Antiviral Pills Offer Hope Against COVID-19
When the SARS-CoV-2 virus began to ravage the nation nearly two years ago, our primary care doctors in Delray Beach were as frustrated as the rest of the medical community. We had no vaccines, no tests to find out who had COVID-19, and no reliable treatments available.
Now, however, we have safe, effective vaccines. Nearly 60% of Americans have received the vaccination against the coronavirus.
Rapid at-home test kits, while still in short supply, are becoming more available for a relatively low cost.
And now we have several treatments that can shorten the symptoms and duration of the infection in most people.
Science marches on
First, there are the monoclonal antibodies that help the body mount an effective defense against COVID-19. Dr. Anthony Fauci said preliminary research shows the drug cocktail can reduce the risk of hospitalization or death by 70-85%.
And the intravenous application of the antiviral drug remdesivir has also been effective in many cases with those who are in the hospital.
And now scientists developed two new pills that can keep those who contract the virus from ending up in the hospital. While not yet approved, they offer another weapon in the battle against the novel coronavirus. You can take the new antiviral COVID-19 pills at home, whereas monoclonal antibodies and remdesivir require a clinical setting.
New antiviral COVID-19 pills
Merck developed one drug, molnupiravir. It is already under review by the U.S. Food and Drug Administration (FDA). Clinical trials showed it reduced the risk of hospitalizations by about 50% and entirely prevented deaths.
Pfizer’s drug, Paxlovid, works slightly differently, and its trials showed it cut the risk of hospitalizations and deaths by 89%. Pfizer requested FDA emergency authorization for Paxlovid on Nov. 16.
Both work by interrupting the replication of the virus in the body, but by slightly different mechanisms.
“It makes the landscape a lot more promising because what these antivirals represent is more evidence of the ability to tame the virus,” Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, told CNN. “It gives us a big toolbox, makes it a more treatable infection. It brings it down from the level of being a five-alarm fire.”
Not a substitute
Many experts worry that, when these drugs have approval, people will see them as an alternative to vaccines.
“There’s a group of people who are really vaccine averse,” Dr. William Schaffner, professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, told CNN. “They’ll say to themselves, ‘Oh, I don’t like the vaccine but in case I get sick, I can get treated.’ They may have too many expectations of this treatment.”
They cannot replace vaccines, for several reasons.
First, these drugs are even newer than the vaccines administered to millions of people worldwide with relatively few safety issues.
Antivirals have proven safe and effective in clinical trials but scientists still may discover side effects. For this reason, at least at first, they may not be available to those who are pregnant or have kidney or liver disease, experts believe.
Second, the effectiveness of the drugs depends on the infection timeline of the person taking the drug.
Like Tamiflu and other antivirals for influenza, Pfizer’s Paxlovid must be taken within three to five days of the onset of symptoms to be effective. Merck’s molnupiravir must be taken within five days.
Therefore, those who will see the best results from these drugs must know early on if they have COVID-19. That means they have to notice the oncoming symptoms and immediately get a test.
“That’s not just human nature,” Kelly Wroblewski, director of infectious disease programs for the Association of Public Health Laboratories, told Kaiser Health News. “If you have a sniffle, you wait to see if it gets worse.”
There’s also the question of supply, even once the drugs have approval. Pfizer plans to manufacture 50 million doses in 2022, and Merck plans to make 10 million doses next year. That’s still millions short of the expected demand for these antiviral COVID-19 pills.
Not getting a COVID-19 infection is better
Finally, although these drugs reduce the risk of hospitalization by 50-89%, that still means a certain percentage of those who have COVID-19 will still be in the hospital, and some of them will die.
Also, recent studies have found that at least half of those who become infected with COVID-19 will have at least some lingering symptoms after recovery (known as “long-haul COVID”).
In addition, one thing we know about this unusual virus is that it can transmit to others before any symptoms appear, which is one thing that is keeping this pandemic going.
Finally, every time the virus invades a human host, it has a chance to mutate and possibly learn to evade all our vaccines and other treatments.
“Although antivirals are promising, we must be sure to get our population vaccinated,” Fauci said at a press conference.
“Antivirals, good as they are, are not our first line of defense against COVID-19,” he said.
