What if you could take a pill as soon as you were positive for Covid, that would stop the virus in its tracks? A pill hat reduced the number of copies in your upper airway by more than tenfold. The chance of hospitalization was reduced by nearly 90 percent.
Paxlovid is a pill that was developed specifically for the Sars-CoV-2 virus, and is a potent inhibitor of the main protease of the virus, called Mpro. The chokepoint is preventing the virus from replicating. It proved to be as safe as the placebo after being tested in two randomized clinical trials.
immunity has been the main approach to dealing with the virus. The immune response is stimulated by vaccines and boosters. Along with a number of other measures, such as masking and distance, and the immune protection derived from prior infections, it was possible to contain the virus in many parts of the world, along with preventing an enormous toll of hospitalizations and deaths. Without the vaccine doses that have been given throughout the world, our hospitals and staffs would have been much worse.
Omicron has achieved extensive immune escape from our vaccines, lowering the effectiveness even with a booster, to 75%, instead of 95%, with the Pfizer shot. That will result in five times as many breakthrough infections compared with prior versions.
The hypermutated variant of the Omicron virus does not look like the earlier versions of the virus, which means that most of the monoclonal antibodies are no longer effective. The high rate of reinfections among people with prior Covid is reported to be three to eightfold in South Africa and the United Kingdom. These were not normal before Omicron and show that immunity alone is not enough.
The immune escape property of Omicron is not the problem. It is the rapid growth of cases in many countries throughout Europe, southern Africa, North America and soon enough throughout the world. There is a definite sense that the cases are less severe than before, but the extent to which and full explanation for this is unknown. It could be the immunity walls that have been built from previous infections and vaccinations.
The transmission onslaught will cause tens of millions of new infections around the world. The Netherlands and other countries are starting to lock down. When Delta is still on the rise in the United States, this is just the beginning of what can happen. With more than 130,000 new infections a day, health systems will get overrun from inadequate staffing of health care workers.
Paxlovid is expected to work well against Omicron because it is the first potent treatment that is not dependent on our immune response. There is only one change in the main protease of the virus, which is not a region that has been prone to change. Paxlovid has been very effective against Omicron.
The Paxlovid five-day pill pack is needed to be available everywhere. There is a grossly insufficient supply of 200,000 treatment courses and only 80 million expected by the end of next year. If we had an unlimited supply of these pills, it would have a huge impact on preventing illness, preserving our healthcare workforce, staving off spread, and eliminating the need for school closings. Paxlovid intervention might reduce the toll of long Covid, a disabling symptom complex that can occur with even mild cases.
The US Food and Drug Administration will authorize Paxlovid in the coming days. It doesn't get us where we need to be. We need to find a way to quickly scale pill pack production for wide accessibility and use throughout the world, whether that involves the Defense Production Act in the United States or other bold measures. It is not appropriate to rely on a single company to mass produce a small molecule which companies throughout the world are capable of making with the highest manufacturing standards.
This pill has all the features of a breakthrough intervention when we need it. It is a sign of light in a tunnel. It will not be realized unless we pull out all the stops to quickly get it made and distributed at mass scale.
