From the New York state Department of Health:
Date: December 27, 2021
To: Health Care Providers and Health Care Facilities
From: New York State Department of Health
COVID-19 ORAL ANTIVIRAL TREATMENTS AUTHORIZED AND SEVERE SHORTAGE OF ORAL ANTIVIRAL AND MONOCLONAL ANTIBODY TREATMENT PRODUCTS
Summary:
• Two COVID-19 oral antiviral therapies have received Emergency Use Authorization from the U.S. Food and drug Administration (FDA), Paxlovid (Pfizer) and molnupiravir (Merck).
o Paxlovid and molnupiravir reduce the risk of hospitalization and death by 88% and 30% respectively, in patients at high-risk for severe COVID-19 when started early after symptom onset.
o Paxlovid is the preferred product and is available for patients age 12 years and
older.
o Molnupiravir should be considered for patients age 18 years and older for whom alternative FDA- authorized COVID-19 treatment options are not accessible or clinically appropriate.
Don’t trust my medical judgment, but I have to say that verbal descriptions of Merck’s molnupiravir have always struck me as, well, terrifying: e.g., it works by “garbling the DNA” of the virus. That sounds good, as long as it doesn’t garble any other DNA, such as my personal DNA, which I’m rather fond of.
Some of the contraindications on molnupiravir sound like a scary sci-fi story: “Pregnancy and Contraception: Treatment with EIDD-2801 is contraindicated in women who are pregnant or nursing and in the male partners of women who are pregnant. Extreme care must be taken to avoid pregnancy during the study and for 4 days after completion of EIDD 2801 dosing in female participants and for 4 days after completion of EIDD-2801 dosing in female partners of male participants.”
Paxlovid sounds, at least in theory, more targeted at this virus. But it’s in high demand and short supply, while there is apparently quite a bit of molnupiravir out there.
• At this time, Sotrovimab (Xevudy) is the only authorized monoclonal antibody product expected to be effective against the omicron variant of SARS-CoV-2.
The other two monoclonal antibodies, including the one Trump took when he was sick, don’t seem to work against the latest variant.
There will be a pause on allocations of bamlanivimab and etesevimab together, etesevimab alone, and REGEN-COV beginning 1/3/2022.
… Supplies of oral antivirals will be extremely limited initially, and there is now
only one monoclonal antibody product that is effective for treatment of infection caused by the omicron variant. While supplies remain low, adhere to the NYS DOH guidance on prioritization of anti-SARS-CoV-2 therapies …Eligibility
Oral antiviral treatment is authorized for patients who meet all the following criteria:
• Age 12 years and older weighing at least 40 kg (88 pounds) for Paxlovid, or 18 years and older for molnupiravir
• Test positive for SARS-CoV-2 on a nucleic acid amplification test or antigen test; results from an FDA-authorized home-test kit should be validated through video or photo but, if not possible, patient attestation is adequate
• Have mild to moderate COVID-19 symptoms
• Patient cannot be hospitalized due to severe or critical COVID-19
• Able to start treatment within 5 days of symptom onset
• Have a medical condition or other factors that increase their risk for severe illness.
• Non-white race or Hispanic/Latino ethnicity should be considered a risk factor, as longstanding systemic health and social inequities have contributed to an increased risk of severe illness and death from COVID-19.
It’s hard to keep track of whether race exists or not these days.
This is good news from the NYT:
Covid Updates: South Africa Says Its Omicron Wave Has Passed With No Big Spike in Deaths
The announcement offers cautious hope to other countries grappling with the fast-spreading variant. The U.S. hits yet another record for new daily virus cases.
Dec. 30, 2021
On the other hand, Africa is pretty different, so who knows for sure?
