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A limiting factor for the effectiveness of anti-virals for Covid is time. Maximum viral load happens often happens before any symptoms are present, and the most

A limiting factor for the effectiveness of anti-virals for Covid is time. Maximum viral load happens often happens before any symptoms are present, and the most severe diseases occurs weeks after infection as a result of the bodies inflammatory response instead of the virus itself. This means that by the time you know that a patient will have severe Covid-19, it is likely too late for any treatment that is based on interfering with the virus itself. Having said that, we have a good demographic understanding of who tends to get severe Covid-19, and a large testing capacity, so a cheap anti-viral treatment with few side effects could still be effectively deployed.

beakerbreaker 5y ago
That's a good point on the limitation, and to expand on your last point, an immediate demographic this could help is frontline healthcare workers and similar jobs who do get routine testing and are at higher risk in general.
- mlyle 5y ago
  Yup. I'm a teacher and vaccinated. If I found out that I was exposed, and then tested positive... post-exposure prophylaxis sounds great. Also there's my dad, who has an immune condition due to old age. He's vaccinated, but who knows how effective the vaccine was for him. The existence of PEP could make it possible for him to do more at a similar level of safety... vs. the current option of staying in a small bubble for the rest of his life despite being otherwise able-bodied and capable.
  - grey413 5y ago
    FYI, your dad would most likely already qualify to receive the antiviral antibody treatments that have been given emergency authorization by the FDA. https://www.covid19treatmentguidelines.nih.gov/therapies/anti-sars-cov-2-antibody-products/anti-sars-cov-2-monoclonal-antibodies/ https://www.covid19treatmentguidelines.nih.gov/therapies/ant...
    - mlyle 5y ago
      Oh sure-- if he got infected, we'd throw the kitchen sink at it-- remdesivir, monoclonals, etc. A "better remdesivir" which is supremely effective would improve the risk picture a lot.
swader999 5y ago
There are some interesting nasal sprays that wipe out early viral load in the nose and throat that are available right now. ImmuneMist and XClear for example.
- dangerlibrary 5y ago
  ImmuneMist is already facing warnings of regulatory action for their false claims re: covid https://www.ftc.gov/enforcement/warning-letters/warning-letter-immunemist https://www.ftc.gov/enforcement/warning-letters/warning-lett...
  - gizmo686 5y ago
    As is XLear https://www.ftc.gov/enforcement/warning-letters/warning-letter-xlear-inc https://www.ftc.gov/enforcement/warning-letters/warning-lett...
    - swader999 5y ago
      There's enough studies since this was sent in April to make an educated decision on how to use these.
    - sterlind 5y ago
      Some nasal sprays do seem to be effective as prophylaxis for COVID infection. I'm not sure about Xlear, but povidone-iodine nasal sprays seem effective and are already used as prophylaxis by dentists. See: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=povidone+iodine+prophylaxis+covid&oq=povido#d=gs_qabs&u=%23p%3DxY_LFXHlVxYJ https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=pov... https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2775984 https://jamanetwork.com/journals/jamaotolaryngology/fullarti... They're not FDA-approved for this but as long as you're taking other precautions, they can't hurt right?
wongarsu 5y ago
I imagine the willingness to get tested would also be a lot higher if the result of a positive test was a reasonably quick antiviral treatment instead of weeks of quarantine. Sure, there will always be sceptics, but for large parts of people, organisations and governments having less perverse incentives might improve things a lot.
- SketchySeaBeast 5y ago
  But you'd need to get tested for every minor sniffle, or if the claim about no symptoms being a time of maximum viral load, you'd have to constantly get tested even without symptoms.
- mywittyname 5y ago
  I feel like I'm pointing out the obvious, but another, extremely effect and quick "treatment" is vaccination. And it works great without the constant need for testing. I have to imagine that anyone willing to undergo treatment at the very start of getting covid, would have also been willing to be vaccinated. The vaccine-hesitant aren't going to go for treatment until the outlook is dire. Additionally, in my experience, physicians aren't terribly concerned about infections in vaccinated individuals. When I was last tested, the physician essentially just assured me that vaccinations have been shown to drastically reduce the likelihood of complications, and not to really worry about it. Granted, I could have had a less rigorous physician, or it could that I'm totally healthy.
  - LurkingPenguin 5y ago
    > I feel like I'm pointing out the obvious, but another, extremely effect and quick "treatment" is vaccination. Does every discussion of about post-exposure prophylaxis have to have comments about vaccination? > And it works great without the constant need for testing. A primary reason for testing has been to help stop the spread of the virus (test positive = isolate), not necessarily to let people with mild symptoms or no symptoms know that they're infected. Vaccinated individuals can still spread the virus and some people are at higher risk even when vaccinated, so testing is still of value. > I have to imagine that anyone willing to undergo treatment at the very start of getting covid, would have also been willing to be vaccinated. That's quite an assumption. Without passing judgment about his decision not to get vaccinated and to throw the kitchen sink at COVID once he was infected, Joe Rogan is an example of a person who is willing to treat an infection but not get vaccinated. I doubt he's the only one. > Additionally, in my experience, physicians aren't terribly concerned about infections in vaccinated individuals. Vaccination certainly reduces the incidence of hospitalization and death, and the data to date suggests that vaccinated individuals are less likely to develop "long COVID" symptoms. But there's still a lot we don't know. Research indicates that individuals with breakthrough infections can have viral loads that are as high as unvaccinated individuals, and some percentage report courses of illness that are virtually identical to a typical course of illness in unvaccinated individuals (respiratory symptoms, extreme fatigue, etc.) so I think it's premature to make too many assumptions. Especially since in immunologically naive people, some with "mild" or even largely asymptomatic infections also report lasting issues too.
UncleOxidant 5y ago
Given that time is of the essence with antivirals, we need to give people lateral flow antigen tests they can take at home (very accurate if they come up positive) as well as some kind of pre-presciption (show the pharmacist your positive test result and get the antivirals or some such). Waiting for a doctors appointment will take too much time.
russdill 5y ago
And I'm going to hazard a guess that the likelihood of not getting early testing correlates strongly with the likelihood of not getting vaccinated.
pfdietz 5y ago
If the antivirals are highly effective one could really slam the immune system to stop any damaging response without the virus again going out of control.
tiahura 5y ago
According to the founders of Ridgeback, Molnupiravir is being tested prophylacticly. They suggested that hopefully by sometime next year, if someone you’ve been in within close contact tests positive, you get on the cocktail of Molnupiravir + the upcoming Pfizer antiviral.
- nradov 5y ago
  Molnupiravir is not a benign medication. There are serious concerns about mutagenic risks. Until more long-term safety studies are completed it certainly shouldn't be prescribed as a routine prophylactic for most patients who are at low risk anyway. https://www.medicalnewstoday.com/articles/molnupiravir-vs-covid-19-will-the-drug-live-up-to-the-hype https://www.medicalnewstoday.com/articles/molnupiravir-vs-co...

beakerbreaker 5y ago

That's a good point on the limitation, and to expand on your last point, an immediate demographic this could help is frontline healthcare workers and similar jobs who do get routine testing and are at higher risk in general.

mlyle 5y ago
Yup. I'm a teacher and vaccinated. If I found out that I was exposed, and then tested positive... post-exposure prophylaxis sounds great. Also there's my dad, who has an immune condition due to old age. He's vaccinated, but who knows how effective the vaccine was for him. The existence of PEP could make it possible for him to do more at a similar level of safety... vs. the current option of staying in a small bubble for the rest of his life despite being otherwise able-bodied and capable.
- grey413 5y ago
  FYI, your dad would most likely already qualify to receive the antiviral antibody treatments that have been given emergency authorization by the FDA. https://www.covid19treatmentguidelines.nih.gov/therapies/anti-sars-cov-2-antibody-products/anti-sars-cov-2-monoclonal-antibodies/ https://www.covid19treatmentguidelines.nih.gov/therapies/ant...
  - mlyle 5y ago
    Oh sure-- if he got infected, we'd throw the kitchen sink at it-- remdesivir, monoclonals, etc. A "better remdesivir" which is supremely effective would improve the risk picture a lot.

swader999 5y ago

There are some interesting nasal sprays that wipe out early viral load in the nose and throat that are available right now. ImmuneMist and XClear for example.

dangerlibrary 5y ago
ImmuneMist is already facing warnings of regulatory action for their false claims re: covid https://www.ftc.gov/enforcement/warning-letters/warning-letter-immunemist https://www.ftc.gov/enforcement/warning-letters/warning-lett...
- gizmo686 5y ago
  As is XLear https://www.ftc.gov/enforcement/warning-letters/warning-letter-xlear-inc https://www.ftc.gov/enforcement/warning-letters/warning-lett...
  - swader999 5y ago
    There's enough studies since this was sent in April to make an educated decision on how to use these.
  - sterlind 5y ago
    Some nasal sprays do seem to be effective as prophylaxis for COVID infection. I'm not sure about Xlear, but povidone-iodine nasal sprays seem effective and are already used as prophylaxis by dentists. See: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=povidone+iodine+prophylaxis+covid&oq=povido#d=gs_qabs&u=%23p%3DxY_LFXHlVxYJ https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=pov... https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2775984 https://jamanetwork.com/journals/jamaotolaryngology/fullarti... They're not FDA-approved for this but as long as you're taking other precautions, they can't hurt right?

wongarsu 5y ago

I imagine the willingness to get tested would also be a lot higher if the result of a positive test was a reasonably quick antiviral treatment instead of weeks of quarantine. Sure, there will always be sceptics, but for large parts of people, organisations and governments having less perverse incentives might improve things a lot.

SketchySeaBeast 5y ago
But you'd need to get tested for every minor sniffle, or if the claim about no symptoms being a time of maximum viral load, you'd have to constantly get tested even without symptoms.
mywittyname 5y ago
I feel like I'm pointing out the obvious, but another, extremely effect and quick "treatment" is vaccination. And it works great without the constant need for testing. I have to imagine that anyone willing to undergo treatment at the very start of getting covid, would have also been willing to be vaccinated. The vaccine-hesitant aren't going to go for treatment until the outlook is dire. Additionally, in my experience, physicians aren't terribly concerned about infections in vaccinated individuals. When I was last tested, the physician essentially just assured me that vaccinations have been shown to drastically reduce the likelihood of complications, and not to really worry about it. Granted, I could have had a less rigorous physician, or it could that I'm totally healthy.
- LurkingPenguin 5y ago
  > I feel like I'm pointing out the obvious, but another, extremely effect and quick "treatment" is vaccination. Does every discussion of about post-exposure prophylaxis have to have comments about vaccination? > And it works great without the constant need for testing. A primary reason for testing has been to help stop the spread of the virus (test positive = isolate), not necessarily to let people with mild symptoms or no symptoms know that they're infected. Vaccinated individuals can still spread the virus and some people are at higher risk even when vaccinated, so testing is still of value. > I have to imagine that anyone willing to undergo treatment at the very start of getting covid, would have also been willing to be vaccinated. That's quite an assumption. Without passing judgment about his decision not to get vaccinated and to throw the kitchen sink at COVID once he was infected, Joe Rogan is an example of a person who is willing to treat an infection but not get vaccinated. I doubt he's the only one. > Additionally, in my experience, physicians aren't terribly concerned about infections in vaccinated individuals. Vaccination certainly reduces the incidence of hospitalization and death, and the data to date suggests that vaccinated individuals are less likely to develop "long COVID" symptoms. But there's still a lot we don't know. Research indicates that individuals with breakthrough infections can have viral loads that are as high as unvaccinated individuals, and some percentage report courses of illness that are virtually identical to a typical course of illness in unvaccinated individuals (respiratory symptoms, extreme fatigue, etc.) so I think it's premature to make too many assumptions. Especially since in immunologically naive people, some with "mild" or even largely asymptomatic infections also report lasting issues too.

UncleOxidant 5y ago

Given that time is of the essence with antivirals, we need to give people lateral flow antigen tests they can take at home (very accurate if they come up positive) as well as some kind of pre-presciption (show the pharmacist your positive test result and get the antivirals or some such). Waiting for a doctors appointment will take too much time.

russdill 5y ago

And I'm going to hazard a guess that the likelihood of not getting early testing correlates strongly with the likelihood of not getting vaccinated.

pfdietz 5y ago

If the antivirals are highly effective one could really slam the immune system to stop any damaging response without the virus again going out of control.

tiahura 5y ago

According to the founders of Ridgeback, Molnupiravir is being tested prophylacticly. They suggested that hopefully by sometime next year, if someone you’ve been in within close contact tests positive, you get on the cocktail of Molnupiravir + the upcoming Pfizer antiviral.

nradov 5y ago
Molnupiravir is not a benign medication. There are serious concerns about mutagenic risks. Until more long-term safety studies are completed it certainly shouldn't be prescribed as a routine prophylactic for most patients who are at low risk anyway. https://www.medicalnewstoday.com/articles/molnupiravir-vs-covid-19-will-the-drug-live-up-to-the-hype https://www.medicalnewstoday.com/articles/molnupiravir-vs-co...