Tidbits from an MD friend's newsletter

Feb 4, 2022, 10:28 AM

Paxlovid--new possible therapeutic for COVID-19:
On 22 Dec 2021 the FDA issued an Emergency Use Authorization (EUA) for a new, oral treatment of patients (adults and older children) with mild to moderately severe COVID-19 that are at high risk for progression to severe disease. It is a combination of two different drugs, nirmatrelvir (a relatively new medicine) and ritonavir (long history of use in treatment of other viral infections). Studies to date have not been done in children. A study of adults with an underlying medical condition or age >65 found that treatment decreased the chance of hospitalization or death by 89%, if treatment was started within 3 days of onset of symptoms. The pills are taken twice daily for 5 days. Kidney disease may alter the dose. Both drugs are protease inhibitors. Interestingly, nirmatrelvir blocks a certain protease the virus needs to replicate itself while ritonavir in turn slows down the protease(s) that break down nirmatrelvir; hence both drugs need to be taken together.

How effective are lockdowns on COVID-19 mortality?:
Not very much, according to a literature review and meta-analysis of over a thousand studies conducted by Johns Hopkins University. They found "little to no evidence that mandated lockdowns in Europe and the United States had a noticeable effect on COVID-19 mortality rates". Overall reduction in mortality by lockdowns, compared to a policy based solely on recommendations, was 0.2%. Shelter-in-place orders (SIPO) reduced COVID-19 mortality by 2.9%. Only closing of non-essential businesses (e.g. bars) seemed to have some effect, reducing mortality by 10.6%. Of concern is that under certain circumstances limiting gatherings may actually increase COVID-19 mortality. Lockdowns that limit access to safe (outdoor) places such as beaches, parks, and zoos, or include outdoor mask mandates or strict outdoor gathering restrictions, push people to meet at less safe places indoors. In some studies SIPOs along with other lockdown measures actually increased mortality by 2.8 %. These results parallel those noted by the WHO in analyzing the 1918 influenza pandemic, where "social-distancing measures did not stop or appear to dramatically reduce transmission..." The paper does note that on the other hand some studies have shown that lockdowns significantly reduce the incidence, transmission, and mortality rate of COVID-19; the authors discuss behavioral responses and other possible reasons for these apparent contradictions. The authors concluded that well-timed but relatively mild lockdowns should work as well as or better than less well-timed but stricter lockdowns.

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