As epidemiologists, “primary prevention” is our main goal—reduce morbidity and mortality by preventing large populations from getting disease altogether.
The independent study cited of Paxlavoid was *in vitro* so my question about whether folks have 5 days to start it, as was the case for Delta, or fewer, because of Omicron’s shorter infectivity timeframe, remains unexplored.
And if you take Lovastatin or simvastatin, you have to stop them 12 hours before starting it, further narrowing the window. Plus the HIGH number of CYP3A drug interactions requires careful and knowledgeable medication review.
“Paxlovid will have a slew of drug-drug interactions including cardiac medications, certain antibiotics, certain anti-epileptic drugs, and certain statins,”
Please comment on the drug-drug interactions with Paxlovid, it seems as though those at greatest risk for death are also taking some very common drugs for which Paxlovid might lead to significant toxicity. Were patients taking those drugs excluded from the trial?
I'm not sure he's a troll -- if by a troll you mean someone who posts ideas he doesn't believe are true, purely in order to infuriate those who hold the majority view. Seems to me Stevenart could very well be someone who truly believes all the ideas he's expressing. So long as he is expressing his views in a civil way, why should he be banned from posting? Those who loathe reading his ideas will quickly learn to skip his posts. Some who disagree strongly with him might choose to try to persuade him of their ideas.
Personally I object much less to his posts than to your 2 posts directed at Stevenart, below, which are outright threatening:
Eli Steurich 1 hr ago
You’d be wise to never cross my path.
Eli Steurich1 hr ago
Guess what I would choose to do if you had the nerve to troll me in person.
I think I'd take a pass on Molnupiravir. But I'm fretting a lot about the testing situation for people wanting and needing Paxlovid . You have to be diagnosed with covid to get it, right?
But it's currently extremely hard to get a test. So the testing situation's a bottleneck.
Is there any information - data, or information speculation - of Paxlovid's potential for reducing Long Covid ?
Specifically, do we now know whether Long Covid is correlated with disease-severity and/or viral-load (and thus Paxlovid's action towards reducing viral load would likely also act to reduce chances of Long Covid) ?
To all the commenters who tend to suggest there's some hidden cabal behind vaccines, please take note of the "Possible dangers" paragraph. This is called actual science.
Another excellent presentation of the data. I really appreciate that you focus on the data and minimally interpret it. It's important for people to understand that unambiguous answers take time, and leaping to conclusions based on preliminary results can be misleading.
Coronaviruses, unlike most RNA viruses, have a "spell checker" function, to detect copy errors. This is a challenge for antiviral drugs that scramble the copying mechanism, like remdesivir, molnupiravir and others in that class.
Thanks doc, hope you and yours are feeling better. Happy New Year!
Here's hoping for 2022, and Cobrevax: give.texaschildrens.org. I am Irish; I am very grateful for what the US has been able to do to get a leash on the pandemic. If I were American, I would be very proud.
no studies yet. but i don't think the consensus has really changed with Omicron. the accompanying ventilation of being outside reduces risk of transmission
People here have started wearing masks on the streets again, and higher quality ones than before. I’ve always used the “if you can smell cigarette smoke, you can inhale a COVID aerosol” idea as my guideline and you can ALWAYS do so on a typical crowded street. With Omicron, it’s not worth the risk.
Paris is a good example of streets with masks. It's understandable there given the density/proximity of people everywhere, and I hope Manhattan, Tokyo, Shanghai, LA, Mumbai etc. would follow suit. Elsewhere, outdoor masking seems mostly like virtue-signaling.
Smells are odor-molecules. There is a bread factory near where I live - its about 4 blocks from our home. We can sometimes smell bread if we open our patio and the wind is just right. We're not going to get COVID wafting all the way over from the factory innards all the way over to our patio.
The heavily vaxxed parts of Manhattan and Brooklyn are masking heavily, voluntarily. I’ve read of a way to fit test N95s at home: if you can smell odors through it, it fails.
This model/simulation study, which I haven’t seen reported anywhere, might be of interest. I lack the expertise to comment upon it’s quality.
“The spatial patterns of the spreading of the COVID19 indicate the possibility of airborne transmission of the coronavirus. As the cough-jet of an infected person is ejected as a plume of infected viral aerosols into the atmosphere, the conditions in the local atmospheric boundary layer together dictate the fate of the infected plume. For the first time - a high-fidelity numerical simulation study - using Weather-Research-Forecast model coupled with the Lagrangian Hybrid Single-Particle Lagrangian Integrated Trajectory model (WRF-HYSPLIT) model has been conducted to track the infected aerosol plume in real-time during March 9-April 6, 2020, in New York City, the epicenter of the coronavirus in the USA for comparing the morning, afternoon and evening release.
Atmospheric stability regimes that result in low wind speeds, low level turbulence and cool moist ground conditions favor the transmission of the disease through turbulence energy-containing large-scale horizontal “rolls” and vertical thermal “updrafts” and “downdrafts”. Further, the wind direction is an important factor that dictates the direction of the transport. From the initial time of release, the virus can spread up to 30 min in the air, covering a 200-m radius at a time, moving 1–2 km from the original source.”
More great info...
FYI - i was had covid - was double vaccinated - just finished omicron.. 2 days mild symptoms, all better now.
Previous COVID didn't help nor did 2 shots . The concept of super immunity can be put to rest... now i have 2 bouts of COVID - 2 shots.
Happy Healthy New Year to all!!!! 2022 will be an amazing year for us all.
Thank you for all you do, Katelyn!
The independent study cited of Paxlavoid was *in vitro* so my question about whether folks have 5 days to start it, as was the case for Delta, or fewer, because of Omicron’s shorter infectivity timeframe, remains unexplored.
i agree, this is a really great point
And if you take Lovastatin or simvastatin, you have to stop them 12 hours before starting it, further narrowing the window. Plus the HIGH number of CYP3A drug interactions requires careful and knowledgeable medication review.
“Paxlovid will have a slew of drug-drug interactions including cardiac medications, certain antibiotics, certain anti-epileptic drugs, and certain statins,”
https://www.prevention.com/health/a38602689/paxlovid-pfizer-covid-19-pill/
Finally, there’s the undiagnosed HIV issue…
https://www.covid19oralrx.com/files/PP-PAX-USA-0007-EUA-Full-Prescribing-Info-HCP-Fact-Sheet-COVID-19-Oral-Antiviral-Combined.pdf
See also
https://www.fda.gov/media/155051/download
We are getting so well educated! Thank you.
Thanks once again for this great analysis. I suspect I would refuse Molnupiravir if it were offered. I
am also surprised that drug was authorized.
Please comment on the drug-drug interactions with Paxlovid, it seems as though those at greatest risk for death are also taking some very common drugs for which Paxlovid might lead to significant toxicity. Were patients taking those drugs excluded from the trial?
Richard Stevenart (see below) is a troll. Who would care to pitch in on a gift to our local epidemiologist so that he might be banned?
I got $20 on it.
I'm not sure he's a troll -- if by a troll you mean someone who posts ideas he doesn't believe are true, purely in order to infuriate those who hold the majority view. Seems to me Stevenart could very well be someone who truly believes all the ideas he's expressing. So long as he is expressing his views in a civil way, why should he be banned from posting? Those who loathe reading his ideas will quickly learn to skip his posts. Some who disagree strongly with him might choose to try to persuade him of their ideas.
Personally I object much less to his posts than to your 2 posts directed at Stevenart, below, which are outright threatening:
Eli Steurich 1 hr ago
You’d be wise to never cross my path.
Eli Steurich1 hr ago
Guess what I would choose to do if you had the nerve to troll me in person.
Eli Steurich1 hr ago
Please go ride your motorcycle into a ditch.
Thank you.
Don't like what I post, don't read them. Easy.
I think I'd take a pass on Molnupiravir. But I'm fretting a lot about the testing situation for people wanting and needing Paxlovid . You have to be diagnosed with covid to get it, right?
But it's currently extremely hard to get a test. So the testing situation's a bottleneck.
Is there any information - data, or information speculation - of Paxlovid's potential for reducing Long Covid ?
Specifically, do we now know whether Long Covid is correlated with disease-severity and/or viral-load (and thus Paxlovid's action towards reducing viral load would likely also act to reduce chances of Long Covid) ?
To all the commenters who tend to suggest there's some hidden cabal behind vaccines, please take note of the "Possible dangers" paragraph. This is called actual science.
Btw, you assume a lot. I have an IQ of 142 and hold three patents. Talk some more smack.
Another excellent presentation of the data. I really appreciate that you focus on the data and minimally interpret it. It's important for people to understand that unambiguous answers take time, and leaping to conclusions based on preliminary results can be misleading.
Coronaviruses, unlike most RNA viruses, have a "spell checker" function, to detect copy errors. This is a challenge for antiviral drugs that scramble the copying mechanism, like remdesivir, molnupiravir and others in that class.
Hope your family is recovering nicely from covid.
Looks like once we get by the Omicron tsunami we might be able to have a mostly normal 2022.
Thanks doc, hope you and yours are feeling better. Happy New Year!
Here's hoping for 2022, and Cobrevax: give.texaschildrens.org. I am Irish; I am very grateful for what the US has been able to do to get a leash on the pandemic. If I were American, I would be very proud.
Is there any thought on outdoor transmission with omicron? Thanks! hope your family is doing well.
no studies yet. but i don't think the consensus has really changed with Omicron. the accompanying ventilation of being outside reduces risk of transmission
People here have started wearing masks on the streets again, and higher quality ones than before. I’ve always used the “if you can smell cigarette smoke, you can inhale a COVID aerosol” idea as my guideline and you can ALWAYS do so on a typical crowded street. With Omicron, it’s not worth the risk.
Cigarette smoke is actually a very good example of a particulate challenge agent for respirators.
Paris is a good example of streets with masks. It's understandable there given the density/proximity of people everywhere, and I hope Manhattan, Tokyo, Shanghai, LA, Mumbai etc. would follow suit. Elsewhere, outdoor masking seems mostly like virtue-signaling.
Smells are odor-molecules. There is a bread factory near where I live - its about 4 blocks from our home. We can sometimes smell bread if we open our patio and the wind is just right. We're not going to get COVID wafting all the way over from the factory innards all the way over to our patio.
The heavily vaxxed parts of Manhattan and Brooklyn are masking heavily, voluntarily. I’ve read of a way to fit test N95s at home: if you can smell odors through it, it fails.
This model/simulation study, which I haven’t seen reported anywhere, might be of interest. I lack the expertise to comment upon it’s quality.
“The spatial patterns of the spreading of the COVID19 indicate the possibility of airborne transmission of the coronavirus. As the cough-jet of an infected person is ejected as a plume of infected viral aerosols into the atmosphere, the conditions in the local atmospheric boundary layer together dictate the fate of the infected plume. For the first time - a high-fidelity numerical simulation study - using Weather-Research-Forecast model coupled with the Lagrangian Hybrid Single-Particle Lagrangian Integrated Trajectory model (WRF-HYSPLIT) model has been conducted to track the infected aerosol plume in real-time during March 9-April 6, 2020, in New York City, the epicenter of the coronavirus in the USA for comparing the morning, afternoon and evening release.
Atmospheric stability regimes that result in low wind speeds, low level turbulence and cool moist ground conditions favor the transmission of the disease through turbulence energy-containing large-scale horizontal “rolls” and vertical thermal “updrafts” and “downdrafts”. Further, the wind direction is an important factor that dictates the direction of the transport. From the initial time of release, the virus can spread up to 30 min in the air, covering a 200-m radius at a time, moving 1–2 km from the original source.”
https://reader.elsevier.com/reader/sd/pii/S0013935120310677?token=83069620F49CF72A43891294541B6B76CEFE7CBF187C0FB52CE0BF89977FE1801D8BFF29DD1D574D41F57AD54342BB33&originRegion=us-east-1&originCreation=20211220014328
Any informatoin on whether Paxlovid would lessen the time someone is infectious?