Dear Dr. Roach: In June 2022, I had a fever of 101 degrees, severe sore throat and headache, and I tested positive for COVID-19 on a home test. I was 67. I called my doctor’s office the next morning and was advised to take Tylenol as needed for pain as well as tea with honey. I did ask about medication, but no antiviral medication was prescribed. But it turned out that I was ill for about two weeks and then fully recovered.
I am really baffled about why I was not prescribed Paxlovid or any other medication, as my understanding is that age 67 would be considered in the high-risk category for COVID. My question is, why did my doctor make that decision? I am in good health and take no regular medications.
J.B.
Of course, I can’t answer what went through your physician’s mind, but it is true that a person with symptomatic new onset COVID and risk factors for severe diseases should be recommended for treatment. And the best treatment is nirmatrelvir/ritonavir (Paxlovid). The specific indications are any of these:
- Over age 65
- Any age if moderately or severely immunocompromised (such as cancer treatment, organ transplant, HIV, or use of medications that suppress the immune system)
- Any age with risk factors for severe COVID (chronic heart or lung disease and a long list of other conditions available at tinyurl.com/CDC-COVID-Risk)
- Over age 50 and unvaccinated
Some medicines need to be held, or the dose needs to be adjusted for Paxlovid (but that’s not the case for you). Some physicians worry about the fact that some people will get symptoms when they stop Paxlovid, called the “rebound” effect; however, the benefit (almost 90% reduction in severe disease) outweighs the risk of recurrent symptoms, which can happen even without the use of Paxlovid. Paxlovid should not be given to people with severe kidney or liver disease. People who already have a severe disease at the time they come in to receive medical attention belong in the hospital, where different treatments are given.
Paxlovid should be started as soon as possible, definitely within five days of the onset of symptoms. I strongly believe that Paxlovid should be recommended to everyone who meets the indication above. Physicians need to know the indications for its use and how to find the potential drug interactions, and they should advocate for the use of this potentially life-saving medicine. Over 500 people a day are still dying of COVID in the U.S. as I write this.
Dear Dr. Roach: Can someone get psoriasis of the brain?
M.K.
No, psoriasis can affect sites besides the skin, such as the eye and the joints, but it doesn’t cause any disease to the brain or nervous system. The eye issues potentially affected by psoriasis are all in the front part of the eye, not the retina, which is essentially a bit of brain tissue.
Psoriasis does cause inflammation in the body, which may explain why people with psoriasis, like other rheumatic disorders, are at higher risk for heart disease, high blood pressure and diabetes.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
