thenerdhead

Very cool website! That sounds like a good next step, thank you so much!

no, vaccines were not available when I got covid and developed long covid months later.

thats strange as I thought Germany is the one investing over the next decade in these conditions?

having posted on this topic for years, your comment is the first I’ve seen come to this rational conclusion. usually people double down on their original perspective

strongest evidence so far in gut and immune cells for living organisms.

They did find it in the brain of one patient when doing an unrelated procedure at the NIH. That could be due to many things though. General findings around the CSF/brain have been negative.

Autopsy - https://www.nature.com/articles/s41586-022-05542-y

Long covid - https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

Also this exists in both children and adults.

they’ve done 15 days all null and the 25 day one was null but has some unique labs they tested but haven’t posted yet.

Paxlovid does something to antiviral genes and shows there’s something there though in secondary analysis (not posted but has been presented at conferences)

sadly Paxlovid doesn’t actually get rid of the viral pieces remaining and a PROTAC or other therapy might be necessary to degrade the proteins.

https://www.nature.com/articles/s41392-025-02539-7

evidence says yes, but bacteria and other antigens are being studied. ME/CFS shows antigen persistence like long covid has clearly shown.

https://www.nature.com/articles/s41467-024-45107-3

is a small proof of concept study not a study anymore? gastric biopsies aren’t exactly easy to obtain at scale.

they are pretty well understood now with growing evidence of viral persistence in the gut and immune cells, and immune dysfunction causing autoantibodies.

they are also distinct from other conditions like ME/CFS or other sequelae although they may share overlapping symptoms. A lot of research is going into different PAIS post acute infection syndromes

severity is only one factor in developing long covid.

https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

not quite. A grab bag of biomarkers being validated in research labs across the USA though

small study yes, meaningless no

what we’re seeing now is that the immune system can go into overdrive, where certain immune cells trigger sepsis-like illness, sometimes in milder or chronic ways. long covid and related conditions seem like part of that same spectrum of immune dysfunction.

there’s some great new research out of the university of virginia looking into this https://www.science.org/doi/10.1126/science.adq2509

mis-c and the adult versions are rare but real, and there’s early promise with a treatment called larazotide https://www.science.org/doi/10.1126/scitranslmed.adu4284

the nih recover autopsy studies are also finding viral persistence in multiple organs, with more results coming soon https://recovercovid.org/pathobiology

i work on multiple NIH RECOVER efforts on this topic and post long covid research on x, and honestly the picture is both fascinating and pretty grim https://x.com/atranscendedman

Have you heard of Novavax or any of the intranasal vaccines in late trials?

Yes and those are being funded well. Look at HIV and cancer mRNA breakthroughs. Those aren’t being cut.

This is specifically about COVID-19 and flu. Which after 5 years we have better science supporting how to combat them long term.

I think a lot of people miss that nuance because of who the message is coming from.

There are legitimate scientific efforts underway to explore next-gen vaccine platforms like mucosal and T-cell-based strategies.

That shift is happening regardless of what RFK Jr. says or doesn’t say. Let’s separate the messenger from the actual science for a moment.

There has been nothing happening on the common cold virus with MRNA vaccines. In retrospect, it seems like CEOs pumping the stock price with wild promises.

So not true. There are numerous candidates for pan-flu and pan-coronavirus vaccines. mRNA and other vehicles.

https://www.nih.gov/news-events/news-releases/clinical-trial...

https://news.ycombinator.com/threads?id=thenerdhead#44805721

Look, it’s not that BARDA is throwing science out the window in favor of some wishful thinking. It’s that they’re looking beyond what works now and toward what might work better, not just for today’s virus, but for the ones waiting in the wings.

Oral vaccines, nasal sprays, multi-antigen, multi-receptor approaches, these aren’t just buzzwords. They aim at mucosal immunity, they aim at T-cells, they aim at the places our current tools often miss. And when you learn that SARS-CoV-2 can persist in the body long after the sniffles are gone(i.e. Long COVID/MIS-C), you realize we need more than just antibodies.

It’s tough to get a clear picture, but if you’ve been following the research closely, it’s obvious that there are better long-term candidates in the pipeline.

Project Next-Gen is highly data-driven, and the most promising candidates are rising to the top as some are already near Phase 3.

Redirecting funding toward these options isn’t as drastic as it may seem. In fact, it makes sense if we want the best outcomes.

https://medicalcountermeasures.gov/nextgen

https://academic.oup.com/cid/article/79/1/115/7607231

agreed on changing guidelines, disagree its unlikely to happen.

the study is done and just needs to be formally published. then recommendations can "officially" change although the science has been clear about this for quite some time now with this specific drug.

other antivirals dont have this problem because they are actually effective for 10+ days even if you take it for 5 days (Ensitrelvir).

there's countless candidates in the pipeline as well for vaccines, antivirals, and monoclonal antibodies. as they keep getting better, the guidelines will shift slowly but surely.

i personally wish we did this with more urgency.

I am criticizing two things.

1. Science magazine's association with his recurring "editorially independent blog". I've been a subscriber for many years and have never enjoyed it personally.

2. His opinion on this topic in general. The drug lived up to the hype even beating some international antivirals on efficacy terms.

Today's science is a bit further ahead still. For example, Pfizer will publish acute 10d data soon? which already has preliminary data showing faster symptom resolution and less rebound.

NIH/Yale/Karolinska will publish their 25d/15d/15d Long COVID Paxlovid studies to see what phenotypes may benefit from extended durations.

And next gen Paxlovid is already on an accelerated approval path and showed great results at IDWeek. https://clinicaltrials.gov/study/NCT06679140#study-plan

It is odd to me because he even wrote a piece about the next gen Paxlovid? Why didn't he reference it! It's in phase 3... https://www.science.org/content/blog-post/next-paxlovid

Ensitrelvir is looking to apply for global approval. It may be a much more affordable option.

there are a number of computational/modeling studies suggesting paxlovid needs to be given for at least 7+ days to slow the viral load and prevent rebound.

Pfizer did a preliminary study(the FDA asked them) and quietly published their results on the topic. their data implies a second treatment might shorten the overall duration of the infection consistent with the studies i allude to above. but you probably haven't heard about this news!

https://clinicaltrials.gov/study/NCT05567952?tab=results

here's my page with countless findings on the topic (you be the judge and feel free to search for other studies too): https://x.com/search?lang=en&q=(paxlovid%20OR%20Nirmatrelvir...

my general thoughts on this article and science "journalism" lately: https://x.com/atranscendedman/status/1856467031157289327

background: 4 years of long covid, work on nih efforts to cure it, and i don’t want anyone to suffer like millions of us do. so i share reliable info with the world.

note: paxlovid is a first-generation drug. in 2025, derek should follow more science rather than zeroing in on one study or griping about the taste when it can prevent your life from flipping upside down with long covid. he has literally written on the next version of it as well.

many elderly patients who are only vaccinated still develop long covid and are often dismissed due to their age. nobody deserves that when an antiviral is available until next-gen vaccine 2b trials finish soon and more treatment options hit the usa market later this year.

I believe Science would benefit from a different approach to reporting, as Derek’s analysis over the past four years has been consistently lacking.

A responsible science reporter should present the full body of evidence rather than drawing conclusions from a single study.

Currently, a 900-person study is exploring Paxlovid’s potential for three clusters of Long COVID patients using a novel ultra-sensitive single-molecule assay. While many question its effectiveness in short treatment durations, there is reason to believe it could have extended benefits, similar to treatments for hepatitis C or feline coronavirus infections.

Having read and shared thousands of studies on SARS-CoV-2 and Long COVID, I find it irresponsible to dismiss a drug based on a single study, especially when broader research suggests that access to antivirals may reduce the risk of developing Long COVID, even among vaccinated individuals.

New antivirals are awaiting FDA approval, and an updated version of Paxlovid is in development. Derek’s analysis is not only misleading but also incorrect, and it would be best if he reconsidered the reach of his words.

I’d keep eyes on the immune system. We are already rethinking migraines and inflammation based on findings from COVID-19.

https://www.nature.com/articles/d41586-025-00456-x

Did this happen after a known infection of some sort? Does it run in your family? These questions may be important to know the answers to until science gets more tests over the counter as they are fairly close already.

For acute yes, who knows for post-acute.

Many viruses are linked to cancers, MS, Parkinson’s, Alzheimer’s, T1D and so on. Research is finding that some of these viruses may actually be low grade infections or left over viral proteins causing constant immune dysfunction.

People who claimed they never got SARS-CoV-2 for example were tested with a novel ultra sensitive single molecule assay and found that 99.9% of individuals samples were indeed asymptomatically infected.

Here’s an earlier version of this claim showing 95%.

https://academic.oup.com/jid/article/230/3/e601/7639429

Some of these individuals later went on to develop Long COVID. They are using this assay in an antiviral trial to see if it reduces the amount of SCV2 proteins this assay can detect.

https://youtu.be/B1sFSW94JZg?si=7mvHAJGjrJiOLaW7

https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

Or a virus known to persist in our tissues for years.

Here’s yet another study suggesting persistent symptoms in kids.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

More than willing to provide a list of studies demonstrating viral persistence as well.