I have covid so I guess I may as well send a newsletter

If you tell me "this variant is mild" I will climb out of your phone and punch you

Well I finally succumbed to the plague. My best guess is I got it at a Janelle Monáe concert that I had thought was outdoors at Fenway but was in fact somehow indoors at Fenway. I did wear a mask the whole night, but, it’s just tight quarters and a lot of ppl. No one else in my family (or my other close contacts) has it yet so please pray for us, or send thoughts, or whatever it is you do.

I was going to send a newsletter about my week being a bog witch at a beautiful campsite by a pond, tech bro culture in backpacking (ENDEMIC! AND AWFUL!), and how strong and healthy I felt out there alone in the woods, but clearly I should be shipping half-assed posts out instead of waiting to fully bake them, because life moves right on by. (Cue Ferris Bueller on life moving pretty fast). Hopefully I’ll get back to that one. It’s sure to come up again next time I go out backpacking because there is apparently literally nowhere in the world a woman can go and not have a man come along and offer unsolicited advice. (“You should do some shakedown trips” WTF do you think this is, sir, do you not see me peacefully assembling my jetboil in order to make my lady friend here tea? I need to learn not to engage but being rude to strange men in the wilderness is probably more dangerous than bears so :shrug: )

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Yes, this is my first time getting covid. I’m a masker, tester, avoid eating indoors if possible person, but once in a while I take a calculated risk. When a friend was headlining at the biggest comedy club in San Francisco, I showed up to support him, in a mask. When Stromae came to town, we went to see him play, in masks.

I often try to mitigate others’ discomfort with my masking by saying I see my elderly in-laws regularly and I don’t want them to get covid. And that’s true, of course, but I also have not wanted to get covid myself. I know that most people want to hear the words long covid about as much as they want to hear the word bedbugs, modern day bogeymen we hope if we use towels to hide ourselves from their gaze, that they won’t find us and ruin our lives, but both those things do, in fact, exist. My health is bad enough without adding other stuff on top.

Anyways much as I hate to mention this bogeyman, the evidence shows that Paxlovid reduces risk of long covid in addition to the risk of other things my GP doesn’t think I’m very much at risk for, so I’m lying in bed guzzling kombucha while trying to coordinate a conversation between my GP and my psychopharmacologist about how to prescribe me Paxlovid even though I take Seroquel, a drug that has a major interaction with Paxlovid. Since this might be of interest to others, let me explain the problem:

First, a note on drug metabolism. You should know this anyways, it’s cool. There’s a bunch of enzymes in our bodies that are primarily responsible for metabolizing drugs in our digestive systems and livers. (Some drugs, like lithium, are instead cleared primarily by the kidneys, and metabolism is complicated so please know this is simplified). Those enzymes are part of what’s called the Cytochrome P450 system. Drugs we take are metabolized by different enzymes, or combinations of them. But drugs we take ALSO affect how much of those various enzymes we have around in our bodies (as do some foods, most notoriously grapefruit, and some genetic variations!).

So for example, one drug you take could require Cytochrome p450 3a4 to be cleared from your system, and another one might decimate your supply of 3a4. If you take them together, well, the one that needs 3a4 is gonna sit around in your body for way longer than usual. If you don’t reduce or eliminate that drug, you will naturally start to feel increased side effects and perhaps toxicity from it, because it is JUST BUILDING UP IN YOUR SYSTEM.

That is precisely the problem with Paxlovid and Seroquel. Seroquel needs 3a4 to clear, and one of the drugs in Paxlovid, ritonavir, absolutely destroys 3a4. (This is INTENDED, apparently, so that the other drug, nirmatrelvir, which is also metabolized by 3a4, sticks around longer in your system to bring your viral load down.).

The cytochrome p450 system explains many (but not all) drug interactions so if you take a lot of meds or just are interested I suggest you learn more about it — it all makes a lot more sense when you understand the underlying mechanisms. ¹

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Anyways, apparently GPs take a look at Seroquel and like to tell you that this variant is mild. (No, I did not punch my GP. But I kinda wanted to.²). I already understood all this stuff about 3A4 going into this adventure and I once had a mishap involving seroquel and grapefruit juice (which inhibits 3a4, be forewarned) and I’ve been dealing with my complex meds for a while so I wasn’t especially worried about this, and my psychopharmacologist has some reasonable recommendations and I just have to get him to talk to my GP so I can get this freaking prescription, but just so you know too if your doc says a hard no because of a med interaction, see if you can get off the med for a week or else do a dose adjustment. It might be entirely possible.

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A thing I especially hate about all this is when doctors decide they are free to make a choice for you that you believe you are competent to make yourself, such as whether hard stopping Seroquel for a week is too risky for you. Doctors of course do this to crazy people all the time, and it’s one reason I really hate doctors, and it’s also an origin story of my abolitionism and you can read more about that here.

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Of course as a person who has tried very hard not to get Covid, I’m angry at myself for finally having gotten it, even though I understand perfectly well that abandoning us to individual choices and ‘your personal risk tolerance’ in lieu of basic public health measures like actually upgrading ventilation, continuing to require indoor masking, continued free testing and care, etc — is a deliberate choice by the state in collusion with capital and not something I have individual control of.

My individual choices can’t keep me and others around me entirely safe no matter what, under such conditions. Many other people have never had the luxury of avoiding high risk situations. Side note: I find that my friends who never could avoid exposure have a much healthier view about whether getting sick is a personal failing or the powers that be not giving a fuck about their lives.

Because of this, I’m going to refrain from offering my assessment on whether this particular high (dancing in silver pasties in a sea of joyful queer people while perhaps the hottest human alive sang about hotness) was worth the pain (assuming I got Covid there). Like pretty much everyone else in the world, covid has come for me, and I’ll take it as it comes.

I do love the combination of doctors not thinking it’s necessary to mask in hospitals or medical offices anymore and that deferring to individual choice is sound public health policy while at the same time informing me that I am not qualified to make a choice about whether I’d rather risk going off my so-called “mood stabilizer”³ for a week or not taking a powerful anti-viral in order to treat something that’s currently making me feel terrible and could also make me feel terrible in the future.

I really love reading Eric Reinhart on public health, mental illness, the ethical obligations of doctors, and other stuff like that.

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Anyhoo, here’s what I’m doing while I have covid:

1. lying in bed

2. more lying in bed.

3. guzzling kombucha

4. matzo ball soup

5. alternating bingeing The Gilded Age (okay) with The Summer I Turned Pretty (pretty bad) which leads to a great deal of reflection on wealth.

6. sleeping

7. drinking green tonics.

8. I am also lying in bed.

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Other stuff to tell you about:

*** My friend Nat and I wrote a song together, based on a poem I published in January, and he’s now recorded the song and you can find it on Bandcamp. This was fun. If you’re wondering where I got the rich story implied in that poem and in the song, please refer back to this disclaimer in which I state that the poems are part of a minecraft ransomware attack.

*** I have room to take on some more coaching clients (not in the next week though, as I will not be working while having covid. anyways see this explanation of my services and why they are great.

anyways thanks for reading, substack will make me put in this button;:

1. I’m not a doctor, and I’m not giving you Medical Advice, for legal reasons. Just… look into this stuff for ‘research purposes only’, it’s very useful.

2. Of course Violence Is Not The Answer.

3. technically seroquel is an atypical antipsychotic not a mood stabilizer, although it does have an FDA authorization for adjunctive treatment of major depressive disorder. the evidence that it serves some mood stabilizing purpose is … slim, and to be honest who the fuck knows what it is doing for me now, I was kinda thinking this would be a great time to get off it anyways, just to see. Which, again, is my right.