After 2 weeks of COVID you are not infectious

[RobertCLL]

I just had a conversation with the Haematology unit of my hospital. I was told that after 2 weeks of COVID you are not infectious. Is that still correct if you have a compromised immune system? And if you still have lingering symptoms (i.e cough)?

[SeymourB]

RobertCLL -

I think that the person who told you that vastly oversimplified it in the interest of processing the most people in the shortest time. "Move along now!"

More than almost any other single, identifiable population, CLL patients, especially those at advanced stage or in treatment, tend to get longer infections. And we're not all alike, either. Some of us are born with genes that can dodge things better, some with genes that dodge things less. We saw incredible variation on after vaccine spike IgG tests.

The person in the unit took a statistical fact based on studies of groups of people, and turned it into a covenient absolute fact. That often works for most people, but since the statistical facts about COVID infections have been almost entirely based on non-immunocompromised people, your experience may differ more than the average person.

If you still have lingering symptoms, I think you should re-test several times - every few days. Keep a log. Oral/nasal antigen test positivity does align fairly well with oral shedding of infectious material statistically. Antigen test negativity is not that specific, though - false negatives are greater than false positives. Sorry, that's just the way things are. So, the best advice I've seen is 2 negatives in a row, a few days apart before declaring it over.

The dilemma is then what to do for a longer case? They don't even have a name for such cases! It's not Long-COVID - that's a different thing.

In such longer cases, doctors in the U.S. almost never give another round of Paxlovid, and will mumble about test positivity lasting months (PCR tests MIGHT last months in outlying cases). If we're hospitalized, we get more attention - possibly Remdesivir or convalescent plasma. But if we're home and not running a fever high enough to visit the A and E, we just fall through the cracks. So keep a log, and pray that you can show it to someone who thinks on the job.

=seymour=

Reference:

ncbi.nlm.nih.gov/pmc/articl...

Immunocompromised Patients with Protracted COVID-19: a Review of “Long Persisters”

Published online 2022 Nov 12

[RobertCLL in reply to SeymourB]

Seymourb. I have been testing every other day and at present a strong line on the LFT. I have a call booked with my GP today to see what he has to say.

[RogerPinner in reply to SeymourB]

Seymour, all very sensible. I read recently, on this site though I can't cite it, that viral rebound which is common, particularly amongst the immunocompromised following a course of Paxlovid, could possibly be eliminated by a longer course, and that the CEO of Pfizer took it for 8 days.

This doesn't help Robert now, but maybe in future if unlucky enough to catch covid, we should explain this and request a longer course.

Roger

[SeymourB in reply to RogerPinner]

RogerPinner -

Dr. Fauci took it for 10 days:

abcnews.go.com/US/fauci-tak...

The problem has been that the FDA authorization or approval was for a 5 consecutive day dose at the start of the infection.

fda.gov/media/155050/download

"LIMITATIONS OF AUTHORIZED USE

...

PAXLOVID is not authorized for use longer than 5 consecutive days.

...

DOSAGE AND ADMINISTRATION

...

Initiate PAXLOVID treatment as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. "

OK, so what I'm thinking is, give it for 5 consecutive days, and rest a day or 2. Re-test, since a positive test is required. Ask about symptoms again, since it has to be given within 5 days of symptom onset. Then re-dose.

The catch is that symptoms may not have disappeared entirely during the negative test, so the onset could remain the original onset. But I think most people notice 1 or more symptoms disappear - especially fever. But most doctors in the US interpret that to mean they cannot give if for longer than 5 days, ignoring the onset, and ignoring consecutive days.

I expect that other countries use FDA documentation as a start, but can certainly do their own dosing.

It's sad that doctors have become lawyers in all this, and that the FDA did not think to cover this even after it became an issue. FDA wants studies to support its decisions. Pfizer should have done a reinfection study. Or maybe they are doin one? I need to look at that.

=seymour=

[RogerPinner]

Seymour, we are in different jurisdictions and I would guess there is more chance that US doctors, or insurers, might be more flexible and recognise the sense in what you have suggested oe something similar. In the UK we have a National Health Service on its knees, and a Government who view everything in terms of short term cost. They refused us Evusheld and probably think they are being magnanimous paying for Paxlovid at all. And I don't think it's available here privately.

It would be good if Pfizer were looking into the recommended dose. If you hear anything please post.

Roger