We have Paxlovid Covid data. Now we need more

A new study that mined health records from the Department of Veterans Affairs hints that the drug Paxlovid might be useful in preventing long Covid.
Scientists have been urging the government and the drug’s manufacturer, Pfizer, to study the idea that lingering virus could be the culprit behind some people’s long-term symptoms, and finally having data is a welcome advance.
But these results, which have yet to be published in a peer-reviewed journal, merely suggest Paxlovid’s effectiveness rather than prove it. What the study truly points to is the desperate need to look more carefully at existing drugs that have the potential to prevent and treat long Covid, which has pulled an estimated 3.5 million people out of the workforce.
The VA study reviewed electronic health records of tens of thousands of veterans who had at least one risk factor for severe Covid and asked whether the use of Paxlovid reduced the number of people who ended up with long Covid. They found that taking the five-day antiviral regimen in the early days of an infection could indeed lower the risk of some symptoms by 26%. It helped lessen the burden of issues like blood-clotting, heart problems, muscle pain, brain fog, fatigue and shortness of breath. That result translated across people who were vaccinated, vaccinated and boosted, or who had never received a Covid shot.
But the patients in the database skewed heavily male, White and older (the average age was 65), which means the positive indications might not translate into the population that is most likely to present with long-term symptoms. A recent survey by the Census Bureau and the National Center for Health Statistics found, for example, that women and younger adults were disproportionately affected by long Covid.
Ziyad Al-Aly, director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System in Missouri, who led the study, stressed that the findings do not address whether Paxlovid can prevent long Covid in lower-risk individuals, namely people who are young and healthy. That’s a study that needs to be done, he said.
And even in the group captured in the data, that 26% reduction in long Covid should be viewed as more of a signal of an effect rather than concrete evidence.
The results are “very interesting, but more hypothesis-generating” than definitive, said Paul Sax, clinical director of the Infectious Disease Clinic at Brigham and Women’s Hospital in Boston. When digging into data captured from the real world rather than a formal study, results can be complicated by differences in the people who did and did not take the drug — factors such as lifestyle and health-care choices that might influence their outcomes regardless of the drug. Those differences can foster or magnify a signal that might not be seen in a trial where people are chosen randomly to receive the drug or not.
—Bloomberg