Just ban COVID cases from being transported across county lines. Problem solved.
I assume doctors will give them out to the most ill patients, regardless of vaccination status. Obviously the unvaccinated will be enriched in the population of recipients just because of how much more likely they are to land in the hospital.
The upside is that Paxlovid is a combination of two small organic molecules. One is already in widespread production (but that will have to be ramped up substantially to meet the increased demand), and the other, I mean, Iâm no expert in organic synthesis, but it doesnât look that bad, and it sounds way, way easier than the microfluidics necessary to make mRNA vaccines. Seems like it should be way easier and faster to get to billions of doses with this than the vaccines.
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Giving them out by how sick the patient is seems tough since you have to take the drug within three days of symptomatic infection. Once patients are showing up to the hospital, going to be way too late for a lot of them. Best way to keep pressure off hospitals likely to be giving them out early in the illness, when symptoms may be mild, to those most at risk of severe outcomes. If we are rationing them, cant imagine giving initial doses to otherwise healthy non-elderly vaxxed individuals.
EDIT: edited five days to three days, its a five day course within three days, wrote the wrong number down in initial post
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You expect me to remember details like that?
Oops. Well, that seems tricky, because you might not even bother taking a test until 4+ days post-infection.
Three days of symptoms, not infection, my bad for being sloppy here. But the main point is, this drug cant really be rationed by individual illness level, it has to be rationed by risk level. That means if we are rationing initially going to go to a lot of higher risk unvaxxed, as it probably should given hospital pressure.
Also, as you note, why this is a game changer but not an answer in and of itself. A lot of barriers in place to getting this pill, especially when healthcare systems are under stress.
Hopefully side effects are mild enough that it can be used readily once production is ramped up. I.e. if you feel symptoms and arent sure if its COVID, can take this anyways.
Also not sure if still is less effective if you take a course later in the illness, but that will make initial rationing even trickier.
This pill is very good news, but I think it only has a bit role in the likely upcoming wave. Certainly will be very frustrating to those left behind the love ones that die just weeks/months ahead of this pill being widely available.
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we might not really know this yet, but is antibody escape as big a concern with this pill as with the vaccine?
I think that question makes sense, but if not I will rephrase.
The MAGA chuds who win Herman Cain awards all wait until the last minute before going to the hospital, gl getting them to take these antivirals within three days of symptoms.
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Yes.
Initial results pretty promising for this variant at least.
black box warnings can be dumb af.
Seems like this one is for inhibition of some drug clearance enzymes in the liver. Shouldnât be too large of a problem over a 5 day course. Some people will have to hold a dose or two of warfarin.
In the US the Omicron variant has surpassed Delta in collections taken from wastewater samples in Orange County, Florida, officials said.
Despite few confirmed clinical infections, wastewater samples showed the new variant is now the dominant strain. Omicron represented almost 100% of strains from wastewater facilities in a sampling this week, Orange County Utilities spokesperson Sarah Lux told AP.
Orange County is home to tourist attractions like Walt Disney World and Universal Orlando.
No, you were right initially. Paxlovid was tested on people within 3 days of symptoms developing, and within 5 days of symptoms developing. Efficacy only dropped off like 1 percent if it was given on day 4 or 5. Itâs a damned useful drug. They didnât test it out further than 5 days bu presumably it still has some efficacy even past 5 days.
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This pill doesnât interact with antibodies at all, and antibodies donât target anything it interacts with. This drug is a combination of two things, one, Nirmatrelvir, is a small organic molecule that binds in the cysteine protease of SARS-CoV-2, orthologs of which are found in essentially all coronaviruses. The second small organic molecule, Ritonavir, is an existing, fully approved drug for HIV patients that inhibits another enzyme that would metabolize protease inhibitors (HIV also relies on an essential protease that is inhibited by a small molecule fairly similar to Nirmatrelvir).
These drugs and their targets function inside the cell to inhibit viral replication, so theyâd be inaccessible to antibodies.
That said, like antibody escape of the spike protein, itâs possible that mutations in the protease render the inhibitor less effective or ineffective. Thus far, there hasnât been any selective pressure on the protease, so thereâs little reason to worry about material differences between the delta and omicron versionsâ response to the drug. It also should be encouraging, though, that these sorts of drugs are still in use for HIV, which is way, way more mutation-prone than any coronavirus, suggesting that there isnât necessarily a ton of ways that a mutation can cause drug inactivation without killing the protease activity also. Itâs also possible to update the protease inhibitor in response to a successful mutation. Since they have a crystal structure of the current protease bound with the inhibitor, it would be pretty easy to generate a crystal structure of any mutant, observe what changed and how that might interfere with the current inhibitor, and start coming up with a short list of changes to the current inhibitor that could be screened for effectiveness with the mutant.
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I was referencing Omicron, yes.
Last stat I saw for US Omicron was from CDC at 3.9% so I thought the âalmost 100%â for florida an interesting stat.
UK will let you know how it performs against the new oneâŚ
It comes after the UK âs antiviral taskforce chair Eddie Gray said on Thursday the country will have access to both Merck âs molnupiravir and Pfizer âs paxlovid treatments over winter.
UK Studies on molnupiravir already underwayâŚ
Molnupiravir will be tested on 10,000 people at risk of serious illness in research led by University of Oxford.
Last month, the UK became the first country in the world to approve its use - a move described as a âgame-changerâ by health secretary Sajid Javid.
In vitro studies have already been done.
The company also said that laboratory experiments indicated that the drug will attack a key protein in the Omicron variant, which is surging in South Africa and Europe and is expected to dominate U.S. cases in the weeks ahead.
Right, American scientists sitting around with their thumbs in their asses waiting on the UK, as always.
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Yeah, paxlovidâs mechanism of action means thereâs no reason to think that it would be any less effective against Omicron than delta.
It would really be good to know how late Paxlovid can be taken and still be effective. Even if it doesnât work as well, it could be a lot more efficient (on a per-dose basis) to give it to people after they get really ill. If you give it to people right when they become symptomatic, you âwasteâ a lot of doses on people who would have gotten better on their own. Maybe we have enough evidence from the trial to split the difference and only give the drug to people who arenât recovering by day 5 after symptoms?
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The labs studies on Pfizer vax vs Omnicron were a little more optimistic than the first real world study that came out a few days ago from SA which studied efficacy in tens of thousands of omicron cases. I doubt there will be a huge difference in the anitvirals though.