What to know about side effects, rebound infections, etc.
Mina called Paxlovid’s 88% effectiveness against COVID-related hospitalizations and deaths an “astonishing metric.”
In a study of 2,085 unvaccinated adults with a pre-existing medical condition (or just older age), only 8, or 0.8%, were hospitalized with COVID or died from any cause compared to 66, or 6% , of those who took a placebo.
The good news is that it looks like Paxlovid is holding up in the real world.
A non-peer-reviewed study of nearly 94,000 elderly or immunocompromised COVID patients in Hong Kong published on May 17 found that those treated with Paxlovid had a 21% reduction in the risk of hospitalization.
Another non-peer-reviewed study published on June 1 found that Paxlovid was associated with a 67% and 81% drop in COVID-related hospitalizations and deaths, respectively, in people aged 65 and over. (But the benefits have not been seen in young adults.)
Although the drug has only been studied in unvaccinated people, there’s no reason to believe it won’t work as well in vaccinated people, Mina said.
“Vaccinated people who get a breakthrough infection are like anyone else who gets a viral infection,” Mina said. “Having a drug that will massively reduce viral replication will obviously reduce hospitalization and mortality in anyone infected, regardless of their vaccination status.”
Rebound infections may occur after Paxlovid
You may have heard that some people taking Paxlovid can get ‘rebound infections’, which is when people who complete their five-day course of Paxlovid test positive again around two to eight days later. have been tested negative.
Symptoms may not always return, but they certainly can, according to a CDC Health Advisory published on May 24.
Case reports so far show that rebound infections after taking Paxlovid are mild and tend to improve or resolve in about three days; none were serious. The CDC said there was no evidence to suggest further treatment is needed with Paxlovid or other available therapies.
Still, rebound infections may contribute to further spread of the coronavirus, although to what extent is unclear. Plus, they’re usually inconvenient, sending people back to self-isolation for the recommended five additional days plus 10 days of mask-wearing after rebound symptoms start.
There’s still a lot to learn about the reasons for the rebound infections, but Mina surmises that the Paxlovid treatment isn’t long enough to completely erase the virus from people’s systems.
“The drug could act as a crutch during your actual infection, so when you stop taking the drug, your immune system is taken by surprise like it’s a new infection all over the place,” Mina said. “If we left the drug on for a few more days, it might actually give the body enough time to kill all the virus.”
Dr. Albert Ko, Raj and Indra Nooyi Professor of Public Health at the Yale School of Public Health, told BuzzFeed News that it’s possible a virus reservoir somewhere in the body remains untouched by Paxlovid and is causing resurgence. symptoms and/or positive test results a few days after the end of treatment. This theory may be more likely in people who naturally have higher viral loads to begin with.
Mina said it’s likely health officials will consider extending the duration of Paxlovid therapy to 8 or 10 days.
The CDC said “a brief return of symptoms may be part of the natural history” of coronavirus infection in some people, regardless of treatment with Paxlovid.
Omicron may also be to blame, Mina said. Omicron is more infectious and immune than Delta, so your immune system may have a harder time working with Paxlovid to rid you of COVID.
People are also experiencing symptoms from Omicron earlier than past variants, Mina said, which means they are also starting Paxlovid treatment earlier in their infection. It is therefore possible that we do not allow enough time for our immune system to develop a robust response to treatment.
The CDC, along with Mina and Ko, still recommend Paxlovid for non-hospitalized people at high risk for severe COVID.
How does Paxlovid compare to other COVID treatments?
A number of treatments exist for COVID, but whether one is better than the other depends on the patient’s medical needs and history, the availability of treatments, and the variants that are spreading in a given area.
What is clear, however, is that Paxlovid has become the therapy of choice for many people.
The National Institutes of Health COVID treatment guidelines state that Paxlovid is the treatment of choice for non-hospitalized patients. The next is remdesivir (brand name Veklury), which is administered intravenously and has been shown to be 87% effective against COVID-related hospitalizations and deaths in non-hospitalized patients at high risk of severe disease. Remdesivir can also be used in hospitalized patients.
Another treatment is bebtelovimab, a new monoclonal antibody, which can be given to outpatients if Paxlovid or remdesivir are unavailable or unsafe for the patient. There are no efficacy data for bebtelovimab yet, but the NIH has said it is “active” against all Omicron subvariants in the laboratory.
While you can also take Lagevrio, the other new antiviral pill, studies show it’s only about 30% effective against COVID-related hospitalizations and deaths, so it should be used as a last resort.
How to get Paxlovid
The Biden administration has launched a Test to Treat Initiative on March 8 that allows people to get tested for COVID at a pharmacy clinic, government health center, or long-term care facility and immediately get antivirals like Paxlovid if they test positive.
People are only allowed to receive Lagevrio and Paxlovid through participating clinics, which are free whether or not you have insurance.
here you can find locations near you which are part of the Test to Treat initiative.
You can also consult your doctor (if you have one) who can prescribe Paxlovid, which you can get at a local pharmacy.
If you take a rapid COVID test at home and it comes back positive, you can get a free telemedicine visit through eMed, Mina said, during which a medical professional can prescribe the treatment. (You must purchase a rapid test from eMed first, though – the rest is free.)
Not long ago, supplies from Paxlovid couldn’t keep up with demand in the United States, but Pfizer officials have ramped up production in recent weeks. The initial scarcity prevented many doctors from prescribing the drug, Mina said, because there was a lack of information about its use that came with it. “It just led to this massive misunderstanding of this really powerful drug for months,” he said.
The number of prescriptions for Paxlovid rose from around 64,000 each week in late April to around 184,000 per week in late May, a health and social services spokesperson told BuzzFeed News via email.
Around 300 Test to Treat sites have also been added since early May, with a total of around 2,600, which is expected to increase, the spokesperson said.
Can Paxlovid reduce the likelihood of developing long COVID?
Although no data has been collected on whether Palovid can reduce your chances of developing long COVID, Mina and Ko agree that we should expect it can and will.
“We have to anticipate that early aggressive treatment to crush the viral load and kill the virus before it really takes hold of you should absolutely reduce the long symptoms of COVID,” Mina said. “Just keeping the viral load at a very low number, that alone should really lead to a better outcome in terms of reduced likelihood of long COVID.”
Ko admits we don’t yet understand the mechanism behind why some people develop long COVID, but knowing the associations between the condition and viral load, “it’s very plausible” Paxlovid can help on that front.
Does Paxlovid work against different variants of COVID?
The clinical test that determined the effectiveness of Paxlovid was conducted between July and early December, before the more infectious variant of Omicron dominated the pandemic in the United States. This means that what we know of Paxlovid’s virus-fighting abilities is based on infections with the Delta variant now defunct.
But the fact is that all variants are and will be sensitive to the drug, Mina said. This is because it targets a different part of the coronavirus which, at least as far as Omicron is concerned, is unaffected by mutations.
“It’s so easy to get caught up in the noise and hear all the negative things, but ultimately the test results weren’t wrong,” Mina said. “People still have their lives saved by Paxlovid.”
That doesn’t mean, however, that future variants can’t develop resistance to the drug, Mina and Ko said, though the CDC noted there’s no evidence that’s happening.