What I’ll Do the Next Time Covid Darkens My Door
Which drugs when
My current Covid experience reshaped my strategies for what I’ll do next time I get infected with Covid or other upper respiratory tract pathogens1. Under ordinary day-to-day conditions between infections I’ll plan to:
Get a booster dose of Covid mRNA vaccine every 4-6 months. I’m planning to take a daily Claritin for one week after the booster dose (see “Vaccines” section below for a rationale)
Drink mint tea plus put plenty of mint family herbs in food
Pop an occasional quercetin or curcumin (or combo Nasafytol) alongside a regular multivitamin
Lucira test (combined nose and throat) a few days after known exposure or if I sense sinus soreness, throat soreness, sneezing, or coughing. Also asymptomatic group Lucira testing at family gatherings
After testing Covid positive, I’ll spend three weeks on the regimen below (in addition to the day-to-day regimen above). During my current infection, I stopped taking medications when my rapid antigen test (RAT) band faded. With hindsight, I can see it was a foolish sin against the 15th Commandment. In the future, I’ll stay on these meds for three continuous weeks regardless of what the RAT is doing.
500 mg metformin twice a day (with food)
20 mg famotidine (aka Pepcid, Zantac) twice a day
One spray in each nostril Astepro (over-the-counter generic azelastine) twice a day
6 mg melatonin before bed
During the first week after testing positive, get a booster dose of mRNA vaccine
•Antihistamines (azelastine, curcumin, famotidine, melatonin, quercetin). See: “Bullfighting Covid”
•Metformin: A front-line choice for defending myself against Covid is a drug called metformin. Metformin is among the safest, most efficacious, and cost-effective medicines for long-term management of diabetes. It has also been considered as a candidate anti-aging treatment. Sixty years of experience with daily metformin use shows that its only common side effect is nausea and diarrhea and this is usually a transient effect that fades with longer term use and can be mitigated by taking metformin with food.
Despite the fact that metformin is as safe as houses, it remains prescription-only. Fortunately, I have an excellent primary care physician who thanked me for sharing a series of overwhelmingly convincing randomized controlled clinical trials (RCTs) documenting metformin’s ability to reduce SARS-CoV-2 viral load, hasten the resolution of Covid symptoms, and prevent long Covid. He agreed to write me an advance “off-label” metformin prescription to have on hand in case I caught Covid.
I’m outraged by the fact that current official guidance on metformin is:
There is insufficient evidence for the COVID-19 Treatment Guidelines Panel to recommend either for or against the use of metformin for the treatment of COVID-19 in nonhospitalized patients.
The scientific literature conclusively shows metformin is safer and more effective than Paxlovid! The cowardly official guidance makes me imagine a counterfactual universe in which I chose to reorient my research program to run an RCT aimed at finding out whether mint can help fight Covid. In the alternate timeline, I gathered overwhelmingly convincing evidence that mint safely and effectively treats Covid, but authorities are still telling everybody they can’t offer any official advice because an infinite treadmill of additional research is needed. Alternate universe Chris Buck might be wrestling with some anger management issues3.
It’s not clear exactly how metformin works against Covid. Metformin can directly block the replication of SARS-CoV-2 in cell culture but only at absurdly high (millimolar) concentrations. The peak concentration of metformin in the blood is a thousand times lower than the concentrations that inhibit virus replication, so there must be something else going on. I note that one of metformin’s many physiological effects is that it can prevent the activation of mast cells (see: “Bullfighting Covid”)
•Mint: A compound called caffeic acid, which is abundant in mint, has been shown to have direct antiviral effects in a cell culture model. Unfortunately, there’s a bit of an in vivo concentration problem along the same lines as antihistamines and metformin. The level at which caffeic acid inhibits SARS-CoV-2 replication in cell culture is about ten times higher than the levels you’d expect to see in the bloodstream after drinking a whole bunch of mint tea. Another problem is that caffeic acid could theoretically act simply by driving the virus into latency, as opposed to permanently eradicating it (see: “Latency, Long Covid, and the Dreaded Rererebound”).
The new possibility I’ve begun entertaining is that mint’s direct antiviral effects in cell culture aren’t at the business end of what makes mint effective in animal models and human clinical trials. I can’t rule out the idea that mint also has antihistamine-like effects or other immune-modifying effects that improve the speed with which the immune system clears the virus.
•Paxlovid: Although the early data from Paxlovid clinical trials led by Pfizer were very encouraging, subsequent trials run by non-Pfizer scientists have mostly found that Paxlovid is of little or possibly no benefit4. The more recent non-Pfizer trials have shown that Paxlovid doesn’t increase the speed at which the infection is cleared, it doesn’t prevent rebound, and it doesn’t prevent long Covid. An attempt to use Paxlovid as a therapy for long Covid showed that it either has no effect or might slightly increase the risk of fatigue and brain fog.
I had initially entertained the hope that starting Paxlovid treatment early and extending the treatment to ten days instead of the usual five would be more effective, but this turned out to be yet another sin against the 15th Commandment. I know four people - including myself - who started Paxlovid immediately after testing positive and continued treatment for 7-10 days. All four of us had rebounds. I’ve become highly skeptical about whether Paxlovid is reliably doing much of anything for anybody. I won’t be bothering with this outrageously expensive and hard-to-obtain drug anymore.
•Tylenol (acetaminophen): taking acetaminophen correlates with worse Covid outcomes. I wonder whether acetaminophen might be doing the opposite of antihistamines - meaning pushing the immune system toward a response that’s less effective for clearing the virus. Aspirin or ibuprofen, which don’t have scary correlations with bad Covid outcomes, seem like safer choices. Although I personally plan to just tough it out and avoid analgesics altogether.
Vaccines: I’m planning to take loratadine (generic Claritin) daily for a week after receiving my next booster dose. A recent paper shows that SARS-CoV-2 Spike directly engages histamine receptor H1 (HRH1)(see: “Bullfighting Covid”). In addition to using HRH1 as an infectious entry receptor, I suspect the virus is engaging histamine receptors for the broader purpose of waving an immune-flummoxing red cape. I’m therefore betting that inhibiting HRH1 signaling after receiving a Spike vaccine could improve my response to the vaccine.
Although azelastine inhibits HRH1, it’s delivered as a nasal spray and only about a third of the dose makes it into circulation. Claritin, which is taken in pill form, seems like a better bet for blocking unwanted HRH1 signaling in the lymph nodes that drain my vaccinated arm. In the future, a testable prediction is that a mutant Spike protein incapable of binding HRH1 would be an intrinsically better vaccine immunogen.
My new thinking about Covid biology makes me prefer mRNA vaccines over Novavax because the mRNA vaccines are better at eliciting killer T cell responses, which I suspect are critically important for bringing the initial infection under control. It doesn’t seem to me that there’s much of a difference between Moderna and Pfizer, in terms of vaccine efficacy. Many people have much worse reactogenicity (feeling like crap the day after the vaccine) with one or the other of the two mRNA vaccines. There’s no indication that reactogenicity correlates with efficacy. Neither of the mRNA vaccines bothers me much, but I imagine other people should choose whichever one doesn’t make them feel like crap.
Regardless of how long it’s been since my last boost, I’ll also plan to get an additional mRNA vaccine booster dose during the first week of any new Covid infection. My theory is that the vaccine in my arm will show T cells the Spike protein in the absence of all the tricks the virus itself is using to flummox the immune response. The properly Spike-educated Th1 cells elicited by the intramuscular vaccine will hypothetically then traffic to my sinuses and bring the infection at least temporarily under control. The post-infection booster dose could also improve neutralizing antibody levels in my blood, which could help ensure the virus can’t spread beyond my sinuses.
My most recent boost targets the XBB.1.5 variant, which first emerged in October of 2022. Things would almost certainly have gone better for me if the boost had contained something more similar to the current FLiRT variant I presumably have. I don’t understand why there isn’t any outrage about the fact that it takes 22 months to make a current-variant boost available when it only took 11 months to develop the original vaccine from scratch. I see the fact that the FDA has us all enrolled in a giant involuntary uncontrolled booster update Tuskegee Study as a causal variable in my Covid ordeal.
•Vitamin D: Although some studies have shown improved clearance of Covid in people given vitamin D supplements, the effects of vitamin D are dizzyingly complex. Amy Proal offers interesting arguments for the view that high dose vitamin D supplementation can have steroid-like immunosuppressive effects, which could theoretically suppress disease symptoms while allowing viruses to replicate out of control. Vitamin D can also exert Th2-skewing effects similar to the “red cape” effects I’m betting Covid exerts.
With all that said, everybody agrees that frank vitamin D deficiency is a disaster. My approach is to get a little sun on long daily exercise walks and to occasionally take a multivitamin with 1000 IU of vitamin D3. I sometimes ask for a vitamin D test at annual physicals and I’ve always been in the middle of the normal range. I note that I’m ridiculously pale.
•Xocova: Clinical trials run by Shionogi, which manufactures an antiviral called Xocova (ensitrelvir), suggest the drug significantly accelerates the clearance of SARS-CoV-2 without rebound effects. Xocova also appears to reduce the risk of long Covid. Xocova has been approved as a safe and effective prescription medicine in Japan since November of 2022. If I’m ever allowed to disenroll from the involuntary Xocova Tuskegee Study, I’ll enthusiastically add it to my treatment regimen. It will also be interesting to find out whether Xocova could be more effective than Paxlovid for treating long Covid.
These are my notes on strategies I might apply to myself in the future. It’s always a good idea to consult a qualified healthcare professional about questions like these (as I have). I am not a healthcare professional. I hope my brainstorming might help you refine your thinking about how best to protect your own health. And Substack is a two-way street! If you think I’m missing something important or if anything I’m proposing doing to myself sounds crazy to you then please pipe up in the comments section. You could help protect not only me but anybody else I might unwittingly be leading astray.
I prefer RAT (e.g., BinaxNOW) over Lucira during the infection period because the speed at which the band develops and the band intensity relative to the control band give a semi-quantitative impression of how much virus is present. RATs are also a lot cheaper than molecular tests like Lucira.
As you can probably tell, I’ve been enjoying the AppleTV show Dark Matter.
This is an advertisement for the idea that clinical trials should be run by competing neutral third party testing organizations.