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Comment by burkaman | Hacker News Reader

No we haven't, and ADHD is disabling for many people in a meaningful way. The criteria here is that a doctor says it is permanent and it "limits one or more aspects of their daily life".

It is also supposed to be a "severe" limitation, but I doubt someone with ADHD would be interrogated about this, everyone involved just wants more people to visit the parks.

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I think the implication of the parent poster is that it's difficult to imagine why ADHD could put you at increased COVID risk to the point of needing Paxlovid. That makes no sense to me but I'm all ears as to the logic here.

ADHD makes it more difficult to support yourself independently, live a "normal life" and keep a steady income - so for pretty much the same reasons as most of the other disabilities.

Again, I see 0 relation between this and Paxlovid. There are about a million things that make it difficult to support yourself: being newly divorced is a huge hardship, as is being newly laid off, as is not having health insurance in the US (see today's stories about Mary Lou Retton needing to crowdfund for her medical care on GoFundMe).

Point being, if that's the bar, they should get rid of the nonsense requirement of needing a "disability" to get Paxlovid. Otherwise they should restrict it to disabilities that actually have a medically demonstrated increased risk of severe illness or death from COVID.

Stubbing your toe makes it harder to walk up stairs, but we still build ramps and elevators for people in wheelchairs.

This is just an American with ADHD who emigrated to Canada speaking but... yea, why don't we lower the bar and remove that nonsense requirement. It'd be great if everyone who needed help could get it in a reasonable manner. Maybe you have severe mobility issues and need physical assistance showering and doing daily hygiene tasks - maybe you're a neurotypical person who just lost a family member, went through a rough divorce and was diagnosed with cancer all in the same week. It'd be great if there was social assistance to help you out - especially if you weren't shamed for using them.

But, specifically on the topic of Paxlovid, ADHD people tend to have less stable, shorter and poorer lives - there is a strong correlation between the illness and the need for financial assistance. ADHD people tend to also be less proactive about health issues and delay treatment more than normal people (because going to the doctor is hard and there are so many considerations) so perhaps the Paxlovid allowance is because people with ADHD are more likely to have more advanced COVID cases - I can't tell you why they made that decision but those are two pretty solid reasons to consider it.

> There are about a million things that make it difficult to support yourself: being newly divorced is a huge hardship, as is being newly laid off, as is not having health insurance in the US (see today's stories about Mary Lou Retton needing to crowdfund for her medical care on GoFundMe).

Don't disagree with any of these also being very significant, personally I wouldn't mind if these folks also got the pax. But

a. these aren't considered "permanent" in the general sense (you can get rehired/remarried), and b. permanent disabilities are much "easier" for a govt to classify than to spend resources everytime someone needed assistance

And > Otherwise they should restrict it to disabilities that actually have a medically demonstrated increased risk of severe illness or death from COVID.

ADHD does have a medically increased risk of severe illness or death from COVID. Perhaps not "directly" like someone on immunosuppressants, but as someone w/ adhd and another chronic health condition (T1 diabetes), adhd makes it several times more difficult to handle my health (and T1D has life threatening complications within arm's reach of poor management).

As someone with ADHD I can't imagine that I would've made it to 25 without severely screwing up my T1D care - that requires pretty constant vigilance and, well, there's a reason I voluntarily don't drive.

I wonder if it's ADHD or just the side effects of continual stimulant usage that causes worst COVID outcomes. Stimulants can be hell on a lot of bodily system functions.

Stimulants at therapeutic (pharmaceutical) doses aren't as terrible on the body as one might expect. Especially when you compare it with something like cocaine (which does funky stuff to the heart/Calcium channels) or recreational doses (several times the avg/median prescribed dose). They can and often do have side effects etc, but Jeff blowing coke at a party is much more likely to have a problem.

I agree with you. But T1 diabetes is something which should suffice for Paxlovid.

BTW if you haven't checked out OpenAPS, I highly recommend it based on friends who have used it. It greatly reduces the self-discipline needed for T1 diabetes maintenance.

> OpenAPS

Thanks, I've been wanting to get on a pump forever. Hopefully it'll be sooner than later. I'm 99% sure I'll use a looping system (either Tandem's or one of the DIY ones), heard a lot of good stuff about them.

As a person with ADHD, I was about to argue that ADHD is not something that would, absent other health issues, qualify someone for something like Paxlovid.

But your argument completely 180'd me. I've got a lifetime of tools to deal with my ADHD, but me from 10 years ago absolutely would have gotten COVID and not taken it seriously (item 12435346 on the list of shit I'd not be tracking well), which is precisely the kind of additional risk Paxlovid was made for.

I heard on a podcast that ADHD can sometimes reduce life expectancy by 13 years. Compared to obesity, which reduces lifespan by 10 years, and type I diabetes, which reduces lifespan by 3-4 years, it's a real disability that needs to be taken much more seriously than it currently is, IMO.

Without looking it up, I can imagine the cognitive effects of Covid might be more severe for someone with ADHD. After looking it up, it seems there is some association between ADHD and worse outcomes: https://journals.sagepub.com/doi/full/10.1177/10870547211003....

It's also possible that ADHD makes it more difficult to scrupulously comply with self-quarantine measures, in which case it's a good public health decision to make Paxlovid available and reduce community spread. I'm not actually sure if Paxlovid reduces transmission though.

Thanks very much, that's the kind of medically appropriate implication I was looking for: "Conclusion: ADHD is associated with poorer outcomes in COVID-19 infection."

I'm sure that ADHD is comorbid with a variety of lifestyle and health problems that make COVID somewhat worse. But in general it does not directly affect health. Why not simply provide it to those with the comorbidities?

I consider community spread mostly a nonissue. We've known for many decades that if you can't get the replication rate below 1, the correlation between replication rate and how many get it is chaotic. We can't get the replication rate of COVID below 1, so there is little correlation between policies and outcomes. Obviously this does not apply if you are at risk or a caregiver of someone at risk. That's why saner countries than the USA (Germany is my favorite example) do not recommend vaccination against COVID for the general public.

> Why not simply provide it to those with the comorbidities?

I don't know, I would guess because they're harder to define and doctors generally diagnose conditions rather than individual symptoms or behaviors.

> Require close contact with those who may be infected, such as a caregiver or family member

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