Feedback: Only you can prevent the next pandemic


Editor’s note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The opinions expressed in this comment are his own. See more reviews on CNN.



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Opponents of American residents, who are active in the Covid-19 pandemic, it seems that doctors have missed the boat again. Just as we’ve reached a quieter moment in the pandemic (or maybe not as winter approaches), a review paper in a medical journal says that Paxlovid, an antiviral that prevents serious outcomes in people over 65, has dangerous interactions with other medications. .

The authors, a leading group of specialists, have inspired a series of articles in the mainstream press warning of the problems posed by taking Paxlovid at the same time as a long list of heart disease or blood clotting drugs.

But the problems with the Paxlovids are anything but new. In fact, the authors cite one of the many articles available since December (when the drug received emergency approval) detailing these very interactions. (Guidelines for interactions came from Pfizer, the US Food and Drug Administration, the National Institutes of Health, the US Centers for Disease Control and Prevention, and other experts).

In these documents, drugs are grouped into well-defined categories: drugs that do not have significant interactions with Paxlovid, drugs that cannot be given with Paxlovid because of interactions, and drugs that can be closely adjusted and monitored but still given with Paxlovid. I have often forwarded these facts to people who have started treatment with Paxlovid and found them to be among the most useful information generated during the pandemic.

The cause for concern is quite real: Those who benefit most from Paxlovid – older adults – are the same people who frequently take heart and blood-thinning drugs. When I took Paxlovid in April, I knew it was stopping a heart medication that prevents me from going into atrial fibrillation, a common heart rhythm disturbance. But off the pace-soothing drug, I immediately fell into an unpleasant and potentially dangerous abnormal rhythm – just another example of the never-ending lunch MO that clouds all medical progress. When my heart medication was restarted post-Paxlovid (as recommended), my heart rate returned to its normal rate.

What is troubling, at least to me, is the tone of some of the news stories suggesting that the problem is new and has somehow been overlooked until now, rather than a “Topic of the Week Review” as the medical journal classifies it. In medical journal parlance, a “review” refers to a summary of existing work, synthesized into a highly readable form. It’s certainly nothing new or edgy.

However, the bottom line seems to be that the experts have somehow unwittingly exposed the world to another of their mistakes: more rigid and careless surveillance. That view seems to overstate criticism of the pandemic response. The conventional wisdom seems to have been blown by the CDC, that perhaps all these promoters were an overreaction and that children were needlessly harmed by the lockdowns.

The assessment of the pandemic is that we were blindsided by an unprecedented disaster, an imperfect, politically poisoned but ultimately effective set of interventions that saved millions of lives. It is uncertain whether we will maintain some control over the pandemic.

This is not a simple scam. Rather, the endless “should do this, not that” opinions could have a long-term detrimental effect as the Covid-19 pandemic begins to take its toll on history. Right now, some seem to insist that public health officials are dimwitted bozos. This approach, if embedded in the history of the Covid-19 experience, will become problematic when the next pandemic presents itself and sends future experts to study the lessons of the great Covid-19 pandemic of 2020-2022.

That rush for the history books is what many of today’s experts did in the early days of Covid-19, trying to learn the lessons, if any, from the 1918 flu pandemic. They found that contemporary articles and historical reviews told more or less the same story: that the tools of the day, including only masks and other pharmaceutical interventions, were recognized to be effective, but that these steps were equally unpopular and therefore only half-used, their effectiveness endangering

We’ve seen reactions like this during the Covid-19 pandemic, as guidelines changed in response to new events or strong public criticism, making the CDC and others look like disoriented sticks in the mud.

Then as now, people hated the rules, the rule makers, and those who would try to implement simple common sense measures designed to minimize disaster. In 1918 and again in the Covid-19 pandemic, the needs for creature comforts were too strong to reason. Effective medications like Paxlovid can make management much easier, but they can never deal with the underlying problem.

So to those reading this in the 22nd century, hoping to find a way to convince your friends to act socially responsible while Covid-63 tears through your warm resin bunkers and stupid ocean houses, we say: Yes. , there is well-established evidence of what to do, but learning about it won’t help.

Rather, our collective message is based on one of the most effective and non-malicious public health messages to date: Only you can prevent the next pandemic.