Paxlovid is a paradox. The A game-changing antivirus It swooped through the pandemic’s worst winter with the promise of greatly slowing COVID deaths. But since it became widely available this spring, death rate I barely budge.
According to the White House, the problem is not the drugs but the very fact of it Very few people they take it. a Latest CDC report It found that from April through July, less than a third of Americans over 80 with COVID ended up taking Paxlovid, even though they were the ones who benefited the most from doing so. what gives? Some Americans may have a problem Paxlovid accessBut it is clear that a significant proportion of patients and doctors say no to antivirals. There are no national statistics on baxlovid rejection, so I spoke with doctors across the country to learn more about their motivations. Who are the opponents of peace, and how dangerous is their faith?
First things first: Paxlovid hesitation appears to be political, but that’s not the whole story. As a general rule, fewer prescriptions are given per capita in red states than blue ones: Wyoming, for example, appears to be the leading Anti-Paxxer state in the country, with only one course of treatment given per 125 residents. ; In Rhode Island, the state most enthusiastic about peace, it is one in every 28 states. (I am using courses of treatment per person rather than per case of COVID because of the generic Unreliability of case data These days and differences in testing and reporting practices between countries.)
However, doctors working in deep red areas of the country tell me that, on this matter at least, their patients are not terribly divided by politics. “Both Republicans and Democrats love Paxlovid,” says Jason Bruner, MD, medical director of primary care at Saint Luke’s Medical System in Idaho. About 20 to 30 percent of his COVID patients refuse to take medication, Lee said, but they don’t seem to be driven by the same polarized attitudes he sees about vaccines. Jessica Callender-Rich, a geriatrician at the University of Kansas Health System, told me that she still gets occasional requests for ivermectin, and that some of her patients insist that Covid is a hoax. But those who categorically reject Paxlovid are not obsessed with microchips or government overreach. Instead, they mostly tell her that they’re worried about the side effects of treatment and the virus’s rebound.
COVID recovery Time and time again when I asked doctors why their patients were hesitant to take Paxlovid. The association between medication and the return of symptoms after initial recovery has been the subject of much concern and debate since the spring; Just last week, researchers in a study that has yet to be peer-reviewed reported a recovery in symptoms of more than twice as common among baxlovid-takers of those who reject it. The fact that several prominent figures in the federal government — including President Joe Biden, First Lady Jill Biden, CDC Director Rochelle Walensky, and White House Medical Adviser Anthony Fauci — have recovered certainly doesn’t help instill confidence. One of Kalender-Rich’s patients specifically cited Fauci’s experience when he refused medication. (The next day, the patient felt worse and accepted a prescription).
recovery It may not be serious, but you have to admit it’s not a good time. “People will say, ‘I’d rather be really sick for four or five days than kind of sick for two weeks,’” says Adam Wetterstein, MD, chief of urgent care at ProHealth Medical Network in New York. The risk of reflux can be especially scary for elderly patients and their families, Because it means spending more time alone.”For some of these older adults, this period of isolation is actually a lot worse than the virus at this point in the pandemic,” Callender Rich said. Oral baxlovid– A bitter and metallic taste that can linger throughout treatment – can be a concern for the elderly, who may already have a lack of appetite or other problems that restrict their intake.
Drug interactions are another concern for Paxxers. Official guidelines for COVID treatment warn that antivirals may have ill effects when combined with either More than 100 other drugs. Callender-Rich told me that geriatric patients in particular may need to adjust their daily regimen of pills during treatment with Paxlovid. This isn’t a medical problem at all, she said, but some people are still reluctant to make the change, especially if a previous doctor told them to never skip a dose.
These potential downsides are extra salient for people who don’t fear COVID as much as they used to. Patients who refuse Paxlovid are the ones who do well, Bruner said: “They don’t feel quite sick and they don’t feel as scared as they did in previous waves.” Hundreds of Americans are still dying daily from COVID, but any given community may have seen only a few severe cases and deaths since the spring. Many patients “don’t feel the need to take medication, because their neighbor is fine,” Callender Rich said.
Doctors can also be anti-Paxxers. Hans Dufelt, MD, a primary care physician in rural Maine, would never prescribe Paxlovid to his patients. He told me via email that he avoids it due to rebound risks, side effects, kidney concerns, and drug interactions. “Paxlovid is a poor choice,” he said, when compared to MolinopiravirAnother anti-COVID virus. To be clear, the data holds that molnupiravir is less effective of Paxlovid in preventing hospitalization and death. Also Preprint Jun found that patients treated with molnopiravir recovered at least as often as those treated with baxlovid. Duvefelt didn’t answer follow-up questions, so I couldn’t ask him about that data.
Other doctors think the good Paxlovid can do but are still struggling with the decision to prescribe it. “This is a much more nuanced discussion of risks and benefits than giving someone amoxicillin for a sore throat,” Jeremy Quills, MD, chief medical officer at Sanford Health in South Dakota, told me. “If you look at that as a physician in the emergency room, who by definition has no follow-up with the patient, it’s very difficult to say, ‘I’m going to give you a drug that interacts with a lot of drugs.'” persistent suspicion About how exactly Paxlovid helps people who are on the lookout for their COVID shots.
Regardless of the cause of baxlovid hesitation, the exact risk is difficult to pinpoint. Last month, Ashish Jha, coordinator of the Biden administration’s response to COVID-19, said: Tell New York times That daily deaths from the pandemic could be reduced by nearly 90 percent if every coronavirus patient over the age of 50 was treated with Paxlovid or a monoclonal antibody. Most doctors I spoke with did not argue this; Callender-Rich said she would “believe a number closer to 75 percent” but agreed with the general opinion. However, none of the doctors I spoke with could direct me to any specific cases where one of their patients had refused Paxlovid only to end up severely ill or dead. And no one knows how many deaths could be reduced specifically by attacking anti-Paxxer beliefs rather than removing barriers to access and encouraging more testing, for example.
Since anti-paxxerism appears to be less structured and ideological than anti-vaxxerism, some favored strategies to combat the latter – for example targeting social media influencers – may not work. The doctors I spoke with said the best place to change minds is in the exam room. “It really comes down to a face-to-face conversation” about the risks and benefits of the drug, Cowells said. “Our patients still trust us enough to have that conversation.”
On the other hand, reluctant providers may need more time to feel convinced that a medication is safe and effective when used properly; Some may wait for more data from Large randomized clinical trials. “In different parts of the country, adoption of new things will always be slower,” Callender Rich said. This isn’t exactly a reassuring idea when hundreds of people still die every day, but it does suggest, at least, that we have something to look forward to.
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