This appears to be a hasty conclusion. Older people with paxlovid did equally well as younger people without paxlovid. That indicates that paxlovid actually works, given that older age leads to covid mortality! The author's only refutation of this is that the same pattern was observed before Paxlovid was around. But that pattern itself is an aberration that is not true of the general population, it's only true in that one geographical area due to, I would assume, a statistical anomaly.
It had no measurable effect in the measured group. You can't say that it works based on that. If it had a measurable effect in that group, you would expect to see improvement in the treatment group between the two scenarios.
If (65-69 no treatment) == (70-74 no treatment) and also (65-69 no treatment) == (70-74 treatment), then (70-74 treatment) == (70-74 no treatment) by the transitive property of equality.
Now the reason for (65-69 no treatment) == (70-74 no treatment) may be its own mystery, but we expect to see at least _something_ happen anyway between (70-74 no treatment) and (70-74 treatment) if the treatment had some benefit for that group, and apparently they didn't see that.
They were comparing two time points as well as two age groups: before vs after Paxlovid became available, and late 60s (disallowed Paxlovid) vs early 70s (allowed Paxlovid).
There was no significant different before or after Paxlovid became available to the early 70s patients. This updates us against Paxlovid being effective in this patient population, for the specific outcome metrics.
For most people now, the whole reason to take Paxlovid is the avoid long covid. The hospitalization risk is less of a concern. The article points out at the end that this drug has shown evidence of avoiding long covid.
There's some evidence in lower risk groups too. It's alas not an on-off switch, and you can't file a complaint Covid sorted you in the wrong group.
Does that mean we should all absolutely take Paxlovid? No, quite likely not. But the question is more "how close to the high risk group are you" than "are you high risk".
For e.g. 20-yo white men, the answer in both cases is roughly the same. But say they're 55 (or 65 and healthy as a horse) it probably deserves a bit more thought
No, any type of patient can get long covid. I suspect a heathy adult gets it from a combination of bad luck and/or not resting enough, doing too much, etc. post infection.
It's a lot easier and less risk to just pop the pills and put up with the disgusting taste and maybe being sicker a bit longer, than it is for you and your doctor to sit down and try to do a whole bunch of fuzzy calculations to figure out just exactly how high-risk you might be and whether that meets the threshold for using paxlovid.
Particularly given we almost certainly don't know all the high risk factors, not every doctor is able to keep up with all the latest research, and the patient and/or treating physician might not even be aware the patient has a particular risk factor.
Depending on how far down the rabbit hole you go - there's an opportunity cost to a physician's time, too, and them spending more time trying to figure out if someone REALLY needs paxlovid means they have less time to spend with other patients.
I took Paxlovid twice. Horrible bitter taste, but kept the symptoms at bay. No long covid or persisting brain fog unlike some of my friends. Tested negative by the end of the treatment. My fiancé didn't catch it from my while I isolated.
Derek doesn't have to take Paxlovid next time, but I will.
I had Covid once. No drugs, no vaccine (don’t jump me it wasn’t available yet). No long covid or brain fog. Sleepiness, loss of taste, flu symptoms for 5 days. Completely better in 10 days.
Anecdotes aren’t usually helpful for effectiveness testing. My experience can vary greatly between my neighbor even with identical demographics and characteristics.
I am in my 70s and within a few hours of taking PAXLOVID my symptoms went away. I took it the first time I had Covid. When I had Covid a second last year I decided to suffer the symptoms without PAXLOVID so I felt crappy for three or four days.
I really think treating Covid for older people is a very different than treating young people.
That said, when I took PAXLOVID my daughter, son in law and grandson had the same Covid strain I did at the same time and their symptoms were very bad and lasted ten days to over two weeks.
My impression has been that taking Paxlovid resulted in faster recovery and less severe symptoms. This is an anecdotal observation with a tiny small sample size so I wouldn't discount placebo or a weaker variant. Still, I'd like to see a broader study that looks into long COVID and severity.
Likewise. I was 2-3 days into testing positive and had a fever that could not be controlled by maximum strength OTC antipyretics, awful cough producing glue-like greyish globs, headache, blood oxygen consistently 2-3% below typical for me, extreme fatigue.
~48 hours after beginning Paxlovid I felt almost back to normal. spO2 returned to typical wake / sleep levels, lungs clearing, little fatigue, etc.
Based on how sick I was when I started treatment, if historical patterns of recovery from respiratory illness are any indication I would have expected an additional ~9-14 days of tapering symptoms at minimum.
Instead I was basically totally normal again after ~5-6 days.
If I get COVID again I will absolutely ask for Paxlovid.
I’ve had Covid 5 times— I’m pretty familiar with how it progresses. The most recent time was the most severe— I went to the ER with a temp of 103 with ibuprofen. Got Paxlovid— the major symptoms nearly switched off like flipping a light switch. Of course there’s a possibility it would have done that anyway, but I’m sure as hell going to take it again if necessary.
Dealing with the drug interactions when prescribing paxlovid j find to be a bloody nightmare. Must have handed it out like 10 times in my last run of shifts
I will say for me when I took it, I could barely get out of bed. I slept 17 hours that day. It was maximum effort just to go downstairs to the kitchen and get food out of the refrigerator.
Anyhow I got the first dose at about 6pm and went to sleep, and when I woke up I felt pretty good and went down to my office to start catching up on my email. It was an amazing turnaround.
This was more or less what happened to me with covid and I didn't take anything at all. It started as a cold, rapidly progressed to being so bad that I spent an entire day in bed, then rapidly subsided to "recovering from a bad cold but feeling mostly normal".
So I wouldn't put much confidence in your experience being down to the drug, personally.
Readit News
It had no measurable effect in the measured group. You can't say that it works based on that. If it had a measurable effect in that group, you would expect to see improvement in the treatment group between the two scenarios.
If (65-69 no treatment) == (70-74 no treatment) and also (65-69 no treatment) == (70-74 treatment), then (70-74 treatment) == (70-74 no treatment) by the transitive property of equality.
Now the reason for (65-69 no treatment) == (70-74 no treatment) may be its own mystery, but we expect to see at least _something_ happen anyway between (70-74 no treatment) and (70-74 treatment) if the treatment had some benefit for that group, and apparently they didn't see that.
Dead Comment
There was no significant different before or after Paxlovid became available to the early 70s patients. This updates us against Paxlovid being effective in this patient population, for the specific outcome metrics.
Does that mean we should all absolutely take Paxlovid? No, quite likely not. But the question is more "how close to the high risk group are you" than "are you high risk".
For e.g. 20-yo white men, the answer in both cases is roughly the same. But say they're 55 (or 65 and healthy as a horse) it probably deserves a bit more thought
It's a lot easier and less risk to just pop the pills and put up with the disgusting taste and maybe being sicker a bit longer, than it is for you and your doctor to sit down and try to do a whole bunch of fuzzy calculations to figure out just exactly how high-risk you might be and whether that meets the threshold for using paxlovid.
Particularly given we almost certainly don't know all the high risk factors, not every doctor is able to keep up with all the latest research, and the patient and/or treating physician might not even be aware the patient has a particular risk factor.
Depending on how far down the rabbit hole you go - there's an opportunity cost to a physician's time, too, and them spending more time trying to figure out if someone REALLY needs paxlovid means they have less time to spend with other patients.
Thanks.
Derek doesn't have to take Paxlovid next time, but I will.
Anecdotes aren’t usually helpful for effectiveness testing. My experience can vary greatly between my neighbor even with identical demographics and characteristics.
Plenty of people don't get long Covid, why were you sure you'd get it if you didn't take paxlovid? Same with brain fog?
Sure, you need to run a study to be absolutely certain, but it just takes one experience to notice the effect.
https://www.nejm.org/doi/full/10.1056/NEJMoa2309003
I was surprised to read it.
I really think treating Covid for older people is a very different than treating young people.
That said, when I took PAXLOVID my daughter, son in law and grandson had the same Covid strain I did at the same time and their symptoms were very bad and lasted ten days to over two weeks.
~48 hours after beginning Paxlovid I felt almost back to normal. spO2 returned to typical wake / sleep levels, lungs clearing, little fatigue, etc.
Based on how sick I was when I started treatment, if historical patterns of recovery from respiratory illness are any indication I would have expected an additional ~9-14 days of tapering symptoms at minimum.
Instead I was basically totally normal again after ~5-6 days.
If I get COVID again I will absolutely ask for Paxlovid.
Anyhow I got the first dose at about 6pm and went to sleep, and when I woke up I felt pretty good and went down to my office to start catching up on my email. It was an amazing turnaround.
So I wouldn't put much confidence in your experience being down to the drug, personally.