You just tested positive for Covid – now what do you do? This scenario is becoming increasingly more common although the prognosis is better than ever. The current Covid variants of Omicron BA.1 and BA.2 are more contagious than earlier variants, but less lethal. That means your chances of getting Covid are higher, but your chances of serious illness or death are lower.

Many people who are already vaccinated are getting Covid. My wife recently had that experience. But fortunately, vaccination is still the best means of lowering your risk of serious illness, hospitalization, or death. Mask mandates are declining so fewer people are wearing masks. The decision to wear or not wear a mask is still yours to make, but don’t be fooled into thinking that will guarantee you don’t get Covid.

What are the current treatments for Covid treatment?

Jared S. Hopkins, writing in The Wall Street Journal, gives us an update on current therapeutics for Covid. There are now antiviral oral treatments for Covid. Paxlovid is an antiviral pill manufactured by Pfizer. Molnupiravir is an antiviral pill manufactuered by Merck and Ridgeback Biotherapeutics. Both are currently available but generally used only in high-risk patients.

Low risk patients, the young and healthy, are usually treated with simple over-the-counter remedies such as Tylenol or Advil and cold-remedies for associated cough or congestion. High-risk patients should monitor fever, cough, and especially shortness of breath, which may be an indicator of developing pneumonia. Shortness of breath is the most important sign that you should seek medical treatment as soon as possible. Early treatment may allow outpatient care, as was the case in the treatment of my wife’s pneumonia. Antibiotics, fluids, and possibly a short course of steroids can arrest early lung inflammation.

Where can I get the antiviral pills?

Both pills are limited to prescriptions from a doctor. There are some differences in effectiveness. Molnupiravir has been shown to reduce hospitalization and death by 30 percent. Paxlovid has been shown to be 89 percent effective in achieving the same. But both have some safety risks and limitations. Paxlovid is taken with another antiviral pill, ritonavir, which can interact with other medications in dangerous and life-threatening ways. Drugs that interact with Paxlovid include common ones such as the cholesterol-lowering pill simvastatin, the antipsychotic lurasidone and the sedative triazolam. It is important to tell your doctor all other drugs you are taking before prescribing these antivirals. Pregnant women and children should avoid the molnupiravir pill, which was not authorized for these patients.

Are these drugs effective against the Omicron variants?

Molnupiravir and paxlovid have both been found to be effective against the Omicron variants. The antiviral drug remdesivir, given by infusion only, has also been found to be effective.

What about monoclonal antibody treatments?

We heard much about monoclonal antibody treatments early in the Covid pandemic, but not so much lately. These drugs are lab-engineered molecules that mimic the natural antibodies produced by the immune system to fight off viruses. They are administered by infusion or injection at hospitals or clinics. There are three manufacturers of these treatments, Eli Lilly, GlaxoSmithKline, and Vir Biotechnology.

Some variations in effectiveness have been found depending on the Covid variant. The GlaxoSmithKline treatment, sotrovimab, was effective against Omicron BA.1 but less so with BA.2. Therefore, the FDA has restricted use of the drug in territories where the BA.2 variant is dominant. Earlier treatments such as regeneron have been restricted in treating any Omicron variant. A new drug from Lilly, called bebtelovimab, has been found to be effective against the Omicron variants and is used for treatment of mild to moderate Covid disease in nonhospitalized individuals 12 and older who are at high risk of severe disease. Those at low risk of severe disease are not considered good candidates for these treatments.

What does the National Institutes of Health recommend?

The NIH recommends paxlovid as the first option for patients with mild to moderate symptoms but who are at high risk of developing severe disease and becoming hospitalized. If the drug is unavailable, or can’t be taken for some reason, then sotrovimab should be administered. Remdesivir is considered the third option. The last two options are bebtelovimab and molnupiravir.

If I am hospitalized, what are the best treatments?

Monoclonal antibody treatments are generally not used once a patient is hospitalized. Remdesivir is fully approved for treatment of people who are hospitalized with Covid. Other treatment options include dexamethasone, a steroid approved in the 1950s for treatment of inflammation. (My wife responded quickly to this treatment and didn’t need hospitalization.) Patients who don’t respond to dexamethasone may be given an immune-suppressing rheumatoid arthritis drug called Olumiant, which received emergency-use-authorization from the FDA when a study showed it helped hospitalized patients recover more quickly. A similar drug, actemra, has also shown effectiveness.

What about ivermectin?

Ivermectin, an antiparasitic drug in use for many years to treat river blindness, has been found to be effective against Covid in some studies. The FDA has not authorized its use for treating Covid, but many doctors still use it for this purpose. In the latest trial, researchers found that the drug didn’t reduce hospitalizations. Nevertheless, ivermectin has achieved some notoriety in treatment of Covid and prescriptions of the drug have increased recently.

How about hydroxychloroquine?

This drug enjoyed some popularity with treating physicians early in the course of the pandemic. But when President Trump touted its effectiveness, it suddenly was the object of pushback from the media and the public-health community. The drug has been used for decades in the treatment of lupus and rheumatoid arthritis, so its safety has never been an issue. The drug initially showed promise but the academic community now recommends against the use of hydroxychloroquine. It is not clear if this is based on science or politics.

When I was a boy, I was active in sports, playing football, baseball, and wrestling. There was a medical theory at the time that when you sweat you lose salt, therefore you need salt tablets to restore your normal balance of sodium. The same theory was used to treat workers at the Bethlehem Steel Plant where many hot jobs led to workers getting dehydrated and experiencing heat stroke.

Then medical researchers found that when you sweat, you lose more water than you lose sodium. This means your blood becomes more concentrated and your sodium content goes up. Giving someone more sodium (salt tablets) only makes the situation worse leading to more dehydration and even higher sodium levels in the blood (hypernatremia). The correct treatment of someone sweating too much is to give them more water. Eventually that knowledge led to a new drink for athletes called Gatorade.

When the Covid pandemic hit, doctors were faced with treating a disease they had never seen before. When Covid patients were found to have very low oxygen levels, they were put on ventilators, the standard care for severe respiratory diseases. But some doctors noticed that severely ill patients responded better to noninvasive ventilation such as high-flow nasal tubes. They shared their findings with other physicians and gentler oxygen support became the norm. That change in treatment has saved tens of thousands of lives.

Allysia Finley, writing in The Wall Street Journal, says such a radical change in treatment from the usual standard of care would become illegal under a proposed new bill in the California legislature. The legislation would require the state Medical Board to take action against doctors found to be spreading “misinformation” related to the “nature and risks of the virus, its prevention and treatment; and the development, safety, and effectiveness of Covid-19 vaccines.”

Naturally, “misinformation” is a poorly defined term, open to interpretation by those in authority. Medicine is not practiced with a cookbook and we don’t need state authorities determining which recipes they approve and disapprove. Much that was labeled “misinformation” by the media and some doctors in this pandemic has more recently found widespread credibility – such as the origin of the Covid virus in a virology lab in Wuhan, China.

Ms. Finley points out the dangers of this California legislation. She says, “So doctors who prescribe or recommend treatments that haven’t been approved by the Food and Drug Administration for Covid-19 – for example, the antidepressant fluvoxamine, which has shown strong results in trials – could be disciplined and even lose their medical licenses no matter if they have scientific evidence to support them. Same for doctors who disagree with masking and vaccines for children.”

“The bill would put physicians’ licenses at risk if they say the vaccines are anything other than safe and effective,” says Teryn Clarke, a neurologist in Newport Beach, California. “But all medicines and medical procedures carry a risk of adverse events, and patients deserve to know what those potential risks are.”

Much of what was learned early in the pandemic was from doctors sharing their clinical experiences and knowledge. Patients receiving oxygen did better when placed in a prone position, for instance, and the steroid dexamethasone could tamp down the “cytokine storm” in severely ill patients. Early in the pandemic some doctors hypothesized that the virus could spread through aerosols, and therefore 6 feet of distance wouldn’t necessarily prevent infection. This outlier view could have been deemed misinformation under California’s proposal. It is now conventional wisdom.

Is this law constitutional? Many believe it would be, but some liberal public-health experts say that makes the Constitution the problem. “Vaccine misinformation during the Covid-19 pandemic underscores how reverence for freedom of speech in the U.S. intensifies our vulnerability to public health threats,” wrote Stanford University’s Michelle Mello recently in the Journal of the American Medical Association. She laments, “the Supreme Court’s attachment to a particular conception of free speech rights,” which limits the government’s ability to impose speech restrictions. She suggests that state medical boards can “suspend the licenses of physicians whose statements constitute unprofessional conduct,” which could include “misinformation” as they define it. I’m sure she’s up in arms over the sale of Twitter to Elon Musk, too. Like many liberal elites, she believes free speech is for me, but not for Thee.

The intolerance of different viewpoints that is infecting the medical profession may itself be a public-health threat. Emails obtained by the American Institute for Economic Research showed how the National Institute of Health’s Francis Collins and Anthony Fauci tried to discredit the authors of The Great Barrington Declaration, which opposed the lockdown consensus. “This is a fringe component of epidemiology,” Dr. Collins told The Washington Post.“This is not mainstream science. It’s dangerous.”

(Author’s note: As of this writing, 929,766 infectious disease epidemiologists, public health scientists, physicians, and concerned citizens from all over the world have signed The Great Barrington Declaration. I am proud to be one of them.)

“There’s no place like home.” That’s an old cliché but one full of wisdom that only a miserable travel experience can make abundantly clear.

My wife and I like to travel. We especially enjoy Viking river and ocean cruises and have sailed with them to many parts of Europe and even Australia – New Zealand. But the Covid pandemic has changed international travel in many ways, possibly forever. The problem is not so much the disease, but the government-imposed travel restrictions that now accompany anyone traveling outside these United States.

Just getting on an airplane bound for a foreign country presents a whole new array of required testing and documentation. First, there’s the need for a negative Covid test before you travel – a PCR test within 72 hours of departure or a rapid antigen test within 24 hours.

You’ll need an appointment to get tested and you’ve got to be sure the test is done within the proper time frame. And it can’t be too late or you won’t have the test results to produce at the airport. There are many ways this process can get complicated, and I won’t bore you with the details, but I had to go to the pharmacy four times in 24 hours to actually get the results on time to travel.

Second, you’ve also got to upload all your Covid testing information, including your vaccination documents, to a travel app along with your passport information. This can be a challenge if you’re not comfortable with a computer. Then there’s probably going to be a “locator form” required by the country you’re traveling to so they can track you if you’re exposed to Covid. You’ll probably be directed to the country’s website, which may be in a foreign language. Your computer may have a translating feature to get you through this step.

Once you’ve got all these documents completed, you’re ready to travel. My wife and I recently traveled to Portugal to join a Viking river cruise. We spent two days in Lisbon enjoying this beautiful city, then traveled to Porto where we boarded our ship for a cruise on the Douro River. Viking requires proof of vaccination and a negative Covid test before you even join the trip; then they continue to test you daily for Covid with a PCR saliva test. Everything was going fine for the first six days of the trip. We traveled up the river observing more vineyards than you can imagine on slopes of mountains that looked too steep for a goat, let alone a vine grower.

Then my wife began to feel ill. She developed a cough and severe fatigue. She continued to test negative for Covid for two more days – and then she turned positive. At that point our world was turned upside down. We were quarantined in our cabin for the next two days until the ship returned to Porto. My wife’s condition got worse and I had to take her to the hospital at 1:00 AM. That turned out to be a good decision since she had developed pneumonia, but antibiotics, steroids, and fluids quickly turned her condition around. After five hours we were able to return to the ship. Later that day we were taken off the ship and sent to a local hotel. There we were quarantined in our room for the next seven days.

Let me take this opportunity to say Viking did a splendid job of taking care of us. They got an ambulance quickly in the middle of the night when my wife’s condition deteriorated and helped us get her into the ambulance. When it was time to move us to a hotel, they made all the arrangements, paid for the taxicab to get us to the hotel, and gave us the name and number of a local contact for any issues that came up. That person called us every day and made the arrangements for our Covid testing and rearranged flight schedule when it was time to go home. Viking did a great job of making a terrible situation tolerable.

Which brings me to my advice about international travel in the era of Covid. Don’t go unless you have Viking, or some other reliable travel service, to lean on when things get difficult. Unless you’re married to a travel agent, like my brother, you need a professional travel company to be there when you need help. Don’t try managing on your own. In fact, maybe it’s a good time to explore all that our own country has to offer. Have you been to any of our national parks lately?