Original articles
The New COVID drugs are a bigger deal than people realize. Monica Gandhi
Wither COVID? How the pandemic ends Richard Simoneaux and Steven L Shafer ASA monitor Volume 85 December 2021
First the bad news: SARS-CoV-2 is never going away. In the U.S., the grim news is that Sars-CoV-2 virus continues to kill over 1,000 people a week. Despite widespread availability of vaccine, this horrific death toll is largely due to the delta variant, which is as infectious as smallpox, and the refusal of a large percentage of the population to get vaccinated. Additionally, not all vaccinated people will be or are protected…no vaccine is 100% effective. What havoc the new Omicron variant will produce remains to be seen.
I’m pretty sure that most of you receive the ASA monitor in your mail. Under the leadership of its editor-in chief Steven Shafer, they have been running a series of COVID stories to keep ASA members up to date. I’d urge all of you to read them. In this month’s issue he writes “once a large fraction of the population is vaccinated, the resistant variants will have a significant evolutionary advantage to spread. Thus, it is exceptionally important to maintain non-pharmaceutical interventions like masks, social distancing, etc. to prevent the establishment of resistant strains” even if you are vaccinated.
Is there any good news? Yes! In the Atlantic monthly, Dr. Monica Gandhi of San Francisco General Hospital discusses targeted therapeutics for those who get infected. “the United States is poised to authorize two oral antivirals: molnupiravir and Paxlovid. The former is the generic name of a drug made by Merck and Ridgeback Biotherapeutics; the latter is the trade name of a drug combination made by Pfizer. Both come in pill form, and a five-day treatment course of each will provide certain patients with significant benefits”.
“Molnupiravir and Paxlovid are particularly exciting because antivirals that effectively target viruses at specific points in their life cycle and are the “holy grail” of viral therapeutics—as past experience with other viruses has shown. Infection with HIV was fatal for nearly all patients until antivirals were developed against enzymes crucial to viral replication and researchers figured out how to combine those drugs to maximize their effectiveness and limit the emergence of resistant viral strains”. Thus, these new antivirals are similar to the oral treatments for influenza and HIV. “Paxlovid, a formula developed largely from scratch for the current pandemic, is actually an RNA-virus protease inhibitor called PF-07321332 “boosted” with another drug called ritonavir”. Molnupiravir, which is named after the Norse god Thor’s hammer, Mjölnir, was being tested for the treatment of the Ebola virus and found to work on Sars-CoV-2. Essentially both of these anti-virals don’t use immunity to prevent infection, they prevent the virus from replicating by hijacking their molecular biology.
All I can say is Wow!. If you can read this article from the Atlantic do it and if you haven’t been vaccinated or gotten your booster do it today! Myron Yaster MD