March 9, 2023 – An earlier study found that compared to placebo, neither metformin, ivermectin, nor fluvoxamine started in the first 7 days of mild-to-moderate COVID-19 illness prevented death or severe illness (hospitalization, etc.). However, long-term follow-up data from that same study, just published as a Lancet preprint, indicate that compared to placebo, metformin appears to be highly effective (42%) in preventing Long COVID. The effectiveness was even greater (63%) in people who had started metformin within 4 days of COVID-19 illness onset. These Long COVID prevention effects were NOT observed in patients who took either ivermectin or fluvoxamine. Although metformin is not yet recommended as an acute treatment of COVID-19, providers should be aware that Paxlovid is already available and, does appear to reduce longer-term risk of Long COVID if given early in the course of COVID-19 illness. 

March 3, 2023 - In partnership with the U.S. Department of Health and Human Services, the APHA has developed downloadable handouts, talking points, posters, and other resources in both English and Spanish to help educate patients about the risks of severe COVID-19 illness and the availability and importance of early treatment. Healthcare providers should consider making some of these available to their patients who are at higher risk from COVID-19.  

March 1, 2023 – A recurring theme in the reluctance of some people to accept mRNA-based COVID-19 vaccines has been a concern that because these vaccines were developed so quickly, there was not enough experience with this “new” mRNA technology to know whether it was safe and effective. Generic responses that vaccine-related mRNA technology has been studied extensively well before these current vaccines were developed have not been sufficient to overcome that reluctance. However, a recent detailed review found that since 2003, >$330 million of U.S. government funding had been invested in dozens of mRNA vaccine-related research studies well before the late 2019 advent of COVID-19. Healthcare practitioners should be prepared to describe the duration and extensive magnitude of this earlier mRNA vaccine-related research if it could help convince some of those reluctant people to accept these current mRNA vaccines.  

February 28, 2023 – Multiple controlled trials have found ivermectin to be no better than placebo for treating mild-to-moderate COVID-19. Some people have argued that the ivermectin doses used in those prior studies were too low. In a recent randomized controlled study published in JAMA, a much higher ivermectin dose (600 mcg/kg) was given for a longer (6 day) period to 602 randomized patients with lab-confirmed COVID-19; placebo was given to 604 controls. The median time to sustained recovery was 11 days in patients receiving ivermectin and 11 days in people receiving placebo. Deaths occurred in one ivermectin patient and no placebo patients. Adverse effects were uncommon in both groups. 

Although ivermectin was well-tolerated at this higher dose, its continued promotion in the absence of any documented benefit constitutes misinformation (or sometimes disinformation) that is an obstacle to the use of other antiviral agents with well-documented benefits such as Paxlovid. An accompanying editorial note provides additional perspective on ivermectin use, including the need to address ongoing misinformation.  

February 27, 2023 – A newly available Post-COVID Conditions (Long COVID) patient checklist provides detailed suggestions for things that patients with suspected or confirmed Long COVID should do before, during, and after their appointments with healthcare providers. The checklist is also available in Spanish. Healthcare providers and their staff should ask that patients calling in for appointments related to Long COVID take the recommended pre-appointment steps in this checklist before coming in for their appointment.