Don’t Count on Paxlovid to Prevent Long COVID

By now, most people have become aware of long COVID. At last count, so-called “long haulers” have reported over 200 symptoms associated with this chronic condition. The most common is “post-exertional malaise.” That means that whenever someone does something physical or mental that requires effort, there is a rebound exhaustion. Other frequent complaints include general fatigue, brain fog, cough, palpitations, chest pain, tinnitus, dizziness, GI problems, smell/taste troubles, thirst and reduced libido. Read more at this link. Is there anything that reduce the risk of developing such complications? Will a booster shot prevent PASC (post-acute sequelae of COVID-19)? Can you rely on Paxlovid to prevent long COVID?

Early Optimism About Paxlovid to Prevent Long COVID:

Last April we received this comment from a visitor to this website:

“I took Paxlovid and I am glad I did. I am 63, and I have diabetes and hypertension, perhaps because I am overweight.

“The day that I tested positive for COVID-19, I started taking medication. My fever was gone, and I felt better in two days. However, I was still fatigued for the rest of the month. I cannot imagine what my bout with COVID-19 would have been like without Paxlovid.

We responded to her enthusiastic support of Paxlovid to prevent long COVID this way:

“A recent study looked at COVID outcomes for people like you with one or more risk factors such as overweight or diabetes (JAMA Internal Medicine, March 23, 2023). Those who took Paxlovid (nirmatrelvir + ritonavir) were about 25 percent less likely to develop long COVID. Even more impressive, they were only about half as likely to die from COVID.”

A Reversal from the VHA (Veterans Health Administration):

A new study published in the Annals of Internal Medicine (Oct. 31, 2023) contradicts the earlier research when it comes to relying on Paxlovid to prevent long COVID. The researchers wondered if using the antiviral medicine Paxlovid during the acute phase of COVID would reduce the likelihood of post-COVID conditions.

To find out, they compared the health records of patients treated for COVID at the Veterans Health Administration in 2022. More than 9500 were treated with Paxlovid within 5 days of symptom onset.

Their subsequent health problems were compared to those who did not receive Paxlovid though they were similar in other ways. The investigators were disappointed to find that Paxlovid reduced the chance of only one type of complication: blood clots in the legs or in the lungs. Other post-COVID problems did not respond.

The investigators described the outcome of their study using Paxlovid to prevent long COVID:

“In this emulated target trial of nirmatrelvir–ritonavir [Paxlovid] versus no treatment among outpatient U.S. veterans testing positive for SARS-CoV-2 during January through July 2022, nirmatrelvir–ritonavir was not effective at reducing risk for many of the PCCs [post-COVID-19 conditions] that were examined, including cardiac, pulmonary, renal, gastrointestinal, neurologic, mental health, musculoskeletal, endocrine, and general conditions and symptoms.”

In other words, Paxlovid did not work to prevent most symptoms of long COVID.

Final Words:

We are not suggesting that Paxlovid did not work! The authors pointed out that this antiviral drug did reduce the risk of “hospitalization and/or death during the first 30 days after COVID-19 illness.”

They go on to add:

“Using an emulation trial design based on VA data, we previously reported that compared with no treatment, both nirmatrelvir–ritonavir and molnupiravir [Legevrio] seemed to reduce the risk for death 31 to 180 days after infection.”

That’s important. But there was hope that doctors could prescribe Paxlovid to prevent PASC. That does not appear to be the case.