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A Couple Of Covid Treatment and Detection Questions


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Just cruised on Celebrity Equinox 5/6 - 5/15. Our friends traveling with us both tested positive on days 4 and 5 respectively. The husband (a high risk person), after I urged him to do so, queried the ship's doctor on the availability of Paxlovid (an antiviral medication considered effective if taken within 72h of symptom onset). The answer was a simple "no". Ships' he was told, identify the illness, evaluate severity over the course of the illness/cruise (and Equinox's medical staff was very thorough in that regard) and act accordingly based on that (immediate transport to a shore based hospital if required treatment exceed what's available on the ship is an option)

The general approach by the medical community is that due to limited availability of the drug and questions about it's efficacy in the clinical setting (as opposed to lab testing of the drug done by Pfizer), the drug is being reserved for hospitalized patients and after that those hospitalized patients that are high risk for serious COVID complications.

On the sewer testing. I've read that the CDC may be doing this selectively aboard cruise ships but it is not a protocol being widely pursued. Why not? First, it's purpose to identify community presence as early as possible and prevent outbreaks. Second, a recognized alternative to sewer testing for the presence of COVID viruses which can be complicated is lots of AG testing followed by confirmatory NAAT (PCR) or PCR testing. The cruise lines are very heavily invested in this. That approach fits perfectly in the congregate setting that cruise ships offer. Guests do-pre cruise testing and they are encouraged to get tested at no charge on board if they develop COVID symptoms. Vaccinated crew members, upon joining ship's company, are quarantined for 7d, tested on day 7 and all crew are tested at 7d intervals and also encouraged to report COVID or flu like symptoms. 

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23 hours ago, JeffB said:

 

The general approach by the medical community is that due to limited availability of the drug and questions about it's efficacy in the clinical setting (as opposed to lab testing of the drug done by Pfizer), the drug is being reserved for hospitalized patients and after that those hospitalized patients that are high risk for serious COVID complications.

 

My sister in law, 40 yr old, no underlying health concerns was just prescribed this drug in NY.  Though she does not live in NYC, NYC has been running commercials advocating for people to go get antivirals went they test positive. No mention is made of underlying conditions.

 

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Not to forget, Paxlovid is especially recommended in ambulatory setting.

For hospitalized patients, there are various more options, depending on the status.

@JeffBwas the person vaccinated - if so, a mild course could have been anticipated by the ships' medical staff...

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My experience with medical practitioners I speak with is that there is wide variance by community practices throughout the US on prescribing Paxlovid. Here in Broward County, FL up until about a month ago, there were multiple test and treat clinics. If you were tested COVID positive at the clinic, you could get an RX if you meet the criteria for dispensing it; in some cases where a clinic had an adjoining pharmacy, dispensing was immediate.  Those have declined with declining availability of Paxlovid along with questions among this community's practitioners about it's efficacy in ambulatory patients in other than high risk COVID patients headed for hospital admission with an antiviral potentially preventing that.

During our Celebrity Equinox cruise, both our friends who tested positive and ultimately developed mild symptoms (husband over 80 infected first, symptomatically recovered after day 7) both were fully vaccinated. The husband was closely monitored by the ship's doctor after he was placed in an isolation cabin. Visited every day for the first 3d,  measured pulse O2 and listened to his lungs on exam. IMO, there is no question his vax status prevented serious illness. His symptoms amounted to a runny nose, dry cough and noticeable fatigue. HIs wife (70) developed the exact same symptoms after debarkation and now at home. She felt improved on day 4 from her first positive test on board (she was ID'ed as a close contact, tested immediately in her cabin but it took over 6h for her to get her NAAT results. She had been given the option to isolate with her husband or in her cabin. She chose the later.

IMO, care from onboard medical staff was excellent but that was delivered by one MD and a few RN types (although they are foreigners with different training and licensing from US). All the testing and isolation management is done by a contractor with medical and guest services in a supporting role. I wasn't impressed. I do not know how many NAAT test machines the contractor had onboard but that it took 6h for our friend (the wife) to be resulted after being swabbed suggests they did not have enough NAAT testing machines to quickly test all guests that required it - either by close contact or presenting to medical with symptoms.

The other problem was debarkation confusion. Both our friends were told they would be escorted to a lounge area then guided to a separate debarkation area at 7am. There was a lot of confusion in doing that. The husband and wife, in different cabins, were supposed to be escorted to the Passport Lounge and then processed off the ship early. The husband wasn't escorted until after 8am and deposited at the Passport Lounge which is fully open to the main Foyer of the ship. By around 8am with regular debarkation in full swing the wife still hadn't been escorted off - I actually did the escorting to get her to the designated area around 8am where there were probably 6 other pissed off people, presumably positive, waiting to be escorted off the ship. Her husband was already off the ship. She and her husband were finally joined up after a lot of confusion about where she was. The testing and management contractor's plan was to Uber them at Celebrity's expense to the airport; that was the only option for them. They live in Stuart FL and had parked their car at our house in Coconut Creek. The Uber driver said he could take them both to our house at their expense instead of going to the airport. They elected to do that. When we debarked you could look down the gangway and see all the limos and Ubers lined up. I'd estimate there were more than 10 of them.

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It seems that such drug's presenceIt seems that such drug's presence on the ship doesn't matter. As practice shows, company owners will gladly take you off without providing treatment. Otherwise, all the covid patients would run on cruises so that it would not be possible to keep up with them, haha. Although, I can be overly critical. For me, any organization that claims to provide medical services outside of full-fledged clinics is a hack. It's the same as sending your child to the school infirmary instead of a pediatric clinic with certified staff. Therefore, if you want to get a treat for Covid, be prepared that treatment will only be your concern. on the ship doesn't matter.

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