Studies that don’t ask a question won’t tell you an answer to the question not asked. No study (or preprint) has yet negated Paxlovid as it is recommended to be prescribed today.
No study (or preprint) has yet negated Paxlovid as it is recommended to be prescribed today — within 7 days, to prevent severe covid and hospitalization. Nothing as of this date has changed on this, so far as I could find, and I don’t know why people are pushing the idea that something has changed.
Not too long ago Jeremy Faust was doom posting on Paxlovid’s impending demise because of one study on symptom duration, that appeared to be conducted by the drug company for the express purpose of seeing if they could expand prescribing for shortening or reducing non severe symptoms so they could promote it for the general public who have employers who want them to get back to work quicker. The secondary data on the hospitalization aspect of that study was statistically underpowered or whatnot, so pointing to it is sort of pointless.
This time Jeremy Faust is now hand wringing about the looming end of Paxlovid because of a preprint – data that hasn’t even been peer reviewed or published yet – that found that Paxlovid did not show usefulness for preventing death in already hospitalized patients. This is a weird deduction because Paxlovid is specifically only recommended to be prescribed to people BEFORE hospitalization to PREVENT hospitalization. So this trial wasn’t about Paxlovid as it’s prescribed now. It was another trial to see if prescribing ought to be expanded. Even though Paxlovid can be started a week into an infection, it’s always been stressed that it should be started as soon as possible, and that it’s probably going to be ineffective for people with an infection situation that has progressed to the point of requiring hospitalization already. This has been reported and reported and restated and restated — it’s not some secret. And by the way, the same thing is true with Tamiflu for influenza! So this preprint isn’t some revelation regarding this aspect of antivirals — they’re not miracle cures.
I also have seen on social media people mentioning a study of Paxlovid for Long Covid that had poor results, and I see people extrapolating this to mean it won’t prevent Long Covid, and using this to again doom post about the demise of Paxlovid. But trialing it to treat long covid tells you nothing about whether it could prevent long covid by treating an acute infection. But wait — there’s also been a study that says Paxlovid is probably not preventing Long Covid. Okay so again, we’re back full circle in that preventing hospitalization and death is a bigger more imminent selling point anyway.
And thus far, there has been no data yet that I could find that negates the use as it’s being currently prescribed: to prevent severe illness, hospitalization, and death.
Jeremy Faust seems to have this pet theory prediction that people who’ve had previous covid and have been vaccinated at some point in the past already get some protection and so don’t need Paxlovid as much — that’s his crystal ball prediction on why he thinks Paxlovid will be proven to be ineffective in trials. This hasn’t been proven and the trials he references as supporting this prediction don’t actually seem to back up his claim — because they weren’t looking at that. So his theory is speculation about the future.
But let’s stop for a second and think this through even if his theory is real and true. And with the stipulation that there was definitely no cumulative effect of prior vaccination and adding an antiviral. Let’s just assume that’s the case. Let’s speculate that Paxlovid isn’t as effective because (some or even many) people in the trials have benefits from being vaccinated and or from prior infection. How do YOU measure that YOU have that benefit right now when you get infected? Because that’s the question I need answered if this is going to influence my decision making — how do I know this effect applies to me? Do you know for sure how much benefit you, as an individual, got from vaccination or a prior infection? How about people who’ve never had covid? How about people who don’t know if they’ve had covid or not? How about people who are unvaccinated? How about people not up-to-date on vaccination? How about people who know that vaccination doesn’t give them protection like other people because they’ve been tested and informed of this because they’re on immunosuppressants? How about the immunocompromised people who don’t know how much vaccination benefit they got one way or another? People walk around with “underlying conditions” sometimes for months or even years before being diagnosed — so many many people are “high risk” and don’t even know that! How are individuals supposed to know if they fall into the category of having that “prior benefit” in Jeremy Faust’s proposed scenario? He says the effect of prior immunity “should not be minimized” — but applying it across the board would be maximizing it inappropriately to apply to everyone, when it so obviously can’t. So what then? It seems like to take Jeremy Faust’s advice (that supposedly paxlovid isn’t worth taking — that’s the clear message he seems to be sending) — it requires a lot of caveats and what ifs. A laundry list checklist of things to consider before turning down Paxlovid, even if you totally buy into his pet theory as if it’s fact. And it’s not proven fact, it’s just speculation at this point.
It’s good that they are doing trials on already hospitalized patients. It’s also good that they’ve looked at potential symptom reduction. It’s good they’re trialing Paxlovid for Long Covid even if experts don’t think viral persistence explains all long covid. It’s good if studies look at whether Paxlovid lowers risks of post-covid complications of any kind. And it’s good if we find out the ways Paxlovid isn’t helpful.
As far as the way Paxlovid is prescribed — there are ongoing studies on effectiveness for preventing severe covid, hospitalization and death in people with underlying conditions — and that should happen and that could change things for the better or worse when we get those results. But none of these studies being used on social media to undermine the use of Paxlovid seem designed to test the actual way that Paxlovid is being prescribed and what it’s supposed to achieve. So as far as I can see, nothing’s changed for my personal decision making based on any recent study.
It’s of course possible that it will turn out that Paxlovid isn’t particularly effective or useful, maybe for anything. Early studies for drugs have been wrong before. It’s being prescribed to treat a virus that is ever evolving because NPIs are non-existent and vaccine uptake is in the toilet, so it’s not unreasonable to worry that the virus will mutate out from under current pharmaceuticals, like happened with Evusheld. But there’s no evidence yet that this has happened with Paxlovid. However, I’m not ruling anything out. But even if that’s the case, why is it that Jeremy Faust is so insistent it has something to do with “natural herd immunity” anyway? Why go there?
Is it just clickbait? Is it trying to hedge and spin any future ineffectiveness as not the fault of failing to prevent covid or mitigate, and instead attribute it to “humans evolving” because that’s a very popular eugenics concept that feels more “positive” to people? Prominent doctors seem to never mention how survivorship bias is involved in that scenario, because that’s the far darker truth of population vulnerability changes — that vulnerable people who died in 2022 can’t die again in 2024. There’s always some PR spin going on, so I’m justifiably suspicious. For example when talking heads in the U.S. claimed the pandemic was over in summer 2021, even while new surges were happening in other countries and were of course bound to reach us with no travel restrictions. And when the even bigger surging wave came, they backpeddled and tried to rewrite history saying, “well it was a different strain, it’s a different virus, nobody could’ve known” — and that supposedly absolved all in leadership who refusing to prepare or mitigate, even while people in disability justice and public health were screaming out at the time. So there is definitely a PR angle here that is interested in deflecting blame from anyone who should be preventing unmitigated covid mutations.
The odd thing is that I don’t think the “herd immunity” theory of “Paxlovid becoming less effective” is very compelling. For one thing vaccine uptake is terrible. Most people are NOT up-to-date on covid vaccinations. But even if you believed that there were a lot of people with viable immunity from past infections, it seems like it would make more sense that any medication would be even more effective because of a cumulative effect. To think it would essentially hide effectiveness seems unintuitive frankly. But perhaps this is a function of the bar being set incredibly low with covid. The general message from leadership has consistently been set at: if you don’t die, it’s a success and everything’s fine no matter the repercussions, and if you do die, you had it coming because of your pre-existing conditions.
The bottom line is that when doctor pundits and scientist influencers talk about anything that the public may use for personal healthcare decisions, they need to be careful because what they say people do take as medical advice, like it or not — some people will listen and take it as advice. And that can be dangerous. Such as when PR was promoting the “covid is mild” idea, and I saw people on social media who would report not being able to breathe or walk, and yet not even considering calling their doctor, let alone going to the hospital, because they were just too invested in covid being “it’s like a cold now” status. Worse, people often misunderstand what is being communicated by doctor pundits and scientist influencers. I have seen many ways people run with ideas that are way off in ways that might shock the people who thought they were doing effective science communication. Hotshots need to be more thoughtful, less reckless, listen to feedback more, and for pity’s sake, stop chasing controversy for clicks and dopamine hits.
Disclosure: I’ve received NO compensation to promote any pharmaceuticals. I’m not a doctor. I’m not a scientist. I’m not giving medical advice.
I personally take information on social media and op-eds with a grain of salt, and seek out multiple sources of information. I don’t assume all doctors are trustworthy or know what they’re talking about. When making decisions about medications, OTC or prescription, whatever I’ve read about, I rely on consulting doctors and other medical providers who have legal and professional responsibility in treating me as their patient in the capacity of healthcare services, and are therefore incentivized to care, and compensated for the effort, and therefore tailor medical advice and treatment to me personally. I approach veterinary care the same way. If a doctor’s advice, prescribing, or recommendations are off from official recommendations or what I’ve read about, I would ask them to give their reasoning, and to include the explanation in my record for future reference. If a doctor seems like a weirdo and is saying things that are really out there, I would at least try to get a second opinion.