Patricia writes:
I’m a nurse in DC, and I have gotten Covid twice, less than 6 months apart. Both times, I received Paxlovid and both times, it helped shorten my illness. However, it was a struggle to secure the prescriptions and added to a very stressful time. I was recently told by my doctor that there is “no guarantee” that the next time I get Covid, I will receive Paxlovid. As a nurse, that feels like a slap in the face.
Getting Covid on a Friday after work is not that unusual for nurses whose immune systems are finally taken off adrenal “hijack” as they exhale for the first time all week, and the virus says, “ah! Here’s my opportunity!” When you get Covid on a Friday, in addition to scrambling to find a doc to Rx it after hours, scrambling to find a pharmacy to fill it, I now have to make sure the charge is not too much more than $1,500, and circle back to the pharmacy to make sure they will honor my Paxcess coupon? I’m just not sure this is tenable.
Yes, there are coupons. The one offered by Pfizer covers up to $1,500. That’s helpful until they next move the goalposts. I know there’s a limited amount of what you can do, but perhaps you can tell us what to do.
Thanks for all you do for patients, doctors and nurses.
Patricia
Charles writes:
Hello Doctors;
As part of the clinical update, would you please go over Lenacapavir.
Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2407001
Thanks,
Charles
[put in link to Puscast]
Ellen writes:
Hi Daniel,
Last year when I tried to get the Novavax vaccine I was told by one local pharmacist that it was only distributed in 10-dose vials that had to be used the same day. It would have cost him $1000 and, if he made ten appointments and one didn’t show up, he would have been out $100, so he chose not to carry it. In the end, after searching the Novavax website, I did find it in one nearby supermarket.
I’m wondering if that pharmacist was misinformed or whether, if he was correct, whether the same problem in vial size will inhibit the availability of the new vaccine. Additionally, it’s my understanding that the larger drug store chains, like CVS, contract with only one manufacturer, which would further limit Novavax availability.
Not enough words to thank you for all you do,
Ellen
Andrew writes:
Dear Dr. Griffin,
I am a long time listener, and although I am not in the biomedical field, TWIV has really helped me to maintain an understanding of the current level of knowledge that is out there with regards to the current situation for viral diseases. In any case, I realized that I have questions that could potentially also be of interest to some listeners regarding the medication metformin and COVID.
There has started to be some literature that metformin may be useful for decreasing viral loads during COVID infections. Although I was able to find at least one study from the University of Minnesota (https://doi.org/10.1093/cid/ciae159) that suggests that viral loads can be decreased by metformin regardless of vaccination status, it does seem a bit speculative what the interplay of paxolovid and metformin might be. This is also echoed by the authors of the study, who bring this up as a question for future research whether there might be any synergy between the two.
This is of interest to me since my wife is currently taking metformin that was prescribed to her for PCOS (polycystic ovary syndrome, for listeners). Although online it does not appear to me that there are any contraindications for taking the two together, I wanted to ask three questions:
1) For people in my wife’s situation, I was curious about what your opinion would be whether my wife should continue to take metformin in addition to paxolovid if/when she develops an infection with COVID?
2) Trying to look at information on Google, I did come across some individuals on the internet who seem to go even further with the mindset that they plan to even combine paxolovid and a start on a metformin regime with the aim of reducing the odds of long COVID as much as possible, despite the current lack of research on combined treatment effects on viral load. In your opinion, how would you rate this approach on the scale of “unsafe or definitely not beneficial,” “safe, but probably not beneficial,” and “safe, and possibly beneficial” –assuming that dehydration from metformin-related GI issues is not a major issue?
3) Based on the current biomedical understanding, with further research, is there cause for optimism that metformin AND paxolovid may turn out to be an effective treatment combination in the future based on the differences in proposed mechanisms of action?
Look forward to your response.
Thank you,
Andrew
Scott writes:
Dear Dr. Daniel Griffin,
My question relates to an antiviral medication that is currently prescribed for COVID-19 infection in Europe and why this medication is apparently not recommended in the U.S. In June, I joined several family members on a European vacation and all six of us came down with COVID-19. I wound up with the worst symptoms, perhaps because of my immunoglobulin A (IgA) deficiency, and was the only one to see a medical doctor while we were visiting the city of Prague. When I inquired about Paxlovid, the doctor said that Paxlovid was not readily available in the Czech Republic, was very expensive if you could find it, and that another medication was actually more effective. The doctor prescribed a 12-day course of Isoprinosine along with azithromycin. Have studies shown that Isoprinosine is effective against COVID-19 infection and, if so, why is that drug not prescribed in the U.S.? I believe this medication is known as Imunovir in some countries.
Thank you,
Scott