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Can COVID Pills End the Pandemic?

Oral antivirals could hit the market soon. Here’s what that means for the course of COVID

illustration of a capsule killing COVID-19

dowell / Getty Images

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The U.S. may soon have access to two new antiviral pills that are designed to prevent hospitalization and death from COVID-19 in people who are most at risk for developing a serious case of the disease. If authorized, the first-of-their-kind treatments, from drugmakers Merck and Pfizer, could help to curtail the roughly 1,000 daily U.S. deaths still being caused by a coronavirus infection, though experts stress that the vaccines remain the most important tool in the fight against COVID.

Unlike current COVID-19 treatments that are administered in health care facilities by injection or an IV, these oral antivirals can be dispensed at pharmacies and taken at home, making them more accessible and convenient for patients and health care providers. Data under review by the U.S. Food and Drug Administration (FDA) shows that molnupiravir, the pill from Merck and its partner Ridgeback Biotherapeutics, reduced the risk of hospitalization and death in high-risk patients by about 30 percent in clinical trials. Pfizer’s pill, whose brand name is Paxlovid, was shown in trials to cut risk by nearly 90 percent, the company said.

“It's another tool to add for those people who are at high risk for having hospitalization and death due to COVID-19, and I think it's a really important tool for them,” says Jason Pogue, a clinical professor of pharmacy at the University of Michigan College of Pharmacy and an infectious diseases clinical pharmacist at Michigan Medicine. “But there are some caveats that are going to come with that.”

Diagnosing the disease early is crucial

Importantly, these new medications need to be started early in the disease course, shortly after symptoms begin. “And that’s where some of the challenges can come into play,” Pogue says, “because it's kind of human nature” to wait a few days when you first get a runny nose or scratchy throat to see how things play out. “But the exact opposite is what we really need to do in this situation,” he adds.

Common Symptoms of COVID-19

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

 Source: Centers for Disease Control and Prevention

The reason? Both molnupiravir and Paxlovid block the virus from replicating inside the body. “The longer [people] wait, the more steam the virus is able to acquire, and the less likely it is that these medicines will help,” says Mark Rupp, M.D., a professor in the Department of Internal Medicine and chief of the Division of Infectious Diseases at the University of Nebraska Medical Center. Merck’s product tricks the virus into making mistakes as it multiplies, Rupp explains. And if you think about the virus as having a “big stack of lumber that it needs to make a dwelling,” Pfizer’s pill “prevents the virus from being able to cut the lumber into the right-sized pieces to build the house,” he says.

Hand in hand with recognizing symptoms at the onset is having access to testing to confirm a case of COVID-19. “And I continue to think that in this country we continue to have a problem with people having access to ready testing that's convenient and cheap and accurate. So that's going to be, I think, a real hurdle that we have to clear in order to use these drugs most effectively,” Rupp says.

Results for PCR tests administered at low or no cost at many health care facilities can take up to a few days to come in. Rapid tests that deliver same-day results are also available — some can even be purchased over the counter at drugstores and completed at home. However, these tend to come with out-of-pocket expenses and may not be sensitive enough to pick up an infection early in the disease course, when the drugs are most effective.

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Pills are not a replacement for prevention

For those who have compromised immune systems or other risk factors that make them more likely to get seriously ill from a coronavirus infection, these new oral treatments could be “a game changer,” by helping to keep them out of the hospital, David Dowdy, M.D., associate professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in a recent media briefing. But they “are not going to be a game changer for prevention, the way the vaccines are,” he added.

Treatments, pill or otherwise, also don’t help thwart transmission of the virus, which continues to spread at high levels throughout most of the U.S. Its continued spread also enables it to morph into new and potentially more dangerous variants, as evidenced by the rapid and worrisome emergence of the omicron variant in South Africa. What’s more, experts are still reviewing the safety data for the pills, and it may be that some populations are excluded from their use.

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Even if the FDA OKs the new treatments and adds them to the COVID arsenal, we’re still “a long ways” from being done with the pandemic, Rupp adds. And older adults, in particular, need to continue to maintain a level of caution while the battle continues.

His advice: If you start to experience any COVID-like symptoms, even if you are vaccinated, talk to your health care provider. “Don't delay. Go ahead and get tested and get put on medicine that will hopefully prevent that breakthrough case from becoming more severe and landing you in the hospital,” he says.

Also, get vaccinated if you haven’t already, to help prevent the need for treatment in the first place. “The thing that would change the trajectory of the entire pandemic would be increasing vaccination rates, which is something that we still are really struggling with in this country,” Pogue says.

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.