A pill helps prevent Long COVID. But not enough people are taking it.

A treatment that kills the COVID-19 virus can also prevent disabling Long COVID, reports an expansive new study, spurring calls to expand access to the medication.

People who took the antiviral drug Paxlovid soon after infection were 26% less likely to have symptoms three months later, according to an analysis of electronic medical records of more than 50,000 Veterans Health Administration patients at risk of severe illness.

The finding bolsters the case for the treatment, which has been significantly underused. Surveys show that it is prescribed to fewer than one-quarter of all people who go to a doctor for COVID care.

“A reduction in the chance of having fatigue or brain fog or cardiac symptoms months after an infection is a powerful incentive for doctors to prescribe, and patients to take, this medication,” said Dr. Robert Wachter, chair of the department of medicine at UC San Francisco.

The study also underscores the urgency of testing the drug to see if it might help people who are already struggling with Long COVID. The National Institutes of Health is planning to launch a trial to start in early 2023.

With results not expected until 2024, some advocates are calling for “compassionate use” access, a regulatory route to making a new, unapproved drug available to treat seriously ill people when no other treatments are available.

“People with Long COVID have been imploring everyone possible to give them a try at Paxlovid,” said JD Davids, co-founder of The Network For Long COVID Justice. “People are losing their homes, their families, their future to Long COVID.”

Long COVID – defined as a range of symptoms that can last weeks or months after infection – affects at least 10% of COVID-19 survivors. It may prevent people from returning to work or, in extreme cases, even getting out of bed.

Despite this substantial toll, there is no approved medication for the prevention or treatment of the symptoms.

Until now, vaccines are the only way to fend off the debilitating illness, reducing risk 30% to 50%. This study shows that there may be an additional tool.

Paxlovid is an antiviral therapy that works by inhibiting a key enzyme that the COVID virus needs to make new particles. It can be taken it at home.

“The idea that reducing the viral load as early as possible would reduce your chances of developing long COVID – that makes all the sense in the world,” said Diana Berrent, founder of Survivor Corps, the nation’s largest grassroots COVID-19 patient group.

“Now we have data to back that up,” she said.

The drug helped patients regardless of whether they were vaccinated or previously infected, reported investigators at the VA Health Care System in Saint Louis.

The study focused only on people who are medically eligible for the antiviral: older adults or people with health problems. It was published online and has not yet undergone peer review.

Hospitalizations and deaths also were reduced, it found, confirming earlier research. A previous study found that the risk of hospital admission or death within a month of infection was 89% lower in patients who got Paxlovid. This benefit persists over time, according to the new VA study, with a 48% reduction of death and 30% reduction in hospitalizations after the first month of illness.

Scientists still don’t know exactly what causes Long COVID. One theory is that virus stubbornly persists in the body, even after acute infection passes. Another idea is that the same protective antibodies that fend off a virus can trigger a new and misguided antibody attack on the body, which is destructive.

No matter what the cause, harm can be reduced by immediately eliminating the virus, say scientists.

Meanwhle, as the holidays approach, COVID cases and hospitalizations are both rising for the first time in several months. About 39,000 Americans are diagnosed with the disease each day.

But not enough physicians are prescribing the drugs, said Wachter.

Not everyone is eligible to get it. Paxlovid can cause adverse reactions in people who are also taking common drugs such as cholesterol-lowering statins.

Only people who are at increased risk for severe disease from COVID-19 qualify for the drug, including people over age 12 who have weakened immune systems or other health conditions that increase risk of serious effects of COVID-19—like asthma, cancer, liver disease, lung disease, heart disease, and obesity.

Some people who take Paxlovid may experience “rebound” COVID, in which symptoms return after the five-day course of pills has ended.

There is too much focus on caveats and concerns, rather than on the overwhelming evidence that Paxlovid helps, said Berrent.

To expand access, earlier this year President Biden launched a “test to treat” initiative is to get antiviral pills to at-risk patients fast and on the spot right after they test positive for the virus.

But the ‘test to treat’ option is offered at only hundreds of select “big box” pharmacies, including CVS in the Bay Area as well as Walgreens and RiteAid elsewhere. Community pharmacists aren’t empowered to give the pill without a physician’s prescription.

Independent pharmacies, which represent one-third of all retail pharmacies in the U.S., aren’t included in the “test to treat” program. It’s therefore hard for people in rural and underserved communities to gain access.

“Concerns about drug interactions, most of which can be avoided fairly easily, and about Paxlovid rebound, which is relatively mild in nearly all cases, have led the drug to be tremendously underused,” said Wachter. “The new study should tip the scales.”

“As a healthy 65-year-old who is fully vaccinated and boosted, and whose wife had Paxlovid ‘rebound,’ I was leaning toward taking the drug if I got COVID,” said Wachter. “The new study moves me even more strongly to favor taking it.”

Source: Orange County Register