Paxlovid onboard - a factor in cruise choice?

[Honolulu Blue]

I was inspired by a member a couple of weeks who posted that they were offered Paxlovid onboard.  Here's their post: 

 

I should stress that this is the only post I've seen that mentioned the availability of Paxlovid for a customer on a cruise ship.  But since the U.S. federal government is trying to scale up availability, there's a chance that it could be available for cruise lines in the future.

 

I'd like to turn the question over to you - is the availability of Paxlovid onboard an incentive for you to choose one cruise line or ship over another?  The poll has three options - Yes unconditionally, Yes only if available for free, and No.

 

Thank you for your interest in this topic.

[Wendy-Europe]

Since Paxlovid is treated by some here as if it were an over-the-counter drug, I plead for these users to read again the indication - but also the side effects. And read very carefully what contraindications there are. There are good reasons why paxlovide should only be prescribed after careful review of the medical record. In particular, the partial component ritonavir blocks important degradation processes in the liver. Therefore, experts suspect interactions with numerous drugs during the treatment period. Also, paxlovid should not be taken in cases of severe liver and kidney disorders.

 

Interactions are suspected with certain:

    Prostate medications (eg: alfuzosin).
    heart medications (eg: amiodarone, bepridil, dronedarone, propafenone, etc.)
    cholesterol-lowering drugs (e.g.: lovastatin, simvastatin, lomitapide, etc.)
    antihistamines (e.g., astemizole, terfenadine, etc.)
    gout medications (e.g. colchicine)
    erectile dysfunction medications (sildenafil, avanafil, vardenafil, etc.)
    cancer drugs (e.g.: neratinib, venetoclax, etc.)
    antibiotics (e.g.: fusidic acid, etc.)
    Painkillers, sedatives and migraine medications (eg: pethidine, diazepam, midazolam, dihydroergotamine, etc.)
    Neuroleptics and antipsychotics (e.g.: lurasidone, pimozide, clozapine, etc.) and many more.

 

This list includes only some of the drugs that may interact with each other. The topic of drug interactions is therefore an important part of the medical consultation prior to a possible Paxlovid treatment.

 

A physician in an onboard hospital does not have the information about a patient that one's primary care physician has and cannot assess whether the use is appropriate.

 

 

[Flatbush Flyer]

Paxlovid can help but, recent indications are that some patients will experience Covid “bounce back.” NOT good!

[mom says]

This drug is not and should not be available just for the asking. Being Covid positive is not , in and of itself, a reason for prescribing it. There are specific parameters for its proper prescription, and the list of contraindications is long. I've already had this discussion with our Primary physician, and she determined that, barring a change for the worse in my medical condition, I wouldn't be a candidate under the current prescribing parameters. So, no, it's availability  on a ship would make no difference to me.

[cruiseryyc]

Geez if you're so worried about treating Covid onboard, why are you cruising at all?

[klfrodo]

Not only No, but hill no.

[jsn55]

Unless they travel with a complete medical history, anyone who would take a serious drug given out on a cruise ship should have their head examined.  My doc and I were just discussing the plethora of drug advertising and how patients are coming in demanding a certain drug for their problem ... because they saw it on TV.  Today's drugs are powerful with a laundry list of side affects.  Absolutely nuts to not take them seriously.

Edited May 31, 2022 by jsn55
clarify

[ontheweb]

And would everyone with a case of the sniffles be asking for this drug. Add me to the "Hell No" category.

[leaveitallbehind]

I'm surprised this is even a legitimate topic for a poll!

Edited May 31, 2022 by leaveitallbehind

[ldubs]

14 hours ago, Flatbush Flyer said:

Paxlovid can help but, recent indications are that some patients will experience Covid “bounce back.” NOT good!

 

That exact thing just happened to a good friend of ours.  I'm not sure what % of patients would experience this, but hope it is low.   

[ldubs]

10 hours ago, jsn55 said:

Unless they travel with a complete medical history, anyone who would take a serious drug given out on a cruise ship should have their head examined.  My doc and I were just discussing the plethora of drug advertising and how patients are coming in demanding a certain drug for their problem ... because they saw it on TV.  Today's drugs are powerful with a laundry list of side affects.  Absolutely nuts to not take them seriously.

 

You bring up a good point about medical histories. With current technology, everyone should have their complete medical history available  -  accessible online of course.  

 

Regarding the poll, I would be very hesitant to ask for or accept paxlovid on a cruise ship.  But then, I'm not among those where it might be indicated.  So,  it is a NO for me. 

[Flatbush Flyer]

1 hour ago, ldubs said:

 

You bring up a good point about medical histories. With current technology, everyone should have their complete medical history available  -  accessible online of course.  

For the most part (over the years), I have worked hard to center my health care at the University of California San Francisco. UCSF uses MyChart for patient medical records. It is the most widely used medical records system in the US and is accessible to any bona fide health care provider at your choice (and via your online action) anywhere in the world with internet connectivity.  You can even have old records (or those from other providers who use a different system) scanned into MyChart  at UCSF. In fact, if I encounter a need for a non-UCSF provider/facility, one of the first questions I ask (beyond Medicare assignment)  is whether they use MyChart.

Nonetheless, I have also, for many years, maintained an abbreviated personal medical summary (incl Hx, Dx, Rx) which I carry on a USB thumb drive and as a hard copy when traveling. 

[GeezerCouple]

And for any new med that we don't already keep with us, we'd email (or call if more urgent) our physician to ask before starting any new med, unless it's truly an emergency.  In that latter case, the current emergency medical team will make any such decisions, but with some oversight/input from the other one of us, in case there's anything special they should be aware of, etc.

 

We travel with our regular meds (obviously) and also with some "just in case" meds recommended by our physician (or the travel clinic depending upon where we are going).

 

And we keep lots of records and copies of Rx paper scripts, etc., in the cloud in case the information is ever needed. (And hard copies as well.)

 

GC

Edited June 1, 2022 by GeezerCouple

[ldubs]

14 hours ago, Flatbush Flyer said:

For the most part (over the years), I have worked hard to center my health care at the University of California San Francisco. UCSF uses MyChart for patient medical records. It is the most widely used medical records system in the US and is accessible to any bona fide health care provider at your choice (and via your online action) anywhere in the world with internet connectivity.  You can even have old records (or those from other providers who use a different system) scanned into MyChart  at UCSF. In fact, if I encounter a need for a non-UCSF provider/facility, one of the first questions I ask (beyond Medicare assignment)  is whether they use MyChart.

Nonetheless, I have also, for many years, maintained an abbreviated personal medical summary (incl Hx, Dx, Rx) which I carry on a USB thumb drive and as a hard copy when traveling. 

 

When you mentioned MyChart in another thread some time ago, I logged on to my health portal and found to my surprise it was set up for MyChart.  

[jsn55]

We have chosen medical professionals all affiliated with the same large hospital about 30 minutes from our home.  Having everything available electronically is a great theory ... but MyChart is only as good as the input.  For all the basic stuff it's fine, but start getting into some serious health challenges and MyChart cannot be relied on.  The oddest things appear on MyChart ... my husband's RN in his oncology office is listed as one of my doctors.  As life gets more complicated medically, it's vital to keep your own records ... in a configuration that makes sense and is easily accessed.

[Elaine5715]

There was recently a huge media story about a prominent person who had minor symptoms and was given Paxlovid as a treatment increasing the demand

[Wendy-Europe]

Apparently, doctors in Germany are much more reluctant to prescribe paxlovid: only 9000 prescriptions have been registered since april, even if Paxlovid is manufactured in Freiburg/Germany for the world market, according to a report by the reputable Tagesschau from 1 week ago. Doctors here prescribe (hopefully) what makes sense, not necessarily what the patient wants.

[Honolulu Blue]

Here's an article about an Israeli study on Paxlovid:  https://www.reuters.com/business/healthcare-pharmaceuticals/pfizers-paxlovid-reduces-covid-risk-seniors-regardless-vaccine-status-study-2022-06-02/

 

TL,DR:  The best summary is a quote from the first two paragraphs:

 

JERUSALEM, June 2 (Reuters) - Pfizer Inc's (PFE.N) antiviral treatment Paxlovid reduces COVID-19 hospitalization and death rates in vaccinated and unvaccinated patients 65 years and older, according to a new study in Israel conducted during the rise of the Omicron variant of the coronavirus.

 

The treatment, however, was not found to prevent severe illness among younger adults, according to research from Clalit Health Services, Israel's largest healthcare provider.

[capriccio]

Here is some more recent information about taking Paxlovid.  It is possible to have a Covid 'rebound' (recurrence) during which you are contagious once again (and may not realize it).  https://www.cnn.com/2022/05/31/health/paxlovid-rebound-contagious-study-wellness/index.html

[cruisingguy007]

For the sniffles and a headache? Hell no. Most would be better off without it and letting your immune system do its thing. This drug may extend infection time and is no covid panacea, though many believe it to be. Sure makes bank for Pfizer though. 

Edited June 3, 2022 by cruisingguy007

[jsn55]

5 hours ago, cruisingguy007 said:

For the sniffles and a headache? Hell no. Most would be better off without it and letting your immune system do its thing. This drug may extend infection time and is no covid panacea, though many believe it to be. Sure makes bank for Pfizer though. 

"Sure makes bank for Pfizer" ... and of course that's the whole point.

[richmke]

Paxlovid was discussed for my wife on the Majestic. Princess would charge ~$700 for it. So it seems available. Given that Princess says they cover all the charges relating to treating covid, the price should be free anyway.

In reading about it, rebound is an issue, but so far it is not materially different from the control group (control group had rebound at a similar rate).

If you are unvaccinated, it is a no-brainer. The main goal is to avoid the hospital, and even if you rebound, the rebound is even less likely to end you up in the hospital.

Less clear for vaccinated people.  Given the long-term effects of COVID, I'd go for the Paxlovid even with the rebound to minimize the worst risks of COVID.

Edited June 7, 2022 by richmke

[Mary229]

I am always stunned by those who think the cruise line has some heightened responsibility for travelers.  It seems to me this is something that should be discussed with your personal physician prior to traveling and if she feels it is beneficial she can prescribe a dose.  We do this with malaria pills why not with Covid. 

[Elaine5715]

45 minutes ago, Mary229 said:

I am always stunned by those who think the cruise line has some heightened responsibility for travelers.  It seems to me this is something that should be discussed with your personal physician prior to traveling and if she feels it is beneficial she can prescribe a dose.  We do this with malaria pills why not with Covid. 

There have been questions if the infirmaries carry the reversal agents for the brand name blood thinner and why don't they, they should, etc.  They don't because some of the agents cost $25,000.  If you think you may need a specific medication, you need to have it.

[Kate-in-Canada]

Totally.  As a cancer survivor who got Covid shortly after finishing treatment, I was prescribed paxlovid, and the difference it made was huge.  My lungs were filling fluid quickly, but 12 hours after starting pax, started clearing again, and the remainder of my Covid illness was easy.

 

I didn’t have any rebound either.  
 

my medical history makes it a bit risky to travel, but I also don’t feel like I beat a deadly disease to stay home forever.  But I would absolutely feel better knowing if I got Covid again, paxlovid was available for those people for whom it is designed for and safe for.