It is becoming harder to avoid
infection, and reinfection, from the coronavirus with each variant that
emerges. Omicron offshoots like the latest one, the XBB.1.5 subvariant, are
better at dodging antibodies. But COVID cases also seem to be growing milder,
either because new variants are less likely to go deep into the lungs or
because most people have been vaccinated, exposed or both.
اضافة اعلان
Which raises the question: Do mild cases of
COVID warrant treatment with an antiviral medication like Paxlovid?
In many cases, they do. Paxlovid is known
to reduce the severity of illness and even lower the risk of developing
long-term symptoms such as chronic fatigue, muscle pain, kidney disease, heart
disease, blood clotting problems, and neurocognitive impairments. Research has
shown that it can offer these benefits for both vaccinated and unvaccinated
people, those who are experiencing their first infection and those who have had
a reinfection.
Paxlovid’s ability to lower the odds of
hospitalization and death is well documented. Studies conducted before the drug
was authorized in December 2021 showed that Paxlovid reduced these severe
outcomes by up to 89 percent in unvaccinated people. While data from last year
was slightly less impressive in vaccinated people, Paxlovid still decreased the
odds of hospitalization and death by about 57 percent.
“The threshold for giving Paxlovid should be lower and more people should be getting it, because it’s really not harmful.”
In a study published online in November and
currently undergoing peer review, researchers found that among patients in the
Veterans Health Administration system who had at least one risk factor
qualifying them for antiviral treatment, those who took Paxlovid within five
days of testing positive were 26 percent less likely to develop long COVID
symptoms. Yet only about 15 percent of patients eligible for the drug took it.
Other studies have suggested an even lower uptake.
Who should take Paxlovid?Many experts agree that more people should
be taking Paxlovid and that the treatment should be considered even for mild
cases of COVID-19.
“A drug that you don’t take surely can’t
prevent long COVID or reduce your likelihood of serious illness,
hospitalization, or death,” said Michael Osterholm, a public health researcher
and the director of the Center for Infectious Disease Research and Policy at
the University of Minnesota.
“The threshold for giving Paxlovid should
be lower and more people should be getting it, because it’s really not
harmful,” said Dr Peter Chin-Hong, an infectious disease specialist at the
University of California, San Francisco.
In particular, studies show that adults
older than 65 benefit the most from taking Paxlovid. Their age puts them at
higher risk for poor outcomes regardless of whether they have other medical
conditions, Chin-Hong said.
Many doctors are not prescribing Paxlovid. And patients who do have access to the drug are refusing it. “It is really baffling,” Al-Aly said.
The evidence is less clear on whether
Paxlovid is worth taking for people younger than 65 who are not
immunocompromised and do not have medical conditions like cancer, chronic lung
disease, diabetes, or many others.
“It is a personal decision between the
person who’s affected and their provider whether to take Paxlovid or not,” said
Dr Ziyad Al-Aly, a clinical public health researcher at Washington University
in St. Louis and chief of research at the Veterans Affairs St. Louis Healthcare
System. When a younger colleague recently had COVID, for instance, Al-Aly, who
led the November study on long COVID, recommended that the person take the
antiviral because it might still provide some of the same benefit against
long-term symptoms.
So why are so few people taking it?Many doctors are not prescribing Paxlovid.
And patients who do have access to the drug are refusing it.
“It is really baffling,” Al-Aly said. “But
that’s what’s happening in the US — Paxlovid is being remarkably underutilized.”
The treatment, which has been available for
more than a year and is provided free in the US by the federal government, has
been plagued with public relations problems from the beginning.
For the first few months after it received
emergency use authorization from the Food and Drug Administration, Paxlovid
supplies were hard to find. Then, patients who took the drug began reporting a
bitter or metallic taste that stuck with them throughout the treatment. Several
high-profile cases of Paxlovid rebound, or the recurrence of COVID symptoms,
also led to the speculation that this unwanted side effect was fairly common.
“There have now been several studies, and
there’s such good information that there’s very little difference in the rate
of rebounds among those who take Paxlovid and those who don’t. Yet that myth
continues,” Osterholm said.
Who should get the antiviral treatment has
also remained a source of confusion for both patients and health care
providers, Osterholm said. Because the drug is provided under an emergency use
authorization by the FDA, doctors do not typically prescribe it outside the
stated eligibility criteria.
“There’s very little difference in the rate of rebounds among those who take Paxlovid and those who don’t. Yet that myth continues.”
Another source of confusion is interactions
that Paxlovid can have with many drugs, including statins, beta blockers, blood
thinners, antipsychotic medicines, seizure medicines, certain migraine
medicines, and hormonal birth control. It is likely that the long list of
potential interactions puts many people off. But a doctor can help patients
take Paxlovid safely and avoid side effects in several cases, Osterholm said.
For example, patients can stop taking statins while on Paxlovid, he said, and
that is “not going to have a material impact on your health”.
Several experts said they knew of cases in
which primary care providers dissuaded patients from taking Paxlovid because
the doctor thought that the patient either did not qualify or did not need the
treatment. Many may be under the false impression that you can take Paxlovid
only if you have severe disease, Chin-Hong said, when, in fact, the drug is for
anyone at risk of such disease.
In July, the FDA revised Paxlovid’s
emergency use authorization so that pharmacists could prescribe the drug. But
that has not had a significant impact on Paxlovid use, Chin-Hong said.
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