A new type of coronavirus is spreading, and it is the most transmissible to date. The number of hospitalizations of patients is increasing. And the elderly act nearly 90% of deaths in the United States due to COVID-19 in recent months, the most since the beginning of the pandemic.
What does this mean for people 65 and older who contract the virus for the first time or those with recurring infections?
The message from infectious disease experts and geriatricians is clear: find treatment with antiviral therapy, which remains effective against new variants of the Covid virus.
Experts said the first choice for treatment is Paxlovid, an antiviral treatment for people with mild to moderate coronavirus who are at high risk of becoming seriously ill from the virus. All adults 65 and over fall into this category. If people cannot tolerate the medication – potential complications with other medications should be carefully evaluated by a medical provider – two alternatives are available.
“There is a lot of evidence that Paxlovid can reduce the risk of catastrophic events that can follow infection with COVID-19 in older individuals,” he said. Dr. Harlan KrumholzProfessor of Medicine at Yale University.
In the meantime, make a plan for what you will do if you catch the virus. Where will you seek care? What if you can’t get to your doctor quickly, as this is a common problem? You must act quickly as Paxlovid must be started no later than five days after the onset of symptoms. Will you need to adjust your medication regimen to protect against potentially dangerous drug interactions?
“It’s time to find out about all this before you catch the virus,” he said. Dr. Alison Weinmanan infectious disease expert at Henry Ford Hospital in Detroit.
Being prepared proved essential when I contracted the virus in mid-December and went to urgent care to get a prescription. As I am 67 years old, have leukemia and an autoimmune disease, I am at increased risk of severe illness from the virus. But I take a blood thinner that can have life-threatening interactions with Paxlovid.
Fortunately, the urgent care center was able to see my electronic medical record, and there was a note from the doctor there saying it was safe for me to stop the blood clot and get treatment. (I consulted with my oncologist beforehand). So, I walked away with a prescription of Paxlovid, and within a day the headache and chills were gone.
Just before I got the virus, I was reading the Important study Approximately 45,000 patients age 50 or older were treated for coronavirus between January and July 2022 at Mass General Brigham, a large health system in Massachusetts. Twenty-eight percent of patients were prescribed Paxlovid, which received emergency use authorization for COVID-19 from the US Food and Drug Administration in December 2021; 72% were not. They were all outpatients.
In contrast to other studies, most patients in this study were vaccinated. However, Paxlovid conferred a notable advantage: Those who took it were 44% less likely to be hospitalized for severe Covid-related illnesses or die. Among those who received fewer than three doses of the vaccine, this risk was reduced by 81%.
a few months ago, study From Israel has confirmed effectiveness Paxlovid — the brand name for the combination of nirmatrelvir and ritonavir — in older adults with the omicron strain of covid, which originated in late 2021. (The original study demonstrating Paxlovid’s efficacy was conducted during a delta strain outbreak and included only unvaccinated patients.) in Patients 65 and overmost of whom were vaccinated or previously infected with the virus, hospitalizations were reduced by 73% and deaths by 79%.
However, several factors have hindered the use of baxlovid among the elderly, including clinicians’ concerns about drug interactions and patients’ concerns about potential “rebound” infections and side effects.
Dr. Christina Mangurianthe vice dean for scholarly and academic affairs at the University of California-San Francisco School of Medicine, faced many of these issues when her parents contracted the virus in July, an episode she chronicled in Recent JAMA article.
First, her father, 84, was told by her doctor at a virtual medical appointment that he didn’t know he couldn’t take Paxlovid because he had a blood thinner — a decision that was later reversed by her primary care doctor. Then, in a separate virtual appointment, her 78-year-old mother was asked to take antibiotics, steroids and over-the-counter medication instead of Paxlovid. Once again, her primary care physician stepped in and offered her a prescription.
In both cases, Mangurian said, the doctors her parents first met with seemed to misunderstand who should get Paxlovid, and under what circumstances. “This indicates a significant deficit in terms of how information about this treatment can be disseminated to frontline medical providers,” she told me in a phone conversation.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, agrees. “Every day, I hear from people who are misled by their doctors or nurse call lines. Generally, they’re told you can’t get Paxlovid until you’re seriously ill — the exact opposite of what’s recommended. Why don’t we do more to educate the medical community? “
The potential for drug interactions with Paxlovid is a major concern, particularly in older patients with multiple medical conditions. more than 120 medicines They are marked for interactions, and each case should be evaluated, taking into account the individual’s circumstances, as well as renal and hepatic function.
The good news, experts say, is that most potential interactions can be managed, either by pausing the medication while taking baxlovid or reducing the dose.
It takes a little extra work, but there are resources and systems in place that can help practitioners know what they should be doing. Brian EssetsHe is a professor at the University of Minnesota College of Pharmacy.
In nursing homes, patients and families should ask to speak to consultant pharmacists if they are told antiviral therapy is not recommended, Isetts suggested.
About 10% of patients cannot take paxlofide because of potential drug interactions, according to the Dr. Scott Dryden Peterson, medical director of covid outpatient treatment for general brigham. for them , viclory (remdesivir), an antiviral infusion treatment given over three consecutive days, is a good option, although it can sometimes be difficult to arrange. also, lagevrio (molnopiravir), another antiviral pill, can help shorten the duration of symptoms.
Many older adults fear that after taking baxlovid, they will get a rebound infection – a sudden return of symptoms after the virus appears to be gone. But in the vast majority of cases “the reflux is very mild and the symptoms usually go away — runny nose, nasal congestion, sore throat — within a few days.” Dr. Rajesh Gandhian infectious disease physician and professor of medicine at Harvard Medical School.
Gandhi and other doctors I spoke with said that the risk of not being treated for coronavirus in the elderly is much greater than the risk of developing relapsing disease.
Side effects of Paxlovid include a metallic taste in the mouth, diarrhea, nausea, and muscle aches, among others, but serious complications are uncommon. “All in all, people tolerate medication really well,” he said. Dr.. Caroline Haradaassistant professor of geriatrics at the University of Alabama-Birmingham College of Medicine, “And feeling better pretty quickly.”
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This article has been reprinted from khn.org Courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization not affiliated with Kaiser Permanente.