Great article, thank you! I’m excited to find another trustworthy and well informed medical voice here on Substack... for a while it seemed like the antivax, ivermectin crowd had a stranglehold. I think they are still more profitable...

I’m guessing the benefit of metformin won’t hold up as well in non-obese patients. What is your guess?

I also don’t discount the potential benefit of paxlovid as much purely based on the less ideal study design. Unless you’re over 65, the main concern with Covid illness should be long haul symptoms (disabling for some) and the consequent rise in cardiovascular events for at least a year after diagnosis. That’s what I’m seeing in my practice, a rise in cognitive problems, heart attacks, pulmonary emboli... anecdotally I know, but still... the endothelial damage of covid makes it a systemic nightmare.

I’ve been a hopeful early adopter of paxlovid treatment ever since a 90% reduction in viral load was announced in the initial trial. That has to be good, right? And the 26% reduction in long covid seen in the VA study was in older individuals mostly >60, a population less likely to develop PASC than the middle aged crowd.

Enjoyed your article in The Atlantic (I subscribe), and will follow your writing from here on out. Thanks for a great post!

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Thanks for this article! I was wondering if you could speculate on the mechanism by which metformin would affect Covid disease processes.

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