Will Pfizer’s Paxlovid Be the Game-Changer that Saves Biden’s “Test to Treat” Program?

By Lambert Strether of Corrente.

Paxlovid — “Peace and love,” dig? Or even just “Pax,” as American’s Chief Pharmaceutical Salesman White House Covid response coordinator Ashish Jha dubs it — is the key treatment in the Biden Administration’s “Test to Treat” program. As readers know, I’m all for treatment — indeed, I can’t understand why the White House didn’t intitiate an Operation Warp Speed for treatments when it took office — but with Paxlovid I have some questions. First, I’ll look at the “Test to Treat” program, as it has performed and as the White House Hopes to Improve It. Then, after looking at the FDA EUA for Paxlovid, I’ll raise issues with the drug that might mean uptake is not what the White House expects it to be. I’ll conclude with a few remarks on treatment equity. But before I dive in, here’s the study from the New England Journal of Medicine that’s driving the enthusiasm for Covid: “Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19.” From the Abstract (or, depending, the sales pitch):

Treatment of symptomatic Covid-19 with nirmatrelvir plus ritonavir resulted in a risk of progression to severe Covid-19 that was 89% lower than the risk with placebo, without evident safety concerns.

(Nirmatrelvir plus ritonavir is Paxlovid[1].) Taking apart a NEJM study is definitely above my paygrade. Two things, however, leap out. First, from Method:

We conducted a phase 2–3 double-blind, randomized, controlled trial [with] symptomatic, unvaccinated, nonhospitalized adults at high risk for progression to severe coronavirus disease 2019 (Covid-19)….

So the test population was unvaccinated? Oh. And:

(Supported by Pfizer; ClinicalTrials.gov number, NCT04960202.

Well, alrighty then. On to the “Test to Treat” program.

“Test to Treat”

Up until this point, the Biden Administration’s “Test to Treat” program has been — hold on to your hats, here, folks — an omnishambles. From Kaiser Health News:

The federal “test-to-treat” program, announced in March, is meant to reduce covid hospitalizations and deaths by quickly getting antiviral pills to people who test positive. But even as cases rise again, many Americans don’t have access to the program.

The program allows people with covid symptoms to get tested, be prescribed antiviral pills, and fill the prescription all in one visit. The federal government and many state and local health departments direct residents to an online national map where people can find test-to-treat sites and other pharmacies where they can fill prescriptions.

But large swaths of the country had no test-to-treat pharmacies or health centers listed as of April 14. And the website of the largest participant, CVS, has significant technical issues that make booking an appointment difficult.

Even people who regularly see a doctor may be unable to get a prescription in time, and that’s where the program comes in. Before the pandemic, 28% of Americans didn’t have a regular source of medical care, with rates even higher for Black and Hispanic Americans….

Although the cost of the pills is covered by the federal government, obtaining a prescription at the pharmacies that dominate the program can be expensive. Though CVS does not charge symptomatic uninsured people for on-site covid tests, MinuteClinics charge upwards of $100 for in-person or telehealth appointments to examine patients and prescribe an antiviral, if needed. People without insurance, whose health plans don’t cover visits to the clinics, or who have high-deductible plans must shoulder the full cost of the appointment.

“All of our public health response relies on lowering the barrier to getting treatments to the right people,” said Dr. Kirsten Bibbins-Domingo, chair of the Department of Epidemiology and Biostatistics at the University of California-San Francisco.

She said the fragmented federal, state, and local public health systems, the U.S. Department of Health and Human Services’ reliance on partners that charge high prices for appointments, and the lack of clear information are stymieing the effort. “The best tools that we have are not going to reach the people who most need them,” she said.

Hey, remember when Trump just gave out vaccines for free? What an idea that was. In any case, here’s how the Biden Administration proposes to improve the program. From CNN:

The Biden administration is set to unveil new details and announcements Monday on Paxlovid, Pfizer’s antiviral Covid-19 pill, a White House official tells CNN.

The administration has plans underway to increase the availability and uptake of the drug, White House Covid-19 Response Coordinator Dr. Ashish Jha announced on Twitter.

… According to Jha’s tweets, the administration is working on establishing more places where Paxlovid will be available, including more test-to-treat sites.

The administration’s nationwide test-to-treat initiative involves “one-stop” sites where people are offered free Covid-19 testing and, if they test positive, can be prescribed free antiviral medications on the spot.

Jha tweeted that the Biden administration’s plans include more education for health care providers on how to use Paxlovid “more regularly” for eligible patients.

The administration’s plans signal “some positive changes” with regard to treating Covid-19 infections, and in some ways, the test-to-treat model “transforms medicine,” Dr. Daniel Griffin, an instructor in clinical medicine and associate research scientist in the Department of Biochemistry and Molecular Biophysics at Columbia University, said Monday.

“When you get sick with a viral illness, the last thing you want to do is try to get an appointment at a physician’s office, get out of bed, wait in the waiting room, get seen, then have to drive somewhere else to pick up at your pharmacy,” Griffin said, adding that “being able to get taken care of as soon as possible without all the delays that our system has introduced” is a positive.

On the ground, it appears that the pace of Covid-19 antiviral prescriptions under the test-to-treat program has not reached the level that health officials expected by this point, said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.

“The bottom line is, the uptake is very, very low and slow despite there being a lot of these drugs in the market and available,” Freeman said.

So, translating, the Administration sees doctors as the problem, and hopes to work around them by getting pharmacists to prescribe Paxlovid to, well, customers directly. Why would that be a problem, and why have doctors been reluctant to prescribe Paxlovid? To understand that, we need first to look at Paxlovid’s FDA EUA, which describes who is eligible for treatment.

The Paxlovid EUA: Who is Eligible for Treatment?

Yale Medicine describes who is eligible for Paxlovid:

The FDA authorized Paxlovid for people ages 12 and older who weigh at least 88 pounds. But in order to qualify for a prescription, you must also have had a positive COVID-19 test result and be at high risk for developing severe COVID-19.

That means you must either have certain underlying conditions (including cancer, diabetes, obesity, or others) or be an older adult (more than 81% of COVID-19 deaths occur in people over age 65). The more underlying medical conditions a person has, the higher their risk for developing a severe case of COVID-19, according to the CDC.

But what is “high risk”? From the FDA’s FAQ on the EUA, see footnote 1:

Footnote 1 punts the definition of “high risk” to the CDC:

And here are the “medical conditions” listed on that CDC page, in alphabetical (and not risk) order:

Cancer, chronic kidney disease, chronic liver disease, chronic lung diseases, cystic fibrosis, dementia or other neurological conditions, diabetes (type 1 or type 2), disabilities, heart conditions, HIV infection, immunocompromised state (weakened immune system), mental health conditions, overweight and obesity, physical inactivity, pregnancy, sickle cell disease or thalassemia, smoking, current or former, solid organ or blood stem cell transplant, stroke or cerebrovascular disease, substance use disorders, and tuberculosis.

(Note CDC’s caveat: “Because we are learning more about COVID-19 every day, this list does not include all medical conditions that place a person at higher risk of severe illness from COVID-19.” Yes, of course, but that does leave footnote 1 in the EUA just a little bit open-ended, no?) In any case, superficially “high risk” seems like pretty good news from the uptake standpoint: Millions of Americans are obese, have heart conditions, have substance abuse disorders, and so forth. So a pretty big market for Pfizer, this “high risk” market. Not so fast.

Potential Problems with Paxlovid that Could Reduce Uptake

Paradoxically, the very complexity of “high risk” patients makes doctors reluctant to prescribe Paxlovid; these patients are almost certainly taking other drugs already, and a conscientious doctor would want to know about drug interactions. But these are not necessarily known. From the Philadelphia Inquirer, “Paxlovid is an effective COVID-19 drug that may not be safe if you have these common health conditions“:

The FDA has published a fact sheet for health care providers on Paxlovid. Much more than a sheet, it’s actually 29 pages crammed with facts – and 12 of those pages list potential side effects.

Here’s the irony: Some of the preexisting conditions that make a COVID infection especially dangerous — such as high blood pressure, diabetes, heart failure and arrhythmias — often are treated with multiple medicines that could also make Paxlovid dangerous.

Some of the common cardiac medications that you cannot take with Paxlovid include amiodarone, flecainide, Plavix, Brilinta, and some statins. Some of these can be stopped for the five-day course of Paxlovid. But other meds, such as amiodarone, hang around in the body for quite a while, and adding Paxlovid is completely contraindicated.

Paxlovid is a combination drug (nirmatrelvir with ritonavir). It inhibits an enzyme in the body essential to produce cholesterol, steroids, and prostacyclins, and can increase the concentration of many other medications/

What’s more, many people might not even realize that they could be harmed by this new medication. Because at least 40% of American adults are considered obese, 14% smoke, and more than 10% have diabetes, there are a lot of people at high risk even though they may feel well. They are all potential candidates to develop severe COVID and may need therapy, and an unknown number are taking multiple medications that can interact with Paxlovid.

In light of this information, taking Paxlovid is not an easy decision. It is very effective in the studies done so far, especially in the unvaccinated. However, the drug interferes with so many medications that are used for chronic medical conditions that it needs to be used carefully.

I would be very reluctant to recommend its use for patients taking multiple medications, all of which should be checked for interactions before use. It is not a panacea. Getting vaccinated to reduce the risk of life-threatening complications and hospitalization seems a much safer option.

For example:

When David Bookstaver tested positive for COVID-19 he happened to have a telehealth consult with his doctor already scheduled that day, to talk about going on medication to moderate his high blood pressure.

On that call Bookstaver, 63, says his doctor mentioned his age and hypertension made him eligible for Paxlovid, Pfizer’s antiviral pill treatment, which has proven highly effective at keeping higher-risk patients out of the hospital, and preventing them from getting even sicker.

Bookstaver is fully vaccinated and boosted and didn’t feel too ill at the time – but warding off a turn for the worse seemed prudent. The doctor sent a prescription for the new medication to the pharmacy and his wife was kind enough to pick up his medicine and bring it home.

But when he read over the drug information, Bookstaver’s eyes caught on some of the fine print: the cholesterol medication he was already on – and the blood pressure medication he had also just been prescribed – were both listed as having potentially harmful interactions with the Paxlovid he had just been given.

“If I was really sick I probably would have gobbled the first dose up and not looked,” Bookstaver said. “I think most people don’t do due diligence. They trust their doctor implicitly. But if people aren’t checking the contraindications labels I think they kind of need to be told.”

(The doctor believed the pharmaceutical salesman and didn’t read the fine print. Holy moley!) The Conversation summarizes:

It’s kind of limited. It could be beneficial for those at high risk of severe disease and possibly death, such as people who are older or who have hypertension, diabetes, obesity, heart disease or who are immunocompromised. And that’s the population that we’re really the most worried about when it comes to COVID-19.

But the more medically complicated a person is – by which I mean the more health conditions they have and medications they take – the more likely it is that Paxlovid will interact with one of their drugs. That means that one drug could alter or interfere with how another drug works, which can be dangerous.

Some of the really important Paxlovid interactions are with anti-rejection medications for people who have transplants. A lot of blood thinners have interactions with it that can be very serious. Medications that treat heart rhythm abnormalities can be a major issue if patients on those medications take Paxlovid. And there’s a whole range of other things that it just doesn’t mix well with in the body.

Some who could most benefit from Paxlovid are also at highest risk for drug interaction with Paxlovid. That makes it somewhat less useful.

The Biden Administration’s solution for this problem is, apparently, to cut the doctor out of the prescription loop entirely, and have patients customers deal directly with pharmacists, who presumably will use checklists or an app of some sort. What could go wrong?

There is also a second, and to my mind lesser, issue with Paxlovid, called “rebound.” From the Boston Globe, “A puzzling phenomenon: Patients report a rebound of COVID-19 symptoms after taking the antiviral Paxlovid“:

But now some patients are reporting on social media an unusual and unnerving phenomenon: their COVID symptoms appear to rebound after taking [Paxlovid].

And it’s not just their symptoms that reappear. Many report that after finishing their five-day course of treatment, feeling better, and testing negative on an at-home rapid test, they then test positive again a few days later.

The issue has captured the attention of at least two teams of Boston-area scientists, who are trying to understand what might be fueling the problem. Resistance to the drug? Patients being quickly reinfected? Or maybe some people just need to take the medicine longer to mount a more effective immune response.

But some infectious disease specialists, while still extolling Paxlovid’s benefits, have expressed concern that the rebounds they are seeing and hearing about may indicate patients, after completing treatment — and testing negative and then positive, again — may still be infectious and transmitting the virus to others.

“If you have a rebound after 12 days and are back at work and not wearing a mask, are you still contagious?” said Dr. Kathryn Stephenson, an assistant professor at Harvard Medical School and an infectious disease physician at Beth Israel Deaconess Medical Center. “If you are testing positive on a rapid antigen test, then you have a decent amount of virus and likely an infectious amount of virus,” she said.

A doctor comments:

We absolutely should have been warning patients (and doctors) that rapid improvement, followed by clinical deterioration and, presumably, high risk of contagion, could happen in some 10% of high-risk patients. It’s also quite clear that we need more information about Paxlovid now.

For one: presumably Pfizer and the FDA know what happened to the trial subjects who saw their viral load rebound. Was this a mere annoyance, or did it increase the risk of hospitalization? If most or all of the small group of hospitalized patients who received Paxlovid (i.e., treatment failures) were in this rebound sub-group, it is highly possible that treating them with an additional course might have made the effectiveness of Paxlovid even better. In the FDA’s most recent approval letter to Pfizer, none of this information was requested or even mentioned; most of their emphasis was data on possible SARS-CoV-2 mutations from people treated with Paxlovid.

(Rebound was described in the EUA, but not to the level of detail “Doctor Buzz” rightly demands.)

Both issues, to my mind, will combine to make Paxlovid uptake slower than the Biden Administration expects; so far, at least, “the dogs won’t eat the dog food,” though it’s clearly Ashish Jha’s mission in life to make them do so.


Other problems with “Test to Treat” stem from our Harkonnen-style health care system. I don’t know how on earth it happened that Trump’s Surgeon General becames one of the most level-headed, empathetic voices around, but here we are:

And speaking of “marginalized communities”:

Why is Kamala Harris a “high risk” patient? The CDC (see above) has a list of medical conditions that would make her so. Mental health? Substance use? In fact, probably not. Probably something much more simple and old-fashioned. Jerome Adams once again:

“The people who know about [Paxlovid] are the people who know how to advocate for themselves, so we are seeing inequities actually expand.

Harris, for example. Or all the attendees at the Gridiron Club, who probably dosed themselves to the gills the day after. You’ll notice that the Biden revisions to “Test to Treat” do absolutely nothing to address the structural inequities identified by Kaiser Health News. First we had “shots in arms.” Now we have “pills in mouths.” So, by Betteridge’s Law….


[1] Health Online describes Paxlovid’s regimen and mechanism of action:

The three-pill regimen contains two different drugs: nirmatrelvir, which disrupts the novel coronavirus’s ability to replicate; and ritonavir, which slows down how quickly the body processes the drug.

The three pills are taken twice daily during a 5-day course.

“Nirmatrelvir works by inhibiting the COVID virus’s protease enzyme that speeds up the replication of the virus in the body,” Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California, told Healthline. “By inhibiting that enzyme it stops the progression of the disease in its tracks. The second drug inhibits the liver system which is responsible for the breakdown and excretion of nirmatrelvir. Therefore, the second drug, ritonavir, prolongs the ability of the first drug, nirmatrelvir, to work within the body to fight the infection.”

Let’s hope you don’t need an uninhibited liver for any other purpose, I suppose.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Steve H.

    > Or even just “Pax,”

    Okay, now that that’s out of the way:


    [Presenting, not confirming.]

    1. playon

      Nirmatrelvir, which disrupts the novel coronavirus’s ability to replicate

      I wonder if this drug’s action is more of a suppression of COVID rather than a “disruption” and so it is still able to replicate after the drug leaves the body. That might explain the rebound effect. I find it difficult to trust Pfizer at this point.

  2. BeliTsari

    Anybody else, trying Zi Cao (Lithospermum Erythrorhizon), antihistamines, Nicotinimide riboside & nitric-oxide precursors (along with Quercetin/ Bromaline, C & zinc) for new PASC symptoms, after 2nd (BA.1) infection? Seems like Paxlovid for Long COVID causes nasty side-effects for some folks?

  3. McWatt

    Wife came down with Covid traveling. After 1 1/2 hours on the phone with two doctors nurses, she was able to get a prescription for Paxlovid. Our daughter scoured the local pharmacy’s and found one that had 36 dose’s left. 24 hours after taking the first dose, 6 pills per day, she felt much better.

    The Dr’s office didn’t seem to have a clue about Paxlovid. My wife had to demand it.

    That was one month ago. She still has the occasional headache and has a loss of get up and go. Can get thru 6 hours of work, but then wants to go home. No loss of taste or smell. She feels Paxlovid is a miracle drug.

  4. Arizona Slim

    Me? I think I’ll just stick with that much-maligned horse dewormer. Stuff is much cheaper than this newfangled drug.

    1. kareninca

      That is what I am doing. I am not vaccinated, and I am taking “I” prophylactically, and I test weekly and so far I have not tested positive (I also use Xlear and mask avoid other humans). However, I’m not sure how well “I” will work for the latest variants. My mom has what looks like omicron (diarrhea and headache)(she is also double vaccinated and boosted) and I had her take “I” for the first two days of symptoms. It didn’t seem to help at all, whereas three other times when she had what seemed like covid symptoms, months ago, “I” seemed to do the trick. Of course, she may not actually have covid; who knows. Her doctors have not tested her for it and she is not in a big hurry to use her home test kits.

      I wish we had more anecdotes about what might help for the symptoms of the latest variants; it wouldn’t be real medical info but it might be better than nothing.

        1. kareninca

          We also used claritin, Quercetin, zinc, melatonin, vitamin C and COQ10. No aspirin due to a med she is on.

      1. Elizabeth Burton

        Maybe I can help. Being in two of the “high-risk” categories, I nevertheless was and will remain reluctant to undertake a course of medication that I know hasn’t even been fully tested, regardless of the “emergency”. In fact, I have no respect for what passes for medical care these days at all, but that’s another story.

        Anyway, early September I developed a really itchy rash along with the standard symptoms and on research assumed I had acquired the Delta version. I suspect it interacts with dormant herpes virus (I had chicken pox as a kid) and triggers it, which might explain why people are coming down with shingles post-infection.

        It happens I have post-polio syndrome, so I take a raft of herbal and other supplements to address the symptoms of that. I suspect these are the reason my first contact with COVID was relatively mild, if itchy. If anyone wants to know what I take, post a reply and I’ll get in touch. So, moving ahead to December and here we go again, only this time it was clearly Omicron, since it went to the gut. Not fun, but still no worse than any bad case of GI flu.

        As we speak, I am recovering from session three, which may be one of the two varieties I gather have recently appeared in Texas and elsewhere along the coast. Pretty much an even milder case of session two. Oh, and my sense of taste seems to be finally coming back, which is nice.

        The silenced voices that warned mass injection with untried vaccines might prolong rather than end the outbreak (I refuse to call it a “pandemic”) seems to be holding true. Maybe if they’d stop terrorizing people into running for yet another essentially useless booster, the d***ed virus would stop mutating, but that doesn’t sell vaccines and provide free test subjects for new antivirals so not holding my breath.

        I know this is “just my personal experience”—trust me, every “we’re all going to die if we take off our masks” propaganda victim on Twitter has pointed that out. However, I begin to see more and more people who have shared said personal experience, which led me to set up a private support group on MeWe for that and for people with the chronic aftermath. Which, btw, is also likely treatable with readily available meds. Of course, the official stance is “We understand your pain, and we’ll be undertaking research to find a treatment”. Quelle surprise.

        For the record, I watched the beginning of the outbreak in the Chinese press, and have kept up on the research since via medical journals and other scientific sources, not to mention studying basic immunology so I knew what I was reading. Meaning it really isn’t “just your personal experience”.

        That’s my story, and I’m sticking to it. Feel free to get in touch.

        1. kareninca

          I would love to know what alternative treatments and preventatives you are using or have heard of. I understand that it wouldn’t be medical advice; it would just be what happens to be working for you or for other individuals. Also I would do total due diligence with taking any of them (or giving them to my mom).

          I think the virus is going to continue to mutate, no matter how many people are vaccinated. Unless they come up with a vaccine that prevents transmission, but I don’t see a prospect of that soon. And anyway there are lots of animal reservoirs. This means that we may need to keep finding new alternative meds, depending on the version we catch.

          I still haven’t caught it (per weekly testing since January, and per occasional testing and lack of symptoms before that). I do use Xlear; I think it may help. I have a bunch of nigella sativa on hand just in case, and have started myself and my mother on turkey tail mushroom capsules for general immune support (they don’t conflict with any of her meds; we checked).

          I hope your health continues to improve.

          1. Elizabeth Burton

            Email me at dymitia@gmail.com, and I’ll send you the menu. And anyone else who’s interested. A reminder these are medications I take on a daily basis for my PPS; it just seems their interactions are precisely what will address how SARS-CoV-2 behaves.

    2. queenslawyer

      Same. Age 40 male, no gene therapy. Tested (for travel) positive without symptoms, woke up feeling bad with a fever. Took IVM. Fever broke within 3 hours and cold symptoms for roughly 36 hours. Feeling better than ever and will always have a supply on hand going forward

    3. T_Reg

      But Pax is a miracle drug, an anti-viral in a pill! Unprecedented! /s

      The stupidity of a large portion of the general populace is demonstrated by the fanatical opposition to the cheap pill, followed by the unquestioning acceptance of the expensive pill. Oh, and by believing anything coming from Big Pharma and their regulatory lackeys.

    4. Juneau

      Getting that drug by prescription may be more difficult now that some “frontline” docs are having licenses pulled. https://www.medpagetoday.com/special-reports/exclusives/98407
      Whether this action is justified or not (due to extenuating circumstances), one doc I know has decided that off label prescribing in this situation is just too risky. Prescribe the repurposed med and you get serious trouble. Even if there is no demonstrated harm….even if there was no available or approved alternative at that time.

  5. kareninca

    Several days ago my 79 y.o. mom (double vaccinated with one booster) went to the ER due to three days of diarrhea (which she never gets) and a mild headache (she never gets headaches). She lives in eastern CT and the local medical system has a stellar reputation, partly due to all the rich New Yorkers who have second homes there. They did bloodwork (which was good) and a scan (and found nothing), and told her it was likely a side effect of a new blood pressure medication she was on. They did NOT test her for covid, even though her symptoms were typical of omicron.

    Yesterday she went to her GP for a follow up appointment. She still had the symptoms, despite having stopped the supposedly offending new medication. He told her that she was in great shape; that in his view she just “had a virus.” He did not test her for covid; covid did not come up. He is actually considered to be a truly excellent GP and there is a tremendously long list of people who want to be his patient. I have met him and think highly of him.

    It is my impression that the local medical community has made some sort of decision. Maybe they are only checking for covid in cases where they think they might want to prescribe Paxlovid? The area is economically dependent on summer tourists. And to be realistic, the local population has been “back to normal” for a long time now in their behaviors.

    I told her she should use her home test kits to at least know what to think. She still has the same symptoms, and is pretty wiped out; nonetheless she has not cut back on her social life.

    1. Jason Boxman

      Given the prevalence of long-COVID, that’s insane, to pretend the pandemic is over. We’re truly proper f*ked. Makes you wonder just how large an undercount our case counts are these days. I follow the Walgreens tracker, now, with test positivity rates reported.

  6. Samuel Conner

    Thanks, Lambert.

    One wonders how many adverse drug interactions will happen in coming months, how severe these will be, and how much attention the incidents will attract. The public health authorities don’t seem too interested in the ways anti-CV therapeutics can go wrong. In the meantime, enjoy the freedom to unmask. /s

    The thought occurs to wonder if the dose of the anti-CV component of the combination could be increased to compensate for liver metabolism, dispensing with the 2nd component. There’s presumably a good reason (presumably a good medical reason) that approach wasn’t employed.

  7. Jason Boxman

    The federal government and many state and local health departments direct residents to an online national map where people can find test-to-treat sites and other pharmacies where they can fill prescriptions.

    And this web site is actually provided by a private entity, is crap, and is basically unusable on my modern 2018 Mac Mini, where it lags so badly, I can’t use it and the CPU fan goes nuts.

    So “access” might be an issue for anyone without a computer from 2022, as well. This is like a mini-ObamaCare debacle.

  8. IM Doc

    I will add a real time story.

    This is going on in my office now as I speak.

    An 82 year old fairly healthy woman with AFIB that is well-controlled was found to be COVID positive on Easter Sunday. She had very very minimal symptoms. She is quadruple vaxxed – with her 4th booster being given on 4-2. I would never have started her on PAXLOVID myself as she is not what I would call high risk.

    Patient is at baseline on OXYBUTYNIN for bladder control from her urologist and trazadone for sleeping at night ( this is an SSRI). She is also on FLECAINIDE for atrial fibrillation.

    Unfortunately all three of these agents are contraindicated with ritonavir. Those of us who have worked around AIDS patients know that this is not a drug to be blown off. Even one dose can set off problems if you happen to be on the wrong other agents.

    She is in my office right now with a condition known as angioedema. Her cheeks and her neck are profoundly swollen and she has some mild swelling of the tongue. Have seen this a couple of times with ritonavir in AIDS patients as well. It is listed as one of the common problems with Paxlovid. And it can kill someone if it happens quickly or dramatically. Yes, it can.

    She is being admitted at this moment.

    She was in the medical system on Easter Sunday. One provider saw her – and another prescribed the drug without looking at her chart. Having this drug handed out by pharmacists who may or may not appreciate the problems puts shivers down my spine. THIS DRUG IS NOT AN M&M.

      1. Milton

        3 out 4 ain’t to bad (SARI)… Anyways, why should I dose tabs of pfizermectin when the real thing is cheaper, safer, and likely more effective.

  9. SocalJimObjects

    We need more information on Pax. Just like the vaccine, Pfizer probably has lawyers ready to make sure that won’t happen for another 70 80 years.

  10. Nevermore


    Look at the chemical structure of Paxlovid on its Wiki page.

    See those 3 fluoride (F) atoms hanging off the bottom of the molecule? No thanks. I’ll stick with ivermectin too.

    And EUA to boot, just like the vaccines which means nobody is going to stand behind this product. You’re on your own.

        1. Yves Smith

          I don’t have time to listen but Dr. Campbell has a very nice manner but does not have a good track record. He basically advocated some flavor of conventional wisdom because he does not have the science or statistical chops to make his own assessment, and then is very slow to correct bad takes when wrong.

  11. Tom Doak

    Is it really that hard to understand why there was no Operation Warp Speed for treatments? Pfizer had Paxlovid in the pipeline and didn’t want competition, and they seem to have an outsized influence on the current Administration’s policies.

    Also – is it really true that my wife could get a Paxlovid prescription and I couldn’t, because she is a former smoker? Who knew smoking might wind up being a survival advantage?

    1. SocalJimObjects

      If the administration is so hell bent in prescribing Pax to everyone and anyone, I bet one day you can just go to Walgreens and say that you used to be a former smoker in order to get your fill. Not suggesting that people should do it, but I bet that’s what’s going to happen. After all two can play at this checklist/app thingy.

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