Reducing Severity And Post-Covid Complications

A total of 7.8 per cent to 17 per cent of Covid-19 patients suffer from long Coronavirus symptoms and sequelae (UK study).

Patients with a mean age of 62 and with at least one comorbidity (older than 60 years, obesity (BMI > 25 Kg/meter square), current smokers, cancer, heart disease, kidney disease, chronic lung disease, diabetes, immune dysfunction and hypertension) were studied. 

A total of 35, 717 received Nirmatrelvir within 5 days of Covid and 2,46,076 patients did not receive antiviral treatment.

Post covid complications included ischemic heart disease, dysrhythmia, deep vein thrombosis, pulmonary embolism, fatigue and malaise, liver disease, acute kidney injury, muscle pain, diabetes, neurocognitive impairment, dysautonomia, shortness of breath and cough.

Post covid complications were 12.99 per cent in Nirmatrelvir as compared to 17.51 per cent in the control groups.

Nirmatrelvir was associated with a reduced risk of post-acute death and post-acute hospitalisation

Nirmatrelvir was associated with reduced risk of Post-covid complications (dysrhythmia and ischemic heart disease), coagulation and hematologic disorders (pulmonary embolism and deep vein thrombosis), fatigue and malaise, acute kidney disease, muscle pain, neurologic system (neurocognitive impairment and dysautonomia), and shortness of breath.

The reduced risk of post covid complications was irrespective of vaccination status 

My take on the subject

No one, in our lifetime, would forget the devastation and loss of lives suffered during the Covid pandemic. As many as 7.8 per cent to 17 per cent of Covid patients suffer from Long Covid symptoms and sequelae. 

There have been consistent efforts at reducing the severity, hospitalisation and deaths by using monoclonal antibodies and antiviral drugs (Remdesivir, Molnupiravir and Paxlovid (A combination of Nirmatrelvir and Ritonavir). The efficacy of these interventions in reducing severity and mortality is well established. 

Among oral medications, Paxlovid has the best efficacy in reducing severity and mortality. This large study has looked at the effect of Nirmatrelvir on post covid complications.

Nirmatrelvir was associated with 26 per cent less risk of post-Covid complications and 47 per cent less risk of post-acute death and 24 per cent less risk of post-acute hospitalisation. 

This benefit is indeed glaring and emphasises the use of antiviral medication during the first 5 days of Covid-19 infection. 

Although this study looked at largely the elder population with at least one comorbidity, the benefit in younger and healthy people in the event of Covid is not ruled out. 

We all have seen crippling symptoms of long covid in young healthy individuals also. Paxlovid is now licensed to be manufactured in India (with different brand names of course).

With the rapid rise in Covid-19 cases recently, there is a case for using this medicine in susceptible populations who are at high risk of severe disease, death and post covid complications.