Appreciate it! Oddly, the “Professional” version of the drugs.com page on Symbicort does mention inhaled corticosteroids:
“MONITOR: The administration of inactivated, killed, or otherwise noninfectious vaccines to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than 10 mg/day or 1 mg/kg/day of prednisone or equivalent for more than 2 weeks), or long-term topical or inhaled corticosteroids.”
That said, a physician friend of mine responded to my similar post on FB by saying the following, so combined with the research you cite, I’m inclined to think that I’m fine: “There’s a big difference between the dosage of inhaled steroid received like Symbicort (micrograms) and oral steroids (milligrams). Budesonide comes in multiple formulations and can be inhaled or oral. I would not consider patients taking inhaled corticosteroids as immunocompromised or immunosuppressed.”
Further, the CDC reference cited by drugs.com says the following, bolstering the argument that Symbicort shouldn’t be a problem. (Though it references live-virus vaccine. It’s unclear how drugs.com got to its conclusion… perhaps it uses the programmatic approach you suggested.)
“Corticosteroid therapy usually is not a contraindication to administering live-virus vaccine when administration is 1) short term (i.e., <14 days); 2) a low to moderate dose (i.e., <20 mg of prednisone or equivalent per day or <2mg/kg body weight per day for a young child); 3) long-term, alternate-day treatment with short-acting preparations; 4) maintenance physiologic doses (replacement therapy); or 5) topical (skin or eyes), inhaled, or by intra-articular, bursal, or tendon injection (37). No evidence of an increased risk for more severe reactions to live, attenuated viral vaccines has been reported among persons receiving corticosteroid therapy by aerosol, and such therapy is not a reason to delay vaccination.” (Drugs.com also cites a CDC reference specific to COVID-19 vaccines, but it does not go into much relevant detail, and it links to the more general reference above.)
So tl;dr, I guess drugs.com is being imprecise here (perhaps for the reasons you mention), and the use of low-dose inhaled steroids should be ok!
Thanks! Would you be willing to give a little context on how you reached your conclusion?
Symbicort is solely a inhaled drug, as far as I can tell, so I believe the drugs.com reference would apply to that, unfortunately.
Napping for 5-25 min or doing Natural Stress Relief meditation (a cheap variant of Transcendental Meditation) are both things I find restorative if I need a short break, without the risk of finding it hard to stop.
I have the same problem you mention with reading. One thing I find helpful for that is reading on a device where I preset something to block my reader (Chrome on laptop, Kindle app on Android) after X minutes (using Leechblock for Chrome or Appblock for Android).
I’ve found Beat Saber helpful too sometimes, since it is immersive and gets my endorphins going (improving my mood), but sometimes get overly engrossed in that and end up going longer than planned.
I found this an excellent summary of both what I found valuable about the Forum and what I found concerning—thank you! (I did it about a month ago.)
Thanks, that makes sense. Sorry to hear lockdown was so rough for you, and glad you were able to get the J&J!
I’m kind of the opposite on both pieces, I think: I’m faring pretty pleasantly under lockdown, but for me, the main things I’m yearning for are relatively high COVID risk—partner dancing with acquaintances or strangers indoors, and dating people I didn’t previously know (and for some reason I keep matching on dating apps with a disproportionate number of people who work in direct patient care roles, haha). So for me it makes sense to delay a bit to get a higher level of protection, and abstain from the riskier activities in the meantime.
Thanks for sharing this. What do you make of the many reviews saying this fits poorly? There are certainly lots of favorable reviews, but negative reviews make me reluctant to plunk down $50+ for a 50-pack.
FWIW, while I evaluate that I’m going with the Powecom masks, which are well-reviewed KN95 on the FDA’s EUA list https://www.amazon.com/gp/product/B087M2T7NP/ref=ox_sc_act_title_3?smid=A3EYD1ZWL7OQ1F&psc=1, and available in a much smaller quantity so I can check fit before buying a large number.
I just got mine today and they seem solid. Details from my Amazon review:
They came back as authentic, and the verification procedure seems to guard against counterfeits (details below). For me, they fit snugly and comfortably, but I probably have a slightly smaller face than the average man. I do notice some fogging of my glasses, but I don’t think there are any widely available masks that avoid this currently (I should probably use surgical tape to get around that?). My ears do stick out in a silly way, but it’s not uncomfortable.
I see that the CDC NPPTL lists Powecom masks as having a filter efficiency of ~98% (https://www.cdc.gov/niosh/npptl/respirators/testing/NonNIOSHresults.html, expand the section “Respirator Assessment Results”—see for example https://www.cdc.gov/niosh/npptl/respirators/testing/results/MTT-2020-211.1_International_GuangzhouPowecomi_KN95-Earloop-Style_TestReport_Redacted-508.pdf, which matches the packaging I got). They do offer a bunch of caveats that these have not gone through the the NIOSH respirator approval process N95s go through, and note that ear loop designs make it harder to achieve a proper fit. So that is a potential drawback, and it’s on the wearer to make sure they fit you appropriately, but this is probably the best we’re going to get with a shortage of true N95s.
The authenticity verification procedure seems legit. It is as follows:- You scratch off a coating on the label on the outside of the package (so you don’t need to open it to verify) and enter the number on Powecom’s website (http://www.powecom.com/index.html—click the “anti-fake check” link on the right on the navigation bar near the top of the page).- You type in the verification number.- If you type in a non-authentic number, it seems to give you the message, “Error with security numbers.”- If you type in an authentic number, it says the product is verified.- If you type in an authentic number again, it gives you a message saying how many times the number was previously checked, and what the first time was. This gives me confidence that a counterfeiter isn’t just buying a real package and then printing the same number on counterfeit packages.
I haven’t studied this extensively, but I’d add to drachenfels’ answer that not only do leaders lack the desire to merge countries, but so do their citizens. Fundamentally, it seems that people are averse to giving up sovereignty/autonomy over the policies that govern them, and merging reduces that sovereignty.
It would be interesting to consider how the United States and EU came to be in spite of this.
Sorry, long hiatus from LW so just saw this comment.
I actually found / find eating low carb maximizes my energy levels generally, sleep deprivation or no. Or, more specifically, it avoids the sluggishness / energy dip that often comes after eating a satiating amount of carbs. I know Atkins and other low-carb proponents claim that it provides more / more sustained energy (IIRC, the mechanism of action is avoiding blood sugar swings), but I haven’t looked into it rigorously, TBH.
I worked as a strategy consultant for several years, with an unreasonable work-life balance, and in college generally did not get enough sleep, so I have some experience to draw on here :-).
I’ve found transcending-based meditation to be super restorative and often much easier to drop into than a 20 minute nap. I practice Natural Stress Relief Meditation ($40 self study course at nsr-usa.org), but I read a recommendation for the 1 Giant Mind app, which teaches a similar technique and I think is free.
As for being productive while awake: I’ve found the following most effective:
cold showers (you can start with a hot shower, just end with a one minute cold shower at the end… Feel free to warm up afterwards with clothing or bedding)
high intensity cardio (I personally do 15 min on the elliptical, alternating between 30 second intervals of sprinting and 30 seconds of easy walking—but the general goal is to get your blood flowing and heart racing without exerting yourself so much that it significantly tires you out).
Eating low carb and as little as you can
Listening to non-vocal electronic music
Using the pomodoro technique
Using blockers like leechblock and appblock
Turning my phone off and putting it in a different room physically
Maximizing clarity of thought:
Storing as much as possible on paper (electronic or physical) - diagrams, bullets, detailed action steps—rather than my working memory