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  • Originally posted by nephron View Post
    . One of my icu attendings is still putting everyone on ivermectim which I gather is not renally dosed.
    For covid, wow. Ok then.

    Back to more mainstream peer reviewed data:

    https://jamanetwork.com/journals/jam...rticle/2788254

    Attached simple table on the benefits. the NNT is striking and nice to see oral med equal to the monoclonals at least based on the current studies.




    Attached Files

    Comment


    • Originally posted by StarTrekDoc View Post
      In other news:
      How are people's monoclonal supplies holding up? We're about to exhaust our stockpile next week of Sotrovimab.

      Anyone with experience with any of the orals? Haven't rx'd any, but there's a short supply at our CVS to access and wondering how folk are utilizing it.
      Only unvaxed pregnant get it at my shop, leading to unintended consequence of fewer vaxed pregnant women.

      Comment


      • Originally posted by CordMcNally View Post

        As I’ve said before, people calling ivermectin a ‘horse de-wormer’ aren’t helping things since it has legitimate human uses outside of COVID.
        Talking of a de-wormer here is a nice story from the 1990's.

        We now have adjuvant therapy for colon cancer like FOLFOX but in the early 1990's nothing was done after surgery and some patients died with metastasis. The first adjuvant therapy that was shown to work better than placebo was a combination of 5-FU and levamisole. Levamisole is a old de worming agent, used in animals, and even in humans in third world countries. It was a long standing generic drug. But once FDA gave approval for this regimen, the maker/ importer of this drug suddenly jacked up the price from literally pennies to >$1000/month ( a huge sum for meds back then). There was no Medicare Part D and some patients could not afford it.

        A few crafty patients found a way - they asked their veterinarian to write a prescription for it ( usually given to cows) and then took it at the appropriate human dose. The medicine was essentially the same. Since it was given adjuvantly and the risk of relapse was not very high, I am unsure if the medication worked as well as the $1000 ones.

        Therein lay the seeds of the sprouting of the Canadian pharmacy drug price lowering scheme.

        Comment


        • Originally posted by StarTrekDoc View Post

          Correct cytochrome issues. the main ones where most at risk will be on: statins. -- includes most of the common, not just lova and simva as posted -- crestor and lipitor both also on the contraindicated list.
          I wonder how long a person has to be off statins before Paxlovid becomes safe to ingest? Maybe it's possible to stop the statin at the same time the Paxlovid is started?

          Comment


          • Yeah how many high risk...65 yo with bmi>30 not on a statin?
            It's a potentiation of the statins so I doubt much of an issue in most cases for statins. Kind of like grapefruit juice.

            Xarelto and Amlodipine along with Wellbutrin and trazodone would be bigger concerns


            Comment


            • Well, it has happened. Oldest daughter in high school, double vaccinated just over 6 months ago, had symptoms (felt cold, cough, loss of appetite) starting earlier today after being out and about with wife and son (basketball games, store). Used at home antigen test and she tested positive. Son, who is ten, had his second vaccine less than a month ago, and wife had her second about 9 months ago (but no booster). Neither of them have shown any symptoms. Neither have any medical problems.

              Other daughter and I happen to be out of town at a sports tournament, having left yesterday. Neither of us have any symptoms whatsoever. I was boosted about 2 months ago, and this daughter is also just over 6 months out from second vaccination. Now the question is, do daughter and I go to a hotel after we get home, or do we just assume we probably already got it, being exposed before we left, and go straight home? Do we isolate until 5 days post-exposure (which would have been yesterday) and then test? Do we just go home and everyone wear masks? I assume the likelihood of this working is about as close to 0% as you can get without being 0.

              I swept out our garage earlier in the week but stupidly didn’t think to wear a mask. For a couple of days afterwards I had increased cough, nasal discharge (full of dust/debris), and congestion, but I assumed it was due to that. I had no other symptoms. Did I have Covid and pass it on to my daughter, who is now showing symptoms?

              Comment


              • Originally posted by MaxPower View Post
                Well, it has happened. Oldest daughter in high school, double vaccinated just over 6 months ago, had symptoms (felt cold, cough, loss of appetite) starting earlier today after being out and about with wife and son (basketball games, store). Used at home antigen test and she tested positive. Son, who is ten, had his second vaccine less than a month ago, and wife had her second about 9 months ago (but no booster). Neither of them have shown any symptoms. Neither have any medical problems.

                Other daughter and I happen to be out of town at a sports tournament, having left yesterday. Neither of us have any symptoms whatsoever. I was boosted about 2 months ago, and this daughter is also just over 6 months out from second vaccination. Now the question is, do daughter and I go to a hotel after we get home, or do we just assume we probably already got it, being exposed before we left, and go straight home? Do we isolate until 5 days post-exposure (which would have been yesterday) and then test? Do we just go home and everyone wear masks? I assume the likelihood of this working is about as close to 0% as you can get without being 0.

                I swept out our garage earlier in the week but stupidly didn’t think to wear a mask. For a couple of days afterwards I had increased cough, nasal discharge (full of dust/debris), and congestion, but I assumed it was due to that. I had no other symptoms. Did I have Covid and pass it on to my daughter, who is now showing symptoms?
                Your story fits a lot of the Omicron cases I’ve seen. The congestion is often blown off as “allergies” or something else minor. Then other family members start to get the congestion, and finally someone gets tested. Many of the admits I’ve had for other things who ended up testing positive, only admit to nasal congestion or a slight cough after I tell them the results. I’d bet you had it.

                Same happened to my brother in reverse last week. Kid’s allergies were acting up, then days later he’s hacking away and tests positive for COVID. (He’s fine now- no worries).

                Comment


                • Originally posted by MaxPower View Post
                  Well, it has happened. Oldest daughter in high school, double vaccinated just over 6 months ago, had symptoms (felt cold, cough, loss of appetite) starting earlier today after being out and about with wife and son (basketball games, store). Used at home antigen test and she tested positive. Son, who is ten, had his second vaccine less than a month ago, and wife had her second about 9 months ago (but no booster). Neither of them have shown any symptoms. Neither have any medical problems.

                  Other daughter and I happen to be out of town at a sports tournament, having left yesterday. Neither of us have any symptoms whatsoever. I was boosted about 2 months ago, and this daughter is also just over 6 months out from second vaccination. Now the question is, do daughter and I go to a hotel after we get home, or do we just assume we probably already got it, being exposed before we left, and go straight home? Do we isolate until 5 days post-exposure (which would have been yesterday) and then test? Do we just go home and everyone wear masks? I assume the likelihood of this working is about as close to 0% as you can get without being 0.

                  I swept out our garage earlier in the week but stupidly didn’t think to wear a mask. For a couple of days afterwards I had increased cough, nasal discharge (full of dust/debris), and congestion, but I assumed it was due to that. I had no other symptoms. Did I have Covid and pass it on to my daughter, who is now showing symptoms?
                  The whole family is exposed. Not a thing you can do. Vaccinated too! CDC said 5 days due to the population not being capable of 10 days.
                  I would not do the hotel thing. You have been left with an ethical choice. Preventing spread.
                  If you PCR test positive, what does that mean if you already isolated 5 days?
                  Back in the box, ethical choice preventing spread.
                  Clear as can be with the guidelines.
                  Good luck. Asymptomatic, you still don’t know, right? Flip a coin?

                  Comment


                  • Originally posted by MaxPower View Post
                    Well, it has happened. Oldest daughter in high school, double vaccinated just over 6 months ago, had symptoms (felt cold, cough, loss of appetite) starting earlier today after being out and about with wife and son (basketball games, store). Used at home antigen test and she tested positive. Son, who is ten, had his second vaccine less than a month ago, and wife had her second about 9 months ago (but no booster). Neither of them have shown any symptoms. Neither have any medical problems.

                    Other daughter and I happen to be out of town at a sports tournament, having left yesterday. Neither of us have any symptoms whatsoever. I was boosted about 2 months ago, and this daughter is also just over 6 months out from second vaccination. Now the question is, do daughter and I go to a hotel after we get home, or do we just assume we probably already got it, being exposed before we left, and go straight home? Do we isolate until 5 days post-exposure (which would have been yesterday) and then test? Do we just go home and everyone wear masks? I assume the likelihood of this working is about as close to 0% as you can get without being 0.

                    I swept out our garage earlier in the week but stupidly didn’t think to wear a mask. For a couple of days afterwards I had increased cough, nasal discharge (full of dust/debris), and congestion, but I assumed it was due to that. I had no other symptoms. Did I have Covid and pass it on to my daughter, who is now showing symptoms?
                    I think the days of family members wearing masks and isolating are long gone. That is, of course, unless you’ve got someone who is high risk in the household. These days it isn’t a matter of if, but when.

                    Comment


                    • Originally posted by MaxPower View Post
                      Well, it has happened. Oldest daughter in high school, double vaccinated just over 6 months ago, had symptoms (felt cold, cough, loss of appetite) starting earlier today after being out and about with wife and son (basketball games, store). Used at home antigen test and she tested positive. Son, who is ten, had his second vaccine less than a month ago, and wife had her second about 9 months ago (but no booster). Neither of them have shown any symptoms. Neither have any medical problems.

                      Other daughter and I happen to be out of town at a sports tournament, having left yesterday. Neither of us have any symptoms whatsoever. I was boosted about 2 months ago, and this daughter is also just over 6 months out from second vaccination. Now the question is, do daughter and I go to a hotel after we get home, or do we just assume we probably already got it, being exposed before we left, and go straight home? Do we isolate until 5 days post-exposure (which would have been yesterday) and then test? Do we just go home and everyone wear masks? I assume the likelihood of this working is about as close to 0% as you can get without being 0.

                      I swept out our garage earlier in the week but stupidly didn’t think to wear a mask. For a couple of days afterwards I had increased cough, nasal discharge (full of dust/debris), and congestion, but I assumed it was due to that. I had no other symptoms. Did I have Covid and pass it on to my daughter, who is now showing symptoms?
                      That is tricky. Typically I would advise family members of positive patients just to assume they either have it or were exposed to it and aren't going to have get it or already had it and don't have symptoms. Even the earlier variants of covid had a fair number of people that either had very mild (not noticeable until after the fact) or no symptoms at all making infection control difficult, this omicron seems so mild (particularly in the vaccinated) and contagious in so many people that infection control is almost impossible. My son told me about one of his friends whose family isolated him in his room after he had covid (everyone vaccinated) which is just silly because by the time you get diagnosed with covid, everyone in the household probably has been exposed. The one variable in you is that you and your daughter happen to be out of town when your other daughter developed covid, and you don't know if you were the original one with covid. If everyone is vaccinated and doesn't have any particular risk factors, I would probably just assume everyone is exposed/had it/not going to get it at this point. If my daughter was immunosuppressed, unvaccinated, etc and I was really concerned, I may just sleep a night or two in a hotel (realizing that the incidence of adverse outcomes in children with covid even without the vaccine is very, very low (the pfizer vaccine trial for both children ages 5-11 and 12-15 both had no serious covid in their placebo groups although subsequent case controlled studies have demonstrated efficacy in the vaccine preventing hospitalizations in children). The fact that they could not show severe adverse events being prevented or even occurring in a fairly large randomized controlled trial gives you an idea of how rare severe events are in children. The number of children who have had covid/been exposed to covid is probably under-reported by several fold so it's hard to determine the incidence of adverse events of a virus when you don't know the prevalence.

                      https://www.nejm.org/doi/full/10.1056/NEJMoa2116298
                      https://www.nejm.org/doi/full/10.1056/NEJMoa2107456

                      Comment


                      • We isolated my 14 year old, she's on day 3 and has had several close contacts as well as symptoms suggestive of omicron, but negative rapid test. Isolated mostly because of the inconvenience factor (I'm on call this weekend so testing positive or developing symptoms would be highly inconvenient for me, my group, my hospital, and my county) and because she's a teenager and the idea of spending three days in her room with unlimited tv and phone usage sounds like heaven to her. If she becomes asymptomatic and tests negative we'll pull her out and assume it was something else. Kids are remote learning this week anyway because of school staff shortages, so it's actually a good week for them to get it.

                        Comment


                        • Originally posted by nephron View Post

                          That is tricky. Typically I would advise family members of positive patients just to assume they either have it or were exposed to it and aren't going to have get it or already had it and don't have symptoms. Even the earlier variants of covid had a fair number of people that either had very mild (not noticeable until after the fact) or no symptoms at all making infection control difficult, this omicron seems so mild (particularly in the vaccinated) and contagious in so many people that infection control is almost impossible. My son told me about one of his friends whose family isolated him in his room after he had covid (everyone vaccinated) which is just silly because by the time you get diagnosed with covid, everyone in the household probably has been exposed. The one variable in you is that you and your daughter happen to be out of town when your other daughter developed covid, and you don't know if you were the original one with covid. If everyone is vaccinated and doesn't have any particular risk factors, I would probably just assume everyone is exposed/had it/not going to get it at this point. If my daughter was immunosuppressed, unvaccinated, etc and I was really concerned, I may just sleep a night or two in a hotel (realizing that the incidence of adverse outcomes in children with covid even without the vaccine is very, very low (the pfizer vaccine trial for both children ages 5-11 and 12-15 both had no serious covid in their placebo groups although subsequent case controlled studies have demonstrated efficacy in the vaccine preventing hospitalizations in children). The fact that they could not show severe adverse events being prevented or even occurring in a fairly large randomized controlled trial gives you an idea of how rare severe events are in children. The number of children who have had covid/been exposed to covid is probably under-reported by several fold so it's hard to determine the incidence of adverse events of a virus when you don't know the prevalence.

                          https://www.nejm.org/doi/full/10.1056/NEJMoa2116298
                          https://www.nejm.org/doi/full/10.1056/NEJMoa2107456
                          Makes sense. The only clarification is that we were around my now positive daughter for half a day (on Friday 1/14) the day before she tested positive (on Saturday 1/15), so it isn’t like we were away from her for that long where I feel like we missed the infectious window, which to me is another notch in the column of just going straight home and dealing with it. Only tricky part is that I’m supposed to take call two days this week. Our school district says that vaccinated individuals with close contacts of positive cases don’t need to isolate/quarantine unless they show symptoms, they just need to wear masks. At least two of my 5th grade son’s classmates (neither of whom wear masks—it’s optional where we are 🙄) were diagnosed positive last week, so maybe he brought it home but since he’s been very recently vaccinated he showed no symptoms. So hard to say anymore. Even prior to this episode with my own family I had come to realize that with as contagious as omicron is, everyone is going to get it at some point unless you’re truly a hermit.

                          Comment


                          • MaxPower - sorry it hit the household. Omicron is so contagious since it concentrates highly in the upper respiratory tract but good too since it tends not to move lower tract unless patient has risk factors. It tends to run through the household once in so hotel really is moot, especially with probable exposure. Omicron has been picking off staff/faculty one-by-one with teenagers as the primary source. Luckily it works its way through without knocking out more than 20% of total at any time this wave.

                            You're exposed already with 1/2 day during symptomatic day. As for isolation with neg antigen and asx, not really anymore.

                            HCP exposed: we're still at conventional status, it's test negative day 2 and 5 with twice a day symptom check, then return to baseline operations but we're an academic center and run quite conservative if able to. If you're on call, you can even use the crisis status if your system allows for it -- all really depends.

                            https://www.cdc.gov/coronavirus/2019...shortages.html

                            Comment


                            • Originally posted by FIREshrink View Post
                              We isolated my 14 year old, she's on day 3 and has had several close contacts as well as symptoms suggestive of omicron, but negative rapid test. Isolated mostly because of the inconvenience factor (I'm on call this weekend so testing positive or developing symptoms would be highly inconvenient for me, my group, my hospital, and my county) and because she's a teenager and the idea of spending three days in her room with unlimited tv and phone usage sounds like heaven to her. If she becomes asymptomatic and tests negative we'll pull her out and assume it was something else. Kids are remote learning this week anyway because of school staff shortages, so it's actually a good week for them to get it.
                              Why don’t you just get a PCR test instead of holing your daughter up with mild non-specific URI symptoms? Or how come you don’t go somewhere else and let your daughter have a run of the house if you’re worried about it?

                              Comment


                              • Originally posted by MaxPower View Post
                                Well, it has happened. Oldest daughter in high school, double vaccinated just over 6 months ago, had symptoms (felt cold, cough, loss of appetite) starting earlier today after being out and about with wife and son (basketball games, store). Used at home antigen test and she tested positive. Son, who is ten, had his second vaccine less than a month ago, and wife had her second about 9 months ago (but no booster). Neither of them have shown any symptoms. Neither have any medical problems.

                                Other daughter and I happen to be out of town at a sports tournament, having left yesterday. Neither of us have any symptoms whatsoever. I was boosted about 2 months ago, and this daughter is also just over 6 months out from second vaccination. Now the question is, do daughter and I go to a hotel after we get home, or do we just assume we probably already got it, being exposed before we left, and go straight home? Do we isolate until 5 days post-exposure (which would have been yesterday) and then test? Do we just go home and everyone wear masks? I assume the likelihood of this working is about as close to 0% as you can get without being 0.

                                I swept out our garage earlier in the week but stupidly didn’t think to wear a mask. For a couple of days afterwards I had increased cough, nasal discharge (full of dust/debris), and congestion, but I assumed it was due to that. I had no other symptoms. Did I have Covid and pass it on to my daughter, who is now showing symptoms?
                                Get boosted, that's for sure.

                                Comment

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