@Grrry Creager: Glad it piqued your interest and we had hoped that a few dozen Intensivists and Pulmonologists would have, at the very least, made the same comments and expressed a modicum of concern for their failures to rescue their COVID19 patients that ultimately were prescribed “Comfort Care”, a virtual death sentence in an era of HMOs.
At the end of your article: "No one is safe until we’re all safe." A few years ago that meant that everybody had to get COVID vaccines for everybody to be safe. Is that what you mean?
That's quite an experience in your "super-spreader" event. (no offense or pun intended). I am now a retired MD having been involved with every phase of this pandemic since early 202O. When I was working in a post-acute care unit (LTACH caring for ICU-type patients) we were asked to "please do something" by patient advocates, most being a spouse, child, sib, etc. Not many physicians. Why? Because they already did "all we can do" and dutifully prescribed all the official EUA protocols. Much to their surprise not all the victims responded the best available - dexamethasone, MCAbs, remdesivir, tociluzimab and the like. Many victims required ventilators, hi-flow O2 and sometimes dialysis when things went south. It was deemed inappropriate, in fact, job-terminating to Rx anything but official protocols whether the first round or the last round and the patients were deteriorating, nonetheless. The LTACH team got the worst of the worst cases and had no precedent therapies to offer. Yes, some of these same patients got HCQ and ivermectin, but often surreptitiously - mostly pre-hospital, and showed, not unexpectedly, zero benefit. Some were prescribed HCQ and ivermectin in later stages and coincident or not, had more complications - cardiac, renal and hepatic among them. So, in the LTACH a novel therapy was provided after consultation with families grateful for something that might help with little risk based upon decades of experience with an FDA-approved drug used world-wide and with a well-studied safety profile for victims of the disorder sickle cell disease. So what's the problem prescribing a drug restoring vital cellular dysfunctions and physiology gone amok for disorders demonstrating the same dysfunctions as progressive COVID19? Rigidity, adherence to EBM without regard to patient advocacy or a novel scenario demanding a different approach - recall the definition describing a repetitive procedure and getting the same negative results). Well, the drug is still being prescribed, mostly in the outpatient setting since the number of hospitalizations has plummeted this past 1-2 years. A diminished patient pool greatly reduces the incentives to get large studies of patients willing to participate in a funded study. Try getting funded for a study using a repurposed, generic drug even if there are NO adverse consequences for a 5 day course, no economic disincentives, and consistency for a positive outcome in hours to days, not weeks, mos, or in the case of Long Covid, years. I am not promoting misinformation. I am promoting common sense and patient advocacy. There are basic principles of scientific discovery deeply entrenched with this approach. Efforts to alert the FDA, NIH etc about the clinical outcomes have fallen on deaf ears. We are not conspiracists. We believe it is all intertwined with the politicized and misinformation campaigns by proponents of HCQ and ivermectin. Repurposing has been poisoned and there is little to no ROI potential for commercial purposes. Long preamble Dr Creager but your colleagues are part of the barriers we have encountered. Disbelief in any and all scientific approaches to prevention as well as therapy and therapeutic research has been stymied by rigid minds and adherence to EBM despite the consequences of premature death or prolongation of multisystems dysfunction. Among those consequences are post-Covid cognitive issues, cardiac arrhythmias appearing months after Covid19, myocarditis, renal disease, pulmonary fibrosis, etc. Your colleagues, like it or not, vaccinated and/or boosted, are deniers and little can be done to make them see reason as long as they have closed minds. That includes physicians and nurse practitioners, in our experience. 6 prescribers in our area can attest to helping nearly 2,500 patients to date. As you stated, Covid is still around, it's not seasonal but it continues to get a boost when people gather and are exposed to others with "cold/allergies/ tickle in the throat" issues. The issue with Paxlovid is its basic pharmacodynamic - it's an antiviral, pure and simple. As for efficacy with the newer variants, it's not at all surprising that it's not as effective for symptom control acutely or for the long term, ie LC/PASC. Our own clinical experiences and increasing knowledge about the virus' mechanisms of action is now going into its 5th year. The basic science, immunology and epidemiology has become increasingly more clear because we have approached this disorder with an open-mind and are willing to share what we have learned with like-minded (open-minded) persons. In the case of the 6 prescribers, they are unique as they are true patient advocates and not beholden to rigid protocols. Treating with a pure anti-viral in the early stage of replication is simply not enough. The virus has invaded and disseminated soon after exposure. If you test too early and it's negative, there is a false assumption that "it's not COVID19", and Paxlovid isn't appropriate according to the PI. If you wait until you are at your worst your test may again be negative. Testing for the antibody status to determine whether you did or did not have COVID19 isn't consistently helpful. If you have felt un-well for weeks to months and your IL-6 and TNF levels are elevated it supports the contention you had COVID19, but what then? There is no approved therapy at that point. Paxlovid data does support the fact that you greatly reduce your risk for being hospitalized acutely and likely won't die, but it doesn't address the risk of continuing PCC/PASC issues. Repeated COVID19 raises your risk of a PCC/PASC/LC scenario. Google or do an AI study (or 3) to read about a7 nicotinic acetylcholine receptors and COVID19, hydroxyurea as an immune modulator, and the anti-idiotypic antibody network as related to Long Covid. You will learn much. I have. It's ongoing. My biochemist/immunology colleagues have ongoing experiments clarifying the mechanisms and the targets for this disorder. Let the naysayers keep on denying. There is a pervasiveness and unwillingness to understand the how and why. Ok, I'll end my rant there. I feel for you and I appreciated hearing about your experience. It's only one of many I've heard for the past 4+ years. The controls are the colleagues with which you gather and those that chose no Rx vs some Rx. A most impressive scenario I was privvy to was the case of 5 healthy 40-70 yr old men working in a Federal capacity who gathered in a small restaurant for a long lunch, all 5 came down with the Delta-era COVID19, all were hospitalized (when hospitals were inundated with COVID19 victims), 1 (a twin 70 yr old) took 2 tabs of HU on the way to the hospital, his brother declined the HU. The other 3 declined HU and were put on vents within 36 hrs. The Rx'd twin's O2 sats in the 70's climbed to 90 within 12 hrs so he was discharged. His twin and the other 3 were dead within 10 days despite "official protocols". Coincidence? Luck? Bad karma for the dead? Do you try a little harder when the official protocol isn't helping? I sure would. I could tell you dozens of other similar stories. Again, the key to the disorder in our experiences and research is the ultimate targets and the host antibody response. You won't get better with a slug of decadron (one such Clinic locally is currently reportedly treating Hispanics by fraudulently injecting decadron @$700 as a COVID19 cure) or the infusions of remdesivir, or MCAbs, as has been shown for all but the archival strains. Paxlovid is a stop-gap with limited benefits, mild-moderate ADR's, non-durability in some cases, but a very very lucrative one at that. HU cost for 5 days? $5.90/10 tabs. It's a complicated disorder and it's ongoing. The public deserves better. Molecular screening and mining EHR's takes years and personnel. When NaCl and O2 by mask turn up as the #1 and #2 therapies for COVID19 on the CDRC/Cure ID website after screening on the massive scale, you know that a bureaucracy is in charge, but it's a fact and I/we are saddened that our ~500 case reports of a viable/credible COVID19 therapy have been totally ignored by the FDA. Close-mindedness again.
I'm a Dr Daniel Griffin fan.
@Grrry Creager: Glad it piqued your interest and we had hoped that a few dozen Intensivists and Pulmonologists would have, at the very least, made the same comments and expressed a modicum of concern for their failures to rescue their COVID19 patients that ultimately were prescribed “Comfort Care”, a virtual death sentence in an era of HMOs.
At the end of your article: "No one is safe until we’re all safe." A few years ago that meant that everybody had to get COVID vaccines for everybody to be safe. Is that what you mean?
That's quite an experience in your "super-spreader" event. (no offense or pun intended). I am now a retired MD having been involved with every phase of this pandemic since early 202O. When I was working in a post-acute care unit (LTACH caring for ICU-type patients) we were asked to "please do something" by patient advocates, most being a spouse, child, sib, etc. Not many physicians. Why? Because they already did "all we can do" and dutifully prescribed all the official EUA protocols. Much to their surprise not all the victims responded the best available - dexamethasone, MCAbs, remdesivir, tociluzimab and the like. Many victims required ventilators, hi-flow O2 and sometimes dialysis when things went south. It was deemed inappropriate, in fact, job-terminating to Rx anything but official protocols whether the first round or the last round and the patients were deteriorating, nonetheless. The LTACH team got the worst of the worst cases and had no precedent therapies to offer. Yes, some of these same patients got HCQ and ivermectin, but often surreptitiously - mostly pre-hospital, and showed, not unexpectedly, zero benefit. Some were prescribed HCQ and ivermectin in later stages and coincident or not, had more complications - cardiac, renal and hepatic among them. So, in the LTACH a novel therapy was provided after consultation with families grateful for something that might help with little risk based upon decades of experience with an FDA-approved drug used world-wide and with a well-studied safety profile for victims of the disorder sickle cell disease. So what's the problem prescribing a drug restoring vital cellular dysfunctions and physiology gone amok for disorders demonstrating the same dysfunctions as progressive COVID19? Rigidity, adherence to EBM without regard to patient advocacy or a novel scenario demanding a different approach - recall the definition describing a repetitive procedure and getting the same negative results). Well, the drug is still being prescribed, mostly in the outpatient setting since the number of hospitalizations has plummeted this past 1-2 years. A diminished patient pool greatly reduces the incentives to get large studies of patients willing to participate in a funded study. Try getting funded for a study using a repurposed, generic drug even if there are NO adverse consequences for a 5 day course, no economic disincentives, and consistency for a positive outcome in hours to days, not weeks, mos, or in the case of Long Covid, years. I am not promoting misinformation. I am promoting common sense and patient advocacy. There are basic principles of scientific discovery deeply entrenched with this approach. Efforts to alert the FDA, NIH etc about the clinical outcomes have fallen on deaf ears. We are not conspiracists. We believe it is all intertwined with the politicized and misinformation campaigns by proponents of HCQ and ivermectin. Repurposing has been poisoned and there is little to no ROI potential for commercial purposes. Long preamble Dr Creager but your colleagues are part of the barriers we have encountered. Disbelief in any and all scientific approaches to prevention as well as therapy and therapeutic research has been stymied by rigid minds and adherence to EBM despite the consequences of premature death or prolongation of multisystems dysfunction. Among those consequences are post-Covid cognitive issues, cardiac arrhythmias appearing months after Covid19, myocarditis, renal disease, pulmonary fibrosis, etc. Your colleagues, like it or not, vaccinated and/or boosted, are deniers and little can be done to make them see reason as long as they have closed minds. That includes physicians and nurse practitioners, in our experience. 6 prescribers in our area can attest to helping nearly 2,500 patients to date. As you stated, Covid is still around, it's not seasonal but it continues to get a boost when people gather and are exposed to others with "cold/allergies/ tickle in the throat" issues. The issue with Paxlovid is its basic pharmacodynamic - it's an antiviral, pure and simple. As for efficacy with the newer variants, it's not at all surprising that it's not as effective for symptom control acutely or for the long term, ie LC/PASC. Our own clinical experiences and increasing knowledge about the virus' mechanisms of action is now going into its 5th year. The basic science, immunology and epidemiology has become increasingly more clear because we have approached this disorder with an open-mind and are willing to share what we have learned with like-minded (open-minded) persons. In the case of the 6 prescribers, they are unique as they are true patient advocates and not beholden to rigid protocols. Treating with a pure anti-viral in the early stage of replication is simply not enough. The virus has invaded and disseminated soon after exposure. If you test too early and it's negative, there is a false assumption that "it's not COVID19", and Paxlovid isn't appropriate according to the PI. If you wait until you are at your worst your test may again be negative. Testing for the antibody status to determine whether you did or did not have COVID19 isn't consistently helpful. If you have felt un-well for weeks to months and your IL-6 and TNF levels are elevated it supports the contention you had COVID19, but what then? There is no approved therapy at that point. Paxlovid data does support the fact that you greatly reduce your risk for being hospitalized acutely and likely won't die, but it doesn't address the risk of continuing PCC/PASC issues. Repeated COVID19 raises your risk of a PCC/PASC/LC scenario. Google or do an AI study (or 3) to read about a7 nicotinic acetylcholine receptors and COVID19, hydroxyurea as an immune modulator, and the anti-idiotypic antibody network as related to Long Covid. You will learn much. I have. It's ongoing. My biochemist/immunology colleagues have ongoing experiments clarifying the mechanisms and the targets for this disorder. Let the naysayers keep on denying. There is a pervasiveness and unwillingness to understand the how and why. Ok, I'll end my rant there. I feel for you and I appreciated hearing about your experience. It's only one of many I've heard for the past 4+ years. The controls are the colleagues with which you gather and those that chose no Rx vs some Rx. A most impressive scenario I was privvy to was the case of 5 healthy 40-70 yr old men working in a Federal capacity who gathered in a small restaurant for a long lunch, all 5 came down with the Delta-era COVID19, all were hospitalized (when hospitals were inundated with COVID19 victims), 1 (a twin 70 yr old) took 2 tabs of HU on the way to the hospital, his brother declined the HU. The other 3 declined HU and were put on vents within 36 hrs. The Rx'd twin's O2 sats in the 70's climbed to 90 within 12 hrs so he was discharged. His twin and the other 3 were dead within 10 days despite "official protocols". Coincidence? Luck? Bad karma for the dead? Do you try a little harder when the official protocol isn't helping? I sure would. I could tell you dozens of other similar stories. Again, the key to the disorder in our experiences and research is the ultimate targets and the host antibody response. You won't get better with a slug of decadron (one such Clinic locally is currently reportedly treating Hispanics by fraudulently injecting decadron @$700 as a COVID19 cure) or the infusions of remdesivir, or MCAbs, as has been shown for all but the archival strains. Paxlovid is a stop-gap with limited benefits, mild-moderate ADR's, non-durability in some cases, but a very very lucrative one at that. HU cost for 5 days? $5.90/10 tabs. It's a complicated disorder and it's ongoing. The public deserves better. Molecular screening and mining EHR's takes years and personnel. When NaCl and O2 by mask turn up as the #1 and #2 therapies for COVID19 on the CDRC/Cure ID website after screening on the massive scale, you know that a bureaucracy is in charge, but it's a fact and I/we are saddened that our ~500 case reports of a viable/credible COVID19 therapy have been totally ignored by the FDA. Close-mindedness again.