This New Year’s will be different. And better.
In the beginning, 2020
Covid-19 infections were initially so serious and scary because we not only had no preventives, but also no specific treatments. A serious infection could result in hospitalization and ICU care where only supportive measures were available. And death was a significant possibility. We subsequently developed better inpatient treatments (with steroids) and hospital deaths lessened.
Vaccines and outpatient antibodies 2020-21
Several companies in late 2020 and early 2021 developed dual monoclonal antibody treatments that could mitigate recent infections if given promptly which further helped reduce mortality.
Then in early 2021 the vaccines (Pfizer, Moderna and J&J) were given emergency approval. Most but not all people started taking them. Our three vaccines are highly effective in preventing serious disease, but do not completely prevent infections. And their benefits are waning with time. Booster shots are now being rolled out which should restore and maintain substantial immunity. We are giving boosters in our offices. And children’s vaccines are out next week.
Yet in late 2021 we still lack specific oral antiviral drugs that can be used outside of hospitals and have no tools to protect the many people with complex diseases who were immunosuppressed and do not mount an antibody response when given the vaccines. This is especially true of transplant patients.
Now our therapeutic options are about to dramatically improve.
New Covid-19 treatments coming online
Around New Year’s we should have effective oral antiviral drug therapy to treat Covid-19 disease with Merck’s molnupiravir. A course of 800 mg twice daily for 5 days appears highly effective. FDA evaluation and likely approval is underway. Other related oral antivirals are close behind. Surprisingly, oral fluvoxamine (an SSRI treatment for obsessive-compulsive disorder) may be somewhat useful for early outpatient Covid-19 cases. And ongoing controlled trials with ivermectin conceivably could show some benefit.
Also around New Years, we are likely to have AstraZeneca’s dual monoclonal antibody treatments (tixagevimab and cilgavimab, which target the receptor binding domain of the SARS-CoV-2 spike protein) that have been demonstrated in two Phase 3 trials to be effective for post-exposure prophylaxis and, perhaps more importantly, for pre-exposure prophylaxis. That means that immunocompromised people can be given two simultaneous intramuscular injections of those antibodies and receive (according to the Phase 3 PROVENT trial data) substantial protection (77% reduction) against infection for many (possibly 6-9) months. I find that truly exciting.
Fighting Covid-19 in 2022
Be optimistic. Our tools to prevent and fight Covid-19 in the New Year will be vastly better. We will have the vaccines and boosters for active immunity for adults and children. (OHC is starting to give Moderna boosters to our members next Monday.) We will have antibody injections for immunocompromised persons to protect them against serious infection for six months or more. We will have a number of antibody injections or infusions to use immediately after documented exposure to short-circuit active infections, and continued therapeutic antibody infusions for early infections. And we will likely have at least molnupiravir as an effective oral antiviral treatment to use for any documented infection. What a difference!
We have all been going stir-crazy for over 18 months. But now I believe it realistic that we will all be safer from Covid-19 as of the New Year and that we should be able to emerge from our protective cocoons and socialize more normally by next spring. Maybe even a good indoor restaurant meal without fear.