11 ms·

Paxlovid: You'd have expected more

84 points by helloworld 2y ago

mark_l_watson 2y ago
I am in my 70s and within a few hours of taking PAXLOVID my symptoms went away. I took it the first time I had Covid. When I had Covid a second last year I decided to suffer the symptoms without PAXLOVID so I felt crappy for three or four days. I really think treating Covid for older people is a very different than treating young people. That said, when I took PAXLOVID my daughter, son in law and grandson had the same Covid strain I did at the same time and their symptoms were very bad and lasted ten days to over two weeks.
merb 2y ago
I took paxlovid and still got hospitalized with pneumonia and I’m 35. it was probably the worst week in my entire life. Paxlovid is so bitter, it actually lingers on your mouth for a few days after you take your last dose. It’s absolutely horrible. But maybe it helped me, the pneumonia was a light one so after the hospital it took me like 2-3 weeks and everything was kinda normal. If it helped me, it’s kinda sad that it costs like ~1000€ in Germany, of course my medi care paid everything.
TwoNineFive 2y ago
HN hosting more right-wing COVID-denier dribble. It has nothing to do with tech and HN, but it stays up anyway.
credit_guy 2y ago
I love Derek Lowe as much as anyone else, but this piece is a bit weak. The (currently) first comment on his site is right on point: > I don’t really see what point this article is trying to make. I’m 65. Vaxxed for covid to the max. Finally got covid. Before I had much in the way of symptoms I took Paxlovid for 5 days. Covid symptoms stopped. Tested clear of Covid after 5 days. Then I had rebound Covid for about a week but it was mild. If I ever get Covid again I’ll take paxlovid again. I don’t care what anyone else thinks. Here are some reasons the article is weak. 1. I'll start with my own anecdote. I got the initial 2 shots of Moderna and later the booster when it became available. Still, I contracted Covid in early 2022 and it was not very fun. Then I contracted Covid in early 2024 and I got Paxlovid this time, and it was a breeze. 2. The mechanism of action of Paxlovid is different from the mechanism of action of the Pfizer/Moderna vaccines (I guess other vaccines as well). The vaccines train the body to recognize the spike protein of the virus, while Paxlovid attacks a protease (called M-pro) that plays some role in the virus's replication cycle. As the Covid virus mutates and the vaccines bases on the older strains become less effective, the added benefit of a drug with a different mechanism of action increases. Note that I said the added benefit, not the absolute benefit, which could very well decrease too. So, a study based on observations between April and October 2022 is likely to understate the benefit of Paxlovid today (for the vaccinated people). 3. Derek does not mention if the study was powerful enough. Absence of evidence is not evidence of absence. Since this was an observational study based on an existing cohort, the observers did not have a chance to do design the experiment to ensure enough statistical power. The conclusion that Derek draws is based on multiple indirect comparisons, and in all of them Derek treats statistical insignificance as equality. 4. Derek talks about long term effects. In my own anecdote, I did suffer from hearing loss for many months after my Covid episode with no Paxlovid. Nothing close to getting me to a hospital. But very annoying. Absolutely no Covid short or long term effects when I took Paxlovid. 5. This statement "if a drug's not doing you any good then you really shouldn't take it at all" is a big error. Derek jumped from "we have no evidence that the drug is good" to "the drug is doing you no good". Boom. Blink and you don't see it.
evnc 2y ago
Always enjoy Derek Lowe's writing. n=1 here, though I've heard others say the same -- but I (fairly healthy 30s male, vaccinated) found Paxlovid massively reduced symptom intensity for me. Within a day my symptoms went from "top 5 fevers I've ever experienced, normal function significantly impaired" to "feels like a cold; can reasonably handle myself around the house and even take a software engineering interview". I most likely would not have got a severe infection and probably would not have got Long Covid, given my age / health / vaccine status, even if I hadn't taken it; but nonetheless I'm glad I was able to get it. Definitely worth it for the weird taste (hard candy helps).
- trillic 2y ago
  n=2, same, generally healthy 28yo male, basically identical anecdote. maybe technically n=3 since I've taken it twice!
- iamben 2y ago
  Both times I had COVID I went from "worst fever ever / my body feels like I've been hit my a bus" to "I have a pretty average cold" in less than 36 hours. Utterly bizarre. (Vaccinated, good health, 40s male) Edit to clarify: I didn't take anything other than paracetamol and ibuprofen.
  - freehorse 2y ago
    I did not take anything special either, vaccinated, and have had more or less the same experience. I got from not being able to even sleep the night due to the pain, to feeling great the very following afternoon. Completely bizarre. None of the people I know experienced it like this, though. This is why properly controlled trials are needed for stuff like that. It is easy to attribute the change to whatever random thing I tried at that point out of desperation.
  - BugsJustFindMe 2y ago
    Yeah, that's what happened to me too. I felt substantially better the next morning.
- 2y ago
jibe 2y ago
Checking GoodRX, Paxlovid ranges from $1,497 at CVS to $1,696 at Costco. Expensive for something that potentially has little effect.
- justin66 2y ago
  Thanks to a helpful pharmacist who let me know about it, I used the manufacturer's copay coupon (I think this is it: https://www.paxlovid.com/paxcess-terms-and-conditions https://www.paxlovid.com/paxcess-terms-and-conditions ) and the cost of the drug for me (with insurance!) went from $400 to zero. I don't know about "potentially no effect." It sure seemed to work well for me, and I've had covid with and without it. The difference was pretty big. I'm fairly certain the more profound difference is for those who are older or otherwise at risk, of course.
stonogo 2y ago
I don't have any insight into hospitalizations, but as someone who was not vaccinated at the time I came down with COVID-19, Paxlovid was the difference between feeling utterly horrible and barely being able to get out of bed to being able to work remotely at full productivity. I took the first dose on the first morning and by the next morning the difference was night and day. I too experienced the bizarre changes in flavors, but that was a very small price to pay for immediately ending my symptoms. I still did the full quarantine duration, but the quality of life was so much better!
- moshegramovsky 2y ago
  Same. I had one night of fever and incredible chills. Thought for sure I was going to get very sick. Got Paxlovid next day. Felt better the following day. It was like having a cold, and I don't think that would have happened without the Paxlovid.
  - monktastic1 2y ago
    I also had one night of fever and incredible chills, followed by two days of no symptoms. No Paxlovid. (But then I did get bad cold-like symptoms for a week, and what seems to be long Covid...)
    - moshegramovsky 2y ago
      Sorry you got long covid. I hope you recover quickly!
- dahdum 2y ago
  That metallic taste still gives me shudders when I think about it, but I’m very grateful for Paxlovid.
francisofascii 2y ago
For most people now, the whole reason to take Paxlovid is the avoid long covid. The hospitalization risk is less of a concern. The article points out at the end that this drug has shown evidence of avoiding long covid.
- monktastic1 2y ago
  But only in high-risk patients, it should be noted.
  - francisofascii 2y ago
    No, any type of patient can get long covid. I suspect a heathy adult gets it from a combination of bad luck and/or not resting enough, doing too much, etc. post infection.
    - fisherjeff 2y ago
      I think the comment you’re replying to was just noting that, according to Derek’s read on it, paxlovid may not reduce the risk of long covid in low-risk patients.
  - groby_b 2y ago
    There's some evidence in lower risk groups too. It's alas not an on-off switch, and you can't file a complaint Covid sorted you in the wrong group. Does that mean we should all absolutely take Paxlovid? No, quite likely not. But the question is more "how close to the high risk group are you" than "are you high risk". For e.g. 20-yo white men, the answer in both cases is roughly the same. But say they're 55 (or 65 and healthy as a horse) it probably deserves a bit more thought
  - KennyBlanken 2y ago
    Nothing supports your 'only' comment. It's a lot easier and less risk to just pop the pills and put up with the disgusting taste and maybe being sicker a bit longer, than it is for you and your doctor to sit down and try to do a whole bunch of fuzzy calculations to figure out just exactly how high-risk you might be and whether that meets the threshold for using paxlovid. Particularly given we almost certainly don't know all the high risk factors, not every doctor is able to keep up with all the latest research, and the patient and/or treating physician might not even be aware the patient has a particular risk factor. Depending on how far down the rabbit hole you go - there's an opportunity cost to a physician's time, too, and them spending more time trying to figure out if someone REALLY needs paxlovid means they have less time to spend with other patients.
moshegramovsky 2y ago
I have quite a bit of anecdata that Paxlovid works very well in helping very sick elderly people stay out of the hospital.
- jgalt212 2y ago
  Yes, but these drugs (and the vaccines) don't make nearly as much money if only taken by those with high risk profiles.
  - moshegramovsky 2y ago
    The copays were pretty expensive! On the order of $400.00.
- robbiep 2y ago
  Dealing with the drug interactions when prescribing paxlovid j find to be a bloody nightmare. Must have handed it out like 10 times in my last run of shifts
- chefandy 2y ago
  I’ve had Covid 5 times— I’m pretty familiar with how it progresses. The most recent time was the most severe— I went to the ER with a temp of 103 with ibuprofen. Got Paxlovid— the major symptoms nearly switched off like flipping a light switch. Of course there’s a possibility it would have done that anyway, but I’m sure as hell going to take it again if necessary.
  - moshegramovsky 2y ago
    I definitely will take it again, no question. It worked really well for me. Side effects weren't too bad either.
shusaku 2y ago
People always complain about replication crisis and a lack of publishing of negative results. From my surface level reading then, it seems nice to have a paper getting attention for just confirming what the original Paxlovid study already found.
energy123 2y ago
This appears to be a hasty conclusion. Older people with paxlovid did equally well as younger people without paxlovid. That indicates that paxlovid actually works, given that older age leads to covid mortality! The author's only refutation of this is that the same pattern was observed before Paxlovid was around. But that pattern itself is an aberration that is not true of the general population, it's only true in that one geographical area due to, I would assume, a statistical anomaly.
- BugsJustFindMe 2y ago
  > That indicates that paxlovid actually works It had no measurable effect in the measured group. You can't say that it works based on that. If it had a measurable effect in that group, you would expect to see improvement in the treatment group between the two scenarios. If (65-69 no treatment) == (70-74 no treatment) and also (65-69 no treatment) == (70-74 treatment), then (70-74 treatment) == (70-74 no treatment) by the transitive property of equality. Now the reason for (65-69 no treatment) == (70-74 no treatment) may be its own mystery, but we expect to see at least _something_ happen anyway between (70-74 no treatment) and (70-74 treatment) if the treatment had some benefit for that group, and apparently they didn't see that.
  - ulfw 2y ago
    [flagged]
    - BugsJustFindMe 2y ago
      Which part of that are you having trouble with? We have two different age ranges, one of them separately measured with and without treatment, with the same outcomes across all groupings.
      - ulfw 2y ago
        Apologies. My dyslexia hit me. You are right and I was wrong
    - 2y ago
talkingtab 2y ago
My experience was odd. And this is just a description with no science. I was vaccinated, got COVID. At no point were my symptoms serious. Because of age and past heart issues I was given paxlovid. Two weeks after the paxlovid (or something like that) I became sick again, more seriously. With COVID. The symptoms I experienced were much worse but not life threatening and I recovered fully. However, it was odd that the COVID came roaring back. My conjecture is that the paxlovid suppressed COVID, but that caused my body to falter in terms of building immunity. So when the paxlovid wore off, I was actually worse off. In the same situation I would NOT take the paxlovid again unless it was clear I had serious symptoms - like I was going to end up hospitialized. I acknowledge there is no science here, but on the other hand none of the doctors were able to suggest why I had a second episode so quickly and why it was more severe. My conclusion is that there was a lot of guessing, placebo, reassuring, best guessing going on. I think that is the take away if we face such a thing again.
- CaliforniaKarl 2y ago
  Research "Paxlovid rebound". It sounds like that is what hit you.
- nanodeath 2y ago
  To add to the anecdata here, I had covid for a week (bedridden but otherwise not that bad), then had a single day in which I tested negative, and then it rebounded for a week, due to Paxlovid. Sounded like it was pretty common. So that was a waste of 15 days. On the plus side, my second week was much the same as the first week as far as symptoms go.
  - cavisne 2y ago
    Another example is Joe Biden, who had this exact thing happen (covid twice in a row with paxlovid). Notable because while the chance of him just catching it again from someone are not 0, but about as low as it can go (an elderly POTUS under intense medical supervision and quarantine procedures).
- gwervc 2y ago
readthenotes1 2y ago
"I think it's very likely that if there had been a Paxlovid trial early on with a median age of 70 among unvaccinated adults (instead of the real median age of 42) that it would have shown much more than that 5.5% improvement in hospitalization risk! " I find it wholly consistent with the entire "Have Faith in Science" trend of the COVID years for someone to say something like this. I think it very likely that we don't know and shouldn't assume.
reify 2y ago
GoodRX, Paxlovid ranges from $1,497 at CVS to $1,696 at Costco. Fuck me! Only for rich muppets then? In my local Boots chemist Aspirin is about £2.00 for 28 tablets. Paxlovid is a combination of 2 medicines called nirmatrelvir and ritonavir. Nirmatrelvir stops the virus from growing and spreading, and ritonavir helps nirmatrelvir from being broken down in your body long enough to do its job. Fuck me! again.
- jimmydoe 2y ago
  for poor people like me, the cost made me hesitate, then the best timing of taking it was gone. so if banning this med is the only way to make the world more equal, I'm all for it.
  - mannyv 2y ago
    You would rather have everyone be worse off than a few be better off?
- thenerdhead 2y ago
  Ensitrelvir is looking to apply for global approval. It may be a much more affordable option.
ecocentrik 2y ago
My impression has been that taking Paxlovid resulted in faster recovery and less severe symptoms. This is an anecdotal observation with a tiny small sample size so I wouldn't discount placebo or a weaker variant. Still, I'd like to see a broader study that looks into long COVID and severity.
- ragle 2y ago
  Likewise. I was 2-3 days into testing positive and had a fever that could not be controlled by maximum strength OTC antipyretics, awful cough producing glue-like greyish globs, headache, blood oxygen consistently 2-3% below typical for me, extreme fatigue. ~48 hours after beginning Paxlovid I felt almost back to normal. spO2 returned to typical wake / sleep levels, lungs clearing, little fatigue, etc. Based on how sick I was when I started treatment, if historical patterns of recovery from respiratory illness are any indication I would have expected an additional ~9-14 days of tapering symptoms at minimum. Instead I was basically totally normal again after ~5-6 days. If I get COVID again I will absolutely ask for Paxlovid.
gp 2y ago
I took Paxlovid twice. Horrible bitter taste, but kept the symptoms at bay. No long covid or persisting brain fog unlike some of my friends. Tested negative by the end of the treatment. My fiancé didn't catch it from my while I isolated. Derek doesn't have to take Paxlovid next time, but I will.
- illusive4080 2y ago
  I had Covid once. No drugs, no vaccine (don’t jump me it wasn’t available yet). No long covid or brain fog. Sleepiness, loss of taste, flu symptoms for 5 days. Completely better in 10 days. Anecdotes aren’t usually helpful for effectiveness testing. My experience can vary greatly between my neighbor even with identical demographics and characteristics.
- riversflow 2y ago
  The extremely well-documented strength of the placebo effect is exactly why medical trials need to be so robust.
- refurb 2y ago
  How doy ou know it kept your symptoms at bay? Plenty of people don't get long Covid, why were you sure you'd get it if you didn't take paxlovid? Same with brain fog?
  - cvwright 2y ago
    Yeah you can read very similar anecdotes from people who took ivermectin. This is why controlled experiments are so important.
  - lostdog 2y ago
    Took paxlovid also. The symptoms go away really really suddenly and fast. Sure, you need to run a study to be absolutely certain, but it just takes one experience to notice the effect.
  - Timon3 2y ago
    It's interesting how religiously "correlation is not causation" is repeated here - except when it's about personal anecdotes.
aaron695 2y ago
[dead]
temporallobe 2y ago
My father almost died on Paxlovid. Almost immediately after taking it, he ended up in the ER, complaining of cardiac issues (severe arrhythmias and pain) and saying he felt like death. It wasn’t exactly a cardiac arrest, rather an “event”. While one could say it was Covid, the timing of the symptoms were too coincidental to ignore. It took him 2 months to start feeling normal. He had had covid twice before and was sufficiently vaccinated.
- HocusLocus 2y ago
  I upvoted because you were gray, apparently wrongthink was being thunk by you. That's pretty sick. MY father, 83 and stable on his meds for years, died 10 days after his first Moderna. COVID tested negative, pulmonary thrombosis. I didn't think that was a coincidence at all, hell no. I'm glad your dad is all right. Let's all try to avoid these coincidences in the future. Maybe my post will be flagged as wrongthink too, it's become a badge of honor at this point.
herf 2y ago
Here is the new 2024 result (all ages) that says mean time to symptom alleviation didn't significantly change on Pax: https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 I was surprised to read it.
thenerdhead 2y ago
I believe Science would benefit from a different approach to reporting, as Derek’s analysis over the past four years has been consistently lacking. A responsible science reporter should present the full body of evidence rather than drawing conclusions from a single study. Currently, a 900-person study is exploring Paxlovid’s potential for three clusters of Long COVID patients using a novel ultra-sensitive single-molecule assay. While many question its effectiveness in short treatment durations, there is reason to believe it could have extended benefits, similar to treatments for hepatitis C or feline coronavirus infections. Having read and shared thousands of studies on SARS-CoV-2 and Long COVID, I find it irresponsible to dismiss a drug based on a single study, especially when broader research suggests that access to antivirals may reduce the risk of developing Long COVID, even among vaccinated individuals. New antivirals are awaiting FDA approval, and an updated version of Paxlovid is in development. Derek’s analysis is not only misleading but also incorrect, and it would be best if he reconsidered the reach of his words.
- fn-mote 2y ago
  Your comment does not cite any scientific evidence that contradicts the assertions in the article. The study you mention is ongoing and small. For comparison, one of the articles cited involves 280k patients with 35k treated. If you're going to call an analysis incorrect, you should should say what's wrong with it. With a comment this strong, I think you should disclose a little more of your own background / stance on the subject. Have you written a self-published book on Long Covid? (It looks like yes, but tl;dr.) My sympathies if you have suffered it.
  - thenerdhead 2y ago
    here's my page with countless findings on the topic (you be the judge and feel free to search for other studies too): https://x.com/search?lang=en&q=(paxlovid%20OR%20Nirmatrelvir)%20(from%3Aatranscendedman)&src=typed_query https://x.com/search?lang=en&q=(paxlovid%20OR%20Nirmatrelvir... my general thoughts on this article and science "journalism" lately: https://x.com/atranscendedman/status/1856467031157289327 https://x.com/atranscendedman/status/1856467031157289327 background: 4 years of long covid, work on nih efforts to cure it, and i don’t want anyone to suffer like millions of us do. so i share reliable info with the world. note: paxlovid is a first-generation drug. in 2025, derek should follow more science rather than zeroing in on one study or griping about the taste when it can prevent your life from flipping upside down with long covid. he has literally written on the next version of it as well. many elderly patients who are only vaccinated still develop long covid and are often dismissed due to their age. nobody deserves that when an antiviral is available until next-gen vaccine 2b trials finish soon and more treatment options hit the usa market later this year.
tehjoker 2y ago
i wonder how the calculus changes when the variant is poorly matched to the last vaccine you got
ChrisArchitect 2y ago
Paxlovid? You'd have expected more people to be doing more to not get infected & reinfected by COVID, and trying to stop the spread. But here we are. 5 years in.
- bigtimesink 2y ago
  What do you propose? Continue social distancing and masking? About the only middle ground is masking in medical settings and crowded, non-social spaces. I guess vaccination rates are low, but that should be a good thing for people who are vaccinated.
  - pabs3 2y ago
    Indoor air filtering might help?
deleted 2y ago
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cameldrv 2y ago
I will say for me when I took it, I could barely get out of bed. I slept 17 hours that day. It was maximum effort just to go downstairs to the kitchen and get food out of the refrigerator. Anyhow I got the first dose at about 6pm and went to sleep, and when I woke up I felt pretty good and went down to my office to start catching up on my email. It was an amazing turnaround.
- amenhotep 2y ago
  This was more or less what happened to me with covid and I didn't take anything at all. It started as a cold, rapidly progressed to being so bad that I spent an entire day in bed, then rapidly subsided to "recovering from a bad cold but feeling mostly normal". So I wouldn't put much confidence in your experience being down to the drug, personally.

84 points by helloworld 2y ago

I am in my 70s and within a few hours of taking PAXLOVID my symptoms went away. I took it the first time I had Covid. When I had Covid a second last year I decided to suffer the symptoms without PAXLOVID so I felt crappy for three or four days. I really think treating Covid for older people is a very different than treating young people. That said, when I took PAXLOVID my daughter, son in law and grandson had the same Covid strain I did at the same time and their symptoms were very bad and lasted ten days to over two weeks.

merb 2y ago

I took paxlovid and still got hospitalized with pneumonia and I’m 35. it was probably the worst week in my entire life. Paxlovid is so bitter, it actually lingers on your mouth for a few days after you take your last dose. It’s absolutely horrible. But maybe it helped me, the pneumonia was a light one so after the hospital it took me like 2-3 weeks and everything was kinda normal. If it helped me, it’s kinda sad that it costs like ~1000€ in Germany, of course my medi care paid everything.

TwoNineFive 2y ago

HN hosting more right-wing COVID-denier dribble. It has nothing to do with tech and HN, but it stays up anyway.

credit_guy 2y ago

I love Derek Lowe as much as anyone else, but this piece is a bit weak. The (currently) first comment on his site is right on point: > I don’t really see what point this article is trying to make. I’m 65. Vaxxed for covid to the max. Finally got covid. Before I had much in the way of symptoms I took Paxlovid for 5 days. Covid symptoms stopped. Tested clear of Covid after 5 days. Then I had rebound Covid for about a week but it was mild. If I ever get Covid again I’ll take paxlovid again. I don’t care what anyone else thinks. Here are some reasons the article is weak. 1. I'll start with my own anecdote. I got the initial 2 shots of Moderna and later the booster when it became available. Still, I contracted Covid in early 2022 and it was not very fun. Then I contracted Covid in early 2024 and I got Paxlovid this time, and it was a breeze. 2. The mechanism of action of Paxlovid is different from the mechanism of action of the Pfizer/Moderna vaccines (I guess other vaccines as well). The vaccines train the body to recognize the spike protein of the virus, while Paxlovid attacks a protease (called M-pro) that plays some role in the virus's replication cycle. As the Covid virus mutates and the vaccines bases on the older strains become less effective, the added benefit of a drug with a different mechanism of action increases. Note that I said the added benefit, not the absolute benefit, which could very well decrease too. So, a study based on observations between April and October 2022 is likely to understate the benefit of Paxlovid today (for the vaccinated people). 3. Derek does not mention if the study was powerful enough. Absence of evidence is not evidence of absence. Since this was an observational study based on an existing cohort, the observers did not have a chance to do design the experiment to ensure enough statistical power. The conclusion that Derek draws is based on multiple indirect comparisons, and in all of them Derek treats statistical insignificance as equality. 4. Derek talks about long term effects. In my own anecdote, I did suffer from hearing loss for many months after my Covid episode with no Paxlovid. Nothing close to getting me to a hospital. But very annoying. Absolutely no Covid short or long term effects when I took Paxlovid. 5. This statement "if a drug's not doing you any good then you really shouldn't take it at all" is a big error. Derek jumped from "we have no evidence that the drug is good" to "the drug is doing you no good". Boom. Blink and you don't see it.

evnc 2y ago

Always enjoy Derek Lowe's writing. n=1 here, though I've heard others say the same -- but I (fairly healthy 30s male, vaccinated) found Paxlovid massively reduced symptom intensity for me. Within a day my symptoms went from "top 5 fevers I've ever experienced, normal function significantly impaired" to "feels like a cold; can reasonably handle myself around the house and even take a software engineering interview". I most likely would not have got a severe infection and probably would not have got Long Covid, given my age / health / vaccine status, even if I hadn't taken it; but nonetheless I'm glad I was able to get it. Definitely worth it for the weird taste (hard candy helps).

trillic 2y ago
n=2, same, generally healthy 28yo male, basically identical anecdote. maybe technically n=3 since I've taken it twice!
iamben 2y ago
Both times I had COVID I went from "worst fever ever / my body feels like I've been hit my a bus" to "I have a pretty average cold" in less than 36 hours. Utterly bizarre. (Vaccinated, good health, 40s male) Edit to clarify: I didn't take anything other than paracetamol and ibuprofen.
- freehorse 2y ago
  I did not take anything special either, vaccinated, and have had more or less the same experience. I got from not being able to even sleep the night due to the pain, to feeling great the very following afternoon. Completely bizarre. None of the people I know experienced it like this, though. This is why properly controlled trials are needed for stuff like that. It is easy to attribute the change to whatever random thing I tried at that point out of desperation.
- BugsJustFindMe 2y ago
  Yeah, that's what happened to me too. I felt substantially better the next morning.
2y ago

jibe 2y ago

Checking GoodRX, Paxlovid ranges from $1,497 at CVS to $1,696 at Costco. Expensive for something that potentially has little effect.

justin66 2y ago
Thanks to a helpful pharmacist who let me know about it, I used the manufacturer's copay coupon (I think this is it: https://www.paxlovid.com/paxcess-terms-and-conditions https://www.paxlovid.com/paxcess-terms-and-conditions ) and the cost of the drug for me (with insurance!) went from $400 to zero. I don't know about "potentially no effect." It sure seemed to work well for me, and I've had covid with and without it. The difference was pretty big. I'm fairly certain the more profound difference is for those who are older or otherwise at risk, of course.

stonogo 2y ago

I don't have any insight into hospitalizations, but as someone who was not vaccinated at the time I came down with COVID-19, Paxlovid was the difference between feeling utterly horrible and barely being able to get out of bed to being able to work remotely at full productivity. I took the first dose on the first morning and by the next morning the difference was night and day. I too experienced the bizarre changes in flavors, but that was a very small price to pay for immediately ending my symptoms. I still did the full quarantine duration, but the quality of life was so much better!

moshegramovsky 2y ago
Same. I had one night of fever and incredible chills. Thought for sure I was going to get very sick. Got Paxlovid next day. Felt better the following day. It was like having a cold, and I don't think that would have happened without the Paxlovid.
- monktastic1 2y ago
  I also had one night of fever and incredible chills, followed by two days of no symptoms. No Paxlovid. (But then I did get bad cold-like symptoms for a week, and what seems to be long Covid...)
  - moshegramovsky 2y ago
    Sorry you got long covid. I hope you recover quickly!
dahdum 2y ago
That metallic taste still gives me shudders when I think about it, but I’m very grateful for Paxlovid.

francisofascii 2y ago

For most people now, the whole reason to take Paxlovid is the avoid long covid. The hospitalization risk is less of a concern. The article points out at the end that this drug has shown evidence of avoiding long covid.

monktastic1 2y ago
But only in high-risk patients, it should be noted.
- francisofascii 2y ago
  No, any type of patient can get long covid. I suspect a heathy adult gets it from a combination of bad luck and/or not resting enough, doing too much, etc. post infection.
  - fisherjeff 2y ago
    I think the comment you’re replying to was just noting that, according to Derek’s read on it, paxlovid may not reduce the risk of long covid in low-risk patients.
- groby_b 2y ago
  There's some evidence in lower risk groups too. It's alas not an on-off switch, and you can't file a complaint Covid sorted you in the wrong group. Does that mean we should all absolutely take Paxlovid? No, quite likely not. But the question is more "how close to the high risk group are you" than "are you high risk". For e.g. 20-yo white men, the answer in both cases is roughly the same. But say they're 55 (or 65 and healthy as a horse) it probably deserves a bit more thought
- KennyBlanken 2y ago
  Nothing supports your 'only' comment. It's a lot easier and less risk to just pop the pills and put up with the disgusting taste and maybe being sicker a bit longer, than it is for you and your doctor to sit down and try to do a whole bunch of fuzzy calculations to figure out just exactly how high-risk you might be and whether that meets the threshold for using paxlovid. Particularly given we almost certainly don't know all the high risk factors, not every doctor is able to keep up with all the latest research, and the patient and/or treating physician might not even be aware the patient has a particular risk factor. Depending on how far down the rabbit hole you go - there's an opportunity cost to a physician's time, too, and them spending more time trying to figure out if someone REALLY needs paxlovid means they have less time to spend with other patients.

moshegramovsky 2y ago

I have quite a bit of anecdata that Paxlovid works very well in helping very sick elderly people stay out of the hospital.

jgalt212 2y ago
Yes, but these drugs (and the vaccines) don't make nearly as much money if only taken by those with high risk profiles.
- moshegramovsky 2y ago
  The copays were pretty expensive! On the order of $400.00.
robbiep 2y ago
Dealing with the drug interactions when prescribing paxlovid j find to be a bloody nightmare. Must have handed it out like 10 times in my last run of shifts
chefandy 2y ago
I’ve had Covid 5 times— I’m pretty familiar with how it progresses. The most recent time was the most severe— I went to the ER with a temp of 103 with ibuprofen. Got Paxlovid— the major symptoms nearly switched off like flipping a light switch. Of course there’s a possibility it would have done that anyway, but I’m sure as hell going to take it again if necessary.
- moshegramovsky 2y ago
  I definitely will take it again, no question. It worked really well for me. Side effects weren't too bad either.

shusaku 2y ago

People always complain about replication crisis and a lack of publishing of negative results. From my surface level reading then, it seems nice to have a paper getting attention for just confirming what the original Paxlovid study already found.

energy123 2y ago

This appears to be a hasty conclusion. Older people with paxlovid did equally well as younger people without paxlovid. That indicates that paxlovid actually works, given that older age leads to covid mortality! The author's only refutation of this is that the same pattern was observed before Paxlovid was around. But that pattern itself is an aberration that is not true of the general population, it's only true in that one geographical area due to, I would assume, a statistical anomaly.

BugsJustFindMe 2y ago
> That indicates that paxlovid actually works It had no measurable effect in the measured group. You can't say that it works based on that. If it had a measurable effect in that group, you would expect to see improvement in the treatment group between the two scenarios. If (65-69 no treatment) == (70-74 no treatment) and also (65-69 no treatment) == (70-74 treatment), then (70-74 treatment) == (70-74 no treatment) by the transitive property of equality. Now the reason for (65-69 no treatment) == (70-74 no treatment) may be its own mystery, but we expect to see at least _something_ happen anyway between (70-74 no treatment) and (70-74 treatment) if the treatment had some benefit for that group, and apparently they didn't see that.
- ulfw 2y ago
  [flagged]
  - BugsJustFindMe 2y ago
    Which part of that are you having trouble with? We have two different age ranges, one of them separately measured with and without treatment, with the same outcomes across all groupings.
    - ulfw 2y ago
      Apologies. My dyslexia hit me. You are right and I was wrong
  - 2y ago

talkingtab 2y ago

My experience was odd. And this is just a description with no science. I was vaccinated, got COVID. At no point were my symptoms serious. Because of age and past heart issues I was given paxlovid. Two weeks after the paxlovid (or something like that) I became sick again, more seriously. With COVID. The symptoms I experienced were much worse but not life threatening and I recovered fully. However, it was odd that the COVID came roaring back. My conjecture is that the paxlovid suppressed COVID, but that caused my body to falter in terms of building immunity. So when the paxlovid wore off, I was actually worse off. In the same situation I would NOT take the paxlovid again unless it was clear I had serious symptoms - like I was going to end up hospitialized. I acknowledge there is no science here, but on the other hand none of the doctors were able to suggest why I had a second episode so quickly and why it was more severe. My conclusion is that there was a lot of guessing, placebo, reassuring, best guessing going on. I think that is the take away if we face such a thing again.

CaliforniaKarl 2y ago
Research "Paxlovid rebound". It sounds like that is what hit you.
nanodeath 2y ago
To add to the anecdata here, I had covid for a week (bedridden but otherwise not that bad), then had a single day in which I tested negative, and then it rebounded for a week, due to Paxlovid. Sounded like it was pretty common. So that was a waste of 15 days. On the plus side, my second week was much the same as the first week as far as symptoms go.
- cavisne 2y ago
  Another example is Joe Biden, who had this exact thing happen (covid twice in a row with paxlovid). Notable because while the chance of him just catching it again from someone are not 0, but about as low as it can go (an elderly POTUS under intense medical supervision and quarantine procedures).
gwervc 2y ago

readthenotes1 2y ago

"I think it's very likely that if there had been a Paxlovid trial early on with a median age of 70 among unvaccinated adults (instead of the real median age of 42) that it would have shown much more than that 5.5% improvement in hospitalization risk! " I find it wholly consistent with the entire "Have Faith in Science" trend of the COVID years for someone to say something like this. I think it very likely that we don't know and shouldn't assume.

reify 2y ago

GoodRX, Paxlovid ranges from $1,497 at CVS to $1,696 at Costco. Fuck me! Only for rich muppets then? In my local Boots chemist Aspirin is about £2.00 for 28 tablets. Paxlovid is a combination of 2 medicines called nirmatrelvir and ritonavir. Nirmatrelvir stops the virus from growing and spreading, and ritonavir helps nirmatrelvir from being broken down in your body long enough to do its job. Fuck me! again.

jimmydoe 2y ago
for poor people like me, the cost made me hesitate, then the best timing of taking it was gone. so if banning this med is the only way to make the world more equal, I'm all for it.
- mannyv 2y ago
  You would rather have everyone be worse off than a few be better off?
thenerdhead 2y ago
Ensitrelvir is looking to apply for global approval. It may be a much more affordable option.

ecocentrik 2y ago

My impression has been that taking Paxlovid resulted in faster recovery and less severe symptoms. This is an anecdotal observation with a tiny small sample size so I wouldn't discount placebo or a weaker variant. Still, I'd like to see a broader study that looks into long COVID and severity.

ragle 2y ago
Likewise. I was 2-3 days into testing positive and had a fever that could not be controlled by maximum strength OTC antipyretics, awful cough producing glue-like greyish globs, headache, blood oxygen consistently 2-3% below typical for me, extreme fatigue. ~48 hours after beginning Paxlovid I felt almost back to normal. spO2 returned to typical wake / sleep levels, lungs clearing, little fatigue, etc. Based on how sick I was when I started treatment, if historical patterns of recovery from respiratory illness are any indication I would have expected an additional ~9-14 days of tapering symptoms at minimum. Instead I was basically totally normal again after ~5-6 days. If I get COVID again I will absolutely ask for Paxlovid.

gp 2y ago

I took Paxlovid twice. Horrible bitter taste, but kept the symptoms at bay. No long covid or persisting brain fog unlike some of my friends. Tested negative by the end of the treatment. My fiancé didn't catch it from my while I isolated. Derek doesn't have to take Paxlovid next time, but I will.

illusive4080 2y ago
I had Covid once. No drugs, no vaccine (don’t jump me it wasn’t available yet). No long covid or brain fog. Sleepiness, loss of taste, flu symptoms for 5 days. Completely better in 10 days. Anecdotes aren’t usually helpful for effectiveness testing. My experience can vary greatly between my neighbor even with identical demographics and characteristics.
riversflow 2y ago
The extremely well-documented strength of the placebo effect is exactly why medical trials need to be so robust.
refurb 2y ago
How doy ou know it kept your symptoms at bay? Plenty of people don't get long Covid, why were you sure you'd get it if you didn't take paxlovid? Same with brain fog?
- cvwright 2y ago
  Yeah you can read very similar anecdotes from people who took ivermectin. This is why controlled experiments are so important.
- lostdog 2y ago
  Took paxlovid also. The symptoms go away really really suddenly and fast. Sure, you need to run a study to be absolutely certain, but it just takes one experience to notice the effect.
- Timon3 2y ago
  It's interesting how religiously "correlation is not causation" is repeated here - except when it's about personal anecdotes.

aaron695 2y ago

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temporallobe 2y ago

My father almost died on Paxlovid. Almost immediately after taking it, he ended up in the ER, complaining of cardiac issues (severe arrhythmias and pain) and saying he felt like death. It wasn’t exactly a cardiac arrest, rather an “event”. While one could say it was Covid, the timing of the symptoms were too coincidental to ignore. It took him 2 months to start feeling normal. He had had covid twice before and was sufficiently vaccinated.

HocusLocus 2y ago
I upvoted because you were gray, apparently wrongthink was being thunk by you. That's pretty sick. MY father, 83 and stable on his meds for years, died 10 days after his first Moderna. COVID tested negative, pulmonary thrombosis. I didn't think that was a coincidence at all, hell no. I'm glad your dad is all right. Let's all try to avoid these coincidences in the future. Maybe my post will be flagged as wrongthink too, it's become a badge of honor at this point.

herf 2y ago

Here is the new 2024 result (all ages) that says mean time to symptom alleviation didn't significantly change on Pax: https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 I was surprised to read it.

thenerdhead 2y ago

I believe Science would benefit from a different approach to reporting, as Derek’s analysis over the past four years has been consistently lacking. A responsible science reporter should present the full body of evidence rather than drawing conclusions from a single study. Currently, a 900-person study is exploring Paxlovid’s potential for three clusters of Long COVID patients using a novel ultra-sensitive single-molecule assay. While many question its effectiveness in short treatment durations, there is reason to believe it could have extended benefits, similar to treatments for hepatitis C or feline coronavirus infections. Having read and shared thousands of studies on SARS-CoV-2 and Long COVID, I find it irresponsible to dismiss a drug based on a single study, especially when broader research suggests that access to antivirals may reduce the risk of developing Long COVID, even among vaccinated individuals. New antivirals are awaiting FDA approval, and an updated version of Paxlovid is in development. Derek’s analysis is not only misleading but also incorrect, and it would be best if he reconsidered the reach of his words.

fn-mote 2y ago
Your comment does not cite any scientific evidence that contradicts the assertions in the article. The study you mention is ongoing and small. For comparison, one of the articles cited involves 280k patients with 35k treated. If you're going to call an analysis incorrect, you should should say what's wrong with it. With a comment this strong, I think you should disclose a little more of your own background / stance on the subject. Have you written a self-published book on Long Covid? (It looks like yes, but tl;dr.) My sympathies if you have suffered it.
- thenerdhead 2y ago
  here's my page with countless findings on the topic (you be the judge and feel free to search for other studies too): https://x.com/search?lang=en&q=(paxlovid%20OR%20Nirmatrelvir)%20(from%3Aatranscendedman)&src=typed_query https://x.com/search?lang=en&q=(paxlovid%20OR%20Nirmatrelvir... my general thoughts on this article and science "journalism" lately: https://x.com/atranscendedman/status/1856467031157289327 https://x.com/atranscendedman/status/1856467031157289327 background: 4 years of long covid, work on nih efforts to cure it, and i don’t want anyone to suffer like millions of us do. so i share reliable info with the world. note: paxlovid is a first-generation drug. in 2025, derek should follow more science rather than zeroing in on one study or griping about the taste when it can prevent your life from flipping upside down with long covid. he has literally written on the next version of it as well. many elderly patients who are only vaccinated still develop long covid and are often dismissed due to their age. nobody deserves that when an antiviral is available until next-gen vaccine 2b trials finish soon and more treatment options hit the usa market later this year.

tehjoker 2y ago

i wonder how the calculus changes when the variant is poorly matched to the last vaccine you got

ChrisArchitect 2y ago

Paxlovid? You'd have expected more people to be doing more to not get infected & reinfected by COVID, and trying to stop the spread. But here we are. 5 years in.

bigtimesink 2y ago
What do you propose? Continue social distancing and masking? About the only middle ground is masking in medical settings and crowded, non-social spaces. I guess vaccination rates are low, but that should be a good thing for people who are vaccinated.
- pabs3 2y ago
  Indoor air filtering might help?

deleted 2y ago

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cameldrv 2y ago

I will say for me when I took it, I could barely get out of bed. I slept 17 hours that day. It was maximum effort just to go downstairs to the kitchen and get food out of the refrigerator. Anyhow I got the first dose at about 6pm and went to sleep, and when I woke up I felt pretty good and went down to my office to start catching up on my email. It was an amazing turnaround.

amenhotep 2y ago
This was more or less what happened to me with covid and I didn't take anything at all. It started as a cold, rapidly progressed to being so bad that I spent an entire day in bed, then rapidly subsided to "recovering from a bad cold but feeling mostly normal". So I wouldn't put much confidence in your experience being down to the drug, personally.