Since the beginning of the pandemic, a huge part of the reason why there’s been a public health emphasis on mitigating COVID spread is because we haven’t had any effective treatments.
So many of the most frustrating parts of the pandemic - masks, social distancing, limits on social gatherings - stem from our total lack of therapeutic options in the face of a potentially deadly and disabling disease.
While we’ve known a lot about risk factors for developing severe COVID, we haven’t had a lot of tools to reduce the risk of mild COVID progressing to severe disease.
In real life, that means that once you’ve got COVID, you basically wait and hope for the best.
If we had safe and effective treatments for COVID to prevent mild illness from becoming severe, it boggles my mind to think about how different the past two years would have been.
With safe and effective treatments for COVID, the public health perspective would be less focused on flattening the curve and more concerned with getting treatments out to folks who need them.
Pfizer’s new drug seems absolutely incredible
Pfizer’s new pill Paxlovid seems to be the type of incredible treatment that could have dramatically altered the course of the pandemic if we had it in great supply in early 2020.
Paxlovid is a combination of two drugs, nirmatrelvir and ritonavir.
Nirmatrelvir is the real innovation here - it’s a drug that blocks the replication of SARS-CoV-2 by interfering with the proteins that it needs to replicate.
Ritonavir is an old HIV drug that seems to increase levels of nirmatrelvir rather than have any direct impact itself.
In a study looking at early treatment with Paxlovid, the drug seems to do a great job at reducing need for hospitalization or death.
You may have seen the 89% reduction number in the press - it comes from this chart showing 27 out of 385 patients in the placebo group were hospitalized or died compared to 3 out of 389 patients in the Paxlovid group:
So the drug seems to work really well if given early on in the disease. And it seems pretty safe - fewer patients in the Paxlovid group had side effects compared to the placebo group in the trial.
But there’s a big problem here: you you’re going to have a hard time getting the drug anytime soon
It doesn’t matter how great this drug is if you can’t get it.
And we know that for the time being, it’s going to be really tough to come by. Paxlovid is going to be in short supply for months - only about 65,000 treatment courses will be available in the US by the end of 2021.
That’s about the number of new cases diagnosed yesterday.
So it’s going to be tough to get for the foreseeable future, despite efforts being made to greatly ramp up production.
I’ve already been told by my hospital system not to expect access to prescribe this drug for several months.
That stinks - this would be a great tool for us to have available. I would certainly take it if I had COVID.
The other problem: it’s really expensive
The original reported price of this drug is $530 per patient.
The US has already spent $5.3 billion for 10 million courses.
It’s possible that the government will subsidize the cost here for the foreseeable future, which means that your individual cost won’t be high, but our societal cost will be if the drugs ends up widely used.
Now, there’s a lot to debate about when it comes to prescription drug costs. I’m not going to pretend that I have any great wisdom on how to sort this type of thing out on a population level.
But creation of a drug like Paxlovid is exactly the type of drug development that you’d want to incentivize through policy.
Think about it: this is a brand new class of drug that has a huge impact on disease and doesn’t need to be taken forever.
It was also developed pretty rapidly for a disease that didn’t exist until two years ago.
I think Paxlovid is a genuine innovation - it’s legitimately great.
I’m just hopeful that we’ll be able to get more of it out quickly and that it won’t bankrupt us in the process. Until then, we’ll always have fluvoxamine!
Thank you for subscribing! Please share with friends and family and encourage them to subscribe!