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This is a really helpful post, and I love your writing style/voice mixed in with the science :)

Particularly: "Paxlovid, while useful, also tastes like pennies, soap and sadness, and comes with a 20.8% rebound rate." SO true. Although the rebound rate is not consistently seen across all studies, and as you know the CDC consensus is that Paxlovid rebound is overall not really a thing more than the two phases we've seen since the beginning (acute viral, then inflammatory stages):

https://www.jwatch.org/na56967/2024/01/03/covid-19-rebound-related-covid-19-therapy

Yet I do think it is kind of a thing from experience in primary care...

The azelastine option is tempting, and I admit I have bottle to use maybe. I think the viral load reduction is just measured in the nose, so who knows how significant that is in terms of the whole body viral load... yet the nose is a factory cranking out viruses, so the less the better I agree.

Here is a deep dive I wrote a while back about nasal sprays for Covid in general... it's paywalled so I'm going to comp you!

https://mccormickmd.substack.com/p/nasal-sprays-for-covid-prevention

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This is remarkably good science writing. Engaging, funny, easygoing, sharp. Wow.

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Thanks, Owen!

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Well done, Bess, a superb presentation of clinically useful information bathed in a sea of Jägermeister bottles on a frat bathroom floor... I so love the punchy delightfulness of your writing!

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Jan 22
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Solidarity.

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