Should reasonably healthy people still take Paxlovid?
post by Sameerishere · 2022-09-29T03:41:02.271Z · LW · GW · 1 commentThis is a question post.
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Answers 18 AllAmericanBreakfast None 1 comment
Should a non-immunocompromised, fairly healthy person in their late 30s take Paxlovid if they get one of the currently circulating strains of Omicron?
How would that answer change if:
- Their symptoms are fairly mild (bad cold)
- They have a high enough BMI to qualify for Paxlovid, but not a super high BMI?
My previous understanding was that it was a good idea to reduce the severity of the case and risk of long-term effects.
However, a few friends' advice leads me to think that taking Paxlovid for a mild case does not make sense for a reasonably healthy non-elderly person:
- "Paxlovid's usefulness is questionable and could lead to resistance. I would follow the meds and supplements suggested by FLCC https://covid19criticalcare.com/.../i-care-early-covid.../" [not sure how reliable that site is, as it recommends Ivermectin, though it seems to be composed of actual MDs]
- [3 anecdotes of nasty rebounds]
- Twitter threads suggesting Paxlovid reduces your protection against later reinfection [which doesn't really seem like the most important thing to be optimizing for]
On the other hand:
- Another friend said: "Eric Topol twitter vaguely seems to suggest that data are broadly indicative of protection; haven't heard of much side effects"
- (And 2 friends in their 30s took it and were fine)
Answers
Paxlovid-associated rebound is quoted in Nature as occurring in 27% of cases, which is more in line with the anecdata I've received than the 5% figures in other research. My anecdata is that it really does hammer down brewing symptoms very effectively, and I haven't seen reports or systematic trends in the anecdata of the rebound being worse than the first go-'round. So from your perspective, it's a shot at not getting sick, or maybe of getting less sick.
The risk is yeah, maybe you contribute a miniscule marginal amount to drug resistant COVID-19. The norms of biomedicine are that you, the patient, do not need to concern yourself with that. If the medicine can help you, and your doctor prescribes it, you can have it. You aren't on the hook to sacrifice the quality of your care for the "greater good."
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comment by Richard Korzekwa (Grothor) · 2022-09-29T05:26:04.184Z · LW(p) · GW(p)
"Paxlovid's usefulness is questionable and could lead to resistance. I would follow the meds and supplements suggested by FLCC"
Their guide says:
In a follow up post-marketing study, Paxlovid proved to be ineffective in patients less than 65 years of age and in those who were vaccinated.
This is wrong. The study reports the following:
Among the 66,394 eligible patients 40 to 64 years of age, 1,435 were treated with nirmatrelvir. Hospitalizations due to Covid-19 occurred in 9 treated and 334 untreated patients: adjusted HR 0.78 (95% CI, 0.40 to 1.53). Death due to Covid-19 occurred in 1 treated and 13 untreated patients; adjusted HR: 1.64 (95% CI, 0.40 to 12.95).
As the abstract says, the study did not have the statistical power to show a benefit for preventing severe outcomes in younger adults. It did not "prove [Paxlovid] to be ineffective"! This is very bad, the guide is clearly not a reliable source of information about covid treatments, and I recommend against following the advice of anything else on that website.