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Chandigarh, April 16, 2023:
Salient features: Journal of Amecican Medical Association 23th March 2023
- 7.8% to 17% of Covid patients suffer from Long Covid symptoms and sequelae (UK study)
- Patients with mean age of 62 and with at least one comorbidity (older than 60 years, Obesity (BMI > 25 Kg/Meter square), current smokers, cancer, Heart disease, kidney disease, chronic lung disease, diabetes, immune dysfunction, and hypertension) were studied. 35 717 received Nirmatrelvir within 5 days of Covid and 246 076 patients did not receive antiviral treatment .
- Post covid complications included ischemic heart disease, dysrhythmia, deep vein thrombosis, pulmonary embolism, fatigue and malaise, liver disease, acute kidney injury, muscle pain, diabetes, neurocognitive impairment, dysautonomia, and shortness of breath and cough.
- Post covid complications were 12.99% in Nirmatrelvir as compared to 17.51% in the control groups.
- Nirmatrelvir was associated with reduced risk of post–acute death, and post–acute hospitalization
- Nirmatrelvir was associated with reduced risk of Post-covid complications (dysrhythmia and ischemic heart disease), coagulation and hematologic disorders (pulmonary embolism and deep vein thrombosis), fatigue and malaise, acute kidney disease, muscle pain, neurologic system (neurocognitive impairment and dysautonomia), and shortness of breath.
- The reduced risk of post covid complications was irrespective of vaccination status
According to Dr(Prof) G C Khilnani, No one, in our lifetime, would forget the devastation and loss of lives suffered during Covid pandemic.. As many as 7.8% to 17% of Covid patients suffer from Long Covid symptoms and sequelae. There have been consistent effort at reducing the severity, hospitalization and deaths by using monoclonal antibodies and antiviral drugs (Remdesivir, Molnupiravir and Paxlovid (A combination of Nirmatrelvir and Ritonavir). Efficacy of these interventions in reducing severity and mortality is well established. Among oral medication Paxlovid has the best efficacy in reducing severity and mortality. This large study has looked at effect of Nirmatrelvir on post covid complications.
Nirmatrelvir was associated with 26% less risk of Post Covid complications and, 47% less risk of post–acute death, and 24% less risk of post–acute hospitalization. This benefit is indeed glaring and emphasises use of antiviral medication during first 5 days of Covid infection. Although this study looked at largely elder population with at least one comorbidity, the benefit in younger and healthy people in event of Covid is not ruled out. We all have seen crippling symptoms of long covid in young healthy individuals also. Paxlovid is now licensed to be manufactured in India (with different brand names of course) . With rapid rise in Covid cases recently, there is a case for using this medicine in susceptible population who are at high risk of severe disease, death and post covid complications.
Dr(Prof) G C Khilnani is the Chairman, PSRI Institute of Pulmonary, Critical care and Sleep Medicine Formerly Professor and Head of Dept of Pulmonary, Critical care and Sleep Medicine. AIIMS, New Delhi
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