Thank you for all of these updates. It’s interesting that even my husband (a NOVID still) who has lived with me and my long COVID for all these years now, seemingly questioned me today when I said that any kind of virus has the potential to make me worse or to relapse. I just sent him a screenshot of that part of your post. Thank you again.
Yes, I have heard that getting another COVID infection or even a cold can cause people to relapse with their Long COVID symptoms. The article is anecdotal but does give the real world experience of several experts who work with people with Long COVID.
I found it very strange, in that article about the struggling kindergartners, that they are blaming all these issues on protective pandemic measures from 2020 and 2021, instead of what seems to me to be the obvious cause: the COVID infections these kids all acquired in 2022, 2023, and/or 2024 when the protections ended. COVID can leave behind neurological and other damage in people of all ages, including young kids. That's a much more likely explanation for their current problems than excess tablet usage two or three years ago. But the article doesn't entertain that possibility, that *likelihood*, at all, not even for one second.
Absolutely. And anyone concerned about what may be going on with kids with concerning symptoms, behavior or struggles in this era should check out Long COVID Kids (if in the US) to learn more about how Long COVID presents in children - it can be very different than adults and include behavioral and developmental symptoms.
Another great update thank you. Not sure I can avoid this wave with lots of social events this month but I’ll try when and how I can.
The antihistamine paper blew my mind. Is it too optimistic and inflated? Most of their data is gleaned from in vitro studies and then mice… but sounds almost too good to be true for clinical treatment or prophylactic use. With such common use from allergies, you would think clinical benefit would have been teased out by now!
That being said, I have occasionally been using azelastine nasal spray before higher risk situations that I just can’t mask in. I plan to keep doing this I guess and perhaps add an antihistamine to my own Covid treatment plan, what are your thoughts about this? I skimmed the article really quick but want to come back to it again.
I only know of nasal spray azelastine, which works surprisingly well for allergy symptoms. I have a lot of those so figure some overlap would be fine in terms of treating allergy symptoms/preventing Covid a little! OTC brand is called astepro, but azelastine nasal spray can also be prescribed (generic).
Like many chemicals tested in vitro, it has some antiviral effects. One small study showed it reduced nasal viral load during infections if not symptom duration of Covid. This might still be significant as the nasal mucosa is really a prime factory for cranking viruses during infection:
I don't think that the antihistamines will help that much since the SARS-CoV-2 virus uses the ACE2 receptor much more than it uses the H1 receptor.
Neosporin in the nose may be more helpful in high risk situations (with the addition of an N95 mask, of course). Here is the study on Neomycin:
4/22/24 PNAS (Yale): Intranasal neomycin evokes broad-spectrum antiviral immunity in the upper respiratory tract https://buff.ly/3W6ihPZ
Neosporin ointment placed in the nose may help prevent COVID and the flu. Intranasal generic antibiotic neomycin increased interferon expression in the nose and protected mice and hamsters from COVID infection and from Influenza A. In humans, Neosporin also increased interferon expression in the nose.
When I saw several derms respond with caution regarding neosporin, I figured I'd wait for more info before I jump in. It's intriguing, and as you say, it has potential for high risk situations.
If I recall, the main concern was that neomycin can cause dermatitis, and clinicians have shifted away from using it. Another caution was that some products under the brand name don't contain neomycin.
I’m less convinced of the utility of this unless there is a nasal spray/solution that could be tested and that penetrates deeper than the swabbing with neosporin ointment. Also doesn’t seem like a sustainable practice, nasal microbiome wise and everything else. But I am certainly intrigued by this and waiting for smarter people than I to keep the conversation going. Thank you. Fascinating study I agree tempting to try
Dr. McCormick, if I'm using nasal spray (iota carrageenan, xylitol, saline, or H1) after a known exposure, to potentially reduce replication in the nose, but I'm also testing so I can get the jump on starting antiviral soon enough to be effective, how does one navigate this? Will the nasal spray mask a positive status? Thank you for your good work.
Not sure I have an evidence based answer but after a known covid exposure if you are trying one of the nasal sprays I would do multiple times daily, and if I developed obvious symptoms like sore throat/fever etc with a known contact I might start Paxlovid presumptively. Although that one study of hospitalized patients showed that those who started antivirals like day 3-4 might have done the best. No definite answer here but best of luck. So many covid cases I’m hearing about lately it’s hard to duck them all
Thank you. This is always so helpful. For a long while, my husband has been tracking deaths from COVID vs deaths from flu(s). You wrote: "Hospitalization data is not being reported by most states." Is this also true from deaths attributed to COVID, or in which it played a role?
Thank you for all of these updates. It’s interesting that even my husband (a NOVID still) who has lived with me and my long COVID for all these years now, seemingly questioned me today when I said that any kind of virus has the potential to make me worse or to relapse. I just sent him a screenshot of that part of your post. Thank you again.
Yes, I have heard that getting another COVID infection or even a cold can cause people to relapse with their Long COVID symptoms. The article is anecdotal but does give the real world experience of several experts who work with people with Long COVID.
I found it very strange, in that article about the struggling kindergartners, that they are blaming all these issues on protective pandemic measures from 2020 and 2021, instead of what seems to me to be the obvious cause: the COVID infections these kids all acquired in 2022, 2023, and/or 2024 when the protections ended. COVID can leave behind neurological and other damage in people of all ages, including young kids. That's a much more likely explanation for their current problems than excess tablet usage two or three years ago. But the article doesn't entertain that possibility, that *likelihood*, at all, not even for one second.
Absolutely. And anyone concerned about what may be going on with kids with concerning symptoms, behavior or struggles in this era should check out Long COVID Kids (if in the US) to learn more about how Long COVID presents in children - it can be very different than adults and include behavioral and developmental symptoms.
Another great update thank you. Not sure I can avoid this wave with lots of social events this month but I’ll try when and how I can.
The antihistamine paper blew my mind. Is it too optimistic and inflated? Most of their data is gleaned from in vitro studies and then mice… but sounds almost too good to be true for clinical treatment or prophylactic use. With such common use from allergies, you would think clinical benefit would have been teased out by now!
That being said, I have occasionally been using azelastine nasal spray before higher risk situations that I just can’t mask in. I plan to keep doing this I guess and perhaps add an antihistamine to my own Covid treatment plan, what are your thoughts about this? I skimmed the article really quick but want to come back to it again.
Hey Doc, is that an OTC nasal spray?
I only know of nasal spray azelastine, which works surprisingly well for allergy symptoms. I have a lot of those so figure some overlap would be fine in terms of treating allergy symptoms/preventing Covid a little! OTC brand is called astepro, but azelastine nasal spray can also be prescribed (generic).
Like many chemicals tested in vitro, it has some antiviral effects. One small study showed it reduced nasal viral load during infections if not symptom duration of Covid. This might still be significant as the nasal mucosa is really a prime factory for cranking viruses during infection:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132439/
Hi Amy and Ryan,
I don't think that the antihistamines will help that much since the SARS-CoV-2 virus uses the ACE2 receptor much more than it uses the H1 receptor.
Neosporin in the nose may be more helpful in high risk situations (with the addition of an N95 mask, of course). Here is the study on Neomycin:
4/22/24 PNAS (Yale): Intranasal neomycin evokes broad-spectrum antiviral immunity in the upper respiratory tract https://buff.ly/3W6ihPZ
Neosporin ointment placed in the nose may help prevent COVID and the flu. Intranasal generic antibiotic neomycin increased interferon expression in the nose and protected mice and hamsters from COVID infection and from Influenza A. In humans, Neosporin also increased interferon expression in the nose.
When I saw several derms respond with caution regarding neosporin, I figured I'd wait for more info before I jump in. It's intriguing, and as you say, it has potential for high risk situations.
Good points. Do you recall any specific concerns they mentioned?
If I recall, the main concern was that neomycin can cause dermatitis, and clinicians have shifted away from using it. Another caution was that some products under the brand name don't contain neomycin.
Yes thank you
I’m less convinced of the utility of this unless there is a nasal spray/solution that could be tested and that penetrates deeper than the swabbing with neosporin ointment. Also doesn’t seem like a sustainable practice, nasal microbiome wise and everything else. But I am certainly intrigued by this and waiting for smarter people than I to keep the conversation going. Thank you. Fascinating study I agree tempting to try
Thank you for all that great info!
Dr. McCormick, if I'm using nasal spray (iota carrageenan, xylitol, saline, or H1) after a known exposure, to potentially reduce replication in the nose, but I'm also testing so I can get the jump on starting antiviral soon enough to be effective, how does one navigate this? Will the nasal spray mask a positive status? Thank you for your good work.
Hi and 🤞!
Not sure I have an evidence based answer but after a known covid exposure if you are trying one of the nasal sprays I would do multiple times daily, and if I developed obvious symptoms like sore throat/fever etc with a known contact I might start Paxlovid presumptively. Although that one study of hospitalized patients showed that those who started antivirals like day 3-4 might have done the best. No definite answer here but best of luck. So many covid cases I’m hearing about lately it’s hard to duck them all
Ps - sorry Dr Crystal - I thought this comment was from my own site just clicking on the email. This is your house!
No problem Ryan. Have a great weekend!
Thank you. This is always so helpful. For a long while, my husband has been tracking deaths from COVID vs deaths from flu(s). You wrote: "Hospitalization data is not being reported by most states." Is this also true from deaths attributed to COVID, or in which it played a role?