Editing COVID prevention and treatment

== COVID infections can cause worsening of symptoms in long haulers ==

Survey data found that at least 20% of vaccine injured people reported significant worsening of their symptoms after a COVID infection.

[[File:Symptoms after COVID infection.png|600px]]

Symptoms also seem to worsen following vaccination, though the two types of long haulers report their experiences very differently.

[[File:Symptoms 2 weeks after vaccination.png|600px]]

The vaccine injured are far more likely to hold negative attitudes about revaccination injury than people with long COVID.

Overall, long haulers seem to be at risk of worsening whenever they are exposed to spike protein, whether it comes from the wild virus or from COVID vaccines.  However, there is a minority of patients who report that their symptoms improved after COVID infection or vaccination.

=== Studies showing a relationship between cumulative spike protein exposure and risk of vaccine side effects ===

==== Risks following vaccination ====

'''https://doi.org/10.1101/2021.12.23.21268276''' - This study funded by Health Data Research UK found that myocarditis was more likely with second and third doses, and significantly higher for Moderna than Pfizer.

'''https://doi.org/10.1001/jamanetworkopen.2021.40364''' - This online cohort study (COVID-19 Citizen Science Study) found that vaccine side effects are more common with Moderna than Pfizer, and after having had a previous COVID infection.  Vaccine side effects were fever, chills, fatigue, sore/scratchy throat, muscle pain, joint pain, headache, other pain, redness/swelling at the injection site, rash other than at the injection site, allergic reaction/anaphylaxis, and other.

'''https://doi.org/10.1038/s41467-022-31401-5''' - This French study found that the risk of myo/pericarditis was highest during the 1st week after inoculation.  It also found that risk was higher for the 2nd dose and for Moderna versus Pfizer.

'''https://doi.org/10.1001/jamacardio.2022.0583''' - This ?retrospective? Nordic cohort study found that the adjusted incident risk ratio for the second dose was '''1.75X''' for Pfizer BNT162b2 and '''6.57X''' for Moderna mRNA-1273.

'''https://doi.org/10.3390/jpm11111106''' -This analysis of VAERS data found an increased chance of myocarditis following the second dose compared to the first.

'''https://doi.org/10.1016/S0140-6736(22)00791-7''' - This FDA-funded study (retrospective analysis of patient health records) found that the incident rate ratio between Moderna and Pfizer was 1.43 (95% CI 0·88 to 2·34).  The result was not statistically significant but trended in favour of Pfizer causing fewer cases of myocarditis, as defined by the study (e.g. those with myocarditis before vaccination during the 'clean window' period weren't counted).

Moderna versus Pfizer branded vaccination may be a factor since Moderna vaccines tend to have more active ingredient than Pfizer vaccines (see the page on [[Vaccine_differences|vaccine differences]]).

==== Risks following COVID ====


'''https://doi.org/10.1002/jmv.27689''' - This study looked at Long COVID patients before and after COVID vaccination (first shot).  Postvaccination symptoms were evaluated - fatigue, joint pain, and taste and olfactory abnormalities.  7/42   patients (16.7%) reported improvement, 9/42 patients (21.4%) reported worsening, and 26/42 patients (61.9%) reported that their symptoms were unchanged.

'''https://doi.org/10.3390/life11030249''' - This online survey found that side effects (e.g. fever, breathlessness, flu-like illness, fatigue) were more likely after a COVID infection.

=== Effect of vaccination on COVID outcomes ===

=== United Kingdom ONS data ===

From [https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlongcovidaftertwodosesofacoronaviruscovid19vaccineintheuk/26january2022 a January 2022 study posted on the ONS website]:

<blockquote>In a sample of UK adults aged 18 to 69 years, receiving two doses of a coronavirus (COVID-19) vaccine at least two weeks before a first test-confirmed COVID-19 infection was associated with a 41.1% decrease in the odds of self-reported long COVID at least 12 weeks later, relative to socio-demographically similar study participants who were not vaccinated when infected</blockquote>

One weakness of the ONS data is that it defines fully vaccinated as two weeks after the second dose.  There does not seem to be a valid scientific or statistical reason to use such a definition.

=== American veterans data ===

A study by Al-Aly and colleagues (https://doi.org/10.21203/rs.3.rs-1749502/v1) suggests that a single vaccination slightly increases mortality risk compared to no vaccination and 2 or more vaccinations.  See Supplementary Table 4 under Supplementary Files --> SupplementaryTables.xlsx.  A visualization of that data is shown below.

[[File:Reinfection study supp table 4.png]]

However, the data in the study may be unreliable.  In the study's data, half of the "reinfections" were within 48-119 days.  Another quarter of the "reinfected" data set had a "reinfection" that was less than 48 days after initial infection.  If true, the results would be shocking and would change our understanding of the time that elapses between initial infection and reinfection.

<blockquote>The median distribution of time between the first and second infection was 79 days (IQR: 48–119), and between the second and third was 65 (43–97).</blockquote>

== Early treatment and prevention ==

The easiest early treatment guide to follow is prepared by the CCCA: https://www.canadiancovidcarealliance.org/all/ccca-prevention-and-early-treatment-guide/

The information is available as a video and as a PDF file.

Most of the items in the CCCA guide can be purchased on short notice.  However, there are a few items that may be extremely difficult to get quickly:

* Melatonin, which is easily purchased except in the United Kingdom (where a prescription is needed).
* Nigella sativa / black seed oil.  This is sold at online supplement retailers (e.g. iHerb, Amazon) and sometimes ethnic supermarkets that cater to Iranians, Pakistanis, Indians (the country), etc.  If you are thinking about trying black seed oil for long haul treatment, you should probably buy a grocery-sized amount.  If you plan on taking 4 teaspoons/day for a week (for long haul treatment), then you will need roughly 120mL.  Less is needed for early treatment.
* Ivermectin, which is a prescription drug in many countries and many states.  See the [https://www.longhaulwiki.com/index.php/Ivermectin|the ivermectin page] for information on how to get it.

The items that are easily obtained are:

* Anti-viral mouthwash.  Look for mouthwash with 1% povidone/iodine, cetylpyridinium chloride (e.g. Scope, Act, Crest), or Listerine with essential oils.
* Vitamin D, which is available in many supermarkets and practically all drug stores / pharmacies / chemists.  Note that the CCCA guide calls for high doses of vitamin D.
* Vitamin C
* Quercetin
* Zinc (with copper)

=== Other early treatment protocols ===

For up-to-date information, you can consult these resources:

# The [https://www.canadiancovidcarealliance.org/all/ccca-prevention-and-early-treatment-guide/ CCCA early treatment guide] is the easiest to follow.
# [https://c19early.com/ C19Early.com] lists various treatments and the evidence/data that might support their use.

==== c19Early.com ====

This website is a little more advanced as it links to studies with data on each of the treatments listed.  Please be cautious as the site can suffer from a "garbage in garbage out" problem.  Pharma companies and other parties have been known to manipulate clinical trial results to make a treatment look safer and more effective than it actually is.  The safe, cautious approach is to only look at treatments that are known to be safe, such as supplements and drugs that have been sold over-the-counter for many years.

Some of the non-prescription items on the c19early list are hard to get on short notice:

* Bromhexine.  This drug is only sold in a few Western countries.  However, it can be purchased from Australia via Ebay, where "Chesty Forte" is a popular drug that is sold over-the-counter.  The packaging should say bromhexine or bromhexine hydrochloride on it (see doi:[https://doi.org/10.7326/M20-6817 10.7326/M20-6817]).

=== Ivermectin's effect on lowering viral loads ===

A randomized controlled study conducted in Israel found that ivermectin helped acute COVID patients test negative faster.

https://www.ijidonline.com/article/S1201-9712(22)00399-X/fulltext

<blockquote>There were lower viral-loads and less viable-cultures in the ivermectin group, which shows its anti-SARS-CoV-2 activity.</blockquote>

<blockquote>On day 6, OR was 2.62 (95% CI: 1.09-6.31) in ivermectin arm reaching the endpoint. In a multivariable logistic regression model, the odds of a negative-test at day six was 2.28 time higher in the ivermectin group but reach significance only on day 8 (OR 3.70; 95% CI: 1.19-11.49, p=0.02). Culture-viability at days two to six were positive in 13.0% (3/23) of ivermectin samples vs. 48.2% (14/29) in the placebo group (p=0.008).</blockquote>

=== Nitazoxanide's effect on lowering viral loads ===

[https://doi.org/10.1183/13993003.03725-2020 A randomized controlled study from Rocco and colleagues] found that nitazoxanide (Alinia) reduced viral loads but did not have much of an effect on symptom resolution.

== Masks ==

Masks will do nothing or very little to protect you against COVID.  While many scientists may tell you otherwise, a Danish randomized controlled trial on surgical masks did not find a statistically significant benefit to mask recommendations (https://doi.org/10.7326%2FM20-6817).  If they have a benefit, the benefit is almost certainly very small.  A cluster-randomized trial in Bangladesh (https://www.science.org/doi/10.1126/science.abi9069) suggests that surgical mask recommendations lead to very low or no benefit.

If you want to protect yourself with a mask, an elastomeric respirator with P100 filters will filter 100% of particles in the air (such as particles carrying the coronavirus) and is known to be many times more effective at filtering than a N95 mask.  While they should be far more effective than N95s, there is very little research on their real-world effectiveness.  Their theoretical protection may or may not materialize in the real world.

If you wish to purchase an elastomeric respirator, they are less than $50 on Ebay.  [https://youtu.be/8petaPoHFnk This Youtube video by Rahoul Ahuja, MD] explains how to use them and where to buy them.