A New Way to Treat COVID: Pills

The country is currently surfing a massive spike in COVID-19 cases caused by the spread of the Omicron variant. Patient hospitalizations and ICU admissions have risen dramatically while daily cases continue to rise by tens of thousands. What may come as welcome news is that, on December 22, the Food and Drug Administration (FDA) approved the world’s first COVID-19 antiviral, Paxlovid, for emergency use to quell the explosion of cases around the country.

Created by Pfizer, Paxlovid is a combination drug that prevents patients with mild to moderate symptoms from developing more serious ones that require hospitalization. Authorized for those above the age of 12 or greater than 88 pounds in weight, each Paxlovid package contains two tablets of nirmatrelvir and one tablet of ritonavir. Both tablets are protease inhibitors, which block and prevent SARS-CoV-2 from utilizing proteins found in the human immunodeficiency virus for replication and reproduction. The two tablets should be taken together orally twice a day, for five days. Consumption of Paxlovid beyond the five days is not yet authorized by the FDA due to undefined side effects.

Pfizer’s clinical trials have shown that these antiviral pills help prevent high-risk patients from developing serious symptoms such as difficulty breathing, chest pain, or confusion. Pfizer’s antiviral studies further confirmed the efficacy of this new pill: in a study with 2,000 volunteers susceptible to extreme COVID-19 symptoms, there was an incredible 89 percent decrease in hospitalization cases in patients who took Paxlovid compared to those who received a placebo. Earlier studies published by Pfizer have shown a similar reduction in the number of deaths, with an overall 79 percent decrease between all patients regardless of severity.

As with all drugs, side effects are present after taking Paxlovid. Most are generally mild, with common side effects including taste changes, diarrhea, muscle aches, and high blood pressure. Additionally, those who take certain medications or have underlying health conditions are advised against taking Paxlovid as it may cause harmful reactions. For instance, the ritonavir tablet from Paxlovid has an adverse effect on patients with liver problems, producing effects like jaundice, and has been shown to interact with common medication used to treat heart diseases and cancer. It is also possible for Paxlovid to dilute concentrations of other medications in the bloodstream. More research is required on Paxlovid’s interactions with other medications as well as its effectiveness against other variants of COVID-19. For example, scientists are currently researching Paxlovid’s effect on the new IHU variant discovered in France last December. Different kinds of antiviral pills will likely have to be developed to combat the various mutations of COVID-19.

In addition to Pfizer’s Paxlovid pill, the FDA also authorized Merck and Ridgeback Biotherapeutics’s antiviral Molnupiravir, another COVID pill, for emergency use in late December 2021. Like Paxlovid, Molnupiravir is also consumed orally over a span of five days. However, instead of targeting viral replicating proteins like Paxlovid, Molnupiravir inhibits SARS-CoV-2 from replicating by introducing errors during viral RNA replication. This is not a foolproof process and could allow chance mutations to occur, resulting in new, more resistant viral strains. This fact, in addition to possible adverse effects on cartilage, bone growth, and pregnancies, contributes to why the pill only had a 30 percent reduction in hospitalizations and was authorized only for patients above the age of 18. Due to these side effects and its lower efficacy compared to Pfizer’s pill, treatment with Paxlovid is preferred by healthcare professionals and Molnupiravir is only recommended as a last resort for those incapable of taking Paxlovid due to shortages or urgent health reasons.

Currently, treatment with both pills is still limited due to a lack of supplies and is only available for patients with the highest risk of developing severe symptoms, such as those suffering from cancer, awaiting transplants, or the elderly. Therefore, while this is not yet a treatment that is open to the general public, the FDA bought $5.3 million worth of Paxlovid to have millions of doses ready to face surges in 2022.

Despite the novelty of oral antiviral pills in our battle against COVID-19, Pfizer’s Paxlovid and Merck’s Molnupiravir pills have been established as effective drugs in lowering the hospitalization rates of COVID-19 in high-risk patients across the board. The development of specific antiviral pills to treat each mutation is essential for the eventual suppression of the pandemic, and, accordingly, further research into other treatments will be facilitated by the existence of Paxlovid. In the future, Paxlovid may become a medication available at local pharmacies, which could help normalize the existence of COVID-19; as patients use an increasing number of tools available to combat the virus, they will become less prone to developing symptoms that require hospitalization, ultimately rendering COVID-19 as an illness no different from the common cold.