Coronavirus and Walt Disney World general discussion

[Heppenheimer]

You posted a few days ago about the benefits of Paxlovid that you've witnessed amongst your patients. I found that encouraging. My family has managed to avoid contracting Covid so far but we are gradually returning to prepandemic activities. Obviously that comes with more risk than staying home. I looked into Paxlovid, how to get it if needed. Everything I found said that it's only being used for high risk people. What is the procedure for acquiring it? Does an infected individual call their primary care office and then the physician determines risk? I'm curious about how hard it really is for people to get. With the limited window for usefulness it seems like having a plan in advance makes sense. Are there any factors that make it unsafe for certain patients?

At this point, we're pretty much prescribing it to any adult who tests positive and doesn't have an absolute contra-indication, which means they have adequate renal function and they're not taking an excluded medication that they can't stop (diltiazem is probably the most common). When the supply was more limited, we did restrict prescriptions to those who met the criteria for high risk, but we have more than enough supplies in our local pharmacies now. Mind you, this very much up to the discretion of the prescribing physician and the local supply of the medication. There's a growing consensus as we become more familiar with paxlovid that its worthwhile treatment for most people with COVID, even though the official EAU remains more restricted.

As I mentioned a few days ago, most patients who test positive now do so through home testing. In most cases, we no longer have the 1-2 day turn-around that was the situation with the send-out PCR tests. With that kind of instant feedback, it's become pretty easy to hit the therapeutic time window for paxlovid. For our patients, if they call us reporting a positive test, we quickly review their chart and if they don't have any obvious exclusions, we prescribe the medication without further delay. For a few patients, I needed to check their kidney function first, but for most, we simply do a chart review. Now, that's just the default that we've kind of fallen into in our practice, what other practices do could be completely different.

 

[drizgirl]

At this point, we're pretty much prescribing it to any adult who tests positive and doesn't have an absolute contra-indication, which means they have adequate renal function and they're not taking an excluded medication that they can't stop (diltiazem is probably the most common). When the supply was more limited, we did restrict prescriptions to those who met the criteria for high risk, but we have more than enough supplies in our local pharmacies now. Mind you, this very much up to the discretion of the prescribing physician and the local supply of the medication. There's a growing consensus as we become more familiar with paxlovid that its worthwhile treatment for most people with COVID, even though the official EAU remains more restricted.

As I mentioned a few days ago, most patients who test positive now do so through home testing. In most cases, we no longer have the 1-2 day turn-around that was the situation with the send-out PCR tests. With that kind of instant feedback, it's become pretty easy to hit the therapeutic time window for paxlovid. For our patients, if they call us reporting a positive test, we quickly review their chart and if they don't have any obvious exclusions, we prescribe the medication without further delay. For a few patients, I needed to check their kidney function first, but for most, we simply do a chart review. Now, that's just the default that we've kind of fallen into in our practice, what other practices do could be completely different.

Just out of curiosity, is the medication just handled like any other prescription or is there any special funding for it? Any idea what the price is? Our health plan subjects many prescriptions to the deductible (which we never meet) so I would likely turn it down unless it was reasonably priced.

 

[Heppenheimer]

Just out of curiosity, is the medication just handled like any other prescription or is there any special funding for it? Any idea what the price is? Our health plan subjects many prescriptions to the deductible (which we never meet) so I would likely turn it down unless it was reasonably priced.

Mind you, I'm on the prescribing end, not the retail end. But it seems to work like any other prescription.

 

[correcaminos]

He is on chemotherapy, so similar situation. Little or no immunity.

I wish him the best then. The person I know is fine, but did need some at home breathing treatments.

 

[drizgirl]

Mind you, I'm on the prescribing end, not the retail end. But it seems to work like any other prescription.

I googled and it looks like a course of this medication is $530. Since it appears I'd have to pay all of that, I would have to pass.

 

[Wendy Pleakley]

As unnecessarily politicized as the vaccines were, I really hope the same bunch of people with malignant intent don't go after paxlovid. I am very impressed with the real-world efficacy of this drug combo, particularly in the fully vaccinated population. It's turned what was a deadly disease into a very treatable nuisance.

As much as I respect Dr. Fauci, I actually wish he wasn't promoting the drug. There's some out there who have been conditioned to automatically nay-say everyting out of his mouth, and these are likely to be the same unvaccinated individuals who are most likely to benefit from paxlovid.

The people who dismiss everything Fauci says were going to dismiss anything that doesn't confirm to their views from any source.

He's an expert and there's no reason he shouldn't be conveying this info.

There's no use in trying to pander to those who won't listen by silencing those who know best.

 

[Bullseye1967]

@Heppenheimer

My 89 year old father currently has COVID-19 and is on Paxlovid. What are your thoughts on the CDC release that spoke of rebound cases of COVID-19 for people treated with Paxlovid?

Could you address this? Also I saw you mentioned adequate renal function. My father only has one kidney and is in stage 3 renal failure. Should I be concerned?

 

[Angel Ariel]

I googled and it looks like a course of this medication is $530. Since it appears I'd have to pay all of that, I would have to pass.

According to this article from May 12, paxlovid should still be free (original article was March, updated in May)


“The drug, developed by Pfizer, has a lot of positives: It had an 89% reduction in the risk of hospitalization and death in the clinical trial that supported the EUA, a number that was high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments; it’s cheaper than many other COVID-19 drugs (it’s provided for free by the U.S. government while there is a public health emergency); and, perhaps most reassuring, it is expected to work against the Omicron variant.”

13 Things To Know About Paxlovid, the Latest COVID-19 Pill

Paxlovid is an oral antiviral pill used to treat COVID-19. Yale Medicine provides 13 things to know about this COVID-19 treatment.

www.yalemedicine.org

And it does appear the US is still in a public health emergency, reviewed/renewed every 3 months, currently through July 15,2022

Renewal of Determination That A Public Health Emergency Exists

aspr.hhs.gov

There may be other costs associated (like the cost of the visit, covid-19 testing, etc - but the prescription itself it does not appear should be $500+ Out of pocket at this time

 

[Heppenheimer]

@Heppenheimer


Could you address this? Also I saw you mentioned adequate renal function. My father only has one kidney and is in stage 3 renal failure. Should I be concerned?

For anyone with inadequate renal function, the treatment of choice is still the monoclonal antibody infusion.

Stage 3 chronic kidney disease is likely still OK with paxlovid (with some exceptions), but the dosage needs to be adjusted.

 

[drizgirl]

According to this article from May 12, paxlovid should still be free (original article was March, updated in May)


“The drug, developed by Pfizer, has a lot of positives: It had an 89% reduction in the risk of hospitalization and death in the clinical trial that supported the EUA, a number that was high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments; it’s cheaper than many other COVID-19 drugs (it’s provided for free by the U.S. government while there is a public health emergency); and, perhaps most reassuring, it is expected to work against the Omicron variant.”

13 Things To Know About Paxlovid, the Latest COVID-19 Pill

Paxlovid is an oral antiviral pill used to treat COVID-19. Yale Medicine provides 13 things to know about this COVID-19 treatment.

www.yalemedicine.org

And it does appear the US is still in a public health emergency, reviewed/renewed every 3 months, currently through July 15,2022

Renewal of Determination That A Public Health Emergency Exists

aspr.hhs.gov

There may be other costs associated (like the cost of the visit, covid-19 testing, etc - but the prescription itself it does not appear should be $500+ Out of pocket at this time

Thank you! That's great news.

 

[Angel Ariel]

Thank you! That's great news.

You’re welcome! Hope you don’t need it, but good to know just in case!

 

[drizgirl]

You’re welcome! Hope you don’t need it, but good to know just in case!

Same to you. It’s something I have wondered about since hearing about the therapeutics. Glad to know we, and others with similar concerns, won’t have to worry about that for now.

 

[DisneyCane]

At this point, we're pretty much prescribing it to any adult who tests positive and doesn't have an absolute contra-indication, which means they have adequate renal function and they're not taking an excluded medication that they can't stop (diltiazem is probably the most common). When the supply was more limited, we did restrict prescriptions to those who met the criteria for high risk, but we have more than enough supplies in our local pharmacies now. Mind you, this very much up to the discretion of the prescribing physician and the local supply of the medication. There's a growing consensus as we become more familiar with paxlovid that its worthwhile treatment for most people with COVID, even though the official EAU remains more restricted.

As I mentioned a few days ago, most patients who test positive now do so through home testing. In most cases, we no longer have the 1-2 day turn-around that was the situation with the send-out PCR tests. With that kind of instant feedback, it's become pretty easy to hit the therapeutic time window for paxlovid. For our patients, if they call us reporting a positive test, we quickly review their chart and if they don't have any obvious exclusions, we prescribe the medication without further delay. For a few patients, I needed to check their kidney function first, but for most, we simply do a chart review. Now, that's just the default that we've kind of fallen into in our practice, what other practices do could be completely different.

It seems like Paxlovid finally gives a good reason to bother testing if you have mild symptoms that seem like a cold or allergies. Before, just assuming you are positive and staying away from people for the recommended time period was reasonable because nothing would really change if you "tested positive." Now, if you test positive you can actually get a treatment to further lower your risk so it makes sense to test if you have any COVID-like symptoms.

 

[danlb_2000]

It seems like Paxlovid finally gives a good reason to bother testing if you have mild symptoms that seem like a cold or allergies. Before, just assuming you are positive and staying away from people for the recommended time period was reasonable because nothing would really change if you "tested positive." Now, if you test positive you can actually get a treatment to further lower your risk so it makes sense to test if you have any COVID-like symptoms.

I believe this is the case for most current COVID treatments, monoclonal antibodies for example, they all need to be used shortly after symptom onset.

 

[DisneyCane]

I believe this is the case for most current COVID treatments, monoclonal antibodies for example, they all need to be used shortly after symptom onset.

True but the monoclonal antibodies were never nearly as easily available, especially for low risk people.

 

[Heppenheimer]

True but the monoclonal antibodies were never nearly as easily available, especially for low risk people.

They weren't even indicated for or generally given to low risk people.

The thought process on why we're now prescribing paxlovid for nearly everyone is because a course of the medication actually seems to be pretty effective at providing symptomatic relief, in addition to the protection against severe illness, hospitalization and death. The infusions, despite being useful tools to prevent severe illness, really don't improve symptoms that much, and in some cases, actually make people feel a little worse temporarily. I'm not sure if the difference comes down to the inherent efficacy of the treatments, or because the combination of home testing and a shorter administrative delay means that we can get paxlovid treatment started much faster.

 

[Heelz2315]

DOJ asks court to reverse the masks on planes

Justice Department asks court to reverse order lifting airplane mask mandate

A federal judge in April struck down the Biden administration’s mandate that masks be worn aboard planes, trains, buses and other public transportation.

www.nbcnews.com

 

[G00fyDad]

DOJ asks court to reverse the masks on planes

Justice Department asks court to reverse order lifting airplane mask mandate

A federal judge in April struck down the Biden administration’s mandate that masks be worn aboard planes, trains, buses and other public transportation.

www.nbcnews.com

 

[Heelz2315]

^yep that’s how I think it’ll be received if it’s overturned

 

[MisterPenguin]

The CDC was going to lift the mandate for planes anyway.

This appeals is just to affirm the right for the CDC to mandate masks if it deems necessary.