Saturday, June 11, 2022

Paxlovid indications and the Test to Treat program

Paxlovid is indicated for persons at significant risk of bad COVID. As of June 2022 it's crazy-making hard to find a description of what makes someone high risk (and I'm a doc). The only readable and public summary I found is from Mayo Clinic and it's quite long. Basically high risk is a mixture of COVID-immune status (vaccination, prior infection), age (65+ but especially 85+), immune suppression (disease, meds), chronic disease of lungs, heart, liver, kidney (dialysis!), psychiatric and cognitive disorders and Downs syndrome. I'd add substance use disorders (alcohol, fentanyl, etc.)

In general if you regularly see a subspecialist for anything you're high risk (and if also not immunized/prior infected you are kind of suicidal).

If you are not high risk and you are well vaccinated think twice about Paxlovid. It's a serious medication.

So you think you have COVID and you are higher risk, how do you get Paxlovid? 

One problem is you need to get it pretty soon (2 days ideal!) after infection, and current antigen tests are turning positive later in the disease (unclear why, maybe antigen drift). So if a test is positive you need it fast. I'd personally like to see highest risk patients have a two day supply on hand to start taking as soon as the test is positive. They would need significant support and education though.

The best current solution appears to be a program even I had not heard of -- the Federal Test to Treat program (phone 1-800-232-023). You can enter your address in a locator and it tells you where to go. Bring test results or they test, bring your meds because drug interactions are a big deal (Paxlovid is intentionally designed to screw up liver drug metabolism because the active ingredient is super expensive and would be rapidly cleared by the liver.)

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