What is in ship medical center to counter Covid?

[generichandle]

Does anyone know what Princess medical facilities stock to interdict Covid diagnosis'? Monoclonals? Paxlovid? 

 

I cannot reach anyone at Princess who knows; perhaps someone who has been aboard knows or can ask?

 

Doug

[VibeGuy]

I have heard *zero* reference to paxlovid being available despite the average Princess passenger being a prime candidate.  I think they’re relying on the low odds of a vaxxed/boosted passenger getting critically ill, rather than the proven value of oral antivirals in non-hospitalised patients. 
 

There’s now a course of Paxlovid in my luggage since my DH hasn’t had a breakthrough case (but I have) - it’s irresponsible of Princess not to be offering it because it does reduce the intensity of viral shedding about 90% and shortens the number of days a patient is shedding. 

[jwattle]

2 minutes ago, VibeGuy said:

I have heard *zero* reference to paxlovid being available despite the average Princess passenger being a prime candidate.  I think they’re relying on the low odds of a vaxxed/boosted passenger getting critically ill, rather than the proven value of oral antivirals in non-hospitalised patients. 
 

There’s now a course of Paxlovid in my luggage since my DH hasn’t had a breakthrough case (but I have) - it’s irresponsible of Princess not to be offering it because it does reduce the intensity of viral shedding about 90% and shortens the number of days a patient is shedding. 

Not arguing with your logic; are cruise ships able to get Paxlovid?

[VibeGuy]

The current supply in the US is 100% owned by USPHS.  I don’t know if there are any barriers to a foreign-flagged vessel getting access to the stash, but there is definitely a mechanism for the government-owned inventory to be distributed via private business - all of the pharmacies that have it now are getting it through that program, as well as the test-to-treat sites.  I suspect CDC could use the voluntary conditional orders and VSP programs as a legal framework to “lend” the US operating entity the pills for shipboard use, if the line wanted to.  

A nomogram-based approach to who should get it and what conditions or other medications would contraindicate use seems to be working well for nurse-practitioner driven TestToTreat sites without lab work, so any barrier isn’t technological. 
 

I don’t know right now how much of the agent is available in other countries in the private market.  

[wowzz]

I had covid coming off our last cruise. 

Two paracetamol was all I needed. Why would you need anything else ?

[Lady Arwen]

11 minutes ago, wowzz said:

I had covid coming off our last cruise. 

Two paracetamol was all I needed. Why would you need anything else ?

Paracetamol (acetaminophen) is widely used for mild to moderate pain and reducing fever and is purchased OTC.  It is not an anti-viral medication.  However, I don’t know if these anti-viral meds are as effective as hoped for in reducing symptoms of Covid. Luckily for you the other did the job.

[syesmar]

45 minutes ago, VibeGuy said:

…There’s now a course of Paxlovid in my luggage since my DH hasn’t had a breakthrough case (but I have)….

Is this something a doctor prescribed “just in case”? I’ve been curious if this was even possible to have done in anticipation for travel.

Thanks!

[VibeGuy]

Any doctor is allowed to prescribe virtually any drug for any reason they see fit.  There is not a shortage of Paxlovid at this time, and the reason to take it is easy to determine (positive COVID test in the context of risk factors that make a severe case more likely or particularly dangerous).  My DH’s doctor felt it would be appropriate given that there could be several days between testing positive and being able to access the drug shoreside.   Toss a couple self-tests along side the five cards of pills and the care is the same as he’d get at home. 
 

It’s not too different than how I have to approach malaria precautions - the usual preventative pills make me really ill, so I have an Rx from the travel medicine clinic that says if I get a fever X high for Y days after travel in Z area, take the treatment pills.   I refresh them every five years or so when I’m at a pharmacy in a malarial region, for what usually comes out under $10. 

[VibeGuy]

34 minutes ago, wowzz said:

I had covid coming off our last cruise. 

Two paracetamol was all I needed. Why would you need anything else ?

Uh,  because not every case goes that way?  My first go with Classic COVID wiped me out for two weeks.  The antivirals are proven to reduce the risk of hospitalisation or death in people like me, and I’d rather get better sooner rather than later. 
 

Congrats your symptoms were mild.  I felt sick enough Day 1 that an MD decided I’d benefit from antivirals. 

[VibeGuy]

Thanks, Doctor.  
 

Paxlovid is prescribed *before* symptoms get bad, simply based on a positive test and a patient’s risk factors for a bad outcome.  It’s not like remdesivir for those who are circling the drain.   There’s no evidence that Princess or other lines are using this therapy that ensures almost everyone who gets COVID has a good outcome.  
 

It’s more like Relenza or Tamiflu, to keep something closer to the sniffles than a major problem.   
 

 

[VibeGuy]

1 hour ago, generichandle said:

Does anyone know what Princess medical facilities stock to interdict Covid diagnosis'? Monoclonals? Paxlovid? 

 

I cannot reach anyone at Princess who knows; perhaps someone who has been aboard knows or can ask?

 

Doug

You might direct your inquiry to Fleet Medical for HAL group.  Try 661-753-2680 - that’s the office that handles medical requests like if you’re travelling on dialysis.  You’re at least likely to get a faint glimmer of recognition of the question. 

[Lucky TGO]

1 hour ago, generichandle said:

Does anyone know what Princess medical facilities stock to interdict Covid diagnosis'? Monoclonals? Paxlovid? 

 

I cannot reach anyone at Princess who knows; perhaps someone who has been aboard knows or can ask?

 

Doug

This is an easy one to answer. See photo 

Tony

[dreaminofcruisin]

Until recently, Paxlovid hasn't been readily available. DD is an NP and she said age hasn't been enough of a factor in who gets it, so DH and I didn't get it when we had covid about a month ago. I haven't asked her lately what the requirements were, but I know at that time she said it was constantly changing, so she had to keep checking on it for her patients.

 

I think it is becoming more readily available in the US. I don't know if the cruise ships have ready access to it yet. I also think it can interact with some drugs, so it's not always a 'given'.

[chengkp75]

Just as I responded to the OP's thread on another forum, remember that just because a drug is approved in the US, it may not be approved in the flag state of the ship, and that is the law the medical center is operating under.

[generichandle]

I am 70 with several comorbidities and very high risk. I am double boosted. Been 'inside' for over 2 years. The only way I am somewhat comfortable about travel is availability of such as Paxlovid. But I am SO sick of these walls, and cruising is calls. 

 

Help!!

 

LOL;

 

Doug

[Roberto256]

2 hours ago, wowzz said:

I had covid coming off our last cruise. 

Two paracetamol was all I needed. Why would you need anything else ?

You might need something else if you have severe symptoms?

[Homosassa]

Because the same poster has posted this question on other forums (and has received the same answer from numerous posters, I am also going to copy a post a made on another forum that will clear up some of the misconceptions about the use of Paxlovid.

 

And if anyone was prescribed a "just in case" prescription of Paxlovid for a cruise, then they obviously have a personal physician who knows the patient well and can prescribe the drug without worrying about the potential problems associated with the drug.

 

The post is as follows:

 

There are many misconceptions about the use of Paxlovid.  My comments only apply to use in the USA as I have no knowledge of use in other countries.

 

Paxlovid for developed and tested against the original strains of covid and the Delta variant. At the time of the US FDA granting an EUA (not an approval, just limited use in an emergency), there was no data about effectiveness against the omicron variant or any other variants.

 

The use was only for those who had a positive Covid test AND was at risk for developing a severe case because of comorbidity that would lead to hospitalization and possibly death.

 

Here is the actual Paxolvid labeling as approved by the US FDA: 

 

https://www.fda.gov/media/155050/download

 

The labeling also includes some information about other antivirals  and links for information on those products.

 

 Notice all the  contraindications for use and the known drug interactions with other drugs. There is a reason why patients need to contact their personal physicians  who know their medical history before deciding that the patient fits under the indications for use.

 

Again, the drug is not an "approved" drug for marketing. It is available under a EUA with the restriction as in the labeling.

 

This leads to  reasons as to why the drug is not available on cruise ships and should not be expected to be available:

 

1. Fitness for travel.  All cruise lines have this caveat in there cruise contract. If a passenger is at risk for the development of severe disease that might lead to hospitalization or death, they should not be cruising and should not expect  a cruise line to be responsible for the intense care they may require.

 

2. The required familiarity with the patient's medical history that the use of Paxlovid requires before use. While the highly qualified medical personnel on board ship can take a history before prescribing any drug, there is the problem of accurate information being given by someone who is determined to obtain Paxlovid.  Again, read the indications for use and the contraindications in the labeling.

 

3. Cost. While the drug might be "free" in the US. It is not free as the US government has negotiated a price of $590 for each five day course of treatment that the US government pays for those available treatments in the US.  This may not be the price available to cruise lines (probably much higher) which means the ship would need to have in stock a very expensive drug that neither the crew or passengers should be qualified to use under the prescribing restrictions (see my first point on "Fitness to Travel).  Even if it was available for use on board, it would not be "free." The cost would be paid by the passenger.

 

4. To repeat again, Paxlovid is not an approved drug for general marketing in the US. It is only available for use under the conditions of the Emergency Use Authorization . For those arguing that "approved" drugs should be carried on board ship , Paxlovid is not an approved drug.  (I hope the horse is dead and no longer needs to be beaten). There is also the need, as explained in previous posts, for the ships to comply with the restrictions of their home country.

 

[cruzin4us]

37 minutes ago, Homosassa said:

1. Fitness for travel.  All cruise lines have this caveat in there cruise contract. If a passenger is at risk for the development of severe disease that might lead to hospitalization or death, they should not be cruising and should not expect  a cruise line to be responsible for the intense care they may require.

 

Exactly, 100%......

 

If risks are great due to your health.......DON'T CRUISE!    Simple Simon

[MustangGT]

1 hour ago, Homosassa said:

Because the same poster has posted this question on other forums (and has received the same answer from numerous posters, I am also going to copy a post a made on another forum that will clear up some of the misconceptions about the use of Paxlovid.

 

And if anyone was prescribed a "just in case" prescription of Paxlovid for a cruise, then they obviously have a personal physician who knows the patient well and can prescribe the drug without worrying about the potential problems associated with the drug.

 

The post is as follows:

 

There are many misconceptions about the use of Paxlovid.  My comments only apply to use in the USA as I have no knowledge of use in other countries.

 

Paxlovid for developed and tested against the original strains of covid and the Delta variant. At the time of the US FDA granting an EUA (not an approval, just limited use in an emergency), there was no data about effectiveness against the omicron variant or any other variants.

 

The use was only for those who had a positive Covid test AND was at risk for developing a severe case because of comorbidity that would lead to hospitalization and possibly death.

 

Here is the actual Paxolvid labeling as approved by the US FDA: 

 

https://www.fda.gov/media/155050/download

 

The labeling also includes some information about other antivirals  and links for information on those products.

 

 Notice all the  contraindications for use and the known drug interactions with other drugs. There is a reason why patients need to contact their personal physicians  who know their medical history before deciding that the patient fits under the indications for use.

 

Again, the drug is not an "approved" drug for marketing. It is available under a EUA with the restriction as in the labeling.

 

This leads to  reasons as to why the drug is not available on cruise ships and should not be expected to be available:

 

1. Fitness for travel.  All cruise lines have this caveat in there cruise contract. If a passenger is at risk for the development of severe disease that might lead to hospitalization or death, they should not be cruising and should not expect  a cruise line to be responsible for the intense care they may require.

 

2. The required familiarity with the patient's medical history that the use of Paxlovid requires before use. While the highly qualified medical personnel on board ship can take a history before prescribing any drug, there is the problem of accurate information being given by someone who is determined to obtain Paxlovid.  Again, read the indications for use and the contraindications in the labeling.

 

3. Cost. While the drug might be "free" in the US. It is not free as the US government has negotiated a price of $590 for each five day course of treatment that the US government pays for those available treatments in the US.  This may not be the price available to cruise lines (probably much higher) which means the ship would need to have in stock a very expensive drug that neither the crew or passengers should be qualified to use under the prescribing restrictions (see my first point on "Fitness to Travel).  Even if it was available for use on board, it would not be "free." The cost would be paid by the passenger.

 

4. To repeat again, Paxlovid is not an approved drug for general marketing in the US. It is only available for use under the conditions of the Emergency Use Authorization . For those arguing that "approved" drugs should be carried on board ship , Paxlovid is not an approved drug.  (I hope the horse is dead and no longer needs to be beaten). There is also the need, as explained in previous posts, for the ships to comply with the restrictions of their home country.

 

I ended up with Covid after our recent River cruise and although my symptoms were very mild ( no fever, cough or runny nose), I was prescribed Paxlovid.  Since the NP had access to all of my medical records, she noted that my EGFR was too low for the full doses and adjusted them accordingly.  My husband tested positive shortly after me and was advised of his drug interaction possibilities with Paxlovid.  He would have to go off of his diabetes, cholesterol and allergy meds.  Since his symptoms were as mild as mine, he decided to skip the Paxlovid.  We both had symptom improvement within 3-4 days on diagnosis and are now past all isolation and masking requirements.

Bottom line - I think there would be a great risk to having anyone prescribe Paxlovid without access to your full medical records.  Just my opinion.  I am not a medical professional nor do I play one on TV 🙂

[Mikel1733]

On 5/5/2022 at 5:29 PM, syesmar said:

Is this something a doctor prescribed “just in case”? I’ve been curious if this was even possible to have done in anticipation for travel.

Thanks!

We asked our Doctor for an RX just in case and he said no.

[Homosassa]

1 hour ago, MustangGT said:

 

Bottom line - I think there would be a great risk to having anyone prescribe Paxlovid without access to your full medical records.  Just my opinion.  I am not a medical professional nor do I play one on TV 🙂

Did you spend last night is a Holiday Inn Express?

[JF - retired RRT]

On 5/5/2022 at 2:42 PM, VibeGuy said:

I have heard *zero* reference to paxlovid being available despite the average Princess passenger being a prime candidate.  I think they’re relying on the low odds of a vaxxed/boosted passenger getting critically ill, rather than the proven value of oral antivirals in non-hospitalised patients. 
 

There’s now a course of Paxlovid in my luggage since my DH hasn’t had a breakthrough case (but I have) - it’s irresponsible of Princess not to be offering it because it does reduce the intensity of viral shedding about 90% and shortens the number of days a patient is shedding. 

Lucky you. I asked my MD for a Rx and he said NO.

[PrincessLuver]

7 minutes ago, JF - retired RRT said:

Lucky you. I asked my MD for a Rx and he said NO.

We met with our Primary MD yesterday and told him what we may encounter on a long cruise and he would not write a prescription for Paxlovid because he says it has serious side effects and he would not be comfortable with us self-administering on a long cruise?

[Steelers36]

5 hours ago, MustangGT said:

I am not a medical professional nor do I play one on TV 🙂

But you probably stayed at a Holiday Inn Express recently.

 

ETA:  Oh darn, I see another wise wag on here beat me to it!!

Edited May 14, 2022 by Steelers36

[generichandle]

10 hours ago, cruzin4us said:

 

Exactly, 100%......

 

If risks are great due to your health.......DON'T CRUISE!    Simple Simon

I know! I know! After nearly 2.5 years hiding I am getting stir crazy. Cruise after cruise I have canceled, with still 4 left to hope for. FCC is 'bye bye', over and over. 

 

I just need something to hope for. I am housebound by fear. And my Doctor says my fears are justified. Having been a nerd [geek, whatever] all my life I am really quite good at reading, online, streaming, cooking and of course gaming of various sorts. But 27 months is difficult. 

 

Next week I am going to Smoky Mountains and a drive up the Blue Ridge Parkway. At least I can pretty safely do outside in the mountains, huh? 

 

Still, if I was sure I would get high quality treatment onboard, I might risk it. 

 

*sigh*

 

Thanks for the comments;

 

Doug