16 AM on March 9, 2023 [4 favorites]
Last May I was feeling symptoms of an oncoming cold - thought to do a covid self test which came up positive. I emailed my employers and doctor's office, and my doctor's office arranged a teleconference with me. I had read of Paxlovid in The Atlantic and asked for it and was given a prescription (I don't know if it would have been offered if I hadn't asked).
This link had been helpful in figuring out how to adjust my other medications (halved one and dropped another for the duration of the treatment and a few days after).
I had been vaccinated prior to this and got the boosters as recommended. I was able to get Paxlovid the same day. I only noticed a very slight metallic taste. The 'slight cold' symptoms passed quickly. I haven't noticed any long term effects, but remain cautious about re-exposure to covid. I think it was most likely I picked up covid at the office (where some co-workers declined vaccination and at least one coworker had covid twice).
posted by rochrobbb at 4:10 AM on March 9, 2023 [3 favorites]
This link had been helpful in figuring out how to adjust my other medications (halved one and dropped another for the duration of the treatment and a few days after).
I had been vaccinated prior to this and got the boosters as recommended. I was able to get Paxlovid the same day. I only noticed a very slight metallic taste. The 'slight cold' symptoms passed quickly. I haven't noticed any long term effects, but remain cautious about re-exposure to covid. I think it was most likely I picked up covid at the office (where some co-workers declined vaccination and at least one coworker had covid twice).
posted by rochrobbb at 4:10 AM on March 9, 2023 [3 favorites]
An update on the Popular science YouTuber Physics Girl has an update on the creators struggles with long Covid.
posted by interogative mood at 7:12 AM on March 9, 2023 [2 favorites]
posted by interogative mood at 7:12 AM on March 9, 2023 [2 favorites]
Not jokingly at all, I think people who are specifically vaccine-hesitant but willing to take a short course of something else are a real group. I think the politicization of the whole idea of being concerned about long COVID might be an obstacle for some in that group but again not everyone.
Sure, there might be a few, in the there are no atheists in fox holes kind of way, but IMO long COVID is just far too rare to be a real threat for a group of people who barely want to acknowledge COVID exists at all. The vast majority of vaccince-hesitant will get better (or not) with benadryl and ibuprofen, not metaformin or paxlovid.
posted by The_Vegetables at 8:13 AM on March 9, 2023
Sure, there might be a few, in the there are no atheists in fox holes kind of way, but IMO long COVID is just far too rare to be a real threat for a group of people who barely want to acknowledge COVID exists at all. The vast majority of vaccince-hesitant will get better (or not) with benadryl and ibuprofen, not metaformin or paxlovid.
posted by The_Vegetables at 8:13 AM on March 9, 2023
retains viabilty on surfaces dozens of hours including on cheese/meats and warm food
I missed that update. I thought fomites weren't a thing with covid?
posted by aniola at 8:31 AM on March 9, 2023 [4 favorites]
I missed that update. I thought fomites weren't a thing with covid?
posted by aniola at 8:31 AM on March 9, 2023 [4 favorites]
You can take all possible precautions and end up spreading COVID misinformation, too.
posted by 0xFCAF at 9:15 AM on March 9, 2023 [9 favorites]
posted by 0xFCAF at 9:15 AM on March 9, 2023 [9 favorites]
from that link, more details:
CONCLUSIONSposted by aniola at 9:19 AM on March 9, 2023 [3 favorites]
The present study provides evidence that fomites may not be as critical in the transmission of SARS-CoV-2 as initially suspected. However, the present study also provides evidence that infectious SARS-CoV-2 can be found on some fomites for a relatively long period of time after contamination with extensive amounts of saliva. Therefore, common hygiene practices (eg, coughing/sneezing into elbows, hand hygiene) should still be considered to avoid surface contamination and virus transfer. Face masks may further mitigate the risk of fomite transmission. Taken together, our findings suggest that fomites contaminated with coughing are unlikely to be an important source of SARS-CoV-2 transmission.
A quick note for those being treated for diabetes, it's not all good news there are some non-metformin drugs you may be taking - in particular if you are taking SGLT-2 inhibitors such as Jardiance/Empagliflozin while you have Covid you can get pushed into ketosis - talk to your doctor as soon as you know you're covid positive (or even before as I have) and ask them if you should keep taking those drugs while you're infected (my doctor says to stop)
posted by mbo at 11:06 AM on March 9, 2023 [1 favorite]
posted by mbo at 11:06 AM on March 9, 2023 [1 favorite]
When China was still pursuing zero COVID, with all the contact tracing that entailed, there were a couple cases that they believed were from fomite transmission. I don't know much more details than that. But I think that's consistent with "unlikely to be an important source of SARS-CoV-2 transmission" - only something you'd really notice in a zero COVID regime across a very large population.
posted by vibratory manner of working at 12:02 PM on March 9, 2023 [4 favorites]
posted by vibratory manner of working at 12:02 PM on March 9, 2023 [4 favorites]
I work in high performance sport. My role had me travel extensively at a time when regions of my country had varying levels of lockdown and spent a lot of time in quarantine. I traveled before I was eligible for vaccination at home, often to places that had very poor uptake *cough*texas*.Also, as an aside, when people tell me they havent had covid yet, i ask them if they have been tested weekly since march of 2020. They haven't.Some of us who have never had COVID yet didn't effectively leave our houses for a year and a half until we were fully vaccinated, and even in March 2023 do not eat indoors in restaurants, do not shop in grocery stores, and still wear N95/KN95 masks when going indoors in other places.
I'm happy to put cash money on a bet that I haven't had asymptomatic COVID, thank you very much.
posted by tclark at 12:10 PM on March 8
My regular place of work had _several_ national teams going prepping for summer & winter Olympic & Paralympic teams. Symptom surveys, extra quarantines for breaking bubbles, required testing at regular intervals, all kinds of things that few people ever needed to worry about. Scratch that significant support and infrastructure helping to keep this microcosm safer than the population at large.
Anyway long-story short: in the 2021 calendar year I had more than 110 negative tests taken not because I was sick but as a matter of protocol. No symptoms, no positive tests. Oh and I finished the year with 10 weeks of no travel and a lot of vacation time home in my pyjamas. In June of 2022 (in a new position working from home, waaaay less travel) mask mandates had been lifted, social distancing had become lore lost in the mists of time and a surprisingly vocal local minority had gotten very militant about their denial. And this guy - the one working at home, a bubble of 4 people who all work from home, exercising due care and attention with good hygiene practices - the one who travelled the world... yeah I got covid from community spread sitting at home. And stayed sick a long time.
110 negative tests in less than a year. 110. And I got it the next spring despite care, prevention and low risk behaviour. So yeah not happy about the lack of political will to just do the right thing. The minimal things that protect everyone from a multitude of diseases. Because asymptomatic carriers is a thing but the goddamned symptomatic carriers who just don't give a damn are apparently so much more important than the needs of the many.
posted by mce at 1:06 PM on March 9, 2023 [16 favorites]
retains viabilty on surfaces dozens of hours including on cheese/meats and warm food
I missed that update. I thought fomites weren't a thing with covid?
They are not, at leas not as a meaningful public health thing.
There are virus particles that are "viable" in the sense that they can be made to reproduce in lab conditions, but ability to get infected from them is low. At one point well into the pandemic countries that did good contact tracing were trying to sort out whether documented cases of transmission from a surface where "one" or "zero."
This is doubly true in the case of getting it from ingesting food: Covid evolved to infect respiratory pathways, not your gut.
I'm not saying don't wash your hands, but if you're somehow doing what it takes to avoid airborne Covid you're surface transmission risk is pretty negligible.
posted by mark k at 4:44 PM on March 9, 2023 [1 favorite]
I missed that update. I thought fomites weren't a thing with covid?
They are not, at leas not as a meaningful public health thing.
There are virus particles that are "viable" in the sense that they can be made to reproduce in lab conditions, but ability to get infected from them is low. At one point well into the pandemic countries that did good contact tracing were trying to sort out whether documented cases of transmission from a surface where "one" or "zero."
This is doubly true in the case of getting it from ingesting food: Covid evolved to infect respiratory pathways, not your gut.
I'm not saying don't wash your hands, but if you're somehow doing what it takes to avoid airborne Covid you're surface transmission risk is pretty negligible.
posted by mark k at 4:44 PM on March 9, 2023 [1 favorite]
Does anyone have a sense of why it was in this trial at all?
It seems possible they may have gotten correlation data from ongoing longitudinal studies. I'm in one where like every week I report in on which medications I'm taking, along with data on whether I've had COVID symptoms, tested for COVID (along with any results), or been in various specific high-risk situations in the past week. They also periodically include mental-health evaluation questions.
posted by limeonaire at 8:21 AM on March 10, 2023 [1 favorite]
It seems possible they may have gotten correlation data from ongoing longitudinal studies. I'm in one where like every week I report in on which medications I'm taking, along with data on whether I've had COVID symptoms, tested for COVID (along with any results), or been in various specific high-risk situations in the past week. They also periodically include mental-health evaluation questions.
posted by limeonaire at 8:21 AM on March 10, 2023 [1 favorite]
Does anyone have a sense of why [metformin] was in this trial at all?
Metformin does several things in addition to lowering blood sugar. It's inhibition of the mTOR complex makes it the leading contender for a life-prolonging drug. Studies are ongoing but, unsurprisingly, it takes a long time to do a study of life prolongation. It definitely prolongs maximum life span of mice from ~120 weeks to ~140 weeks. Some former colleagues of mine are doing a human study using biomarkers as outcomes, but we don't really have a good biomarker (i.e. blood test) for aging.
But if you are taking metformin for diabetes, the harms of diabetes far outweigh the effects of metformin.
posted by neuron at 11:21 AM on March 10, 2023 [3 favorites]
Metformin does several things in addition to lowering blood sugar. It's inhibition of the mTOR complex makes it the leading contender for a life-prolonging drug. Studies are ongoing but, unsurprisingly, it takes a long time to do a study of life prolongation. It definitely prolongs maximum life span of mice from ~120 weeks to ~140 weeks. Some former colleagues of mine are doing a human study using biomarkers as outcomes, but we don't really have a good biomarker (i.e. blood test) for aging.
But if you are taking metformin for diabetes, the harms of diabetes far outweigh the effects of metformin.
posted by neuron at 11:21 AM on March 10, 2023 [3 favorites]
Note that in the study of metformin to reduce risk of long covid, the effect was strong in people who were unvaccinated and weak in vaccinated. And vaccination is much more effective than metformin.
posted by neuron at 11:22 AM on March 10, 2023 [4 favorites]
posted by neuron at 11:22 AM on March 10, 2023 [4 favorites]
And vaccination is much more effective than metformin.
While it is always good to have additional tools, that is the real take home message: Get vaccinated.
Coincidentally, I just got a text yesterday from the local vax clinic that the new Covid booster is now available. Will be booking it in first thing Monday.
posted by Pouteria at 7:01 PM on March 11, 2023
While it is always good to have additional tools, that is the real take home message: Get vaccinated.
Coincidentally, I just got a text yesterday from the local vax clinic that the new Covid booster is now available. Will be booking it in first thing Monday.
posted by Pouteria at 7:01 PM on March 11, 2023
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posted by any portmanteau in a storm at 11:12 AM on March 8, 2023 [5 favorites]