10 ms·

I am thinking: if and when this is approved, we have to think about distribution. This drug is fantastically effective at preventing hospitalisation and death,

by orra 5y ago

I am thinking: if and when this is approved, we have to think about distribution. This drug is fantastically effective at preventing hospitalisation and death, if administered within three days of symptom onset. That gives quite a long time! But we still need to make it easy to take. Do pharmacies give it out? ER rooms? We don't want to wait until people are hospitalised; we are trying to avoid that. So when you test positive, does the government send you out a pill with the "sorry, you have to isolate" SMS?

GhettoComputers 5y ago
Who is the market for this? The assumption is that you give it ASAP and people want to take it. If people aren’t interested in vaccinations they may not want it either, and the vaccines are already very effective at preventing these issues.
- delecti 5y ago
  I think skepticism of vaccines largely doesn't transfer to the broader medical field. The ineffective fad treatments (ivermectin and hydroxychloroquine) are still medicine, but are still "popular" with vaccine skeptics. It's not rational, but I think vaccine skepticism is largely not rational to begin with.
  - mchusma 5y ago
    Anecdotally, hearing from doctors working in COVID wards, they consist almost entirely of anti-vaxxers who are now seeking (and receiving) treatments only recently approved. So while not everyone will take this, I think probably many would once they have symptoms. That said, this does work better it seems if taken early, before the anti-vax sentiment may have worn off. Hard to say. What it does signal is really the "end of the pandemic". We have both a vaccine (now approved for kids) and a cure. That sounds like it to me.
    - laurent92 5y ago
      This. Being antivax when one has 93% if not facing the virus ≠ refusing drugs when infected. At that point, it’s worth doing everything because the risk is realized.
    - sdenton4 5y ago
      The first three days of symptoms for an anti-vaxxer are obviously just a flu, because covid is fake. It's not covid until they're hooked up to a machine...
      - geerlingguy 5y ago
        There are many who won't even get a test now, to check if it's COVID. They ride it out, and won't know if they just had a flu, cold, or COVID. And thus it seems we've currently plateaued in case counts in the US :(
        ryanobjc 5y ago
        Check out Reddit.com/r/hermancainaward for this exactly
        blindmute 5y ago
        How does knowing the name of your infection help you? If I'm sick I'm going to stay home and rest, not run to a test clinic out of pure curiosity.
        orra 5y ago
        A lab in the UK performing PCR tests messed up big time, and returned 40 000 false positives. 40 000 people forced to work by their employers, who then spread it to colleagues and customers, because they had a respiratory disease but ‘it isn’t COVID’. COVID is particularly bad, but employees should also be allowed to stay home and rest, to not spread the cold and flu.
  - tshaddox 5y ago
    The fad treatments are "still medicine," but crucially are not generally approved of by the "mainstream medical establishment." This lack of approval is the key feature of these treatments.
    - nkozyra 5y ago
      > This lack of approval is the key feature of these treatments. Lack of approval + length of use as medicine. There's a narrative that drug X has been used for 50 years (despite what it's used for) and therefore the pharma industry is uninterested in its success because they can't get rich off of it. The latter is a common thread, along the lines of "what THEY don't want you to know."
      - pfisherman 5y ago
        But this makes absolutely no sense. Plenty of previously approved drugs, such as anticoagulants and dexamethasone, are part of the current standard of care; and their effectiveness has unambiguously been borne out by the data with multiple independent studies / analyses that all agree. So why are THEY for these but against ivermectin? Of course the whole idea of THEY is nutty. The idea that there is this level of coordination / cooperation among pharma companies is ridiculous enough to be the punchline of a joke.
        effie 5y ago
        You only make it ridiculous, it's actually really simple. Bureaucrats in agencies have their procedures and their agenda. Very little coordination is needed to ignore some controversial medication, associated with poor countries and antivaxers, when there are other things they can appear to be working on. Many people sick with COVID are not getting this "standard of care" you suggest exists. Just tylenol and good luck. So those other drugs are not very far from ivermectin in terms of accessibility. All effective drugs are controlled and access is not given to the broad public, only to doctors and pharmacists, and many of these gatekeepers keep them from the sick people. You have to be lucky and have a good doctor who cares about you, not just about following what government agencies tell him to do. Then he may give both "unproblematic" stuff like heparines and also more "controversial" stuff like ivermectin.
- orra 5y ago
  The vaccines are 92–95% effective at preventing hospitalisation and death. (They also reduce spread significantly.) That's great. However, that means something like this is still very useful because of that 5–8%, especially for the elderly and the immunosuppressed, etc. (I share your skepticism anti vaxxers would be interested in an effective treatment.)
  - penultimatebro 5y ago
    The mRNA vaccines do not, and never have, reduce the spread of the virus from one infected person to someone else. The only thing they do is reduce symptoms. That has been known from clinical trials. Everything else is a talking point not based on a peer reviewed scientific study. Or if you think you have a study that refutes this, please post.
    - SideburnsOfDoom 5y ago
      > The mRNA vaccines do not, and never have, reduce the spread of the virus from one infected person to someone else That's simply not correct.
      - penultimatebro 5y ago
        Well I’m convinced. Case closed, you win.
        dang 5y ago
        We've banned this account because it has been using HN primarily for ideological battle. That's not allowed here, regardless of what you're battling for or against. Please don't create accounts to break HN's guidelines with. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
        SideburnsOfDoom 5y ago
        I can see your comment history, and you made the same false statement 3 days prior to this one. You were given long responses with links then. ( e.g. https://news.ycombinator.com/item?id=29078217 https://news.ycombinator.com/item?id=29078217 ) The same thing 5 days ago: https://news.ycombinator.com/item?id=29058624 https://news.ycombinator.com/item?id=29058624 you were given a response that you ignored. Those didn't make any impression on you; you carried on saying the same false thing. So there was no point in trying to convince you this time, it's clear that would be simply a waste of my time to try to change your mind again. You aren't here for that. I'm merely marking your misinformation for the benefit of others.
- jdhn 5y ago
  I'd say that this will appeal to people who are covid vaccine skeptical. If you're skeptical of the mRNA vaccines, you'd probably be in favor of this treatment than the vaccines.
  - dboreham 5y ago
    Because _absolutely_ _anything_ is less dangerous than mRNA.
    - epakai 5y ago
      mRNA has potential to be dangerous. There is nothing inherently dangerous in what our bodies already use as building instructions, nor is there evidence to suggest current mRNA vaccines cause any of these theoretical issues.
      - oblio 5y ago
        Yeah, plus on top of that, anything has the potential to be dangerous. Take, for example, water. Everybody knows about its positive sides, and about most of the negative ones. But 99% of people don't know that water can kill you. I'm not talking about drowning. https://en.wikipedia.org/wiki/Water_intoxication https://en.wikipedia.org/wiki/Water_intoxication If the most benign substance on the surface on the planet can kill you, anything can.
    - atleta 5y ago
      I have bad news for you (unless it was irony, which I can't rule out): the SARS-CoV2 virus contains its genome as RNA that is used directly (IIRC) as mRNA. Because it's needed for the protein synthesis to build new virus particles. This is true for every virus, BTW: they either contain RNA that can be used by the cell for protein synthesis (i.e. mRNA) or they do synthesize (or make the cell synthesize) the mRNA based on their genome, one way or another. So no matter what, you'll get the viral mRNA in your body. Either through infection or through the vaccine. The vaccine just contains a small fragment and it does not proliferate. Unlike the virus.
  - 5y ago
- tempoponet 5y ago
  And unfortunately the window for this closes before a skeptic will get desperate. Once people go on a vent they appear to become open minded to other treatment options.
- jollybean 5y ago
  Unfortunately, it's the opposite. Anti-Vaxx people seem to absolutely love non-vax treatments. I don't know if the rationalization is sound, but I'm not sure it's really that. The anti-vaxx stigma pre-COVID I think has had it's toll. The notion of 'government pushing you to take something' as well. Whereas, 'you get sick, you take a pill' is an easy concept. My fear is that a lot of people won't bother with a vax if they think there's a 'cure'.
  - UnFleshedOne 5y ago
    I think the main difference is one has to necessarily take on vaccine risk without catching covid, so you balance chance of vax complications vs chance of getting covid multiplied by chance of getting bad case of covid. So 1 * P(bad vax) vs P(getting covid) * P(bad covid case). While most of other proposed treatments are after you already got it. So P(bad side effects) vs 1 * P(bad covid case). Depending on your priors and health, those balance very differently. Also, if the new pill ends up as effective as they say it is, there is no reason to push for 100% vax uptake anymore -- it would turn covid into a slightly more dangerous cold.
    - orra 5y ago
      > one has to necessarily take on vaccine risk without catching covid Thankfully that risk is tiny. > Also, if the new pill ends up as effective as they say it is, there is no reason to push for 100% vax uptake anymore -- it would turn covid into a slightly more dangerous cold. No, vaccination remains far cheaper. Mass vaccination also reduces the risk of mutation, and of infection others. If everybody gets vaccinated AND this anti viral is widely available for those infected, COVID will be well and truly deranged.
      - effie 5y ago
        > Mass vaccination also reduces the risk of mutation, and of infection others. Only if the vaccine is effective enough. With these moderately effective vaccines, there is a danger that breakthrough cases will generate new variants.
- KennyBlanken 5y ago
  > Who is the market for this? Wealthy people.
jiggawatts 5y ago
COVID-19 is not the only coronavirus! If this drug is safe and can be made sufficiently cheap, it could be a great treatment for most kinds of common cold. Why suffer for weeks with cold symptoms if you can simply spray this up your nose and feel better? It could (potentially) be used similarly to Tamiflu.
- orra 5y ago
  Alas you are a tad optimistic. The majority of the common cold cases is caused by rhinoviruses. But yes, like 20% (ballpark) are caused by coronaviruses.
nieve 5y ago
I highly recommend Derek Lowe's post on it for some of the details. It links to the press release which contains this information showing it was very effective still starting at 5 days from symptoms onset: > Similar reductions in COVID-19-related hospitalization or death were observed in patients treated within five days of symptom onset; 1.0% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (6/607 hospitalized, with no deaths), compared to 6.7% of patients who received a placebo (41/612 hospitalized with 10 subsequent deaths), with high statistical significance (p<0.0001). In the overall study population through Day 28, no deaths were reported in patients who received PAXLOVID™ as compared to 10 (1.6%) deaths in patients who received placebo. Those extra two days (three versus five) could make a huge difference.
Bombthecat 5y ago
Hope anti vaxxer will take it. To free up hospitals.

by orra 5y ago

GhettoComputers 5y ago

Who is the market for this? The assumption is that you give it ASAP and people want to take it. If people aren’t interested in vaccinations they may not want it either, and the vaccines are already very effective at preventing these issues.

delecti 5y ago
I think skepticism of vaccines largely doesn't transfer to the broader medical field. The ineffective fad treatments (ivermectin and hydroxychloroquine) are still medicine, but are still "popular" with vaccine skeptics. It's not rational, but I think vaccine skepticism is largely not rational to begin with.
- mchusma 5y ago
  Anecdotally, hearing from doctors working in COVID wards, they consist almost entirely of anti-vaxxers who are now seeking (and receiving) treatments only recently approved. So while not everyone will take this, I think probably many would once they have symptoms. That said, this does work better it seems if taken early, before the anti-vax sentiment may have worn off. Hard to say. What it does signal is really the "end of the pandemic". We have both a vaccine (now approved for kids) and a cure. That sounds like it to me.
  - laurent92 5y ago
    This. Being antivax when one has 93% if not facing the virus ≠ refusing drugs when infected. At that point, it’s worth doing everything because the risk is realized.
  - sdenton4 5y ago
    The first three days of symptoms for an anti-vaxxer are obviously just a flu, because covid is fake. It's not covid until they're hooked up to a machine...
    - geerlingguy 5y ago
      There are many who won't even get a test now, to check if it's COVID. They ride it out, and won't know if they just had a flu, cold, or COVID. And thus it seems we've currently plateaued in case counts in the US :(
      - ryanobjc 5y ago
        Check out Reddit.com/r/hermancainaward for this exactly
      - blindmute 5y ago
        How does knowing the name of your infection help you? If I'm sick I'm going to stay home and rest, not run to a test clinic out of pure curiosity.
        orra 5y ago
        A lab in the UK performing PCR tests messed up big time, and returned 40 000 false positives. 40 000 people forced to work by their employers, who then spread it to colleagues and customers, because they had a respiratory disease but ‘it isn’t COVID’. COVID is particularly bad, but employees should also be allowed to stay home and rest, to not spread the cold and flu.
- tshaddox 5y ago
  The fad treatments are "still medicine," but crucially are not generally approved of by the "mainstream medical establishment." This lack of approval is the key feature of these treatments.
  - nkozyra 5y ago
    > This lack of approval is the key feature of these treatments. Lack of approval + length of use as medicine. There's a narrative that drug X has been used for 50 years (despite what it's used for) and therefore the pharma industry is uninterested in its success because they can't get rich off of it. The latter is a common thread, along the lines of "what THEY don't want you to know."
    - pfisherman 5y ago
      But this makes absolutely no sense. Plenty of previously approved drugs, such as anticoagulants and dexamethasone, are part of the current standard of care; and their effectiveness has unambiguously been borne out by the data with multiple independent studies / analyses that all agree. So why are THEY for these but against ivermectin? Of course the whole idea of THEY is nutty. The idea that there is this level of coordination / cooperation among pharma companies is ridiculous enough to be the punchline of a joke.
      - effie 5y ago
        You only make it ridiculous, it's actually really simple. Bureaucrats in agencies have their procedures and their agenda. Very little coordination is needed to ignore some controversial medication, associated with poor countries and antivaxers, when there are other things they can appear to be working on. Many people sick with COVID are not getting this "standard of care" you suggest exists. Just tylenol and good luck. So those other drugs are not very far from ivermectin in terms of accessibility. All effective drugs are controlled and access is not given to the broad public, only to doctors and pharmacists, and many of these gatekeepers keep them from the sick people. You have to be lucky and have a good doctor who cares about you, not just about following what government agencies tell him to do. Then he may give both "unproblematic" stuff like heparines and also more "controversial" stuff like ivermectin.
orra 5y ago
The vaccines are 92–95% effective at preventing hospitalisation and death. (They also reduce spread significantly.) That's great. However, that means something like this is still very useful because of that 5–8%, especially for the elderly and the immunosuppressed, etc. (I share your skepticism anti vaxxers would be interested in an effective treatment.)
- penultimatebro 5y ago
  The mRNA vaccines do not, and never have, reduce the spread of the virus from one infected person to someone else. The only thing they do is reduce symptoms. That has been known from clinical trials. Everything else is a talking point not based on a peer reviewed scientific study. Or if you think you have a study that refutes this, please post.
  - SideburnsOfDoom 5y ago
    > The mRNA vaccines do not, and never have, reduce the spread of the virus from one infected person to someone else That's simply not correct.
    - penultimatebro 5y ago
      Well I’m convinced. Case closed, you win.
      - dang 5y ago
        We've banned this account because it has been using HN primarily for ideological battle. That's not allowed here, regardless of what you're battling for or against. Please don't create accounts to break HN's guidelines with. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
      - SideburnsOfDoom 5y ago
        I can see your comment history, and you made the same false statement 3 days prior to this one. You were given long responses with links then. ( e.g. https://news.ycombinator.com/item?id=29078217 https://news.ycombinator.com/item?id=29078217 ) The same thing 5 days ago: https://news.ycombinator.com/item?id=29058624 https://news.ycombinator.com/item?id=29058624 you were given a response that you ignored. Those didn't make any impression on you; you carried on saying the same false thing. So there was no point in trying to convince you this time, it's clear that would be simply a waste of my time to try to change your mind again. You aren't here for that. I'm merely marking your misinformation for the benefit of others.
jdhn 5y ago
I'd say that this will appeal to people who are covid vaccine skeptical. If you're skeptical of the mRNA vaccines, you'd probably be in favor of this treatment than the vaccines.
- dboreham 5y ago
  Because _absolutely_ _anything_ is less dangerous than mRNA.
  - epakai 5y ago
    mRNA has potential to be dangerous. There is nothing inherently dangerous in what our bodies already use as building instructions, nor is there evidence to suggest current mRNA vaccines cause any of these theoretical issues.
    - oblio 5y ago
      Yeah, plus on top of that, anything has the potential to be dangerous. Take, for example, water. Everybody knows about its positive sides, and about most of the negative ones. But 99% of people don't know that water can kill you. I'm not talking about drowning. https://en.wikipedia.org/wiki/Water_intoxication https://en.wikipedia.org/wiki/Water_intoxication If the most benign substance on the surface on the planet can kill you, anything can.
  - atleta 5y ago
    I have bad news for you (unless it was irony, which I can't rule out): the SARS-CoV2 virus contains its genome as RNA that is used directly (IIRC) as mRNA. Because it's needed for the protein synthesis to build new virus particles. This is true for every virus, BTW: they either contain RNA that can be used by the cell for protein synthesis (i.e. mRNA) or they do synthesize (or make the cell synthesize) the mRNA based on their genome, one way or another. So no matter what, you'll get the viral mRNA in your body. Either through infection or through the vaccine. The vaccine just contains a small fragment and it does not proliferate. Unlike the virus.
- 5y ago
tempoponet 5y ago
And unfortunately the window for this closes before a skeptic will get desperate. Once people go on a vent they appear to become open minded to other treatment options.
jollybean 5y ago
Unfortunately, it's the opposite. Anti-Vaxx people seem to absolutely love non-vax treatments. I don't know if the rationalization is sound, but I'm not sure it's really that. The anti-vaxx stigma pre-COVID I think has had it's toll. The notion of 'government pushing you to take something' as well. Whereas, 'you get sick, you take a pill' is an easy concept. My fear is that a lot of people won't bother with a vax if they think there's a 'cure'.
- UnFleshedOne 5y ago
  I think the main difference is one has to necessarily take on vaccine risk without catching covid, so you balance chance of vax complications vs chance of getting covid multiplied by chance of getting bad case of covid. So 1 * P(bad vax) vs P(getting covid) * P(bad covid case). While most of other proposed treatments are after you already got it. So P(bad side effects) vs 1 * P(bad covid case). Depending on your priors and health, those balance very differently. Also, if the new pill ends up as effective as they say it is, there is no reason to push for 100% vax uptake anymore -- it would turn covid into a slightly more dangerous cold.
  - orra 5y ago
    > one has to necessarily take on vaccine risk without catching covid Thankfully that risk is tiny. > Also, if the new pill ends up as effective as they say it is, there is no reason to push for 100% vax uptake anymore -- it would turn covid into a slightly more dangerous cold. No, vaccination remains far cheaper. Mass vaccination also reduces the risk of mutation, and of infection others. If everybody gets vaccinated AND this anti viral is widely available for those infected, COVID will be well and truly deranged.
    - effie 5y ago
      > Mass vaccination also reduces the risk of mutation, and of infection others. Only if the vaccine is effective enough. With these moderately effective vaccines, there is a danger that breakthrough cases will generate new variants.
KennyBlanken 5y ago
> Who is the market for this? Wealthy people.

jiggawatts 5y ago

COVID-19 is not the only coronavirus! If this drug is safe and can be made sufficiently cheap, it could be a great treatment for most kinds of common cold. Why suffer for weeks with cold symptoms if you can simply spray this up your nose and feel better? It could (potentially) be used similarly to Tamiflu.

orra 5y ago
Alas you are a tad optimistic. The majority of the common cold cases is caused by rhinoviruses. But yes, like 20% (ballpark) are caused by coronaviruses.

nieve 5y ago

I highly recommend Derek Lowe's post on it for some of the details. It links to the press release which contains this information showing it was very effective still starting at 5 days from symptoms onset: > Similar reductions in COVID-19-related hospitalization or death were observed in patients treated within five days of symptom onset; 1.0% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (6/607 hospitalized, with no deaths), compared to 6.7% of patients who received a placebo (41/612 hospitalized with 10 subsequent deaths), with high statistical significance (p<0.0001). In the overall study population through Day 28, no deaths were reported in patients who received PAXLOVID™ as compared to 10 (1.6%) deaths in patients who received placebo. Those extra two days (three versus five) could make a huge difference.

Bombthecat 5y ago

Hope anti vaxxer will take it. To free up hospitals.