“I was surprised that doctors decided against prescribing Paxlovid to my 82-year-old mother when she recently contracted covid-19 for the first time. She is fully vaccinated and in good health, with no chronic conditions. Her only prescription is for daily Lipitor. The doctors at her rural hospital admitted her and prescribed three days of intravenous remdesivir instead of Paxlovid, which they said had too many side effects to be a wise choice. After all we’ve heard about the magic of Paxlovid — to the point where I had her obtain a prophylactic prescription before our overseas trip last year! — I am curious about this. (By the way, she recovered fully within two weeks.)” – Carmen from Pennsylvania
Remdesivir, which is given as an intravenous infusion or a series of injections, is an option for people diagnosed with covid who are not able to take Paxlovid. It is not a first-line medication because it is relatively difficult to administer.
It’s unclear to me why your mother did not receive Paxlovid during her bout with covid. The cholesterol medication Lipitor, or atorvastatin, can be paused while taking Paxlovid and resumed immediately after completing the antiviral treatment.
As I wrote in a previous newsletter, Paxlovid does have side effects, but most are minor, such as changes in taste and gastrointestinal discomfort. These are typically not reasons to withhold the medication.
Perhaps there is something else in your mother’s medical history that prompted doctors to give her remdesivir. For instance, she might have been quite ill by the time she sought treatment. If that were the case, remdesivir would be the right choice over Paxlovid, as the latter is not given to patients who are already ill enough to be hospitalized.
In any event, it’s good you have confirmed that your mother is able to receive Paxlovid and has a “just in case” prescription on hand. And I’m very glad that she recovered.
“I read your newsletter every week and, many times, you’ve recommended to people traveling overseas that they prepare in case they contract covid by asking their doctor for Paxlovid to take with them during the trip. Well, last week I had my annual physical and I asked my doctor for Paxlovid for my January cruise to South America. He refused. He said he didn’t believe in it because people might take it as a prophylactic, when they didn’t really have covid. I assured him that I wouldn’t do that, but he still refused. So my question to you is: If I can’t get Paxlovid from my doctor, where can I get it before my cruise?” — Laura from Delaware
Here are some options. First, consider speaking with your doctor again. Explain that you understand the uses of Paxlovid and that you will not take it unless you test positive. Show him the National Institutes of Health coronavirus guidelines that Paxlovid is a first-line treatment for covid and ask him what his plan would be if you were to contract covid while on the cruise. Surely, he would want you to access this medication when you need it.
If he still refuses a Paxlovid prescription, call the cruise operator. Large ships from major cruise lines will have a physician on board. Will this physician be able to prescribe Paxlovid, and is this antiviral treatment available on the ship that can be dispensed to passengers? If so, are there additional requirements? For instance, do passengers have to have bloodwork in advance to prove they have good renal function?
If there is no option on the cruise, you could also ask around your social network. Perhaps a friend has a primary-care provider who is willing to prescribe the “just in case” antiviral treatment. You could consider a visit to this physician.
“Lemonheads (or I’m guessing other lemon drops) were very helpful for the metallic taste from Paxlovid.” — Bonnie from Montana
Thank you for this helpful advice!
“I now know six senior citizens, all fully boosted and who have followed Centers for Disease Control and Prevention guidelines throughout the pandemic, who have chosen to return home from overseas or domestic vacations, knowing they were covid positive when they got on the plane. I know it can be days before a person tests negative. However, is it fair to other passengers for them to fly when they are positive? They mask, but I question their judgment.” — Elizabeth from Maryland
CDC guidance states that individuals can be in public five days after they test positive as long as they wear a well-fitting, high-quality mask while around others. Your friends who have covid should not board a plane immediately after they test positive for the coronavirus.
If they are doing so, it should be a cautionary tale to everyone traveling. Even previously conscientious people are ignoring public health recommendations. Those who wish to avoid the coronavirus need to assume that others around them have covid and take extra precautions to protect themselves.
“My husband and I go to lots of public performances, and I always wear a mask. Though during the height of the pandemic, he would always wear a mask when out and about, he will no longer wear one. A friend asked me what is the point of just me wearing a mask, if my husband doesn’t wear one and gets sick? Should I keep wearing a mask even if my husband doesn’t?” — Nancy from Virginia
If your goal is to continue avoiding the coronavirus, you should keep masking in indoor, crowded places. Doing so will protect you, even if your husband gets sick.
Interestingly, a large meta-analysis published in JAMA found that, during the time of omicron predominance, only 43 percent of household members became ill when someone in the house became infected. If your husband starts exhibiting symptoms or tests positive for covid-19, you should stay away from him, but even close contact with an infected household member does not always result in infection. To me, that’s more reason to take additional precautions yourself in crowded places, even if your husband is not following them.
“I wear three surgical masks, each with a metal nose piece, one over the other. By doing this, am I really giving myself more protection?” — Susan from Florida
Surgical masks are not designed to be worn on top of one another. The best protection is wearing a single respirator mask (N95, KN95 or KF94). People who cannot tolerate these masks can don a surgical mask with a well-fitting cloth mask over it.
“I am trying to get the latest covid booster. My previous doses have been Pfizer. All of the new boosters are difficult to find, but Pfizer is impossible to find in my area for some reason. Would it be better to continue to look for the Pfizer booster or to get the Moderna or Novavax booster?” — Denise from Pennsylvania
You should get whatever booster is easily accessible to you. There is no clear benefit between Pfizer and Moderna. Some people might prefer Novavax, but a small head-to-head study of its use as a booster in people who previously received Pfizer or Moderna found no improved antibody protection over the mRNA vaccines. If you can obtain Moderna or Novavax now, I’d opt for one of these and not wait for Pfizer.
“I am 81 years old and have recently received both covid (Pfizer) and RSV shots in the same arm. I experienced no discomfort following the injections. My partner received only the covid booster but his arm ached for a couple of days. (I have never experienced more than a mild ache from any of the covid shots.) Is there a reason why some folks get adverse reactions, and some folks don’t?” — Beryl from California
There are two main types of reactions to vaccines. One is local, which manifests as soreness or redness at the site of injection. The other is systemic, which shows up as some combination of fever, chills, headaches, body aches and fatigue. Both typically resolve within a day or two.
It’s not known why some people experience stronger reactions than others. Some studies suggest people who have more significant reactions have a more robust antibody response. It’s also possible that some are more sensitive to the discomfort accompanying vaccine reactions than others.
Please keep your excellent questions coming. I’ll answer more next week. Have a great Thanksgiving!
Credit: Source link
