Beyond the Noise #38: An underutilized livesaver

If given early in the illness, Paxlovid can prevent COVID hospitalizations and save lives. Why is this drug underused?
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[@AlbertMark-nb9zo]

The under utilization of Paxlovid is quite common. In Canada, even though many doses were bought and paid for, the various recommendations have not pushed the use of the drug. Especially in the optimized period.

[@arlisskowski]

They've actually made it harder to get in Ontario because of the new data. It's only for the immune suppressed and those over 75 as far as I know.

[@Sceince007]

@@arlisskowskino in recent studies it has shown benefit on most age groups .

[@Sceince007]

When a physician tells you that she/he is worried about the Paxlovid rebound tell her/him it’s not a thing and he/she needs to check that out . Since this medicine is not advised based on how one is doing but on risk factors , all My pts already know exactly what to do . I already printed their drug interactions from Liverpool interaction tool on color printer. They know if they have to miss any other drugs for a period or take reduced doses. When they get covid they call me , pick their med the same day and start.

[@LisaMartinez-ri6ve]

Wow that is impressive.

[@nextgenerationhippy]

My 94 year old grandfather lives with my parents. He tested rapid antigen positive and came down with the "worst sore throat of his life." My mother, a nurse practitioner, could hear the fluid in his lungs and after a few days the primary care physician ordered Paxlovid. It's been months since then and my grandfather is doing well. It seems Paxlovid kept him alive.

[@NyRenalMD]

I fought for Paxlovid to be added to my hospital formulary. The practical problem many elderly patients are on drugs that interact making it very inconvenient.

[@lisavitale8410]

There was a study published last month in the New England Journal of Medicine by Jennifer Hammond PhD et al that concluded “The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received nirmatrelvir-ritonavir and those who received placebo.” How do you account for that?

[@personzorz]

It probably doesn't make a difference for most people who will clear it easily on their own, but for the small fraction of people who have bad outcomes, it heads it off.

[@moose304]

I find the suggestion "work with your doctor" (in the context of drug/drug interactions) while also saying "many physicians are not giving paxlovid because of rebound" to be a bit confusing. Still a good and useful video though. Thanks!

[@Sceince007]

When a physician tells you that he is worried about the Paxlovid rebound tell him it’s not a thing and he/she needs to check in that out . Since this medicine is not advised based on how ot is doing but on risk factors . My pts already know exactly what to do . I already printed their drug interactions from Liverpool interaction tool on color printer. They know if they have to miss any other drugs for a period of take reduced doses. When they covid they call me pick their med the same day and start.

[@marthabeck3981]

@Vincent - It would be informative to those not familiar with Dr. Offit's impressive credentials to begin with a few sentences about them. That information would provide a context for his remarks.

[@JillKnapp]

Thank you, gentlemen, as always! And an extra thank you for the line "Paxlovid rebound is not a thing; just like The Eagles' defense last year was not a thing."

[@Logotic]

I'm off to Amazon to look up "The Pathogenesis of Infectious Diseases". If Paul Offit says it's the best he's ever read, it's for sure good enough for me!

[@Sceince007]

Me too. Recommended by the best .

[@patriciahoke4722]

So the recommended cohort for this drug is very different than what I've heard from TWiV in the past, mostly due to the age - 75 and above.

[@arlisskowski]

New guidelines

[@margaretash9706]

They have been talking about paxlovid for quite awhile.

[@patriciahoke4722]

@@margaretash9706 It's the 75 y.o. part that is new.

[@janechadwick2635]

In the UK only a small number of people have access to paxlovid. Primarily if you have a transplant and others who are immunocompromised. Despite having lung disease, long covid with associated health issues, T1D , being overweight and of an age, i do not qualify. I recently had covid again and was pretty ill, albeit not hospitalised, and my health has suffered a lot, so have become more of a burden to our over stretched health service. So even in two western societies, when to give paxlovid and who to give it too is world's apart.

[@karenkaren3189]

Thankfully our doctor is very positive about Paxlovid

[@chrisdancy6191]

I actually get Paxlovid EARLY before I travel. Had two scripts. Didn't need either one, but having it on hand, MAKES a difference.

[@Sceince007]

Since this medicine is not advised based on how ot is doing but on risk factors . My pts already know exactly what to do . I already printed their drug interactions from Liverpool interaction tool on color printer. They know if they have to miss any other drugs for a period of take reduced doses. When they covid they call me pick their med the same day and start.

[@traianliviudanciu8665]

If SARS COV2 better replicate at low tissue temperature , theoretically fever can mitigate SARS COV2 infection. Did we know at what tissue temperature did SARS COV2 better replicate? Why? Because at TWiV 659 at min29 virologist Christian Drosten indicate that SARS COV2 better replicate in different tissues if incubator temperature decrease to 34C

[@MNP208]

Sadly, it’s politics. We offer Paxlovid in our urgent care and many patients refuse. 🤷‍♀️ Some social media channels are anti-Paxlovid. I don’t see them distributing true information in the upcoming election season.

[@karenkaren3189]

Hundreds of thousands, maybe millions of unnecessarily severe illnesses and deaths. These are sad times.

[@auntie-sd3iy]

🤣

[@traianliviudanciu8665]

If Paxlovid is a reversible protease inhibitor , theoretically ,If a cell was infected with SARS COV2 viral replication is stoped only If protease inhibitor is prezent. When level of protease inhibitor decrease,viral replication go on,If infected cells was not destroyed

[@personzorz]

But you've given your immune system a chance to ramp up and hold it down.