Giving Paxlovid to an older adult with COVID is a clinical no-brainer. So why is there so much Paxlovid prescribing phobia? EricTopol interviews White House COVID Chief AshishKJha46 on why it's underused.
For other medications the patient is taking, you might just have to make modifications, such as lowering the dose or stopping the medication for the 5 days of Paxlovid treatment. We do that all the time clinically. For example, for a patient scheduled for a dental procedure, we often stop their blood thinner temporarily. If a patient becomes dehydrated for some reason, we will often stop their blood pressure medicine for a short period of time.
Although some people in the Twitterverse and other places believe that Paxlovid rebound is really common, when you look at it carefully, the rates of rebound aren't that high. And we also see rebound in people who were not treated with Paxlovid.Unfortunately, it has become a bit of lore. It didn't help when very high-profile folks like Dr Fauci and the President of the United States got rebound. But I always say, anecdote aside, you have to go to the evidence.
It stands to reason that if you shut down viral replication, you're going to get a different kind of immune response. You may get less immune dysfunction. One thing we think may be causing some long COVID is persistence of the virus. If you shut down viral replication with a really powerful antiviral, you're going to get less persistence of virus.
That said, for some pharmacists, because they're not used to prescribing, often to complicated patients, there may still be a learning curve. I was also surprised to see the low rates of prescribing among pharmacists. My hope is that over time, with more comfort and experience, we will see more pharmacists prescribing Paxlovid.
It's fantastic that Paxlovid is working as well as it is. We do have Lagevrio, which the clinical data suggest is not as good, but it has some benefit. And then, obviously, we have remdesivir. But the truth is that the mainstay now is Paxlovid. We don't want to be so reliant on one medicine, especially when in the laboratory we've seen the emergence of resistance.
We're not done. We're going to look in every place we can within the federal government and go back to Congress as we need to. We've got to keep fighting this fight because a lot of people are dying unnecessarily of this virus. The virus is going to be with us for a very long time, probably for the rest of our lives.
So there are some very important long-term investments here. I don't think it's anti-science. I just think people feel that we've made so many investments for COVID and we're in a better place. So we have been making the case that this goes well beyond COVID. This is really important for the long-term security of our nation. I'm finding more and more people beginning to understand and get motivated by that.
And our vaccines — some years are good, some years are a miss. Tamiflu is very weak. It doesn't have a large impact on hospitalizations or deaths, the outcomes that we really care about. We have the ability, with these investments, to make COVID far more manageable. We can tame this virus. But we're going to have to make those investments. But let's not use flu as some golden ideal. We should be able to do much better than that.
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