Interesting.
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tl;dr: with a two-part innoculation, get the second shot in the same arm as the first shot
Researchers in Germany found people [n = 300] who got all their shots in one arm had a stronger immune response than those who distributed shots between both arms. … Two weeks after receiving the shots, researchers discovered certain immune cells – commonly known as “killer T cells” – were detected in 67% of people who received both injections in the same arm versus only 43% of those who got them in different arms.
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The problem is that Paxlovid needs to be started early, before the patient and physician know whether the infection appears serious enough. So a “wait and see” approach is not effective. Either it needs to be prescribed unconditionally, or unconditionally for those defined as “high enough risk”. However, it may end up being unnecessarily used by some people who get the unpleasant unwanted effects.
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Thing is, it will interfere with the enzymes the virus needs to infect more cells. By limiting the spread early, and to other cells in the body, it has the possibility of reducing severity of symptoms, reducing the risk of hospitalization, reducing the odds of long CoViD.
There simply is no way to know if someone would have never developed long CoViD anyway, or would have levelled off with mild symptoms anyway, thus making Paxlovid “unnecessary”.
And, yes, someone who still has a detectable active virus load after a 5 day course, there is a chance of a rebound once the inhibiting effects from Paxlovid are missing. In that case a second course might be necessary.
Given the difficulty I had in getting my 1st course of paxlovid prescribed, I cannot imagine it would be possible to get a second course if needed!
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I think the duration of the course was selected with the cost/side effects/benefit in mind with 5 days being the sweet spot at that time. There are ongoing clinical trials of longer duration in certain at risk groups.
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Yes - many procedural details of the vaccines and treatments (such as length/dosage) were “informed guesses” of what should be broadly tested. And once any particular combination could be proven safe & effective, it was moved forward towards approval, rather that going back and trying more variations for many months in order to potentially “fine-tune”.
So, those are not necessarily the optimal (most effective) dosages or administrations - but given the urgency to have anything available, they were shown to certainly be “good enough”.
Therefore “5 days” is not a number to be understood as edged in stone, or particularly significant.
H and I are in a two-seat row. He’d better not be infectious! 
Better talk to my primary. Don’t think I’ll be able to find Paxlovid in Ukraine.
H and I leave on 10/14 for Portugal and London. We are hoping the updated Covid booster will be ready at the end of September so that we can get it along with our flu shots before we travel.
LA County Public Health has a weekly press release. In yesterday’s release, they stated,
Anyone who tests positive for COVID-19 should talk to their health care provider about treatment options, such as Paxlovid, as soon as possible. Treatment must begin within five days of the onset of symptoms.
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We heard back from our PCP team ,and they recommended that it made sense for us to get another booster prior to Europe trip. (Our last booster was Sept 2022, and we both had mild Covid in the winter.)
When we called for nurse appt. as directed, they did not have vaccine available. Husband (over 65) successfully got his shot today. We drove 20 miles to CVS were I get my vaccines, and the pharmacist said due to my age (61) and lack of risk factors, I did not meet CDC requirements. I was not upset with him, but I was annoyed that the website that knew my age and answers to questions still allowed the appointment.
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YLE has some suggestions on fall vaccinations for flu, COVID-19, and RSV:
The chart above does not mention that there are various formulations of flu vaccines. Some are non-egg-based, so those with egg allergy may want to ask for those options.
EG.5 and FL.1.5.1 (both XBB descendants) are growing and displacing XBB.1.5 (which the upcoming vaccines target).
However, BA.2.86 has been discovered, with 34 mutations relative to BA.2, 36 mutations relative to XBB.1.5, and 58 mutations relative to the ancestral virus.
I’d be annoyed, too. I haven’t looked at the particulars of vax eligibility in a while, since my age alone qualifies me. But is the immunocompromised/immunosuppressed requirement still there? If you checked that, would you qualify?
I have a friend who wanted a booster a year or so ago. She has health issues, but did not technically meet the requirement for a booster. She made an appointment at one of the public health covid vax sites. They gave her a very hard time, asking many questions about her immunocompromised condition. It’s supposed to be sel;f-disclosure with no questions asked! I even heard them say that at one of the CDC advisory committee meetings.
This is very different from the lying people did to get the initial vaccine when it was in short supply. There is an overabundance of vaccine now, and anyone who wants it should be able to get it. The CDC is not concerned with anyone’s health as an individual. They are (supposedly, because it doesn’t seem so now) concerned with population-level morbidity and mortality. We’re all on our own if we want to protect our own health.
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I was very annoyed, too, as I tried several times. I’m 63. I’ll be wearing a darn mask in the airports, trains and planes yet again. We will just be 4 people, so not on a tour. But I’ll wear one inside museums where we may be around many. I just bought some more N95 masks.
CVS really should update their web page.
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You know, I take medication for asthma. It’s never been severe, but it helps. Do you think that might sway the pharmacy to give me one? However, I’ve read that getting another bivalent booster isn’t really going to help much with this new Covid strain around.
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What does your doctor say? I was suggesting to pursue the “Immunosuppressed/immunocompromised” option to @Colorado_mom since their PCP recommended getting boosted before their trip.
It’s a really tricky question for people who will be traveling, yet too soon too get the new booster.
I assume if I had lied on the web signup questions or in person the phamarcist would have given me the booster. I didn’t want to lie.
We talked to the assistant, but I suspect the doctor (who knows us both well) had a higher concern about my husband who is older and has some health risks. We did both survive Covid in March / April, from different sources. Our travel partners are older and will get a booster. Still I had liked the idea of an August booster.
I was the 1st in my family of 4 to get covid, after 6 covid shots (last one was 3/2023). H (who hit his 6 shots when i did) tested positive next day or so, then D and lastly S). D and S have had fewer shots.
We all got snf started paxlovid promptly. S later grumbled it made things taste awful—D and I never noticed that side effect.
We were glad to have gotten paxlovid promptly. Covid seems to be going around again. Nephew and his D got it about 2 weeks before us. Another niece got it after us and a few weeks later another niece and after she was better yet another niece now has covid. 
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Can’t PM you, so I’ll ask here: Can you speak more about this? I’m pro-vax as well, but hemmed and hawed about the second vax for my teenage boy b/c of increased myocarditis frequency. (He did end up getting it, so has 2 vaxes and then got covid 7/22, so I consider that a “booster”. ) It wasn’t until after school ended this year that he took his mask off b/c there was some component of fear to do so. As a result, I would consider getting him boosted if that felt like a good option.
Do you not rec 4th/5th doses across the board? Or just with peds?