A few days ago, US President Joe Biden presented his plan for the management of Covid19 with the aim of entering a new phase of “coexistence” with the virus. To make this coexistence feasible, the American government will use some tools including Paxlovid, a drug produced by Pfizer recently approved in Europe.
The American strategy was called test and treat that is “test and cure” but what exactly is it? What are the weaknesses of this strategy?
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Prevention is better than cure
In addition to being a well-known proverb with many variations and uses, “prevention is better than cure” is also a fundamental principle in the management of public health. In fact, the use of resources, time and money destined to prevent a disease is always less than what it would take to cure it.
The American approach would seem to go against this principle: in fact, the American initiative is called “test and cure” and not “test and prevention”. President Biden explained that in the coming weeks, citizens will be able to go to the pharmacy and in the event of a positive test they will be able to receive treatment with Paxlovid.
The American approach seems to accept the fact that the vaccination campaign has not reached a satisfactory degree and, especially in some states, the adhesion of the Americans has been very low. The vaccine, unlike the Paxlovid, represents a true prevention against the disease, both symptomatic and severe and can be administered to the entire population, in a preventive manner.
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How is Paxlovid used in Italy?
In Italy, Paxlovid is prescribed by general practitioners or by doctors of the USCA (Special Continuity of Care Unit) to positive patients who are not vaccinated and not yet hospitalized but at high risk of hospitalization.
The drug acts as an antiviral by slowing down or preventing viral replication and it is essential that it is taken as close as possible to the infection in order to stop it in the bud.
Paxlovid is not free from side effects or important interactions with other drugs: this is why administration should be carefully monitored by a doctor or specialist.
Finally, the treatment with Paxlovid includes 30 tablets in 5 days, 10 of Ritonavir and 20 of Paxlovid, making the intake more complex.
The weaknesses of the “test and treat”
The American approach has several weaknesses. Let’s try to analyze them:
- Timing of administration
- Discrimination of patients who will benefit from the drug
- Monitoring of side effects and interaction with other drugs
- Correctness of treatment
We have seen that the strength of an antiviral is timing, in fact Paxlovid has proven to be very effective in reducing hospitalizations of patients at risk if taken in the 5 days following the onset of the first symptoms (which is very difficult since the first symptoms are often minimal. or ignored). Will American citizens be ready to recognize the first symptoms and show up at the pharmacy in time for administration?
Paxlovid demonstrates its full power in patients at risk of hospitalization and death and it is not always trivial to determine who will develop a serious disease. How does a citizen know if he will develop a serious illness? There are some conditions that correlate with severe disease: obesity, type 2 diabetes, cardiovascular disease, but these are not always known.
Clinical trials carried out on Paxlovid have identified a series of side effects but above all a very long list of interactions with other drugs and treatments. Many of the drugs with which Paxlovid interacts are taken by patients at risk: drugs to reduce blood pressure, regulate heartbeat, reduce lipids, etc.
Furthermore, as anticipated, the treatment with Paxlovid involves the administration of 6 tablets a day for 5 days with two different drugs and such a high number of tablets increases the risk of forgetfulness or errors, consequently invalidating the correctness of the treatment.
Paxlovid is an excellent drug, which drastically reduces the likelihood of hospitalization and death in unvaccinated at-risk patients. Despite its high efficacy, it is not a preventive measure like the vaccine and must be taken in certain ways and with the support of doctors.
TAKE HOME MESSAGE:
1) Paxlovid reduces the risk of hospitalization and death and treats the symptoms of the disease in some patients
2) Paxlovid is a drug that must be taken with a precise timing and under medical supervision
3) The very high efficacy of Paxlovid does not replace the preventive action of vaccines
REF:
https://www.aifa.gov.it/documents/20142/847786/G.U.31_07-02-22_Paxlovid.pdf
https://qz.com/2136582/what-is-covid-19-new-test-and-treat-strategy/
https://www.nhs.uk/conditions/coronavirus-covid-19/treatments-for-coronavirus/
https://www.aifa.gov.it/en/-/ema-riceve-domanda-aic-paxlovid-per-pazienti-covid-19
https://www.bmj.com/content/375/bmj.n2713
Aureliano Stingi, doctor in molecular biology works in the field of precision oncology. He collaborates with the World Health Organization in the battle against Covid19-themed fake news
Twitter: @AurelianoStingi Instagram: Aureliano _Stingi