Correspondence letter regarding ‘Is standby therapy for Covid-19 a practical option for travellers?’
Bibliographic record
Abstract
I have read with interest the perspective piece by Chen and Connor1 regarding the use of standby therapy for COVID-19 amongst travellers. Vaccination, including regular booster doses, will certainly remain the principal preventive measure to mitigate the risk of serious COVID-19 illness and complications amongst international travellers for the foreseeable future.2 Nevertheless, recent guidelines published by the Canadian Committee to Advise on Tropical Medicine and Travel for the Public Health Agency of Canada (available at https://www.canada.ca/en/public-health/services/catmat/statement-covid-19-international-travel.html) also recommend provision of standby treatment in certain cases. Rapid testing kits are widely available, and offered for free or low cost in many jurisdictions. There is widespread familiarity with their use, although testing proficiency amongst the general public has not been well studied. Informal surveys by colleagues confirm that nirmatrelvir–ritonavir remains difficult to obtain in many countries. In Canada, and perhaps elsewhere, there remains a problem with legal prescription of this medication for this indication. Although there appear to be no issues related to sufficient supply, distribution of nirmatrelvir–ritonavir remains under the control of provincial governments, using a federal government stockpile, rather than the usual wholesale pharmaceutical system. Provincial criteria for distribution by pharmacies include the need for a positive test for SARS-CoV-2, and there are currently no provisions for retail sales outside the government system. In other words, even for someone willing to pay for their prescription, which costs hundreds of dollars per course when purchased by governments, the medication remains unavailable to travellers who are not currently infected. Travel medicine providers should consider lobbying their local regulatory authorities, as well as insurance agencies, to raise awareness of this paradoxical situation. The author had no financial support for this manuscript. The author is the chair of the Committee to Advise on Tropical Medicine and Travel for the Public Health Agency of Canada. However, this correspondence represents his personal opinion alone, and does not represent the position of the Public Health Agency of Canada or Health Canada.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.015 | 0.013 |
| Insufficient payload (model declined to judge) | 0.042 | 0.020 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".