By Tony Shields, M.D., Ph.D. / Detroit
David Fink, J.D., S.O.B. / Bloomfield Hills, Mich.
I know we are all so tired of Covid-19 illnesses and restrictions, but the virus is not going away–ever. We will have to learn how to deal with it and carefully get on with our lives.
Fortunately, the numbers are improving, and we have vaccines and treatments to help. The U.S. still reports about 45,000 cases (a real underestimate) and almost 500 deaths daily. Getting fully vaccinated and boosted are the best first steps for protection. The latest bivalent booster includes activity against the omicron variants and decreases the risk of severe disease by about 60%.
I routinely test myself before and after travel and large gatherings. I still wear a mask on airplanes and in the grocery store, but we now regularly go to restaurants and eat inside. I have been lucky in avoiding the virus. Despite being vaccinated, boosted, and taking reasonable precautions, far too many of my family, friends, and patients are still coming down with infections.
I regularly get calls about the use of Paxlovid for those infected and highly recommend its use. Paxlovid needs to be taken within the first five days of infection, and the earlier the better. One should test at the first sign of a Covid infection and repeat the test in a couple of days if the first test is negative. Older people or those with health issues (lung and heart problems, diabetes, etc.) should get Paxlovid immediately since it decreases the risk of severe illness by about 45% in vaccinated patients.
Please don’t wait until you feel awful, since Paxlovid is meant to improve the symptoms. It may also decrease the risk of long Covid symptoms. I strongly encourage those afflicted by the virus to take it.
When Paxlovid was first approved for use in early 2022, it was in short supply in a limited number of pharmacies, and a hassle for doctors to order. It is now readily available, and when a patient calls me to report that they have had a positive home test, I call a local pharmacy with the prescription.
Generally, patients take 3 pills twice daily for five days (2 of nirmatrelvir and 1 of ritonavir, and all three pills come together (in a blister pack) and the most common side effect is a metallic taste while on the drugs. There can be issues with interactions with other medications, so these may need to be altered for a few days and should be discussed with your physician.
Don’t let your physician discourage you from taking Paxlovid. Much has been reported about infection rebound after taking Paxlovid, but in one study it occurred in only about 14% of people who took the medication and 9% of those who didn’t. Furthermore, almost all rebound infections are quite mild.
Given the benefits of Paxlovid, it should be used much more frequently than it currently is. Please do a home test if you have any mild symptoms, and if it is positive, consider starting Paxlovid immediately.
When I tested positive for Covid shortly after Thanksgiving dinner (nine people were infected at that superspreader event), I did what any rational alumnus of the Oak Park High School Class of 1970 would do—I called Tony. He asked me if I was planning to take Paxlovid, and I told him that my doctor had discouraged its use, because it could have adverse consequences when taken in conjunction with other maintenance meds that I take. I also told Tony that some friends had decided not to take Paxlovid because of the possibility of rebound and because of the nasty taste it is reputed to cause.
Tony quickly disabused me of any concern regarding rebound. (A 14% chance of rebound with Paxlovid vs. a 9% chance without it didn’t seem significant to me.). At that point, I took a closer look at the potential interactions with my other meds, and realized I could just go a few days without alfuzosin and avoid that issue (ok, maybe that’s a little too personal, but a few days of discomfort from not taking alfuzosin was not really a big deal).
Weighing the risks and rewards was not that complicated. With all of the unknowns regarding long Covid, any potential to prevent a chronic condition strongly outweighed the 5% increased risk of rebound, a few days of discomfort and a funky taste in my mouth.
So, I did take Paxlovid, as did my girlfriend Carol (who naturally shared my Covid). It far exceeded expectations. I was taking it for two reasons: 1) to reduce the risk of a more serious case of Covid; and 2) to reduce the risk of developing some form of long Covid. What I hadn’t anticipated was the startlingly fast recovery that I experienced. Almost immediately after I noticed the metallic taste, my Covid symptoms dissipated. Within hours I was well on my way to recovery, and the next day I was virtually symptom-free.
Of course I continued the full course of treatment, but the primary “symptom” I experienced after the first day on Paxlovid was a taste my son-in-law described as “a penny dying in your mouth.” A small price to pay for relief from the other symptoms of Covid and peace of mind that I have done what I could to reduce the risk of long Covid.
Also, I protected myself from Tony ever saying “I told you so.”
The authors have been friends for 61 years.
Tony Shields and David Fink at their confirmations at Temple Israel in Detroit (1967)
Friends relaxing at the Finks' cottage circa 1975 on Big Lake in Springfield Township, Mich. (L to R): David Fink, David Burleson, Tony Shields, Russell Steinman, Jeff "Manzana" Appel, Jonathan Licht, Mark Silverman, Michael Treblin