" This drug was a pandemic game changer (assuming you could get it, which is another story)." As an on-the-ground Familit Medicine physician working closely with Community-based organizations to fight for Equity, I would love to see a post (or series of posts) dedicated to the Inequities of COVID (which literally affects everything from access to testing and treatments, to case/hospitalization/death burden, financial/housing/food insecurity, and mental health burden), and what has worked to address them. Systemic Inequity is pertinent to each and every post. I am curious if it would be possible to speak to as a standing component to each post as well.
Add to list of Covid inequities: rich people are more likely to have independent doctors who are willing to write off-label prescriptions for early Covid treatments that aren’t yet approved by the FDA or CDC, such as Fluvoxamine (which is also recognized as a legitimate early treatment for Covid by Johns Hopkins and Florida, with favorable results in recent TOGETHER study).
Paxlovid seemed miraculous. I started Paxlovid within 24 hours of getting moderate symptoms. By the end of the day after I took the drug, all symptoms except fatigue had resolved. I took all 5 days. Fatigue remained but symptoms were gone and I first tested negative on Day 6. I was also negative on Day 8. By the evening of Day 8 I felt quite sick but was still negative. I tested positive on the morning of Day 9. Today is Day 10 and I am much worse than yesterday though oxygen is still fine. I begged the doc for another Paxlovid round but she says it is not allowed and has referred me to an infectious disease doc and I am waiting for his call. Though I had the usual side effects of Paxlovid, it was truly like a miracle drug and I am praying this new doctor will re-prescribe. Because my oxygen is okay, I am not scared but it is hard feeling this badly and knowing how quickly the paxlovid could relieve the aching all over, stinging lungs, very sore throat, deep hurting cough …
(Paxlovid did disarm my Wellbutrin so I had some surprise physical anxiety for a few days that resolved 2 days after my last dose)
Thank you for this post. Do you have any intuition or studies about the rebounding regarding: the original Paxlovid study ONLY had unvaccinated subjects. And now Paxlovid is being offered to vaccinated people, but their immune system will respond differently because of their vaccination--could this potentially explain rebounding effect?
Thanks as always for the informative post! I work with a population of immunocompromised clients. I have read that Paxlovid may be contraindicated for them. Would you comment on antivirals and severely immune compromised patients (specifically women with cancer undergoing some forms of chemotherapy)?
Quote: "Use antigen tests to determine when to exit isolation, even if you’re feeling better."
This brings up such a frustrating discrepancy between the official advice, i.e. to wait 10 days and ignore antigen tests, and the concern that antigen tests could still be valid. Today is day 19 since symptoms started, and today is finally my first negative test. I've been torn between the official guidelines and the concern from positive tests.
As an aside, I've been sharing space with my spouse for more than five days and he has not caught the virus from me.
I understand and share your frustration! I finally got my first negative today, 12 days after my first positive and 13 days after symptoms started. This is the first time it's made it through our precautions. We think it started in our house with one of our 7 year olds, who had identical symptoms to mine, but never tested positive (daily RATs and a pcr on day 5 have been negative). Most likely contracted at school, because that is the only place they go. Because it started with our younger kids (Mr. 1st symptoms/negative tests shares a room with his twin, who also briefly had symptoms, but tested negative), I did not isolate from my family. I did mask (except while eating together), I slept separately from my husband for 10 days (until symptoms were gone), and we have had windows cracked (it's cold here), 2 air purifiers running on high and the furnace fan constantly running).
My husband, 13 year old and both 7 year olds have continued to test negative; my husband and 13 year old remained symptom free. My husband is also an elementary educator, he wears a kf94 (as we all do in public/at school). The week before my positive, there was a covid cluster in his team teacher's class (their wall is almost always open and they co-teach most things, which means there is a lot of co-mingling of their students). Husband continues to test negative (he runs an air purifier in his classroom, now his team teacher has one too, and we provide one for our 7 year old sons' class the beginning of the year also). In other words my husband feels a little like a super hero or a ticking time bomb right now 🤷♀️. This virus is weird and we've used a ton of tests (everyone has tested every morning). Thankfully we love in WA and have ordered our 10 free ones from the state each month, plus the federal ones, so we had a decent supply of them to work with. We could also get testing at the schools if needed.
This was the best post you have yet put up at this site. Very informative, well-written, and helpful. As my ancestors in rural west Texas would say, "bless yer heart and thank yew". . . .
It's interesting to note that a similar rebound effect with Tamiflu (oseltamivir, used similarly to Paxlovid) was observed in 2013 in some patients being treated for H7N9 avian bird flu in Shanghai. The patients that experienced rebounds were taking corticosteroids. FWIW
PS even if subsequent testing confirms that it is a game changer, if many of us can't take it, what are the chances of drug companies investing in researching a new drug that would work for us? I know these questions require speculation, but your knowledge and experience makes your speculation more valuable. thanks
What are your thoughts about the apparent drug interactions with those typically used to treat arrhythmia? With blood thinners, how dangerous would it be for somebody to go without them for a week to 10 days to take Paxlovid and avoid the bad interactions. Also, what is the relative risk of dying from lack of blood thinner (to take Paxlovid) versus dying from the disease? (When you are 75 and obese - as I am). I am also curious about why the online NY State questionnaire getting appointments for the very first vaccines wouldn't allow scheduling if you anwered "yes" you were on blood thinners, but if the answer given was "no", then the appointment was scheduled. I had read at the time (I think) that blood thinners weren't supposed to create a risk. Was that wrong? Was somebody in NY just being overly cautious and overzealous about this? Could that be the case with Paxlovid warnings?
Dr. Jetelina, I hope you will put up a post soon about the plight of the immunocompromised -- people whose body cannot make antibodies in response to the vaccine. There is a drug called Evusheld that compensates pretty well for the deficiency, but not enough was made for the 2-3% of people who need it. And the distribution was a mess. States distributed it to whoever they felt like, and some Evusheld ended up in small town pharmacies/beauty spas that mostly do botox, etc. Some doctors have not heard of the drug, and others have no idea how much is available and where it is. 4+ months after drug was shipped 3/4 of it at least is still sitting on shelves in pharmacies and hospitals. Some of it will expire soon. Here is a site set up by a Microsoft engineer whose wife needed Evusheld after cancer treatment, which shows you the sites in your state holding Evusheld (and also Paxlovid, etc.) and how much they have. It is free, and doesn't even ask the user to register: https://rrelyea.github.io/evusheld/?state=AL
If you scroll down to Alabaster, Alabama, you'll find Southern Wellness, LLC (https://southernwellnessmed.com) , a beauty spa that has been holding 54 doses for months and has not distributed a single one
A bit off topic, but is it unusual for a virus to mutate so frequently as we've seen with SARS-CoV-2? For example, was that the case with measles, mumps, rubella, polio where once you had the natural infection or were immunized, it was very unlikely to acquire the infection again? Influenza seems to have several variants but does it keep rapidly 'evolving?' Is there something virologically special about SARS-CoV-2? Or is it too early to tell?
not necessarily special to SARS-CoV-2 other than high global transmission, so ability to change very quickly. we think once transmission is more predictable (like seasonal) it won’t change as fast. it’s currently faster than flu, but we expect it to become slower than flu eventually. it will always be faster at mutating than measles
My husband had paxlovid and did well. No rebound and absolutely no trouble getting it. He had to go to the ER for dehydration (he had digestive symptoms) and was told specially not to depend on testing out. He did and cleared the virus several days more quickly than I did even though my case was much more mild. Also of note, two of my three kids never got sick even though my house is small and they were with me while I was ill.
" This drug was a pandemic game changer (assuming you could get it, which is another story)." As an on-the-ground Familit Medicine physician working closely with Community-based organizations to fight for Equity, I would love to see a post (or series of posts) dedicated to the Inequities of COVID (which literally affects everything from access to testing and treatments, to case/hospitalization/death burden, financial/housing/food insecurity, and mental health burden), and what has worked to address them. Systemic Inequity is pertinent to each and every post. I am curious if it would be possible to speak to as a standing component to each post as well.
" This drug was a pandemic game changer (assuming you could get it, which is another story)." As an on-the-ground Familit Medicine physician working closely with Community-based organizations to fight for Equity, I would love to see a post (or series of posts) dedicated to the Inequities of COVID (which literally affects everything from access to testing and treatments, to case/hospitalization/death burden, financial/housing/food insecurity, and mental health burden), and what has worked to address them. Systemic Inequity is pertinent to each and every post. I am curious if it would be possible to speak to as a standing component to each post as well.
Add to list of Covid inequities: rich people are more likely to have independent doctors who are willing to write off-label prescriptions for early Covid treatments that aren’t yet approved by the FDA or CDC, such as Fluvoxamine (which is also recognized as a legitimate early treatment for Covid by Johns Hopkins and Florida, with favorable results in recent TOGETHER study).
The ability to spend money on drugs that may be of little or no use is not necessarily an advantage, IMO.
And in Tennessee, Ivermectin is available over-the-counter, no prescription needed:
https://thehill.com/news/state-watch/3261642-tennessee-senate-passes-bill-to-allow-over-the-counter-sales-of-ivermectin/
Isn’t it possible that the 5 day protocol needs to be extended ?
My Experience
Paxlovid seemed miraculous. I started Paxlovid within 24 hours of getting moderate symptoms. By the end of the day after I took the drug, all symptoms except fatigue had resolved. I took all 5 days. Fatigue remained but symptoms were gone and I first tested negative on Day 6. I was also negative on Day 8. By the evening of Day 8 I felt quite sick but was still negative. I tested positive on the morning of Day 9. Today is Day 10 and I am much worse than yesterday though oxygen is still fine. I begged the doc for another Paxlovid round but she says it is not allowed and has referred me to an infectious disease doc and I am waiting for his call. Though I had the usual side effects of Paxlovid, it was truly like a miracle drug and I am praying this new doctor will re-prescribe. Because my oxygen is okay, I am not scared but it is hard feeling this badly and knowing how quickly the paxlovid could relieve the aching all over, stinging lungs, very sore throat, deep hurting cough …
(Paxlovid did disarm my Wellbutrin so I had some surprise physical anxiety for a few days that resolved 2 days after my last dose)
Thank you for this post. Do you have any intuition or studies about the rebounding regarding: the original Paxlovid study ONLY had unvaccinated subjects. And now Paxlovid is being offered to vaccinated people, but their immune system will respond differently because of their vaccination--could this potentially explain rebounding effect?
Thanks as always for the informative post! I work with a population of immunocompromised clients. I have read that Paxlovid may be contraindicated for them. Would you comment on antivirals and severely immune compromised patients (specifically women with cancer undergoing some forms of chemotherapy)?
Quote: "Use antigen tests to determine when to exit isolation, even if you’re feeling better."
This brings up such a frustrating discrepancy between the official advice, i.e. to wait 10 days and ignore antigen tests, and the concern that antigen tests could still be valid. Today is day 19 since symptoms started, and today is finally my first negative test. I've been torn between the official guidelines and the concern from positive tests.
As an aside, I've been sharing space with my spouse for more than five days and he has not caught the virus from me.
I understand and share your frustration! I finally got my first negative today, 12 days after my first positive and 13 days after symptoms started. This is the first time it's made it through our precautions. We think it started in our house with one of our 7 year olds, who had identical symptoms to mine, but never tested positive (daily RATs and a pcr on day 5 have been negative). Most likely contracted at school, because that is the only place they go. Because it started with our younger kids (Mr. 1st symptoms/negative tests shares a room with his twin, who also briefly had symptoms, but tested negative), I did not isolate from my family. I did mask (except while eating together), I slept separately from my husband for 10 days (until symptoms were gone), and we have had windows cracked (it's cold here), 2 air purifiers running on high and the furnace fan constantly running).
My husband, 13 year old and both 7 year olds have continued to test negative; my husband and 13 year old remained symptom free. My husband is also an elementary educator, he wears a kf94 (as we all do in public/at school). The week before my positive, there was a covid cluster in his team teacher's class (their wall is almost always open and they co-teach most things, which means there is a lot of co-mingling of their students). Husband continues to test negative (he runs an air purifier in his classroom, now his team teacher has one too, and we provide one for our 7 year old sons' class the beginning of the year also). In other words my husband feels a little like a super hero or a ticking time bomb right now 🤷♀️. This virus is weird and we've used a ton of tests (everyone has tested every morning). Thankfully we love in WA and have ordered our 10 free ones from the state each month, plus the federal ones, so we had a decent supply of them to work with. We could also get testing at the schools if needed.
That is so difficult!
This was the best post you have yet put up at this site. Very informative, well-written, and helpful. As my ancestors in rural west Texas would say, "bless yer heart and thank yew". . . .
It's interesting to note that a similar rebound effect with Tamiflu (oseltamivir, used similarly to Paxlovid) was observed in 2013 in some patients being treated for H7N9 avian bird flu in Shanghai. The patients that experienced rebounds were taking corticosteroids. FWIW
PS even if subsequent testing confirms that it is a game changer, if many of us can't take it, what are the chances of drug companies investing in researching a new drug that would work for us? I know these questions require speculation, but your knowledge and experience makes your speculation more valuable. thanks
What are your thoughts about the apparent drug interactions with those typically used to treat arrhythmia? With blood thinners, how dangerous would it be for somebody to go without them for a week to 10 days to take Paxlovid and avoid the bad interactions. Also, what is the relative risk of dying from lack of blood thinner (to take Paxlovid) versus dying from the disease? (When you are 75 and obese - as I am). I am also curious about why the online NY State questionnaire getting appointments for the very first vaccines wouldn't allow scheduling if you anwered "yes" you were on blood thinners, but if the answer given was "no", then the appointment was scheduled. I had read at the time (I think) that blood thinners weren't supposed to create a risk. Was that wrong? Was somebody in NY just being overly cautious and overzealous about this? Could that be the case with Paxlovid warnings?
Dr. Jetelina, I hope you will put up a post soon about the plight of the immunocompromised -- people whose body cannot make antibodies in response to the vaccine. There is a drug called Evusheld that compensates pretty well for the deficiency, but not enough was made for the 2-3% of people who need it. And the distribution was a mess. States distributed it to whoever they felt like, and some Evusheld ended up in small town pharmacies/beauty spas that mostly do botox, etc. Some doctors have not heard of the drug, and others have no idea how much is available and where it is. 4+ months after drug was shipped 3/4 of it at least is still sitting on shelves in pharmacies and hospitals. Some of it will expire soon. Here is a site set up by a Microsoft engineer whose wife needed Evusheld after cancer treatment, which shows you the sites in your state holding Evusheld (and also Paxlovid, etc.) and how much they have. It is free, and doesn't even ask the user to register: https://rrelyea.github.io/evusheld/?state=AL
If you scroll down to Alabaster, Alabama, you'll find Southern Wellness, LLC (https://southernwellnessmed.com) , a beauty spa that has been holding 54 doses for months and has not distributed a single one
Such a helpful explanation. And I feel like Edward should just be awarded his MD/PhD at this point! Such a talented scientist!
A bit off topic, but is it unusual for a virus to mutate so frequently as we've seen with SARS-CoV-2? For example, was that the case with measles, mumps, rubella, polio where once you had the natural infection or were immunized, it was very unlikely to acquire the infection again? Influenza seems to have several variants but does it keep rapidly 'evolving?' Is there something virologically special about SARS-CoV-2? Or is it too early to tell?
not necessarily special to SARS-CoV-2 other than high global transmission, so ability to change very quickly. we think once transmission is more predictable (like seasonal) it won’t change as fast. it’s currently faster than flu, but we expect it to become slower than flu eventually. it will always be faster at mutating than measles
My husband had paxlovid and did well. No rebound and absolutely no trouble getting it. He had to go to the ER for dehydration (he had digestive symptoms) and was told specially not to depend on testing out. He did and cleared the virus several days more quickly than I did even though my case was much more mild. Also of note, two of my three kids never got sick even though my house is small and they were with me while I was ill.
" This drug was a pandemic game changer (assuming you could get it, which is another story)." As an on-the-ground Familit Medicine physician working closely with Community-based organizations to fight for Equity, I would love to see a post (or series of posts) dedicated to the Inequities of COVID (which literally affects everything from access to testing and treatments, to case/hospitalization/death burden, financial/housing/food insecurity, and mental health burden), and what has worked to address them. Systemic Inequity is pertinent to each and every post. I am curious if it would be possible to speak to as a standing component to each post as well.
Hi Katlyne - is there any update on Paxlovid-induced rebound, since your last piece in May?