I first heard about this new virus before I went to South Sudan for the last time in early 2020. I wasn't worried. There had been flu pandemics in my lifetime and we had muddled through. How bad could it be? People were starting to wear masks in the airport, which I thought was silly. As it spread to western Washington state, it looked like it might be more serious than I had predicted. Then it got awful in Europe, then finally the US became a disaster of full hospitals and patients dying in hallways. I enthusiastically got my first vaccination on 12/21/2020.
I continued to work in our community clinic. We switched to mostly telehealth and I worked from home 2 of three 10 hour days, visiting with patient on the phone or through a video interface, with one day still spent in clinic seeing patients in person. We wore masks and tried not to share offices, changed airflows and avoided seeing people with respiratory infections in the clinic. We still did see our share of "surprise Covid" patients who revealed their symptoms after we had been in a stuffy little office together for several minutes with their masks gaping around their faces, but miraculously I did not get sick. Our office even had special paid Covid days off, outside of our usual paid time off so employees had no reason to work sick. We stopped having office parties. The lounge where we ate had a limit to the number of people who could be there. I stopped going to restaurants or parties or church or anything that might expose me to lots of potentially infected people. I stopped singing with my singing groups. I religiously wore masks whenever I was inside with anyone other than family and switched to KN95's when they became available. I got all of my vaccinations and then some. All of these things were very effective. Neither I nor my husband got Covid. Or any other infectious disease, for that matter.
Lately I have been relaxing my masking more. After getting my first vaccination I decided that I would not worry about masking with close friends or family, unless they were sick. I did continue to mask in other situations. But in the last few months I sometimes go to stores with no mask, if they aren't too crowded, and sometimes at the gym, while doing cardio, with a fan blowing the air away from me, I don't wear it. In the office I no longer nag my patients to wear their masks properly in the examining room if they are not having Covid symptoms.
A week ago Tuesday I had a bit of a sneezy nose. Nothing very unusual, but I took a Covid test just to be sure. It was negative. No symptoms at all on Wednesday. By the end of the day Thursday I had a bit of a sore throat and my skin felt sore. I took another Covid test in the evening. It was negative. I looked at the public health websites and found that both flu and Covid were at a very low level in our community. I wondered how we would really know, since mild cases of both are never reported and in Idaho at least, reporting of positive home tests is not encouraged. But I was reassured. My throat was still sore Friday morning, so I tested again, just to be sure. It was negative. So I went to my physical therapy appointment. It was a great appointment and I decided not to have my hip replaced after all, which was incredibly valuable. I masked with my handy dandy well fitting KN95 mask during our time in the small office, though my therapists did not. I got home, told my husband I definitely had something viral and if he liked I would relocate to the little house in the backyard. He said yes, please.
I spent a painful but not horrible day in bed reading books and cancelling my hip replacement. The next morning at about 3 AM when my sore throat told me I had to get up and take some tylenol I also took another Covid test. It was positive. Such a bold red line! And so quickly!
I found that 440 mg of naproxen twice a day with up to 4000 mg acetaminophen daily in doses of 1000 mg every 6 hours kept my throat tolerable. At least it did for awhile. When it stopped helping as much I decided I might as well try Paxlovid, which would definitely fight the virus. Paxlovid is, so far, the most effective drug to fight mild to moderate Covid and is indicated for anyone at higher risk. I consider myself young and healthy, but I am significantly over 60 and have hypertension which does put me at slightly higher risk. Also Paxlovid is harmless (other than a bazillion drug interactions) and not in short supply. So I called in a prescription of that for myself. The number of pharmacies that carry Paxlovid is limited, possibly because of low reimbursement along with difficulty getting it, but I was able to find a pharmacy that had it (Walmart.)
I hoped with Paxlovid my sore throat would rapidly feel better. I longed for that feeling when the antibiotic kicks in and the problem melts away. Unfortunately that was not to be. I don't know if I would have kept getting sicker without Paxlovid, so I am glad I took it. But I do understand why it isn't a blockbuster drug.
Paxlovid is a combination of ritonavir and nirmetralvir. The nirmetralvir is a protease inhibitor, reducing the virus' ability to cleave its proteins adequately, thus reducing its ability to reproduce and cause disease. Ritonavir is a drug, first used to treat HIV, which actually slows down an enzyme in the body that breaks down nirmetralvir. A dose of Paxlovid is 3 tablets, two 150 mg nirmetralvir and one 100 mg ritonavir. These pills are pretty huge and difficult to swallow with a sore throat, and man was my throat sore. And within about 30 minutes of taking them, my mouth developed a horrible bitter taste that was there for 11+ hours, just starting to fade when it was time to take it again. So the pills wouldn't get stuck on their way down, I took to coating them with butter and swallowing them with a full glass of water and then some bulky food, like oatmeal or bread. There are various solutions online for Paxlovid mouth, but let me add mine. Chicken. The flavor of chicken-in soup, baked, on pasta, whatever- cleared out the taste, at least while I was eating.
The cough and sore throat made sleeping or being comfortable at all pretty challenging, but throat coat tea with honey was a good adjunct to over the counter pain killers, and I found that a tiny dose of the ten year out of date hydrocodone that I was able to find in my medicine kit was magic for cough. Half of a 5/325 pill of hydrocodone/acetaminophen kept my cough well and truly gone all night and much of the next day, without significant side effects. It did not, however, help with pain, strangely enough.
Once I started to feel better, around day 4, I started to test myself again, hoping to be allowed into the main house without a mask. Turns out I was still vigorously positive for Covid antigen until the start of day 6.
I don't know if there will be any long term bad effects. So far, I seem to be back to nearly normal activity level and my brain seems the same. I have a little cough which is annoying, but that's it on day 8.
This is really just the story of finally succumbing to covid, without any earth shaking wisdom. I guess my distilled take home points from the experience would be:
1. Paxlovid tastes really bad, but other than that and the huge pill size, we should be adopting it more widely to reduce the severity of Covid. All things chicken are a good antidote for the bitter taste.
2. Acetaminophen and naproxen aren't too bad for pain relief. We read all those articles insisting that non-opiate pain relievers are as good as opiate combinations, and I'm thinking this is really true, at least for some kinds of pain.
3. Hydrocodone is a long acting anti-tussive (stops a cough.) It doesn't take much. It comes in a cough syrup as well, but it's the opiate, not the preparation that calms the cough.
4. I'm not sure we can trust information about community transmission of Covid at this point. The new variants are extremely transmissible and most people are either not testing for Covid or not reporting home tests.
5. It can be a long time after symptoms start that a Covid test comes up positive. Keep testing if you need to know!
6. Being vaccinated and not getting Covid during those really awful early days are gifts for which I am truly grateful. Being a doctor and having a safe and comfortable place to be sick are privileges not available to the vast majority of the world's population and I do recognize how lucky I am!
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