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PoundSand)
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When my partner got got last year she was prescribed pax immediately but thanks to her doctor being slow on the draw actually getting the prescription in (and this was her actual doctor and not an app) and then sending her prescription to the wrong pharmacy followed by the two pharmacies not being able to agree on which one of them needed to do something to release the pills, it took about three days to actually get the drugs and I'd rather just have a couple courses on hand now. Also, no idea how long the no questions asked telehealth situation with SesameCare is going to last and I'd rather not be pleading my or her case in the moment.
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Aug 20, 2023 19:19
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speng31b posted:I'm not going to quote all the others but there was some pretty hosed up stuff posted. Bob has had some bad COVID opinions on twitter and a pretty influential following so I understand the impulse to hate on the guy, but please steer clear of this kind of stuff from now on under the thread reboot rules. I assume we're also going to police the people who like to come in here and talk about how PASC is a mental illness as well then, since you managed to quote my earlier post comparing the two stances without attaching that context?
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Aug 20, 2023 19:23
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The Oldest Man posted:I assume we're also going to police the people who like to come in here and talk about how PASC is a mental illness as well then, since you managed to quote my earlier post comparing the two stances without attaching that context? Those people suck too, as I said Bob has bad opinions and you're under no obligation to like the guy.
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Aug 20, 2023 19:25
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speng31b posted:Those people suck too, as I said Bob has bad opinions and you're under no obligation to like the guy. I don't actually wish any ill at all on Bob Wachter, he's far more perplexing than outright evil like some of his co-workers and has suffered far more personal consequences for his decisions than the vast majority of them have. My post was comparing people who like to say bed-ridden long covid victims are psychiatric cases to someone who would stand over a guy with head trauma and describe that as a result of his not getting therapy since to me they're pretty equivalently disgusting.
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Aug 20, 2023 19:27
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The Oldest Man posted:When my partner got got last year she was prescribed pax immediately but thanks to her doctor being slow on the draw actually getting the prescription in (and this was her actual doctor and not an app) and then sending her prescription to the wrong pharmacy followed by the two pharmacies not being able to agree on which one of them needed to do something to release the pills, it took about three days to actually get the drugs and I'd rather just have a couple courses on hand now. Also, no idea how long the no questions asked telehealth situation with SesameCare is going to last and I'd rather not be pleading my or her case in the moment. This is somewhat of a nuanced point but Paxlovid wasn't necessarily studied as a covid cure but rather as a treatment to prevent disease progression and morbidity and mortality. To that point taking it at day 3 is within the window where it was studied to do that. It's a bummer there was prescriber/pharmacy mixup and your partner might have felt crappy for an extra day or two because of it but otherwise seems fine I guess?
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Aug 20, 2023 19:28
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jetz0r posted:get yourself a pax script right now, so you can start taking asap if you start to feel sick. at worst, you've spent 0-$20 on a box of pax to have on hand for your next covid infection. at best, it lets you start treatment immediately, without worrying about business hours or weekends. I took another test and it turned positive right away so going to get my paxlovid now. gently caress me
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Aug 20, 2023 19:29
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Glumwheels posted:I took another test and it turned positive right away so going to get my paxlovid now. Feel better bud 
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Aug 20, 2023 19:30
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Glumwheels posted:I took another test and it turned positive right away so going to get my paxlovid now. 
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Aug 20, 2023 19:30
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The Oldest Man posted:I don't actually wish any ill at all on Bob Wachter, he's far more perplexing than outright evil Yeah that's my take too, appreciate the clarification.
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Aug 20, 2023 19:32
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Poppers posted:This is somewhat of a nuanced point but Paxlovid wasn't necessarily studied as a covid cure but rather as a treatment to prevent disease progression and morbidity and mortality. To that point taking it at day 3 is within the window where it was studied to do that. It's a bummer there was prescriber/pharmacy mixup and your partner might have felt crappy for an extra day or two because of it but otherwise seems fine I guess? She was pretty severely ill for about three weeks. Would getting paxlovid on day 1 or 2 of symptoms rather than day 3 or 4 have helped mitigate that to any degree? Well there's no way to know for sure but I'm going to make sure she gets it on day 1 next time rather than trusting in an obviously uncaring and sometimes incompetent medical administration system to do the right thing.
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Aug 20, 2023 19:32
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The Oldest Man posted:When my partner got got last year she was prescribed pax immediately but thanks to her doctor being slow on the draw actually getting the prescription in (and this was her actual doctor and not an app) and then sending her prescription to the wrong pharmacy followed by the two pharmacies not being able to agree on which one of them needed to do something to release the pills, it took about three days to actually get the drugs and I'd rather just have a couple courses on hand now. Also, no idea how long the no questions asked telehealth situation with SesameCare is going to last and I'd rather not be pleading my or her case in the moment. Contrast this with a wealthy relative of mine during Delta. Tested positive, called his physician's office for a same day appointment. Was immediately given monoclonal antibodies (and offered ivermectin) that were absolutely impossible to find (I know because I spent countless hours trying to find some for another relative of mine). So I base my standard of care on that. Can I afford a concierge physician service? No. Can I attempt to approximate that level of care by having therapeutics on hand for the inevitable? Yes. Will I regret not having taken every step I could to protect my family from a pathogen that causes long term illness in 10-20% of cases? Yes. I'm not going to hoard my supply like a dragon, but there is a very finite window of effectiveness. A delay of as much of a day gives the virus that much more time to wreak havoc. I think part of the reason I recovered so well from my first infection was because I was able to start taking Paxlovid immediately upon pozzing. And lest there be accusations of self-medicating, my PCP said he would happily prescribe Pax. If same day telehealth appointments with him weren't impossible to get, I'd happily go that route. Poppers posted:This is somewhat of a nuanced point but Paxlovid wasn't necessarily studied as a covid cure but rather as a treatment to prevent disease progression and morbidity and mortality. To that point taking it at day 3 is within the window where it was studied to do that. It's a bummer there was prescriber/pharmacy mixup and your partner might have felt crappy for an extra day or two because of it but otherwise seems fine I guess? That's great, except testing frequently lags symptoms, sometimes by many days. Tests most people can take aren't super sensitive, from a combination of new variants and user error. If you've been sick as a dog and only pop positive on the 4th day since you started throwing up, there isn't some treaty with science that COVID has signed that says, "I give the sick person 5 days to start Paxlovid. I will only cause minimal damage until then as they have only now tested positive." The clock for Paxlovid's window of effectiveness expires in 5 days from symptom onset. Therefore the optimal strategy is to be able to take it as soon as possible, not when your overworked strip mall physician's assistant finally has time to call in a prescription. Glumwheels posted:I took another test and it turned positive right away so going to get my paxlovid now. Look at it this way, at least you no longer have to isolate from each other. Vicks VapoShower tablets are on Prime, and will be your best friend for the next few days. Raskolnikov2089 has issued a correction as of 19:54 on Aug 20, 2023 |
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Aug 20, 2023 19:33
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speng31b posted:Yeah that's my take too, appreciate the clarification. The vocal "you should be concerned about car crashes" guy at the "car crashes are actually fine" institution is not really a bad guy by any reasonable yard-stick imo. But his deal is that keeps getting hit by cars then posting about how while he thinks it's worth avoiding getting hit by a car again he's not quite ready to start looking both ways before crossing the street - yet! And that is tough to puzzle out.
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Aug 20, 2023 19:35
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I’m not that congested yet, I just have a fever and a headache. I’m worried about the kids, I’ll test them again and continue wearing masks. The prescriber said there is a major interaction with paxlovid and rinvoq (something I’m on) and just gave me molnupiravir. Is it even as useful?
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Aug 20, 2023 19:47
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^^^ According to https://www.covid19treatmentguideli...g-interactions/ you could still take pax if your Rinvoq is adjusted, but that is something your doc would need to look into. Molnupiravir is unlikely to help much at this point, though from my understanding it's not totally impossible. Hoarding is when you keep it all to yourself. I have gotten some pax for myself when I was not sick, held onto it in case I needed it, and then when people in my life got sick, I gave it to them. And to be specific so as not to be accused of practicing medicine without a license or whatever people think is happening in here, these were people who got prescribed a 5-day course from their doctor, so someone with a diploma said they were OK to take it. Just following the science and doing what Saint Fauci did. (USER WAS PUT ON PROBATION FOR THIS POST) CK07 has issued a correction as of 19:52 on Aug 20, 2023 |
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Aug 20, 2023 19:49
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Glumwheels posted:I’m not that congested yet, I just have a fever and a headache. I’m worried about the kids, I’ll test them again and continue wearing masks. From what I recall, it can speed recovery time, but not to the degree originally promised, and nowhere near as effectively as Paxlovid. It also may be creating new variants: https://www.nature.com/articles/d41586-023-00347-z
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Aug 20, 2023 19:49
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I think I I had my first crack ping moment of the year. A good long term friend and I recently had an argument because he’s had COVID a few times but he claims changing his diet solved long COVID and then in June we got in a huge fight because he said blah blah blah just like the flu masks are useless blah blah blah….and this dude is stubborn as gently caress. he posted a picture of himself wearing a mask landing in Tampa today. that’s how I know poo poo is dire.
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Aug 20, 2023 19:52
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Glumwheels posted:I’m not that congested yet, I just have a fever and a headache. I’m worried about the kids, I’ll test them again and continue wearing masks. It's less good than pax and if we're only concerned about reducing poo poo like getting hospitalized or dying there were some studies saying it didn't help with those outcomes and only really helped with reducing how long it takes mild/moderate cases to resolve. Also, it's been implicated in spawning new variants: quote:Cytosine metabolism is known to drive the evolution of SARS-CoV-2 [24]. Merck claimed no viable SARS-CoV-2 remained after the 5-day treatment in the phase 2 trials on subjects at standard risk, 89% of whom cleared the virus anyway [25], but no virus isolation was attempted during the phase 3 trial in subjects at higher risk for disease progression (including the immunosuppressed) [12]. Concerns about ongoing replication in the majority of molnupiravir-treated patients who did not eradicate the virus after molnupiravir was first raised by William A. Haseltine (a Harvard scientist renowned as an HIV pioneer and human genome sequencer) [26,27], Carl T. Bergstrom, and James E.K. Hildreth (an FDA advisor within the Antimicrobial Drugs Advisory Committee who voted against molnupiravir EUA) on 11 November 2021. Normally, the transitions-to-transversions rate is about 2:1 for SARS-CoV-2 [28], while molnupiravir typically induces a 14:1 ratio [29]. In chronically infected patients, >80% of nucleotide changes are nonsynonymous as a result of strong selective immune pressure on the encoded antigens (with Spike overrepresented). On 5 October 2022, Ryan Hisner, a science teacher from Indiana active on GitHub as a SARS-CoV-2 variant seeker, first reported on Twitter that he had observed in GISAID 4 hypermutated SARS-CoV-2 sequences (BA.5.2.1, BA.2.3, BA.1.1, BA.4.1.1 [30]) with hallmarks of molnupiravir action (transition-to-transversion rates > 9), i.e., with a much higher incidence of synonymous transitions homogeneously distributed across the entire genome, mostly from countries with large molnupiravir use (despite after authorization black market has been widespread in low-and-middle-income countries [31]). On 3 November, a BM.2 sublineage with a transition-to-transversion ratio of 41 was reported from 9 Australian sequences [32], first suggesting that on a large scale, apparently unfit mutations can occasionally be fit. No large-scale surveillance study has been conducted to date, nor for patients formerly treated for influenza [6]. Alteri et al. recently reported that SARS-CoV-2 strains in 8 patients under molnupiravir pressure were characterized by a 6-fold higher genetic diversity compared to 7 patients under Paxlovid® (Pfizer, New York, NY, USA) pressure and 5 patients under no antiviral pressure, with a peak between day 2 and day 5 [33]. So I dunno seems less than ideal at a population level but probably fine for the individual.
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Aug 20, 2023 19:55
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CK07 posted:^^^ According to https://www.covid19treatmentguideli...g-interactions/ you could still take pax if your Rinvoq is adjusted, but that is something your doc would need to look into. Molnupiravir is unlikely to help much at this point, though from my understanding it's not totally impossible. JAK inhibitor toxicity is no joke, like Rinvoq lands people in the hospital pretty regularly. It’s likely not worth it to fiddle with for a five day course and risk an RA flare or acute toxicity.
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Aug 20, 2023 19:56
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so I have to monitor my pax intake if I take amlodipine which I only have to take because I got COVID in the first place?
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Aug 20, 2023 20:00
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Poppers posted:JAK inhibitor toxicity is no joke, like Rinvoq lands people in the hospital pretty regularly. It’s likely not worth it to fiddle with for a five day course and risk an RA flare or acute toxicity. I’m not going to risk it but I will call my clinic and see if I can get a hold of the on call doctor. Otherwise I’ll get the prescription they gave me and call tomorrow to see if my clinic will stop rinvoq and give me paxlovid.
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Aug 20, 2023 20:00
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Poppers posted:JAK inhibitor toxicity is no joke, like Rinvoq lands people in the hospital pretty regularly. It’s likely not worth it to fiddle with for a five day course and risk an RA flare or acute toxicity. This is why the thread makes fun of, "we have the tools". We have exactly 1 tool that's not a vaccine, and a large percentage of people can't have it. Does metformin have any more studies? It seems like there was that big one, then no followups were announced that I could find. I'd like to think it would help, but there was a similar glowing study on Fluvoxamine back in 2021 that ended up going nowhere.
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Aug 20, 2023 20:01
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Pillowpants posted:so I have to monitor my pax intake if I take amlodipine which I only have to take because I got COVID in the first place? Things I’ve seen done with amlodipine are hold for the course, half dose for the course, if it’s a low dose don’t make any changes, etc. Besides syncope and hitting your head having too much amlodipine in your system is unlikely to cause major damage and hypertension is a disease of chronic damage so missing five days of antihypertensive are unlikely to have serious consequence. Not comparable to Rinvoq.
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Aug 20, 2023 20:04
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Glumwheels posted:I’m not going to risk it but I will call my clinic and see if I can get a hold of the on call doctor. Otherwise I’ll get the prescription they gave me and call tomorrow to see if my clinic will stop rinvoq and give me paxlovid. I mean you do you but I’d probably imagine an RA flare to be more disabling than a typical covid infection. I dunno, I’m not a rheumatologist.
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Aug 20, 2023 20:05
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eXXon posted:How so? Didn't mean that seriously
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Aug 20, 2023 20:15
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Poppers posted:I mean you do you but I’d probably imagine an RA flare to be more disabling than a typical covid infection. I dunno, I’m not a rheumatologist. It’s Crohn’s disease and I’m on two drugs, skyrizi and rinvoq, with a wbc that is somewhat low as a result. . Right now I just have a pounding headache and a fever. Took 2 Tylenol and it’s barely going down after 2 hours. Just called the clinic and they said to wait until tomorrow and speak to my doctor, not to take anything and wait and see if they’ll change my prescriptions. The on call doctor won’t do poo poo.
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Aug 20, 2023 20:23
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The Oldest Man posted:She was pretty severely ill for about three weeks. Would getting paxlovid on day 1 or 2 of symptoms rather than day 3 or 4 have helped mitigate that to any degree? Well there's no way to know for sure but I'm going to make sure she gets it on day 1 next time rather than trusting in an obviously uncaring and sometimes incompetent medical administration system to do the right thing. i am not aware of any evidence that shifting paxlovid anywhere in the 1-5 day time window helps or hurts, but later than 5 days reduces efficacy. Glumwheels posted:It’s Crohn’s disease and I’m on two drugs, skyrizi and rinvoq, with a wbc that is somewhat low as a result. . Glumwheels, a drug to consider is remdesivir (veklury). It has no interactions with risankizumab (skyrizi) or upadacitinib (rinvoq) (https://www.covid19-druginteractions.org/checker) (or anything else) and it is just as effective as paxlovid at preventing progression to severe disease. you can use https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/ and select your region and outpatient remdesivir to try and find locations near you. unfortunately, outpatient access remains limited in much of the country because we live in a failed state. if you can't get that, talk to your doctor. there is no interaction with skyrizi, but there may be with rinvoq; however, the contraindication has not been studied (https://www.covid19-druginteractions.org/interactions/29008). it may be you can adjust or pause the rinvoq. paxlovid is only effective if started in =<5 days, but remdesivir can be started in the first 7. so you don't need to rush to make a decision tonight (i'm sorry you are feeling crummy). in the very unlikely event you progress to hospitalization, remdesivir can also be used in the inpatient setting in a hospital for those in the inflammatory stage. the NIH recommends going for either of these things over molnupiravir. Petey has issued a correction as of 20:56 on Aug 20, 2023 |
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Aug 20, 2023 20:50
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hey fosborb — might want to add this to the OP for remdesivir locating https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/ and also this for a quick summary of pax interactions: https://www.idsociety.org/paxlovid; the full https://www.covid19-druginteractions.org/ is already linked in there
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Aug 20, 2023 20:54
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Most intravenous drugs aren’t generally available outpatient at will lol. There may even be reasonable reasons for such…
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Aug 20, 2023 20:54
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it's called "outpatient remdesivir" because you do not need to be checked into the hospital for it. it is only administered at healthcare institutions, but not enough of them to make access realistic for most people. earlier in the pandemic, some states were doing at-home infusions of remdesivir through a visiting nurse, but i'm not sure if anyplace is still doing that. (I'm no drug developer but given remdesivir is shelf-stable you would think that they could put it in the little self-administerable injectables that i use for my monoclonal cholesterol medication and just send you home with them)
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Aug 20, 2023 21:00
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Petey posted:i am not aware of any evidence that shifting paxlovid anywhere in the 1-5 day time window helps or hurts, but later than 5 days reduces efficacy. Can I stop and switch to paxlovid or remdesivir later like tomorrow? The Tylenol isn’t doing poo poo and I can’t take Advil or Motrin. Should I just go to the ER and see if they’ll give me remdesivir?
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Aug 20, 2023 21:00
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Petey posted:it's called "outpatient remdesivir" because you do not need to be checked into the hospital for it. it is only administered at healthcare institutions, but not enough of them to make access realistic for most people. earlier in the pandemic, some states were doing at-home infusions of remdesivir through a visiting nurse, but i'm not sure if anyplace is still doing that. Aren’t the PCKS9 inhibitors all subcutaneous? Entering systemic circulation is a highly risky act for the average person to be doing at home.
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Aug 20, 2023 21:04
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^^ yeah duh, that's probably right (like i said, am not a drug developer) Glumwheels posted:That’s all useful but I don’t see remdesivir in my state. I have to wait until tomorrow morning to figure this out or start taking molnupiravir now. you popped positive today right? there's no clinical evidence i'm aware of that starting it on day 2 or 3 is better or worse than day 1. and mostly, as others have said, paxlovid isn't evaluated for reducing symptoms (though it may do that), but for preventing progression of disease. i don't remember my pax making my symptoms suddenly better or anything. i don't know about starting molnupiravir and then switching — no info on that. personally i would not just roll up to the ER while newly covid positive, but you could certainly call around to some places and ask if they will do outpatient remdesivir in the hopes that DHHS site is not fully up to date, or otherwise google around for info. a way to kill time while isolating before tomorrow morning. hope you feel better soon and the fam is okay
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Aug 20, 2023 21:09
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Petey posted:it's called "outpatient remdesivir" because you do not need to be checked into the hospital for it. it is only administered at healthcare institutions, but not enough of them to make access realistic for most people. earlier in the pandemic, some states were doing at-home infusions of remdesivir through a visiting nurse, but i'm not sure if anyplace is still doing that. yeah currently Veklury (remdesivir) is only able to be administered as an IV infusion lasting 30-120 minutes, not as an intramuscular or subcutaneous bolus like an autoinjector or other self-administered injectables, and it's no longer considered shelf-stable after it's been reconstituted for infusion. I'm not a drug scientist so I can't tell you if there's any reason why that is other than "that's what it's currently approved for and been studied as" but that's the way it is right now hailthefish has issued a correction as of 21:22 on Aug 20, 2023 |
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Aug 20, 2023 21:16
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Reconstitution generally breaks sterile barriers, so even with aseptic technique drugs that are reconstituted for parenteral administration have a limited beyond use date.
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Aug 20, 2023 21:18
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If you want a “fun” story about what can go wrong with nonsterile technique look up the New England Compounding Center
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Aug 20, 2023 21:21
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tuyop posted:you lie Sure but I'm saying they ask for you to show a positive test on camera with you or poo poo like that
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Aug 20, 2023 21:27
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Petey posted:^^ yeah duh, that's probably right (like i said, am not a drug developer) Yes I popped positive today, I will just wait until tomorrow and talk to my doctors. If I get worse I’ll go to the ER I guess. Just wish I could kick this headache and fever. Oh and molnupiravir is out of stock at my local pharmacy lol, lmfao.
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Aug 20, 2023 21:29
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Glumwheels posted:It’s Crohn’s disease and I’m on two drugs, skyrizi and rinvoq, with a wbc that is somewhat low as a result. . A nice little nuance of the American healthcare system is that if something happens on a weekend, you're poo poo out of luck until Monday.
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Aug 20, 2023 21:35
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Various people I know are all headed to Florida right now. Is something special going on? It feels like when japan opened to tourism and everyone I knew or watched on TV was like, "OMG, I finally can go to Japan! Poggers, soy!"
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Aug 20, 2023 21:36
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Petey posted:it's called "outpatient remdesivir" because you do not need to be checked into the hospital for it. it is only administered at healthcare institutions, but not enough of them to make access realistic for most people. earlier in the pandemic, some states were doing at-home infusions of remdesivir through a visiting nurse, but i'm not sure if anyplace is still doing that. Gilead is working on an oral version of remdesivir to get around that problem: https://www.reuters.com/business/he...ies-2023-04-04/ Nothus posted:A nice little nuance of the American healthcare system is that if something happens on a weekend, you're poo poo out of luck until Monday. That's okay, according to experts, covid is required to wait until you can get a paxlovid prescription filled. I think congress passed a law or something. Raskolnikov2089 has issued a correction as of 21:45 on Aug 20, 2023 |
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Aug 20, 2023 21:38
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