Covid.  It’s about as good as it gets right now. Wastewater surveillance, weekly deaths, and hospitalizations are at or near pandemic lows. Yet Covid is still a thing to watch, and many of us still adjust our behaviors based on the weather forecast.  So welcome back to some monthly highlights from a place I call Covidlandia.  Here I present recent news, scientific discoveries, and medical knowledge that caught my attention and that is of interest to primary care.  I curate and comment, and realize that one human being cannot possibly keep up with everything.  But I try to highlight useful, actionable stuff.

 January, February, March.  And now April. Covidlandia is a unique place. Here we try to see the gradient between black and white, carefree and cautious, pandemic beginning and end.  We will start with some happy news. Another vote of confidence in metformin to prevent long Covid This is really big news, again. A 42% reduction in long Covid rates for those average risk patients treated with oral metformin.  That’s huge for a disease that is a slowly moving, mass disabling event for millions of people. Here’s exactly what the study showed in addition to reducing long Covid rates: Despite headlines this week trumpeting the news, and respected doctors like Paul Sax, MD writing mainstream commentaries, this data is not new.

 In fact, I’ve been writing about this good quality, randomized, placebo-controlled clinical trial called COVID-OUT for over a year now.  For example: I shared this stuff on some doctor sites and mostly I got skeptical or even cynical feedback.  Doctors (and people in general) can be really resistant to change and new ideas that are not obvious and accepted by the herd.  I’ve had very few patients take me up on the offer to try metformin, as many have heard Covid is just a cold now. It often is not.

So why is metformin finally poised to become a more mainstream treatment for Covid?

 I suppose it’s because this further data from the COVID-OUT trial published this week in Clinical Infectious Diseases really focused on a mechanism of action.  Metformin reduced viral loads in the body by 3.6-fold. Paxlovid also reduces viral loads by up to 90%, by the way, and I’ve written about how it has been discarded prematurely by many thought leaders as well.  But I digress.  Back to metformin. Beyond the viral load reduction as a mechanism, metformin has other effects that were not measured in this trial.  I’ll quote my previous article: So bottom line here is that long Covid is what I fear the most for myself and my patients… not so much hospitalization and death anymore.

 I also fear cumulative damage that goes undetected and shows up later, unofficially counted by ever-increasing excess mortality in the world; Covid has probably claimed 30 million precious lives.  When people ask me for advice I’ll err on the side of aggressive treatment. I’ve already shown you my cards. This summary is just the first of a baker’s dozen I posted last night on Examined.  If you want to read the rest, which I strongly recommend, please click over there and join me.  I tried to copy and paste the rest here but the graphs got all screwed up on this platform. Take good care :)