During the Covid-19 pandemic, the FDA used its authority to allow new medications and vaccines to reach the public, without its usual lengthy approval process. That power—emergency use authorization (EUA)—saved a lot of lives by getting new vaccines and therapeutics to people in months, instead of years.
Somewhat relatedly, I’m curious whether at this point those few of us who are still (to our knowledge) infection-naïve would be considered “immunocompromised” with respect to COVID.
We have a family member who is immunocompromised by definition, so we have been and remain pretty tightly locked down, wearing N95 when out, etc., so we think it’s possible that we haven’t been even asymptomatically infected.
There's definitely a difference between infection-naive and immunocompromised. I'd say that the paxlovid is most likely to help the infection-naive who and unvaccinated (trial data) and likely even more useful for the immunocompromised. But I would not consider these all to be interchangable. I'm like you, by the way....still never had Covid to my knowledge!
Thanks - you put your finger on the real thrust of my question, which is whether the infection-naive should be more aggressive about reaching out for Paxlovid if/when they do become infected.
I have a surprising number of friends in my immediate peer group (highly vaxxed blue state knowledge professionals who are able to work remotely at their pleasure) who have not had Covid. Another common thread is that all of us are sort of hoping that we catch it so that we stop feeling the deep psychological need to maintain tight masking and other precautions. Half-joking conversations about Covid parties like chicken pox parties, etc.
There’s probably a psych paper in there someplace…
Greg: I was you until 2 days ago (now I am looking forward to at least a month or two of wild indoor restaurant going and mad movie attending without an N95. My friends (all have had Covid) think I have Covid neurosis (and I did). As a psychiatrist, I have dealt with Covid anxiety in my therapy practice -- mostly very high functioning blue state professionals. I do feel like I somehow failed by getting Covid--I have been very careful -- but maybe now I can live a bit more freely.
Just got Covid for the first time (knowingly). I was traveling in Europe -- wore KN95s pretty much everywhere but on planes wore N95. Probably got it eating indoors in Vienna (it was raining a lot and there were few options). I am taking Paxlovid but now wonder if I should be. I am 66, have Inflammatory bowel disease but I am not on immune suppressants. I have not responded well (via AB testing) to vaccines but I was vaxxed to the max. I do feel sicker than anytime since I had the flu in 2018. I just hope taking Paxlovid isn't harmful. I do have access to 10 days if I want. Just grateful I made it this far without infection. Of note, I was also in Czechia for a week and did not wear a mask at all -- I was bike riding 309 miles and ate outdoors most of the time. No one was masking in Czechia or Vienna. Maybe saw 10 masks the whole time. Post Covid world for sure.
I made it all the way to Dec 2022 without catching it. We survived 83 days in the NICU, baby's surgeries and tons of her doctor visits, and being severely immunocompromised due to SLE meds.
As soon as I had a sniffle I took the test, was positive, and my local FM doc sent in Paxlovid for me and my husband (he is not immunocompromised but asymptomatically tested positive 5 days after I did, started Paxlovid at that time). Sometimes it's nice being a doc- was able to take the first dose within 3 hours of first symptom.
I felt increasingly bad for the next 36hrs but never dipped below 90%. Woke up on day 3 and felt almost back to my normal self. I genuinely think Paxlovid, and my five rounds of vaccines by the time I caught C19, prevented hospitalization for me.
Dr Faust, I have seen the data that Paxlovid reduces the rates of the mostly the cardiovascular/pulmonary forms of long COVID. Is there any data to indicate that it reduces the rates of the me/cfs-like forms of disabling long COVID in young to middle-aged people? If so, would you consider it useful to fully vaccinated and up-to-date on their boosters middle-aged folks who would like to avoid the disabling condition?
I'm 80 and in treatment (ADT) for cancer (chemo and radiation 7 and 17 years ago, respectively), fully vaccinated (including 2 bivalent boosters). My sense at this point is that if I am infected with covid (test positive with symptoms), I would ask my primary care physician for Paxlovid. Am I right in thinking there's nothing in what you say about wanting more data that would contradict that? Thanks.
I would check for medication interactions, and things like that, and then recommend it.
Studies have shown reduced rates of long Covid, too. I’m guessing less cardiovascular risk over the next year, and hope this is being measured.
Paxlovid “rebound” doesn’t seem to be much above the typical two phases of Covid illness - the acute viral and the subacute inflammatory stages.
5 days seems arbitrary, and suspiciously echoes the number of fingers we have. A better base 10 duration of treatment is likely 10 days, especially for 80 year olds. We also have 10 fingers if we count both hands, so that should satisfy our subconsciously derived treatment durations! Will see if the evidence backs that up.
I can’t swallow pills so I chew them up. I couldn’t find out if it would be safe to chew Paxlovid because nobody had ever done this in the history of ever.
Any thoughts on if it would be safe to chew Paxlovid, or if this information will become available in the future? The pills aren’t small and I doubt I’m the only one with this problem.
UPDATE: From Dr. Bryan Hayes, a master clinical pharmacy expert at Mass General. Short answer=no
Here's what Bryan says...
"It's a good question. There is actually a list out there of meds that shouldn't be crushed. Paxlovid isn't on it, however... Below is what Lexicomp says about crushing it (ie, don't). Also, other products with ritonavir are on the list not to crush because they make an amorphous solid dispersion that reduces bioavailability. So, for now, I'd recommend *against* crushing it unless the manufacturer puts out additional info."
PAXLOVID (source: Lexicomp):
Administration: Adult
Oral: Administer with or without food. Swallow tablets whole; do not chew, break, or crush. Nirmatrelvir must be coadministered with ritonavir; failure to correctly coadminister may result in insufficient plasma levels (Ref). NG tube : The manufacturer of Paxlovid, Pfizer, had previously posted information on how to prepare and administer nirmatrelvir and ritonavir tablets via NG tube on the medical information section of their website. However, they have subsequently removed this information and now state they are unable to make any recommendations regarding alternate preparations for administration.
Looking forward to some clinical trials and more information about drug interactions
Somewhat relatedly, I’m curious whether at this point those few of us who are still (to our knowledge) infection-naïve would be considered “immunocompromised” with respect to COVID.
We have a family member who is immunocompromised by definition, so we have been and remain pretty tightly locked down, wearing N95 when out, etc., so we think it’s possible that we haven’t been even asymptomatically infected.
There's definitely a difference between infection-naive and immunocompromised. I'd say that the paxlovid is most likely to help the infection-naive who and unvaccinated (trial data) and likely even more useful for the immunocompromised. But I would not consider these all to be interchangable. I'm like you, by the way....still never had Covid to my knowledge!
Thanks - you put your finger on the real thrust of my question, which is whether the infection-naive should be more aggressive about reaching out for Paxlovid if/when they do become infected.
I have a surprising number of friends in my immediate peer group (highly vaxxed blue state knowledge professionals who are able to work remotely at their pleasure) who have not had Covid. Another common thread is that all of us are sort of hoping that we catch it so that we stop feeling the deep psychological need to maintain tight masking and other precautions. Half-joking conversations about Covid parties like chicken pox parties, etc.
There’s probably a psych paper in there someplace…
Greg: I was you until 2 days ago (now I am looking forward to at least a month or two of wild indoor restaurant going and mad movie attending without an N95. My friends (all have had Covid) think I have Covid neurosis (and I did). As a psychiatrist, I have dealt with Covid anxiety in my therapy practice -- mostly very high functioning blue state professionals. I do feel like I somehow failed by getting Covid--I have been very careful -- but maybe now I can live a bit more freely.
Just got Covid for the first time (knowingly). I was traveling in Europe -- wore KN95s pretty much everywhere but on planes wore N95. Probably got it eating indoors in Vienna (it was raining a lot and there were few options). I am taking Paxlovid but now wonder if I should be. I am 66, have Inflammatory bowel disease but I am not on immune suppressants. I have not responded well (via AB testing) to vaccines but I was vaxxed to the max. I do feel sicker than anytime since I had the flu in 2018. I just hope taking Paxlovid isn't harmful. I do have access to 10 days if I want. Just grateful I made it this far without infection. Of note, I was also in Czechia for a week and did not wear a mask at all -- I was bike riding 309 miles and ate outdoors most of the time. No one was masking in Czechia or Vienna. Maybe saw 10 masks the whole time. Post Covid world for sure.
I made it all the way to Dec 2022 without catching it. We survived 83 days in the NICU, baby's surgeries and tons of her doctor visits, and being severely immunocompromised due to SLE meds.
As soon as I had a sniffle I took the test, was positive, and my local FM doc sent in Paxlovid for me and my husband (he is not immunocompromised but asymptomatically tested positive 5 days after I did, started Paxlovid at that time). Sometimes it's nice being a doc- was able to take the first dose within 3 hours of first symptom.
I felt increasingly bad for the next 36hrs but never dipped below 90%. Woke up on day 3 and felt almost back to my normal self. I genuinely think Paxlovid, and my five rounds of vaccines by the time I caught C19, prevented hospitalization for me.
Definitely want to see independent data now.
Dr Faust, I have seen the data that Paxlovid reduces the rates of the mostly the cardiovascular/pulmonary forms of long COVID. Is there any data to indicate that it reduces the rates of the me/cfs-like forms of disabling long COVID in young to middle-aged people? If so, would you consider it useful to fully vaccinated and up-to-date on their boosters middle-aged folks who would like to avoid the disabling condition?
I'm 80 and in treatment (ADT) for cancer (chemo and radiation 7 and 17 years ago, respectively), fully vaccinated (including 2 bivalent boosters). My sense at this point is that if I am infected with covid (test positive with symptoms), I would ask my primary care physician for Paxlovid. Am I right in thinking there's nothing in what you say about wanting more data that would contradict that? Thanks.
I would check for medication interactions, and things like that, and then recommend it.
Studies have shown reduced rates of long Covid, too. I’m guessing less cardiovascular risk over the next year, and hope this is being measured.
Paxlovid “rebound” doesn’t seem to be much above the typical two phases of Covid illness - the acute viral and the subacute inflammatory stages.
5 days seems arbitrary, and suspiciously echoes the number of fingers we have. A better base 10 duration of treatment is likely 10 days, especially for 80 year olds. We also have 10 fingers if we count both hands, so that should satisfy our subconsciously derived treatment durations! Will see if the evidence backs that up.
Hope this issue doesn’t come up for you though 🤞
The taste is gross. Sugar free lozenges help!
I can’t swallow pills so I chew them up. I couldn’t find out if it would be safe to chew Paxlovid because nobody had ever done this in the history of ever.
Any thoughts on if it would be safe to chew Paxlovid, or if this information will become available in the future? The pills aren’t small and I doubt I’m the only one with this problem.
UPDATE: From Dr. Bryan Hayes, a master clinical pharmacy expert at Mass General. Short answer=no
Here's what Bryan says...
"It's a good question. There is actually a list out there of meds that shouldn't be crushed. Paxlovid isn't on it, however... Below is what Lexicomp says about crushing it (ie, don't). Also, other products with ritonavir are on the list not to crush because they make an amorphous solid dispersion that reduces bioavailability. So, for now, I'd recommend *against* crushing it unless the manufacturer puts out additional info."
PAXLOVID (source: Lexicomp):
Administration: Adult
Oral: Administer with or without food. Swallow tablets whole; do not chew, break, or crush. Nirmatrelvir must be coadministered with ritonavir; failure to correctly coadminister may result in insufficient plasma levels (Ref). NG tube : The manufacturer of Paxlovid, Pfizer, had previously posted information on how to prepare and administer nirmatrelvir and ritonavir tablets via NG tube on the medical information section of their website. However, they have subsequently removed this information and now state they are unable to make any recommendations regarding alternate preparations for administration.
Thanks! :)
Arete---let me see if I can get a pharmacologist to answer this! I'll let you know!