My high school friend from West Virginia, texted me this morning the following:
“Hi Rene, how are you.? I have a question. I have severe cough. Started with runny nose, and then coughing. It’s been 5 days already. I did home test for Covid last Wednesday, and it was negative. I called my doctor. He said, most likely it is Covid and he asked me to take the test again. I did another home test this morning and it was also negative. But my doctor said, even though it’s negative, take PAXLOVID 300/100 mg BID for 5 days.
Should I take the medication even my tests are negative?”
And here is my reply to her:
“Hi my friend!
– re-infection of Covid-19 is rare but can happen. We have new variants, BA.4 and BA.5.
– There was one reported case in Spain, had the Delta and then the Omicron last December 2021.
– if you got vaccinated, the risk of hospitalization and death is less.
– ideal time to test: 5th day of exposure or from start of illness. Early test might give false negative result. (I still check as early as 3rd day)
– for the past few weeks, the usual course of Omicron illness I see in my patients was 5-7 days (4.4 days was the average duration during the Omicron Dominated months). Maybe my patients would only consult when their symptoms reach 5-7 days.
About Paxlovid treatment:
– should be given, early, on the first 5 days of illness.
– new kind of medication
– a SARS-CoV-2 3CL protease inhibitor
– modality of action is THE SAME AS IVERMECTIN
– Because the molecular structure of Paxlovid is different and new, it can be patented and can make money for the next 20 years.
-cost is around $530 per course of treatment
– Contains Nirmatrelvir and Ritonavir
Avoid taking Paxlovid if you are taking the following medicines:
– amiodarone, quinidine, colchicine, clozapine, ergotamine, lovastatin, simvastatin, sildenafil (Revatio), carbamazepine, rifampin, St.John’s Wort.
– check other interactions with drugs with high affinity to CYP3A
PAXLOVID dose should be adjusted if you have kidney functional disease:
(I used that term “kidney functional disease”) GFR 60 ml/min and up
– NMV 300 mg + RTV 100 mg PO BID for 5 days.
GFR 30-60:
– NMV 150 mg + RTV 100 mg PO BID for 5 days
GFR <30 or severe hepatic impairment (Child-Pugh Class C):
– Not recommended
Paxlovid when used for Covid-19 infection reduces hospitalization and death by 6% Absolute Risk Reduction (The media report it as 89% reduction -Relative Risk Reduction). We term that “mismatched framing”.
Side effects: (mostly relatively mild)
– Liver problems
– Allergic reactions
– Muscle aches or pains
– High blood pressure
– Altered sense of taste, bitter metallic taste (“Paxlovid Mouth”)
– Diarrhea, nausea, and other gastrointestinal distress
– Resistance to HIV medicines
I have not read any evidence to suggest that Paxlovid reduces the risk of PASC (Post-Acute Sequelae of Covid, the new term for Long-Covid).
I don’t have data for Omicron-related PASC, hopefully rare.
Give me a call if you have more questions. I’m only a phone away. I’m inside your purse!
I hope you get better soon, my friend! ”
From,
Rene
May 26, 2022
***
Another question is if you’re vaccinated, that reduces hospitalization and death, what more would Paxlovid’s 7% reduction do on that 0.5% hospitalization of Omicron cases as reported by Kaiser? (Would it go down to 0.46% hospitalization?). What is your goal in taking Paxlovid?
Source:
Kaiser Permanente Study on Omicron Hospitalizations, Jan 11, 2022, “Hospital admissions occurred among 235 (0.5%) and 222 (1.3%) of cases with Omicron (52,297 cases of B.1.1.529) and Delta (16,982 cases) variant infections, respectively.”
