COVID and PAXLOVID

Before I re-enter the world of diseases, first, a couple of updates on another one, the first cabinet meeting President Donald Trump presided over yesterday:

• He said he wants school policy to be left to the states, so the Department of Education will be abolished.
• Of course, he needs congressional approval to do this, and education secretary, Linda McMahon, was hired to do just that.

• Like most of Trump's dictatorial announcements, this created confusion and alarm.
• Democrats expressed huge concern.
• The Education Department distributes funding for K-12 schools serving more than 50 million students in almost 100,000 public and 32,000 private schools

• 
  Project 2025 advocated this, and to end Title 1 funding in phases.  Title 1:
• Was created in 1965, and reauthorized by the No Child Left Behind Act of 2001.
• The act emphasizes equal access to education, aiming to shorten the achievement gaps between students by providing federal funding to support schools with children from impoverished families.
• Another mandate undermining the poor and middle class ethnic minorities.

• 
  Further on his Gold Card: 
• We’re going to be putting a price on that card of about $5 million and that’s going to give you green card privileges, plus it’s going to be a route to citizenship. And wealthy people will be coming into our country by buying this card.

• 
  He further said that this card would be available in about two weeks.
• Yet, most authorities believe this needs to pass through Congress first.
• From Lori Nessel (right), professor of law at Seton Hall University, again depriving certain ethnic minorities and the less privileged, while aiding the very rich:

To say, on the one hand, we are going to deport everyone in this country who's here without permission and we are going to close down our borders. And then, at the same time, say we're going to dramatically increase the number of people that can come in—if they've got millions of dollars—it's very clear messaging in terms of who's wanted in American society.

• 
  The “gold card” would replace the existing EB-5 immigrant investor visa program, which allows foreign investors to apply for lawful permanent residence if they invest in commercial enterprises and plan to create or preserve 10 permanent full-time jobs for U.S. workers, according to USCIS.

• 
  The EB-5 program, which the Administration said they were replacing, was created by Congress in 1990. That program allows potential immigrants who invest $1,050,000, or $800,000 in targeted employment areas—meaning rural areas or areas experiencing high unemployment—to apply for a green card, though there are a number of other qualifications applicants have to meet and it can be a rather lengthy process.  The EB-5 visa has an annual cap of about 10,000 visas a year, or some 7.1% of the 140,000 employment-based visas available every fiscal year, per the State Department.  The president does not have the authority to just toss it our.
• 
  Trump hopes to attract about a million rich foreigners into his attempt to improve the U.S. budget.  Managing this effort will be herculean, and un-Constitutional, but might actually be worthy, if financial gain is the overriding justification, and action legal.

So on to my topic of the day.  Here is something new.  Say you get infected with COVID-19--the world had 46,000 new cases last week--and you are "old."  Should you ease the discomfort and maybe more importantly, reduce being hospitalized or dying by taking Paxlovid?

In a research letter published in JAMA on Feb. 20, Dr. John Mafi, associate professor of medicine at the David Geffen School of Medicine at UCLA, and his colleagues used Canadian data to explore what happened when people took Paxlovid. A Canadian health policy in 2022 allowed prescriptions for Paxlovid only for symptomatic people around age 70 in order to reserve the medication for those who needed it most. Older people are at higher risk of developing complications from COVID-19. The policy allowed the scientists to compare people in this age group who took Paxlovid to those who didn’t.

• Studied were 1.5 million Canadians, and most were vaccinated.
• For vaccinated older adults, PAXLOVID SHOWED NO STATISTICALLY SIGNIFICANT IN COVID-19 HOSPITALIZATIONS OR ON MORTALITY!!!
• Pfizer, the supplier, had there own study, which showed that Paxlovid reduced hospitalization and deaths of COVID-19 by 89%, compared to people who received a placebo.
• But they studied mostly middle-age and unvaccinated individuals.
• The list price of Paxlovid is $1,650/course.
• Pfizer refused too comment on the Canadian study.
• 
  The lead researcher, John Mafi said:

We are not saying that Paxlovid is useless.  What this research is saying is that its effectiveness in older groups who are most vulnerable to COVID-19, but who are vaccinated, is far lower than what the earlier evidence from unvaccinated groups showed.

Dr. Katherine Kahn, distinguished professor of medicine at UCLA and the study’s senior author, says that she will discuss the latest results with her patients, and “for generally health people, I’m not encouraging or discouraging [Paxlovid] if they meet the criteria for taking it,” she says. “But for people with higher risk of morbidity or mortality, we’re more likely to say we might consider [Paxlovid] at this time, even though we don’t know 100% if you will benefit.”

All the above is beginning to make more sense to me because during the pandemic, the medical profession must have already had a sense that Paxlovid might not be necessary for vaccinated people even in their 80's.  While many who got infected at 15 Craigside, where I live, took Paxlovid, and the general reaction was that their symptoms quickly diminished, others, some into their 80's, had doctors who did not recommend the treatment course.  These individuals also did NOT pass or away or get hospitalized.  My sense then was that vaccinated individuals did not need to take Paxlovid.  Remember, the Pfizer study only looked at UN-vaccinated patients.

During the pandemic, a second viewpoint was that those who took Paxlovid had a higher chance of getting reinfected.  Two studies were reported in 2023:

• Pfizer research showed a rebound of 2.3% for those who took Paxlovid, and 1.7% of those who didn't.
• Another study said 14% showed rebound for those who took Paxlovid, and 9% for those who didn't.
• Again, this could be because Pfizer tested unvaccinated people.
• The general medical sense, then, as now too, seems to be, there is no strong evidence of COVID rebound from Paxlovid.

So if you today get infected, should you take Paxlovid?  Check with your doctor.  My recommendation is to get vaccinated and keep up with those annual boosters.  But I'm not a physician.  My general sense, though, is that if my medical plan or the federal government pays for the $1650 cost, heck take those pills, for all reports indicated a shorter period of incapacitation.  But keep this is mind.

Paxlovid must be taken within five days of developing symptoms. You take three Paxlovid pills twice daily for five days for a full course (adding up to 30 pills). Paxlovid interacts with a long list of medications, including such common ones as cholesterol-lowering statins, so it’s important to talk to your doctor or pharmacist about other drugs you may be taking.

To close, here is a video Trump shared of an AI-generated Gaza Strip future.

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