Here are the latest good and bad news about COVID-19 medicines

You may have heard that the pandemic is over in the United States. (Not so.) Masks are no longer needed in most places, and large gatherings are becoming common again. According to the US Centers for Disease Control and Prevention, most countries are environmentally friendly. Tracking site, Monitor COVID-19 infection and hospitalization rates. Many people rely on vaccines to control their outbreaks, and new attention is focused on getting new available treatments for sick people.

However, the number of cases of coronavirus is increasing again. More than a quarter of the county Report high level transmissions. And they are official numbers. No one really knows Some Home test returns positive Will not be reported (SN: 4/22/22). These cases are boosting hospitalization rates, with yellow and orange pockets popping up on the CDC map, indicating that the hospital is in an overwhelming danger zone. The death toll remains fairly low. If another wave of infection hits the country, it can change.

Mark Denison, a coronavirus researcher at Vanderbilt University Medical Center in Nashville, said:

Preventing hospitalization and death is designed to be done by vaccines, but even the very good COVID-19 vaccine is not perfect. In addition, the new antigenic escape variant of the coronavirus raises health concerns for those who have been vaccinated or previously infected with COVID-19, especially those who are elderly or have weakened immunity. Even some people can be admitted to the hospital.

The next line of defense against the negative consequences is three antivirals and monoclonal antibodies that may prevent newly diagnosed people with COVID-19 from becoming seriously ill and dying.

Test-to-treatment initiative

Approximately 20,000 pharmacies, hospitals, emergency medical centers, and other locations have Pfizer-manufactured antiviral drug Paxlovid (a combination of the two drugs).The federal government has that number 40,000 in the next few weeksAshish Jha, COVID Response Director at the White House, said at a press conference on April 26.Many of those sites also have Molnupiravir (Logevrio) Merck antiviral drug (SN: 12/2/21).Expansion is part of the federal government Test-to-treatment initiative To make testing and treatment widely available.

With a much more limited supply, there are intravenous administrations of monoclonal antibodies and the antiviral drug remdesivir. It is the only antiviral drug fully approved by the US Food and Drug Administration for the treatment of COVID-19.

One of the prophylactic treatments is a monoclonal antibody called Evusheld. It is for people who have weakened immunity and do not respond to the vaccine or who cannot be vaccinated. In clinical trials Reduced risk of developing symptomatic COVID-19 infection by 82% Compared to placebo, researchers on April 20 New England Journal of Medicine..There are many treatments, Not often used..

RemdesivirOr its manufacturer, Gilead Sciences, called Veklury, which was approved by the FDA in 2020 for the treatment of inpatients (SN: 4/29/20).In recent clinical trials, this drug Reduced the chance of hospitalization by 87% For non-hospitalized people at high risk of severe illness, researchers reported on January 27. New England Journal of Medicine.. Such a positive result is FDA extends its approval to outpatient use People over 12 years old.Then on April 25th, the FDA said the drug Used for children under 12 years oldMake it the first antiviral COVID-19 treatment available to infants.

The main drawback of remdesivir is that it needs to be given intravenously. “There’s nothing useful about that,” says Abraar Karan, an infectious disease doctor at Stanford University. Researchers are working on the oral form of remdesivir.In the early experiments it was Effective for protecting mice For severe illness. We still need to test to see if it helps people as well.

The other two medicines, Paxlovid and molnupiravir, are provided in the form of tablets. They are easier to obtain in theory, but many do not know about them or how to get them.Several Social media posts Even if they know about them, it suggests that putting a hand on a drug after a positive COVID-19 test is not as easy as it sounds.

“It’s not as simple as’there was a pill and now everything is settled’,” says Karan.

Jason Gallagher, a pharmacist and infectious disease doctor at Temple University in Philadelphia, said some doctors are or are unaware that they can or should prescribe drugs to high-risk patients infected with the coronavirus. .. “There is a lot of education needed on the medical side,” he says.

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Ideally, people would talk to their doctor about whether they are drug candidates before they get infected, says Karan. Also, if you don’t have a doctor, timing is important and you need to know your options. The pill should be started within 3-5 days of the onset of symptoms.

Access to the drug is better, but there are still patches.To prepare, I went COVID.gov To find out where to get medicine if you are infected with a coronavirus. I’m relatively lucky. There are seven Site from test to treatment Within 5 miles of my house just outside Washington, DC, one is a military hospital that isn’t open to the public. And I consulted my doctor and asked if I should take Paxlovid if I got COVID-19. He said I should, and if I do a home test, I could call with the results, and he said he would call my pharmacy a prescription.

My mother in the countryside of Nebraska is in a different situation. She needs to drive at least 25 miles from her nearest test to treatment location. Many other rural areas have pharmacies where you can prescribe, but people need to go elsewhere to be tested and have their doctor prescribe the medicine. For example, residents of Gypsam, Colorado may be tested somewhere, receive a prescription from a doctor, drive about 6 miles to fill out a prescription, or travel nearly 100 miles to the outskirts of Denver for testing. need to do it. site.

Disadvantages of these drugs

There are other wrinkles besides access to the use of medicines. “For all treatments, they have been studied primarily in unvaccinated people at risk of developing serious illness,” Gallagher said. “Therefore, we are basically projecting that data onto the current population. This population is primarily vaccinated.” It is at risk, especially if it is boosted with a vaccine. It is not clear that everyone in good health needs medicine. The drug may relieve symptoms, but there is no real evidence that people are effective in making them feel better faster, he says.

But medicines are good at keeping people away from the hospital. Paxlovid has a relative risk of hospitalization and death About 89 percentResearchers reported on April 14 New England Journal of Medicine.. Its side effects included taste distortion and a small number of people developed diarrhea.

The bigger drawback is one of the Paxlovid combo medicines. Paxlovid’s main drug, nirmatrelvir, works by blocking enzymes that the virus needs to replicate. Take with a drug called ritonavir. Ritonavir prevents nirmatorelvir from being broken down by enzymes in the body. Ritonavir can react with other drugs, such as cholesterol-lowering statins, to dangerously increase the levels of these drugs in the body. But there are several ways to get around it, says Gallagher. For example, cholesterol-lowering medications can be stopped for a short time. “No one can’t stop taking it for a week or two while being treated for COVID-19,” he says.

Another wrinkle is recurrence. 1 Preprint And others Anecdotal account Some people reported having a recurrence of the virus a few days after stopping Paxlovid. No one really knows how common it is and why it happens. According to a statement sent to me by the National Institute of Allergic Infectious Diseases, the National Institutes of Health is working with the CDC and FDA to better understand this phenomenon. However, these agencies have not conducted formal investigations.

The expert I talked to had some ideas about what was happening. Gallagher speculates that the immune system may “chill” while people are taking the drug, giving the virus a chance to rebound if the drug is stopped. Alternatively, the virus may hide in a specific area of ​​the body, making it difficult for the drug to reach, Denison said. Both of these situations may be resolved by giving people longer doses of medicine, they say.

However The FDA rejected the proposal In a post quoting John Farley, Director of Infectious Diseases at the agency. Farley emphasized that the virus rebound may not be related to taking the drug, as similar recurrences occurred in people taking placebopills in Pfizer’s drug clinical trials. And there are no signs that people will get sick and will be hospitalized after a recurrence. Also, there is no data to show whether taking Paxrovid for a longer period of time will benefit or taking the pill again in the event of a recurrence.

Drug resistance is another reason why an infection can recur. “I think drug resistance is the least likely explanation,” says Denison. To prevent the virus from spawning, you need to replicate the virus, but not when the drug is on the market. Still, researchers need to be aware of viral mutations taken from relapsed patients who may be resistant, he says.

None of the drugs have the potential to prevent a wave of infection. For example, Paxlovid Slightly reduced the chance of getting infected with COVID-19 People who were exposed to infected household members, but the results were statistically meaningless, Pfizer reported in a news release on April 29. In other words, it is not a good preventive measure and does not affect the number of cases.

“what [the drugs] What can be flattened is a surge in hospitalizations and deaths, “says Gallagher. However, he states that people at high risk of severe illness should not rely solely on medicines to save them. “I don’t think any of these treatments are as good as boosters.”

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