A new generation of Covid-19 treatments will soon be available, and they matter more than many people realize.
They have the potential to substantially reduce hospitalization and death. And they are likely to be effective against the Omicron variant, many scientists believe, even if Omicron makes the Covid vaccines weaker at preventing infections. As Dr. Monica Gandhi of the University of California, San Francisco, told me, the treatments are “a huge deal.”
In the simplest terms, they can help turn Covid into a more ordinary respiratory disease, similar to the common cold or flu, rather than one that’s killing about 1,000 Americans a day and dominating daily life for millions.
Two treatments are on the way — one from Pfizer and one from Merck — and they will have both medical and psychological benefits. Not only can they reduce serious Covid illness, but they can also reduce Covid fears and help society move back to normalcy, lessening the pandemic’s huge social and economic side effects.
(If you haven’t read my colleague Campbell Robertson’s story about the continuing crisis in schools — including mental health problems among children and exhaustion among teachers, nurses and janitors — it’s sobering.)
Both Pfizer’s and Merck’s treatments are pill regimens that people take for five days after a positive Covid test. The pills prevent the virus from replicating inside the body and are broadly similar to treatments that revolutionized H.I.V. care in the 1990s.
Pfizer’s version, which is likely to become widely available early next year, appears to be the more effective: It reduced the risk of hospitalization or death by 85 percent in a research trial. Merck’s version, which should be available sooner, reduced risk by 30 percent.
An F.D.A. panel of experts this week voted narrowly — 13 to 10 — to recommend the approval of the Merck treatment. The agency has not yet said when its experts might vote on Pfizer.
“These will be game-changing for our ability to control Covid worldwide in 2022,” Gandhi said.
Pandemic side effects
In truth, the virus has already been largely defanged for most Americans, and it would be surprising if Omicron changed that. The death rate for vaccinated adults under 50 is virtually zero, according to data from Minnesota and King County, Wash. (which publish detailed statistics); the hospitalization rate is similar to that of a typical flu. For children, vaccinated and not, the risks are even smaller.
But I know that many Americans remain terrified of Covid. After nearly two years of pandemic living, returning to normal can be hard, especially with the genuine uncertainty about Omicron. Once the treatments are widely available, they can offer reassurance, as a last line of defense against severe Covid.
Of course, the medical benefits will be even bigger than the psychological benefits for people who remain vulnerable to Covid.
Deaths are predominantly occurring among the unvaccinated, although vaccinated Americans older than 65 — especially those with existing medical problems — are also at some risk. So are a small percentage of younger Americans, like those who have had an organ transplant or are receiving some cancer treatments. (Find the death rate for any county.)
One major advantage of the pills is that people can take them at home. Current Covid treatments, like monoclonal antibodies, are typically administered in a hospital.
Another advantage is that they do not attack the part of the virus that changes most with each new variant: the spike protein. That’s why scientists expect the treatments will work even as the virus evolves.
30 pills, 5 days
Pfizer has projected that it will produce enough doses to treat 20 million people in the first half of next year and another 60 million in the second half. The Biden administration has agreed to buy 10 million of the treatments, known as Paxlovid, at a cost of about $530 each. Americans will probably not have to pay much, if anything, out of pocket.
As a rough sense of scale, 10 million treatments would have covered every American 65 and above who tested positive for Covid in the past year — with millions of doses left over.
Merck projects that it will produce more than 10 million courses of its drug, called molnupiravir, by the end of this year, and at least 20 million more in 2022. The federal government has agreed to buy 3.1 million of those courses for around $700 each. A Merck spokesperson said that the government would provide the drug to patients for free.
Both treatments will present logistical challenges. People will likely need to prove that they have tested positive for Covid and then receive a doctor’s prescription. At least for the next several months, only vulnerable people — those who are older or have medical conditions — may be eligible. And the treatments involve a detailed schedule of pill-taking: three pills, twice a day, for five days, in Pfizer’s case, and two additional pills per day in Merck’s case.
Ideally, the treatment should begin within five days of the first Covid symptoms.
For people who can get access to the pills and take them as prescribed, they may make all the difference. In Pfizer’s research trial, the treatment reduced the risk of hospitalization by about 90 percent among people who started it within three days of having symptoms. There were zero deaths among the patients who received it.
“These treatments are not going to single-handedly end the pandemic, nor are they going to be anywhere near as impactful as vaccines,” Rebecca Robbins, who covers pharmaceuticals for The Times, told me. “But if they can reach people fast enough, and that’s a big if, they have very real potential to save lives and ease the burden on hospitals.”
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Stephen Sondheim, who died last week at 91, was among the most revered composers and lyricists in musical theater. He left a “life’s outpouring of rapturous, hilarious, gorgeous and tortuous song in his wake,” Jesse Green, The Times’s chief theater critic, writes. And he nurtured generations of theater-makers as a mentor, a teacher and an audience regular, occasionally sending encouraging typewritten notes.
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