Much like its sister and brother, influenza and the common cold, COVID-19 is unlikely to ever disappear in spite of vaccinations and natural immunity, given that it is continuing to mutate. Fortunately there are at least three promising antivirals for covid being tested in clinical trials, with results expected as soon as late fall or winter. So far, only one antiviral drug, remdesivir, has been approved to treat covid. But it is given intravenously to patients ill enough to be hospitalized, and it isn’t intended for early, widespread use. By contrast, the top contenders under study can be packaged as pills. They work by interfering with the virus’s ability to replicate in human cells. In the case of molnupiravir, being investigated by Merck and Ridgeback Biotherapeutics, the enzyme that copies the viral genetic material is forced to make so many mistakes that the virus can’t reproduce. That, in turn, reduces a patient’s viral load, shortening infection time and preventing the kind of dangerous immune response that can cause serious illness or death. Merck announced on Friday that molnupiravir significantly reduced the risk of hospitalization or death among non-hospitalized adult COVID-19 patients with mild-to-moderate symptoms who were considered high risk due to other health conditions such as obesity, diabetes, or heart disease. Among patients who took a 5-day course of the drug, 7.3% were hospitalized or died compared with 14.1% of patients who took a placebo, according to the interim analysis of the Phase 3 MOVe-OUT trial. Merck said it will file an application for Emergency Use Authorization (EUA) with the FDA as soon as possible, as well as filing applications for marketing with regulatory agencies globally. If emergency use is granted, millions of Americans would have access to a daily orally administered medication that could be taken for five to ten days at the first confirmation of infection. In June, the Biden administration announced it had agreed to obtain about 1.7 million treatment courses of Merck’s molnupiravir, at a cost of $1.2 billion, if the product receives emergency authorization or full approval. The same month, the administration said it would invest $3.2 billion in the Antiviral Program for Pandemics, which aims to develop antivirals for the covid crisis and beyond.
The CDC issued an urgent health advisory and has urged clinicians to educate pregnant patients about the benefits and safety of COIVD-19 vaccination and to encourage and offer vaccination to patients who are pregnant, recently pregnant, or might become pregnant. The CDC reports that only 31% of pregnant people have been vaccinated and there have been more than 125,000 laboratory confirmed COVID-19 cases resulting in more than 22,000 hospitalized cases and 161 deaths. About 97% of hospitalized patients were unvaccinated. The CDC has a toolkitand a one page flyer to help clinicians communicate with patients and new parents about COVID-19.
As the number of infected people has grown rapidly during this third wave of COVID, there is increasing debate about the role of vaccination in previously infected individuals. The British Medical Journal published an article last month questioning why natural immunity “doesn’t count” in the US. A retrospective observational study reported in a preprint concluded that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease, and hospitalization caused by the Delta variant compared to vaccine induced immunity from the BioNTech/Pfizer vaccine. An article in Science notes that for many infectious diseases, naturally acquired immunity is known to be more powerful than vaccine-induced immunity and it often lasts a lifetime. Other coronaviruses that cause the serious human diseases severe acute respiratory syndrome and Middle East respiratory syndrome trigger robust and persistent immune responses. At the same time, several other human coronaviruses, which usually cause little more than colds, are known to reinfect people regularly. As I routinely say, ask me about this in three or four years and I will give you a much more accurate answer.
CSSE is reporting 43,523,321 positive cases in the U.S. and 699,010 deaths.
