u/Jazzlike-Cup-5336

So, the Burger King app, as far as I know, offers the quickest and easiest refunds in fast food, so I’m pretty frequently taking advantage of that. If they give me an incorrect item or forget an item, I’ll always go in the app and tell the chat bot, and I always receive a coupon for greater than the item’s value every time. And it happens a lot, because, well, they mess up a lot, just like any fast food restaurant in 2026. But at any other restaurant, where the refund process isn’t as easy as spending 60 seconds with a chatbot, I’ll usually just ignore the minor issues.

Anyway, I’m just wondering, since I end up doing it fairly frequently:

• Do individual stores or employees ever get contacted/notified about refunds?

• Can employees specifically see when you use a customer support coupon for an order (and would they potentially think anything of that)?

• Are there ever any consequences for individual employees for refund-related issues?

I doubt that those things would be an issue, but I would just hate to be known by local staff as a “problem customer”, or even worse, cause someone to get in trouble, because fast food is never that serious. So I just wanted to get a vibe check on the situation

By now, you’ve probably seen at least some information floating around over the past few years that over-the-counter antihistamines could be a beneficial addition to COVID treatment protocols.

The science behind H2 blockers is more robust, and picking a product is also a much easier task. There’s really only one on the market that makes sense, which is Famotidine/Pepcid. In 2022, we got this small randomized clinical trial suggesting that Famotidine during an acute infection can improve the rate of symptom resolution: https://gut.bmj.com/content/71/5/879

For H1 blockers (the more common antihistamines that you probably think of (eg. Benadryl)), there is also speculation that they may be beneficial in treating acute COVID, however, the choice of selecting a product is a lot more complicated, with close to a dozen potential options on the market.

The theory that H1 blockers may be beneficial mainly stems from this 2024 paper, which demonstrates that the H1 histamine receptor can act as an alternative receptor for SARS-CoV-2 entry, in addition to ACE2: https://journals.asm.org/doi/10.1128/mbio.01088-24. Therefore, an H1 blocker that competitively binds to H1 should theoretically work to prevent SARS2 entry.

From what I’ve been able to identify, there are 3 options that likely stand out above the others:

• Fexofenadine (Allegra)

• Cetirizine (Zyrtec)

• Levocetirizine (Xyzal), the active, purified component of cetirizine

That 2024 paper also studied the IC50 of 11 different antihistamines, which is the concentration that would be required to inhibit SARS2 binding by 50%. Their choices of antihistamines, though, aren’t very helpful, because those 11 only included a couple of OTC options that would make sense for outpatient COVID treatment, like Benadryl and Claritin. However, the takeaway is still important - although there was some slight variation, the IC50 of all 11 antihistamines fell into the range of 1.6 to 3.6 micromolars (μM). For the sake of making a choice, since it’s the only thing that we can really do, we can assume that most available OTC antihistamines will also likely fall within that same range, or at least be similar.

From that starting point, we can look at the Cmax of available OTC antihistamines, which is the maximum plasma concentration that they achieve in the body, and comparing them to the IC50 range that the study lays out. At the typical oral dose, these are the Cmax concentrations of some popular OTC options:

• Fexofenadine (Allegra) - 0.98μM

• Cetirizine (Zyrtec) - 0.80μM

• Levocetirizine (Xyzal) - 0.69μM

• Diphenhydramine (Benadryl) - 0.27μM

• Dimenhydrinate (Dramamine) - 0.15μM

• Chlorpheniramine - 0.055μM

• Loratadine (Claritin) - 0.020μM

As you can see, the 3 that I mentioned are the only options that come anywhere close to reaching the desired concentrations.

Since any theoretical benefit is based solely on the mechanism (ie. no trials yet), combined with the fact that none of the options actually do reach the required Cmax, I probably definitely wouldn’t suggest H1 blocking antihistamines as a blanket treatment that everyone infected should automatically take. But it’s certainly a legitimate pathway to consider, and is fairly low-risk.

So, if you do want to add an antihistamine, why not just select the best performing in Cmax, which is Fexofenadine (Allegra)? Well, there are some other individual characteristics to consider.

Fexofenadine (Allegra) is the one option that comes with essentially no risk of drowsiness, while both Cetirizine (Zyrtec) and Levocetirizine (Xyzal) do both typically come with with at least slight drowsiness, the caveat being that they’re also slightly more potent at their job of H1 blockade. Allegra is more polar, meaning that it’s less “membrane sticky”, which means that it crosses the blood brain barrier less, which is why we get the benefit of no drowsiness. However, that relative lack of concentration at membranes also means that it may not perform as well in the SARS2 cell entry context, since that area is where the viral entry is happening. This could theoretically increase the IC50 of Allegra, making it more similar (or even a slightly worse option) when compared to Zyrtec or Xyzal. Our best guess is that it probably wouldn’t increase the IC50 dramatically, but it’s still something that should be considered.

So, TLDR, my recommendation would be:

• If you want the safest bet with an all-around favorable profile, and you don’t mind some drowsiness or plan to take it at bedtime, then the best options are either Cetirizine (Zyrtec) or Levocetirizine (Xyzal).

• If you don’t tolerate drowsiness at all, or if you want the option that may perform better, but does have some question marks surrounding its mechanism for blocking SARS2 cell entry, then the best option is Fexofenadine (Allegra).

A quick comparison of both trials:

COVID-OUT:

• Dec 30, 2020, to Jan 28, 2022

• n = 1,126

• Symptomatic COVID for <7 days

• Outpatients aged 30-85, either overweight or obese

• 55% with at least 2 prior SARS2 vaccines

• No prior SARS2 infection

• Percent with PASC symptoms (cumulative) by day 300: 6.3% with metformin vs. 10.4% with placebo

• Hazard ratio [HR]: 0.59 (95% CI 0.39 to 0.89)

• When started within 3 days of symptom onset: Hazard ratio [HR]: 0.37 (95% CI 0.15 to 0.95)

ACTIV-6:

• Sept 19, 2023 to May 1, 2024

• n = 2,983

• Symptomatic COVID for <7 days

• All outpatient adults aged 30+

• 54% with at least 1 prior SARS2 infection

• 68% at least 2 prior SARS2 vaccines

• 83% either prior infection or vaccine

• Percent with PASC symptoms on day 180: 2.3% with Metformin vs. 3.0% with Placebo

• Adjusted risk of symptoms on day 180 was 0.8 percentage points lower with metformin (95% credible interval [CrI] -2.2 to 0.6)

• Risk ratio [RR]: 0.79 (95% CrI 0.474 to 1.230)

Link to today’s VRBPAC meting: https://youtube.com/live/3wU0NWzXvZY

The vote was 8 Yes, 0 No, and 1 Abstain for the question “For the 2026-2027 Formula of COVID-19 vaccines in the U.S., does the committee recommend JN.1-lineage XFG variant as the preferred variant for an updated monovalent vaccine?”

Slide decks, for anyone interested:

• Sanofi: https://www.fda.gov/media/192766/download

• Moderna: https://www.fda.gov/media/192768/download

• Pfizer: https://www.fda.gov/media/192765/download

• CDC epidemiology and genomics: https://www.fda.gov/media/192772/download

• CDC vaccine effectiveness: https://www.fda.gov/media/192771/download

• WHO TAG-CO-VAC: https://www.fda.gov/media/192767/download

• FDA strain selection: https://www.fda.gov/media/192769/download

Previous post about former meeting materials: https://www.reddit.com/r/Novavax_vaccine_talk/comments/1toftl6/fda_has_published_meting_materials_agenda_roster/

Voting question and discussion topic:

• For the 2026-2027 Formula of COVID-19 vaccines in the U.S., does the committee recommend JN.1-lineage XFG variant as the preferred variant for an updated monovalent vaccine?

• Please discuss circumstances that may warrant recommendation of a non-JN.1 lineage variant (e.g., BA.3.2) for COVID-19 vaccine use in the U.S.

So, perhaps as expected, we’ll very likely be getting a recommendation for an updated XFG vaccine. Which I think is the most obvious and correct choice, but I still wish they would leave the issue a bit more in the hands of manufacturers, by issuing a wider recommendation (like what essentially was the case with JN.1 last year). We’re also still going to need to figure out, which I’m sure will be discussed at the meeting, what constitutes an “XFG variant” vaccine, since XFG has now progressed to the point of essentially being an entire lineage on its own - with variants like XFG.1, XFG.14.1, and especially XFG.1.1, etc. becoming more dominant lately.

Briefing document:

> All licensed manufacturers have indicated that they are prepared to produce an XFG vaccine for COVID-19 vaccines (2026-2027 Formula).

Meeting roster:

There are 4 temporary voting members (3 of them returning from previous terms serving on VRBPAC) that are being brought on for this meeting in addition to the 6 permanent members who will be attending. That isn’t very surprising, that’s the same approach that was used for the flu selection meeting back in March. I wasn’t thinking we’d get any new permanent member announcements this close to the meeting, anyway, even though there are now 9 vacancies listed on the roster.

It's notable that this is the first year where Sanofi is attending on their own (with no Novavax speaker) after the Nuvaxovid license transfer. Last year, it was a joint effort (Novavax’s CMO Robert Walker, and, just like this year, Tonya Colpitts from Sanofi).

That makes me a bit wary, honestly…it’s anyone’s guess as to whether Sanofi will continue to have as advantageous of an approach to strain selection as Novavax did. I would personally like to see it continue to be a joint effort.

That said, the change is not surprising. At the Cantor global healthcare conference last September, Novavax was asked about strain selection duties, and the comment was:

> Moderator: “When it comes to future strain selection and so forth, whose responsibility is that? Is it joint? Is it…”

> Novavax: “So, of course, as Sanofi’s going to take over, that decision is going to belong to Sanofi more and more. For this transition year, we have worked together for the strain selection.”

But it’s notable that the tech transfer, where manufacturing of Nuvaxovid is transitioned from Novavax to Sanofi, is still not yet complete, just the global marketing transfer. Tech transfer was originally expected to be completed by now, but on the February earnings call, Novavax mentioned that the timeline had been extended because Sanofi made the pivot to produce Nuvaxovid in the United States, which was not the plan originally (presumably, due to the current admin’s efforts in that area).

Meeting agenda: https://www.fda.gov/media/192691/download

Previous post on the meeting announcement, public comment is still open until midnight Thursday for anyone who would like to leave one: https://www.reddit.com/r/Novavax_vaccine_talk/comments/1sxw993/the_fdas_vaccines_and_related_biological_products/

Voting question and discussion topic:

• For the 2026-2027 Formula of COVID-19 vaccines in the U.S., does the committee recommend JN.1-lineage XFG variant as the preferred variant for an updated monovalent vaccine?

• Please discuss circumstances that may warrant recommendation of a non-JN.1 lineage variant (e.g., BA.3.2) for COVID-19 vaccine use in the U.S.

So, perhaps as expected, we’ll very likely be getting a recommendation for an updated XFG vaccine. Which I think is the most obvious and correct choice, but I still wish they would leave the issue a bit more in the hands of manufacturers, by issuing a wider recommendation (like what essentially was the case with JN.1 last year). We’re also still going to need to figure out, which I’m sure will be discussed at the meeting, what constitutes an “XFG variant” vaccine, since XFG has now progressed to the point of essentially being an entire lineage on its own - with variants like XFG.1, XFG.14.1, and especially XFG.1.1, etc. becoming more dominant lately.

Briefing document:

> All licensed manufacturers have indicated that they are prepared to produce an XFG vaccine for COVID-19 vaccines (2026-2027 Formula).

Meeting roster:

There are 4 temporary voting members (3 of them returning from previous terms serving on VRBPAC) that are being brought on for this meeting in addition to the 6 permanent members who will be attending. That isn’t very surprising, that’s the same approach that was used for the flu selection meeting back in March. I wasn’t thinking we’d get any new permanent member announcements this close to the meeting, anyway, even though there are now 9 vacancies listed on the roster.

It's notable that this is the first year where Sanofi is attending on their own (with no Novavax speaker) after the Nuvaxovid license transfer. Last year, it was a joint effort (Novavax’s CMO Robert Walker, and, just like this year, Tonya Colpitts from Sanofi).

That makes me a bit wary, honestly…it’s anyone’s guess as to whether Sanofi will continue to have as advantageous of an approach to strain selection as Novavax did. I would personally like to see it continue to be a joint effort.

That said, the change is not surprising. At the Cantor global healthcare conference last September, Novavax was asked about strain selection duties, and the comment was:

> Moderator: “When it comes to future strain selection and so forth, whose responsibility is that? Is it joint? Is it…”

> Novavax: “So, of course, as Sanofi’s going to take over, that decision is going to belong to Sanofi more and more. For this transition year, we have worked together for the strain selection.”

But it’s notable that the tech transfer, where manufacturing of Nuvaxovid is transitioned from Novavax to Sanofi, is still not yet complete, just the global marketing transfer. Tech transfer was originally expected to be completed by now, but on the February earnings call, Novavax mentioned that the timeline had been extended because Sanofi made the pivot to produce Nuvaxovid in the United States, which was not the plan originally (presumably, due to the current admin’s efforts in that area).

Meeting agenda: https://www.fda.gov/media/192691/download

Previous post on the meeting announcement, public comment is still open until midnight Thursday for anyone who would like to leave one: https://www.reddit.com/r/ZeroCovidCommunity/comments/1sxvsyr/the_fdas_vaccines_and_related_biological_products/

Link to statement: https://www.who.int/news/item/16-05-2026-statement-on-the-antigen-composition-of-covid-19-vaccines

Key points:

• The WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) held its twice-yearly decision-making meeting in May 2026 to review the evolution of SARS-CoV-2, the effectiveness of currently approved COVID-19 vaccines and the implications for COVID-19 vaccine antigen composition.

• The objective of any update to COVID-19 vaccine antigen composition is to enhance vaccine-induced immune responses to circulating SARS-CoV-2 variants, when needed.

• Following this meeting, the TAG-CO-VAC advises vaccine manufacturers that monovalent LP.8.1 is the recommended vaccine antigen.

• Other antigens (e.g. XFG, NB.1.8.1) or other approaches that demonstrate broad and robust neutralizing antibody responses or efficacy against currently circulating SARS-CoV-2 variants could also be used.

• Vaccination remains an important public health countermeasure against COVID-19 and vaccination should not be delayed in anticipation of access to vaccines with an updated antigen composition. As per the March 2026 WHO Strategic Advisory Group of Experts on Immunization (SAGE) recommendations, Member States should consider routine COVID-19 vaccination of groups at highest risk of severe COVID-19 disease.

Personal thoughts:

This conservative approach of what is essentially multiple recommendations is a continued philosophy that they’ve also exhibited at their last 2 meetings. This essentially tosses the issue to the individual vaccine manufacturers to use their specific platform to what they feel is the best of its ability, as well as for local governing bodies (eg. EMA in Europe, FDA in the US) to make more specific recommendations based on their geography.

I am generally a fan of that approach, even though I absolutely disagree with the outright preferential recommendation of LP.8.1 here. LP.8.1 has not been detected in US wastewater since August 2025 and represents a dead-end branch on the SARS2 evolutionary tree (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00308-1/fulltext), while XFG and NB.1.8.1 have continued to dominate and result in the creation of countless fitter variants.

As I’ve said before (https://www.reddit.com/r/ZeroCovidCommunity/comments/1sxvsyr/the_fdas_vaccines_and_related_biological_products/), I will be advocating for manufacturers to update to XFG or NB.1.8.1 at the upcoming May 28th FDA VRBPAC meeting, which I still think makes the most sense for our specific situation by far.

Also, this is what I was expecting, but I’m very relieved to see confirmation that they are not recommending a BA.3.2 component to the vaccines. That would’ve been a big mistake, since BA.3.2 remains a pretty irrelevant development for the time being.

Over the past couple weeks, most companies have been releasing their Q1 earnings reports. Here is a brief summary from 3 of the companies that I routinely follow in the infectious disease space (Novavax, Sanofi, and Vaxart). There isn’t much groundbreaking news here that would’ve really necessitated a single post on its own, but I figured that there are enough nuggets of information that it might be useful for someone when combined.

Sanofi:

• Highlighted the recent COMPARE study, where Nuvaxovid showed better tolerability (reactogenicity/side effects) than Moderna’s mNEXSPIKE in a head-to-head study

• Highlighted the recent NIRSE-GAL study, which showed that a single dose of Beyfortus, their pediatric monoclonal antibody for RSV, generated an 85.9% reduction in hospitalizations during the first season and remained largely effective throughout the second season, reducing hospitalizations by 55.3%.

• Confirmed that they’ve submitted an application to the FDA to expand the indication of their high-dose influenza vaccine, FluZone HD, down to 50 years of age (currently 65+).

Vaxart:

• Reiterated that the first data (n=400) from the phase 2b trial of their oral COVID-19 vaccine is still expected very soon, within the next couple of months.

> In the first quarter of 2026, our team remained focused on the operational execution of our Phase 2b COVID-19 trial . . . We are currently finalizing the topline 12-month safety and efficacy data from our 400-person sentinel cohort and are working to release these data as soon as our partnership protocols and contractual data-sharing guidelines permit.”

• Shifted the release timing for the full results from the 5,000-person trial slightly, from late 2026 to early 2027.

Novavax:

• Highlighted the continued and substantial interest across the pharmaceutical industry in their saponin-based Matrix-M adjuvant. 4 of the top 10 pharma companies have now signed a material transfer agreement (MTA) to evaluate Matrix-M for use in their company’s vaccine products. Companies are now actively experimenting with the use of Matrix-M in 30 unique fields across infectious diseases and oncology.