The end of the pandemic? Pfizer's new COVID pill cuts hospitalizations and deaths by 90% in high-risk people

AP Photo/Bebeto Matthews

Is this it?

I wrote yesterday that vaccine approval for kids aged five to 11 plus the bloodbath in blue states on Tuesday night has the expert class suddenly wondering if it’s time to declare the pandemic over. From a scientific standpoint, the nuclear weapon against infectious disease — vaccination — has now been almost fully deployed across the population. From a political standpoint, the association of Democrats with protracted oppressive COVID restrictions like school closings is killing the party at the polls.

Suddenly they’re looking for an exit. But they need a way to communicate to Americans, especially risk-averse lefties, that it’s now safe to return to normalcy. Or as safe as it’s going to be for the next few years as America adjusts to the reality of endemic COVID.

And so I repeat the question: Is this it?

The arrival of a fantastically effective therapeutic portends a new era in which COVID is rarely fatal for anyone, even people formerly at high risk of death due to underlying conditions. We already had good news on that front a few weeks ago when Merck announced that its new antiviral, molnupiravir, cut hospitalizations and deaths in high-risk people by 50 percent in trials. That wasn’t quite as effective as monoclonal antibodies but the antibody treatment is given via IV. It’s expensive and requires care from a professional. Molnupiravir is a pill and a course of treatment costs only a third of what the antibodies do. Eventually it could be available at every drug store in America, ready to be dispensed as soon as someone tests positive. Hospitalizations and deaths would plummet if everyone who needed it could get it.

Today’s news from Pfizer improves considerably on the good news from Merck. Their new antiviral pill, paxlovid, was 90 percent effective in trials against hospitalization for high-risk people, better than even monoclonal antibodies. Conceivably a cocktail of therapeutics that includes paxlovid could be more effective still. We’re on the cusp, it seems, of turning COVID’s death rate into something more akin to the flu’s.

So is this it? The end of the pandemic?

The work on Pfizer’s antiviral drug, called paxlovid, built off efforts by Pfizer scientists to develop treatments for the outbreak of severe acute respiratory syndrome (SARS) nearly two decades ago. Paxlovid combines a new molecule designed by Pfizer scientists in July 2020 and ritonavir, an antiviral drug used to treat HIV.

In a clinical trial, participants at high risk of developing severe illness were given the drug regimen — a combination of three pills, taken twice a day — within three days of their covid-19 symptoms beginning. Half received the experimental drug and half received a placebo. Paxlovid was 89 percent effective in reducing risk of hospitalization and death. Among 389 people who received the drug, three hospitalizations and no deaths were reported. Among 385 people who got a placebo, 27 hospitalizations were reported, with seven subsequent deaths…

The drug also appeared to be effective even at five days after symptoms began. For about 600 people who received the drug within five days of symptoms, six people were hospitalized. Among the 600 who received a placebo, there were 41 hospitalizations and 10 subsequent deaths.

“We were hoping that we had something extraordinary, but it’s rare that you see great drugs come through with almost 90% efficacy and 100% protection for death,” said Pfizer’s chief scientific officer afterward. Let me emphasize again that these weren’t garden-variety healthy young COVID patients. The subjects were at high risk due to various comorbidities like obesity, diabetes, etc. And still — zero deaths among those who received paxlovid, even those who didn’t start treatment until five days after their first symptoms.

How does it work? Differently from Merck’s drug, it turns out. Molnupiravir “hacks” the virus by scrambling its genetic code, but some recipients are destined to worry that it might cause cell mutations too. Paxlovid is a protease inhibitor. Protease is an enzyme in cells that a virus exploits to help it replicate inside the body by “cutting” strands of proteins to form new viral molecules. Pfizer’s drug prevents the cutting from happening. Protease inhibitors have also worked magic in fighting HIV and Hepatitis C. Now they’re a miracle cure for COVID too.

And Pfizer’s already experimenting with cocktails. Per the WSJ, “Adding ritonavir helps slow the breakdown of the Pfizer drug, extending its duration to help fight the virus, according to the company.”

Scott Gottlieb is a member of Pfizer’s board so he has a bottom-line reason to tout the drug, but I think his analysis here is right. This is the beginning of the end of the pandemic. Watch, then read on:

“We have an overwhelming toolbox right now to combat COVID,” he says, which is true — prospectively. But Pfizer will be able to crank out “only” 180,000 pill packs by the end of the year and is aiming for at least 21 million packs in the first six months of next year. That’s progress, but America is still averaging more than 80,000 cases per day. The pills will have to be reserved at first for the elderly and people with serious comorbidities since there won’t be enough to go around.

Should being unvaccinated count as a comorbidity in assessing high risk? Will the unvaccinated even want a highly effective therapeutic from the same company that manufactures the demon vaccine? We’re about to have another national argument about how scarce care should be rationed in the age of COVID.

On the flip side, will Biden stick with his divisive federal vaccine mandate in January if Pfizer’s and Merck’s drugs are on the market, helping to minimize severe illness in the infected on the back end?

It’s possible that we won’t need a huge stockpile of paxlovid this winter. Some scientists (like Gottlieb) believe that we’ve seen our last major wave of COVID. Note, however, that Germany’s currently experiencing one of its worst waves of the pandemic and they have a higher vaccination rate than we do. Maybe we have more natural immunity in the population here to limit the spread, but if not, we might not be done with waves after all. Quick regulatory approval of Pfizer’s drug by the FDA and an all-out effort to enlist spare manufacturing to flood the market should be top priority for the feds.