Six weeks ago, I wrote about a new drug called malnupiravir from Merck that was a game changer in the treatment of COVID-19. When taken in the first few days of infection it was 50% effective in the prevention of hospitalization and death. While not as good as monoclonal antibodies this was considered an amazing result and the study was terminated early in order to immediately ask for emergency approval. It was recently approved in Great Britain and large supplies were purchased by Britain, the United States, and other wealthy countries.
Last week this was all moot. Pfizer announced a new COVID-19 drug named ritonavir, brand-name Paxlovid, that was 89% effective in reducing the risk of hospitalization and death compared to placebo in non-hospitalized high-risk adults with COVID-19. Based on a randomized, double-blind study of non-hospitalized adult patients with COVID-19 who were at high risk of progressing to severe illness or death the interim results showed an 89% reduction in in progression of the disease, hospitalization,
and death when compared to placebo when they were treated within three days of the onset of symptoms.
Only 0.8% of the patients who received ritonavir were hospitalized within the first month, compared to 7.0% of those who did not receive it. There were no deaths in the treated group compared to 1.8% of deaths in the untreated group. The statistical significance of this is high. In a parallel study the results were similar when treatment was begun within five days with 1.0% hospitalized. Again, no deaths were reported within the first 28 days of treatment which was chosen as the endpoint.
The results were monitored by an independent committee and reviewed by the U.S. FDA and the decision was made to terminate the study and immediately ask for emergency use authorization as soon as possible.
So, what’s the bad news?
It appears that despite, or paradoxically partially because of improving treatments we will never get rid of COVID and just like the flu it will become endemic, that is, permanently in the population. Just like the flu, elderly will die from it every year. The treatments for COVID may potentially have even better results than those of the flu. We are probably looking at booster vaccine shots at some interval, whether a year plus or minus, possibly protective against different strains of COVID just like the flu vaccine to protect against different strains but ultimately unless everyone everywhere is vaccinated with an
effective formulation for all possible strains it doesn’t look like we will wipe it out.
The fight to wipe out polio has been going on for 70 years. It still exists in small pockets in several countries including Afghanistan. Aid workers have not been welcome in those communities and have even been kidnapped and killed. The disease stubbornly hangs on and has spread, though the number of new cases is only in the double digits out of a global population of 7.8 billion. If we can’t defeat a virus with only a handful of active cases worldwide it is very unlikely we will wipe out COVID (though not impossible, we seem to have wiped out polio after over 200 years of vaccinations).
We can’t just declare the pandemic over and walk away and go back to life as we knew it. It demands vigilance and some action going forward. Like the flu, transmission can be decreased by masking, distancing, avoiding crowded indoor areas, and not subjecting others to ourselves when we are sick.
Worldwide cooperation is necessary. I hope we can get it but I am not holding my breath
Dr. Richard Sternberg, retired Bassett Hospital orthopedic surgeon, is providing his professional perspective during the COVID-19 threat. Also a village trustee, he lives in Cooperstown.