COVID-19: Chapter 10 - Mission Achomlished!

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I like itā€¦ but it really is a tricky drug to prescribe with the interactions.

If you had a high-risk patient would you go the biden route and advise they stop their other medication so they can take paxlovid?

Depends on the meds and the reason. The one that catches people more than anything else is people who have cardiac stents placed on clopidogrel.

is what I use to guide thingsā€¦ plus sometimes a call to pharmacy. PharmDs are awesome.

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They asked me to stop taking a cholesterol med while on the Paxlovid.

We havenā€™t talked to him yet but my wife got a text from her brother warning her that ā€œDad may have said heā€™s COVID free but he misread the test. When told he is positive he decided to still go out. Both mom and dad are mad at me for reacting to it.ā€

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So when this says prior infection is 79.7% at preventing BA.4/5 reinfection and 76.1% effective at preventing symptomatic BA.4/5 reinfection, are those stacked? Does that mean that it prevents 79.7% of cases and once you have a case it reduces your risk of symptoms by an additional 76%?

Otherwise the numbers make no sense and seem backwards.

Thereā€™s also a likelihood that at some point it runs out of room to mutate while still being able to infect us, at which point the vaccines win. Whether thatā€™s next year or in 100 years, who knows? So at least thereā€™s a little bit of hope.

I assume it just means that about 4% of the reinfections are asymptomatic?

Nah, it canā€™t work like that, because the numbers only make sense when comparing to the other case, in this case, people whoā€™ve never had a prior infection. So people without a prior infection are more prone to asymptomatic infection than people whoā€™ve had a prior infection, and people with a prior infection, if they get a reinfection, are a bit more likely to be symptomatic.

Ah, I can see that I was wrong and why. And now am really wondering WTF the numbers actually do mean. (Well the second number.)

Say 10k people have had covid before, and 10k havenā€™t (to make the math easy).

If N people who havenā€™t had covid got BA.4 or BA.5, then (1-0.79) * N people who had covid got BA.4 or BA.5. And if M (<= N) people who havenā€™t had covid got a symptomatic BA.4 or BA.5, then (1-0.76) * M people who had covid got a symptomatic case of BA.4 or BA.5.

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I canā€™t completely follow, but Iā€™ll take your word for it and appreciate the effort. Is it possible from the numbers given to extrapolate what percent of the total reinfections with BA.4 or BA.5 were asymptomatic?

4 people out with covid this week in my physician group. Weā€™re super short, and theyā€™re begging people to cover shifts, but they took away the 1.5x pay to cover extra shifts on short notice so Iā€™m not doing shit.

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You tell 'em!

It does seem like we have three choices in the living with COVID world of healthcare

ā€”-Reduced access to healthcare due to COVID waves and general attrition
ā€”-More resources towards beefing up healthcare (that sort of overtime pay+more staffing) with the end consumer paying for it through materially higher healthcare costs
ā€”-workers just work with COVID. Not totally solving the issue with choice one and makes medical care super risky for the at risk, but would reduce staffing pressure.

Not sure the right choice tbh.

Anyone following the Alzheimerā€™s research fraud news in detail? (We can move it if becomes a significant topic).

Is this a one-off is is the whole died of amyloid plaques being called into question???

I only skimmed so far. Life has been coming this way fast the past few weeks.

Lay article

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It may very well be the latter. This is from a Daily Kos article about it:

Since that 2006 publication, the presence or absence of this specific amyloid has often been treated as diagnostic of Alzheimerā€™s. Meaning that patients who did die from Alzheimerā€™s may have been misdiagnosed as having something else. Those whose dementia came from other causes may have falsely been dragged under the Alzheimerā€™s umbrella. And every possible kind of study, whether itā€™s as exotic as light therapy or long-running as nuns doing crossword puzzles, may have ultimately had results that were measured against a false yardstick.

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Jfc. My son is married into a family that has familial early onset. They are part of a study. There is a gene thatā€™s determinative. Weā€™ve had a lot of hope that the research was going to pay off in time for the upcoming generation and my grandkids generation.

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Alzheimerā€™s, per my understanding at least, isnā€™t diagnosed via amyloid plaques. Itā€™s clinical. Thatā€™s something seen on autopsy. Blood tests are still in early stages.

Now that littlest Jgirl is going to be vaccinated + 14 days, Iā€™m taking the family to Disney World in 3 weeks for the first time in almost 3 years. We are still going to wear kn95 masks everywhere when indoors, outdoors when in crowds (so basically everywhere) and not eat any meals indoors. Odds that my luck runs out and I finally get the ā€˜Cron?

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