Covid, Round Two
Roughly six months after my first bout of covid, I got it again. As with the first time, it was from a known high-risk exposure. In this case someone was at a singing party with me and tested positive the following morning. They were masked, but I was not. We were sitting next to each other for large parts of the party. Windows were cracked open, but not wide. As far as I know, out of fifteen or so people at the party, two more of us (not counting the index case) tested positive the following week.
Getting Paxlovid
This time around, I opted to get a Paxlovid prescription. This was very easy, thanks to Massachusetts’ telehealth system. I filled out a form online with medical details. 15 minutes later a provider called me, ran through the instructions for taking it, and sent a prescription to my local pharmacy. I expected I would have to justify my need, but it didn’t come up. The form did ask questions about risk factors and specifically my weight and height, so it’s possible I was approved by virtue of being “overweight,” but I didn’t specify any risk factors beyond that.
I highly recommend anyone in Massachusetts who gets covid any wants Paxlovid go through this system. It’s so easy.
Why Paxlovid?
I wasn’t super worried about my symptoms being bad, but I was eager to test negative as quickly as possible. I had plans to go to three weeks of camp starting the following week and I wanted to miss as little of it as possible. Under the theory that Paxlovid would help me test negative more quickly, I decided to get it preemptively and decide later whether to take it.
I also wanted to avoid rebound, though, where a covid infection recurs a few days to weeks after recovery. This is more common when people take Paxlovid¹. One theory as to why rebound happens with Paxlovid is that it suppresses viral replication so effectively, your own immune system doesn’t have enough time to develop a specific immune response. When the Paxlovid clears your system, a small amount of replicating virus may remain and come roaring back. I know of at least one study in which participants who took Paxlovid later had a lower rate of rebound. So, though the medical advice for Paxlovid is to take it as soon as possible, I knew that if I decided to take it at all, I would wait at least three days.
I should point out that I am in no way a medical expert and don’t necessarily endorse the choices I made for this course of treatment. Paxlovid is officially recommended for preventing severe outcomes with covid. Its effect on improving mild cases is mixed and as far as I was able to tell scanning the literature, its effect on the duration of testing positive is basically unstudied. There was minimal reason for me to believe it would work the way that I wanted. Nevertheless, I figured, as long as the side effects were mild, it wouldn’t hurt to experiment.
My Covid Course
The first time I had covid was mild. This time around it was milder still – less than most colds I’ve had.² Because my symptoms were so light, I was reluctant to take Paxlovid when day 3 rolled around. By day 4, though, I was feeling mostly better, but still had a dark positive line on my antigen tests, which spooked me enough that I decided to start my course of Paxlovid. On day 5, I tested negative.
The quick negative took me by surprise³. I tested positive for nearly two weeks the first time I had covid and thought of covid as a one or two week affair. It’s tempting to attribute the quick recovery to the Paxlovid, but 12 hours seems quick for it to have a significant effect. After talking to a number of others who had covid recently, I’ve heard several stories of people who recently had a similarly brief case. As far as I can tell, no one is publishing data on this, but I’ve revised my mental model of covid to have a much wider range of durations, including much shorter.
- Day -3 Wed: I am exposed to covid this evening.
- Day -2 Thu: I find out about my exposure in the morning. I have mild congestion, to an extent that is common for me, even when not sick.
- Day -1 Fri: I have mild congestion that persists, a little fatigue, and just a general ickiness that I can’t place. I’m not sure if I’m sick.
- Day 0 Sat: I’m distinctly sick, with persistent moderate sinus congestion, a mild sore throat, an occasional cough, and mild fatigue. I test negative on an antigen test. (I count this as Day 0, meaning the day I have symptoms distinct enough to be sure I am sick.)
- Day 1 Sun: My symptoms are similar to the day before, though less fatigue but more congestion and a worse sore throat. This is the worst day of symptoms and it’s really not bad. I test positive on an antigen test.
- Day 2 Mon: Moderate to mild congestion. The sore throat is gone, but I cough occasionally.
- Day 3 Tue: Same as the day before. I test positive on an antigen test.
- Day 4 Wed: My symptoms are nearly gone. I still test positive. I initiate my course of Paxlovid.
- Day 5 Thu: I feel mostly better and test negative. I continue to test negative in the following days.
I continued my course of Paxlovid for all five days, despite testing negative for most of it. I did not experience rebound.⁴ I had only minor side-effects from the Paxlovid, primarily a persistent and unpleasant, but mild, bitterness in my mouth.
In this case I’m not convinced the Paxlovid had much effect at all and, though side-effects were only mild for me, I would probably not go through the effort to take it again in the future.
Though it can happen on its own, even without. ↩︎
I actually had a quite nasty cold earlier this year that knocked me on my back for two days and gave me one of the worst headaches I’ve ever had. I tested negative for covid and it didn’t have the hallmarks of the flu, so it was likely something else that was much worse than either of my experiences with covid. ↩︎
It happened so quickly that I was permitted to go to camp on time if I wanted, though, as it happened, I was no longer logistically prepared to go to camp on time, since I hadn’t been expecting to. I ended up going just a day late. ↩︎
As part of the three weeks of camp I’m at, I have to test once a week, so I’m relatively certain I did not even experience asymptomatic or paucisymptomatic rebound. ↩︎