News on the possible non-use of Paxlovid for those with COVID

Dear Hyde Park readers,

My cousin Dr. Robert Colton, of Boca Raton, Florida ... has been one of the best communicators about COVID, since it began.

Dr. Colton has a very important summary that he wrote and posted earlier this afternoon, on his Facebook page, at https://www.facebook.com/robert.colton.52/posts/pfbid02wJGVeoj6kfmMokFKjiJFpnhs1yAjPjYKHLaZfuhNaUbYXQUyFdHFqTbzBdiA77Bfl

His main topic is a currently prescribed medicine, Paxlovid; its possible creation of a "covid-rebound" effect; and the resulting importance for each person to work closely together with their own doctor, for a you-plus-your-doctor consensus treatment for COVID for you.

I have pasted it, below.

Yours,
Sid Colton, Patch Mayor for the Hyde Park Patch

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Robert Colton

COVID UPDATE JULY 2022

I had hoped my previous post would be my last, but so much has changed in the last few months.

The COVID virus mutates constantly. We started with the alpha virus, moved onto Delta, then Omicron. Omicron has mutated from its original form to BA.1, BA.2 and now BA.4 and BA.5. Each “new” virus overtakes the others due to increased infectivity and evasion of the immunity resulting from vaccination and previous infection.

The BAD news now:

1. With each successive mutation, protection from acquiring infection in those previously vaccinated and/or infected dwindles.

2. Even individuals with infection from the earlier forms of Omicron as recent as one month ago can get reinfected.

3. Due to rapid in-home testing, only about 20% of COVID infections are reported. Currently, epidemiologists estimate 500,000 Americans become infected daily, like the peak in January 2022. If this rate continues, 35 million Americans or 10% of the population will become infected in the ten-week period starting July 1.

4. There is no societal will for reinstating mitigation measures like masking and social distancing that could slow the pandemic. How many people are currently wearing masks in crowded indoor settings, airports, airplanes? Very few. 5. It remains to be seen how many people will suffer from Long Covid.

The GOOD news

1. Even though case numbers are rapidly rising once again, death and hospitalization rates remain very low. Mortality rate is currently averaging 300 to 400 people a day compared to the peak last year in January 2021 of 3300 people per day.

2. Although each successive mutation has led to a virus that is more contagious and evades existing immunity. none of the new mutations are more virulent and in general lead to much less severe disease.

3. Almost everyone has been vaccinated, infected or both. While a full series of vaccinations, including at least one booster, offers little protection against infection, it robustly protects against hospitalizations and death. The CDC estimates COVID vaccines have saved about 235,000 lives from Dec 2020 until October 2021. If you have only had 2 shots and no infection, get at least one booster, and discuss the second booster with your doctor. If you are a rare person who has never been vaccinated or infected, you are a lucky fool, but your luck will likely run out.

Treatment

The risk of hospitalization and death from COVID today amongst the vaccinated and boosted or those with natural immunity is very low. Most everybody will get better with symptomatic treatment alone.

Paxlovid is a new antiviral pill manufactured by Pfizer. The drug blocks viral replication, preventing the production of millions of new copies of the virus. It is well tolerated except for an awful taste. It is now widely available. There are some interactions with other drugs. Initial studies in HIGH-RISK UNVACCINATED individuals showed a 90% reduction in death and hospitalizations compared to the placebo group. A recent study in low to moderate risk vaccinated patients showed no statistically significant benefit. Furthermore, Paxlovid “rebound” may occur. A patient finishes the Paxlovid, tests negative, and then symptoms return a few days later leading to quarantine once again.

I am one of those rebounders. I recently came home from a vacation with COVID symptoms and a positive rapid test.

Due to my age (70), I took 5 days of Paxlovid, gradually improved, and tested negative on day 10 of my illness. The next day, all my symptoms returned: body aches, cough, runny nose, and fatigue. It is now day 14 of my illness, and I’m still not completely better, and still testing positive.

The current literature states the risk of Paxlovid rebound is about 2%. I think this is a vast underestimate. Anecdotally, I have heard of many cases of rebound, including Dr. Fauci himself. My friend, Dr. Marty Makary from Johns Hopkins, a COVID expert and consultant, believes the number may be closer to 50%! Nobody knows the exact mechanism, but it may have something to do with rapid metabolism of the active drug in Paxlovid.

Recommendations

It’s hard to avoid getting infected but wearing N-95 or KN-95 masks in crowded indoor spaces and avoiding indoor dining does reduce risk. This is a personal choice that I have not adhered to.

If you are at low or moderate risk of severe infection, I see no benefit to Paxlovid, and I recommend the usual quarantining protocol with symptomatic treatment.

For those older than 65 or with many risk factors- this is a tough one. I may be biased due to my recent experience, but Paxlovid rebound is real and probably much higher than 2%. Therefore, I would only recommend it in the highest risk categories.

Monoclonal antibodies are still available and effective, and they are a logical alternative in the higher risk groups.

As with most illnesses, treatment needs to be individualized. If and when you do get infected, through a process called shared decision making, you and your doctor should decide what treatment is best for you.

Moderna and Pfizer are working feverishly to produce the next generation of COVID vaccines specifically attacking the newest Omicron variants. It is too early to determine when they will be available and how effective they will be.

Robert Colton MD Boca Raton, Fl.