Paxlovid or Ivermectin?

[Newman]

Which do you go with right after testing positive for the Wuhan cooties?

Paxlovid:
Paxlovid: Uses, Dosage, Side Effects, Warnings - Drugs.com

Treatment Options for COVID‑19 | HHS/ASPR

Paxlovid has "emergency use authorization," a phrase I trust NOT AT ALL. Paxlovid is a Pfizer product.

It seems the real world downside of Paxlovid is a common "rebound" of symptoms after the 5-day regimen is finished. My friend is going through that just now.

In the world of medical info about Paxlovid, ivermectin may as well be named Voldemort. Typical is this one,

COVID-19 Treatments: What We Know So Far > News > Yale Medicine

Or my personal favorite, from the AARP. COVID Update: What You Need to Know Now (aarp.org)

This passage takes Bill Clinton's Depending on What the Meaning of Is Is to a whole new universe:

Can you get COVID-19 even if you’re fully vaccinated?


The COVID-19 vaccines can help prevent a coronavirus infection, but importantly, they are highly effective at preventing serious illness from COVID-19. Unvaccinated individuals 50 and older are 14 times more likely to die from COVID-19 than their vaccinated peers who are up to date on their COVID-19 vaccines, federal data from June 2022 shows. Hospitalization rates are also much higher among unvaccinated adults.

Despite these protections, the vaccines are not 100 percent effective at stopping the virus — and preliminary data shows that omicron is better at sneaking around the vaccines than previous variants — so it is possible for fully vaccinated individuals to get COVID-19. This is called a breakthrough infection.

Though people with breakthrough infections are less likely to develop serious illness from COVID-19 than unvaccinated people, they can still be contagious and spread the virus to others. Wearing a mask in indoor public settings can help prevent people with asymptomatic or mild illness from unknowingly spreading the virus to others.

The word is Yes.

Ivermectin is in smaller universe:

A five-day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness - PubMed (nih.gov)

or

Ivermectin Is Safe and Effective: The Evidence (theepochtimes.com)

Ivermectin is on the World Health Organization (WHO) List of Essential Medicines and is approved by the US Food and Drug Administration (FDA). This well-tolerated but potent anti-parasitic medicine has been prescribed billions of times in its 36-year history against a wide range of parasites. It is a drug in the avermectin family, so named because those compounds are produced by the soil organism Streptomyces avermitilis. It has also been studied and used against a wide range of viruses especially over the last decade, and there is evidence of potent antiviral effects against Influenza A and over a dozen other viruses tested. [309]

In a meta-analysis of 63 studies of ivermectin versus COVID-19 in humans, 100 percent of these have shown positive results. Studies were from all continents except Antarctica. Considered individually, 29 of those studies were found to be statistically significant regarding use of ivermectin alone. Over the 63 studies in meta-analysis, pooled effects showed 69 percent improvement in early treatment, and prophylactic use showed 86 percent improvement. Of those studies in the meta-analysis that were peer-reviewed, overall improvement in early treatment was found to be 70 percent (64 percent in randomized controlled trials), and 86 percent of those in which ivermectin was used prophylactically showed improvement (84 percent in randomized controlled trials).

Mortality from COVID-19 over all time periods of delay in treatment was 76 percent improved over controls (69 percent in randomized controlled trials), whereas mortality was improved 84 percent in early treatment of COVID-19 (82 percent in randomized controlled trials). Forty studies were excluded from the meta-analysis for complicating factors or insufficient detail reported, and these also showed 100 percent positive results.

It is estimated that the likelihood of an ineffective treatment showing such positive results as the above results in the 63 studies in the meta-analysis to date is exceedingly small. That probability is estimated to be one in one trillion. [310] The overall results of the meta-analysis were not only found to be “overwhelmingly positive,” but also “very consistent, and very insensitive to potential selection criteria, effect extraction rules, and/or bias evaluation.” The data in the meta-analysis are as of date of this article, and are continually updated as new studies are reported.
. . . .

Is Paxlovid merely suppressing symptoms and prolonging the illness?

[scott]

Paxlovid works by inhibiting the protease responsible for replication. That's also why sometimes there is a rebound after a course of treatment. It isn't that the drug is causing the rebound, it's that the particular variables in some patients foster a massive rebound and infection. Without the drug they would likely be dead if what we know is true.

Ivermectin shouldn't work as a viral inhibitor because it's an anti-parasitic, but it seems to sometimes work by acting on the ACE-2 receptor blocking viral entry and preventing the transport of viral proteins into the target cell by competing with the same receptor that SARS-Cov-2 uses. The problem with that is that the dosing required to completely block the virus from using those proteins would be very high and toxic. Ivermectin also inhibits the inflammatory response which helps to prevent the "cytokine storm" that COVID-19 causes. The problem is that there are no good human clinical trials showing that Ivermectin works well in a large set of humans infected with COVID-19. I suspect it has to do with individual characteristics of how different people metabolize Ivermectin but we just don't know.

If I were to choose, I'd pick Paxlovid.

[Newman]

Paxlovid works by inhibiting the protease responsible for replication. That's also why sometimes there is a rebound after a course of treatment. It isn't that the drug is causing the rebound, it's that the particular variables in some patients foster a massive rebound and infection. Without the drug they would likely be dead if what we know is true.

Ivermectin shouldn't work as a viral inhibitor because it's an anti-parasitic, but it seems to sometimes work by acting on the ACE-2 receptor blocking viral entry and preventing the transport of viral proteins into the target cell by competing with the same receptor that SARS-Cov-2 uses. The problem with that is that the dosing required to completely block the virus from using those proteins would be very high and toxic. Ivermectin also inhibits the inflammatory response which helps to prevent the "cytokine storm" that COVID-19 causes. The problem is that there are no good human clinical trials showing that Ivermectin works well in a large set of humans infected with COVID-19. I suspect it has to do with individual characteristics of how different people metabolize Ivermectin but we just don't know.

If I were to choose, I'd pick Paxlovid.

Thanks. I'm sure my doc will lean that way, and I'll take her advice. I'm thinking this evening that I really don't have significant symptoms that can't be ascribed to a fading bout of the flu. Again, however, I'll take her advice. My feelings may be more vanity than wisdom.

[Newman]

Maybe I'll end up singing that old song by the Shirelles, almost:

Plaxlovid, Oh my little Plaxlovid,
I'll be taking you.
You weren't my first choice,
But you'll be my last choice,
And I guess you'll have to do,
I'll be taking you...

Put down that glass of wine, son, and close the laptop slowly. . . .

[scott]

Maybe I'll end up singing that old song by the Shirelles, almost:

Plaxlovid, Oh my little Plaxlovid,
I'll be taking you.
You weren't my first choice,
But you'll be my last choice,
And I guess you'll have to do,
I'll be taking you...

Put down that glass of wine, son, and close the laptop slowly. . . .

I sang that.

[Lady Marva]

Ehhh.... just take two aspirin and some wine or bourbon and go to bed. You're cured.

[Celeste Chalfonte]

Maybe I'll end up singing that old song by the Shirelles, almost:

Plaxlovid, Oh my little Plaxlovid,
I'll be taking you.
You weren't my first choice,
But you'll be my last choice,
And I guess you'll have to do,
I'll be taking you...

Put down that glass of wine, son, and close the laptop slowly. . . .

Yeah, for real. That was one of your all-time stinkers.

[Newman]

Yeah, for real. That was one of your all-time stinkers.

Would it help if I'd spelled Paxlovid correctly?

[Newman]

Would it help if I'd spelled Paxlovid correctly?

Actually it would. Paxlovid fits Soldier boy better than Plaxlovid, which sounds like something out of a dental hygienist's gift bag.

[Michele]

I'm going with LM here...why do you need either medication?

[Newman]

Ehhh.... just take two aspirin and some wine or bourbon and go to bed. You're cured.

I'm going with LM here...why do you need either medication?

Maybe I don't. It appeals to my vanity to tough it out—I joked elsewhere about my Chardonnay and Ritz therapy, and it's true that before now I haven't had as much as a sniffle since I retired about 8 years ago.

But I've seen vanity not work out well. "Never took a day off," "never saw a doctor till the day he died" (do you get a merit badge for that?). Endurance is a virtue, but it can be misconstrued.

Here the downside of foolish vanity is too steep. What are the pluses and minuses of taking the meds, and of not taking the meds?

It's a bit like buying insurance. What's the premium, what's at risk. I probably don't need insurance. But in my estimation the worst possible outcome is unacceptable.

[Frostbit]

There were protective associations of physical activity for adverse COVID-19 outcomes across demographic and clinical characteristics. Public health leaders should add physical activity to pandemic control strategies.

[Frostbit]

What are the pluses and minuses of taking the meds, and of not taking the meds?

.

It's called risk vs. benefit. You yourself pointed out Paxlovid is released under an EUA. Essentially a shortcut.