I feel the need to get Paxlovid’s back. The antiviral medicine for Covid has served us well. As a primary care doctor who has seen the worst of what this disease can do to people, and who has followed the medical literature, experts, and consensus guidelines since this whole thing started, I’m disappointed by the current trashing of this medicine. I wrote a post that is three times as long, but three times as good in my opinion as the one I will share here on Daily Kos… but it’s a 10-15 minute deep dive read and I’d rather get the main points across for the average interested reader!
So here is a condensed version of the document, around 1,000 words, as broken down by Claude.ai. Think of this as an overview… and if you want the purely human-written, hyperlinked with clinical references version, please see the original post here on Examined.
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As I was saying, as a primary care doctor, I'm disappointed by the recent criticism of Paxlovid, the antiviral medicine for COVID-19. The prestigious New England Journal of Medicine (NEJM) published a small study that found Paxlovid didn't clear every symptom faster than placebo in lower-risk people. However, this study had several weaknesses, including considering participants "treated" even if they took just one pill, a narrow definition of "symptom resolution," and a population skewed towards younger, healthier individuals.
While the study showed a 50% relative risk reduction in hospitalization and death with Paxlovid, the absolute risk reduction was small (0.8%) due to the low-risk population. The study was not designed to evaluate Paxlovid's potential to reduce long COVID, which is a significant concern, especially for those aged 35-50, the group most likely to develop it.
Despite this study's limitations, some prominent physicians have declared the "rise and fall" of Paxlovid, but this assessment is premature. Numerous other studies have demonstrated Paxlovid's effectiveness in reducing hospitalizations, deaths, and long COVID.
For example, a CDC study found that Paxlovid was associated with a 51% lower hospitalization rate, including a 50% lower rate among those with three or more vaccine doses. A Lancet study showed Paxlovid reduced hospital admission or death within 30 days by 54% overall and up to 90% when taken within 5 days of symptom onset. An NIH preprint found Paxlovid reduced 28-day hospitalization by 26% and mortality by 73%.
Regarding long COVID, a VA study found Paxlovid was associated with 26% less risk of long COVID, 48% less risk of post-acute death, and 30% less risk of post-acute hospitalization. While the absolute risk reductions were modest, the potential benefit for preventing long COVID in middle-aged persons should be greater than what was found in this older population.
I plan to keep prescribing Paxlovid, strongly recommending it to high-risk patients and recommending it with caveats to younger, healthier patients at higher risk of long COVID. If contraindications exist, I'll discuss alternative antivirals. I believe lowering viral loads is still beneficial for reducing various risks, and a 5-day treatment course is likely too short.
Just as treating strep throat with antibiotics doesn't alleviate symptoms but prevents rheumatic fever, and treating shingles with antivirals doesn't reduce pain but prevents post-herpetic neuralgia, Paxlovid may not significantly improve acute COVID symptoms but could prevent long-term complications like long COVID, cardiovascular events, and increased mortality.
While we lack definitive randomized trials, the evidence suggests Paxlovid can reduce severe COVID outcomes and long COVID risk. I'll continue offering it, especially to high-risk patients, as an essential tool in our fight against this ongoing pandemic.
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AI summary version here, versus purely human doctor version over there… I think each serves a purpose. Boiled down to 1,000 words for easier consumption, or expanded to 3,000 for more expert analysis, which works better for you?
Either way, I hope that more people who would benefit from Covid treatment reconsider the contrarian anti-Paxlovid memes out there, and that their doctors do the same.