there are a number of computational/modeling studies suggesting paxlovid needs to be given for at least 7+ days to slow the viral load and prevent rebound.
Pfizer did a preliminary study(the FDA asked them) and quietly published their results on the topic. their data implies a second treatment might shorten the overall duration of the infection consistent with the studies i allude to above. but you probably haven't heard about this news!
The Paxlovid dosing guidelines probably need to be changed, but given the current climate and cost it's unlikely to ever happen.
Similarly, the initial two-shot vaccine guidelines probably needed more time in between the doses for more effectiveness, but that's what was tested so that's the official recommendation.
agreed on changing guidelines, disagree its unlikely to happen.
the study is done and just needs to be formally published. then recommendations can "officially" change although the science has been clear about this for quite some time now with this specific drug.
other antivirals dont have this problem because they are actually effective for 10+ days even if you take it for 5 days (Ensitrelvir).
there's countless candidates in the pipeline as well for vaccines, antivirals, and monoclonal antibodies. as they keep getting better, the guidelines will shift slowly but surely.
I believe Science would benefit from a different approach to reporting, as Derek’s analysis over the past four years has been consistently lacking.
A responsible science reporter should present the full body of evidence rather than drawing conclusions from a single study.
Currently, a 900-person study is exploring Paxlovid’s potential for three clusters of Long COVID patients using a novel ultra-sensitive single-molecule assay. While many question its effectiveness in short treatment durations, there is reason to believe it could have extended benefits, similar to treatments for hepatitis C or feline coronavirus infections.
Having read and shared thousands of studies on SARS-CoV-2 and Long COVID, I find it irresponsible to dismiss a drug based on a single study, especially when broader research suggests that access to antivirals may reduce the risk of developing Long COVID, even among vaccinated individuals.
New antivirals are awaiting FDA approval, and an updated version of Paxlovid is in development. Derek’s analysis is not only misleading but also incorrect, and it would be best if he reconsidered the reach of his words.
In the Pipeline is an “editorially independent blog,” [1] so I’m not sure that it’s fair to criticize Science or Derek Lowe for the “reporting.”
I’m a big fan of Derek’s blog. And I think his comments about long COVID at the end of the post are enough to convince me to ask for Paxlovid if/when I get COVID again (I’ve taken Paxlovid before).
1. Science magazine's association with his recurring "editorially independent blog". I've been a subscriber for many years and have never enjoyed it personally.
2. His opinion on this topic in general. The drug lived up to the hype even beating some international antivirals on efficacy terms.
Today's science is a bit further ahead still. For example, Pfizer will publish acute 10d data soon? which already has preliminary data showing faster symptom resolution and less rebound.
NIH/Yale/Karolinska will publish their 25d/15d/15d Long COVID Paxlovid studies to see what phenotypes may benefit from extended durations.
Your comment does not cite any scientific evidence that contradicts the assertions in the article. The study you mention is ongoing and small. For comparison, one of the articles cited involves 280k patients with 35k treated.
If you're going to call an analysis incorrect, you should should say what's wrong with it.
With a comment this strong, I think you should disclose a little more of your own background / stance on the subject. Have you written a self-published book on Long Covid? (It looks like yes, but tl;dr.) My sympathies if you have suffered it.
background: 4 years of long covid, work on nih efforts to cure it, and i don’t want anyone to suffer like millions of us do. so i share reliable info with the world.
note: paxlovid is a first-generation drug. in 2025, derek should follow more science rather than zeroing in on one study or griping about the taste when it can prevent your life from flipping upside down with long covid. he has literally written on the next version of it as well.
many elderly patients who are only vaccinated still develop long covid and are often dismissed due to their age. nobody deserves that when an antiviral is available until next-gen vaccine 2b trials finish soon and more treatment options hit the usa market later this year.
Did this happen after a known infection of some sort? Does it run in your family? These questions may be important to know the answers to until science gets more tests over the counter as they are fairly close already.
Many viruses are linked to cancers, MS, Parkinson’s, Alzheimer’s, T1D and so on. Research is finding that some of these viruses may actually be low grade infections or left over viral proteins causing constant immune dysfunction.
People who claimed they never got SARS-CoV-2 for example were tested with a novel ultra sensitive single molecule assay and found that 99.9% of individuals samples were indeed asymptomatically infected.
Here’s an earlier version of this claim showing 95%.
Some of these individuals later went on to develop Long COVID. They are using this assay in an antiviral trial to see if it reduces the amount of SCV2 proteins this assay can detect.
These headlines are accurate to the study and their noted limitations, not necessarily the actual prevalence which is already known to be much higher than this.
Unfortunately, I can't access the full text of the study directly, but I would argue it would be more accurate to say it impacted (past tense) 1 million children, assuming this paragraph from the news story is correct:
> Results of the analysis, published in the journal JAMA Pediatrics, showed approximately 1.01 million children, or 1.4%, are believed to have ever experienced long COVID as of 2023 and about 293,000, or 0.4%, were experiencing the condition when the survey was being conducted.
There are certainly reasons to think it might be under-reported, so perhaps that should go in the headline (or subheadline) as well. But I don't think the headline should suggest this particular study estimated 1 million children were experiencing it at the time.
That’s a fair point. Science reporting often skips the discussion section, which adds important context. A strong report would compare this with other studies to show the bigger picture, especially given concerns about undercounting.
This report has led to a lot of minimization and misinterpretation especially from certain bad faith actors. Some claim the number is “stable” year over year, suggesting long COVID isn’t a big deal, overlooking that this study uses a completely new sample each year, not the same children.
Long COVID in kids is real and widespread. It’s not "rare". Far more than 200k are affected. This latest survey aligns with previous data, but it’s likely an undercount(noted by the authors as a limitation) due to reliance on parental reporting. Kids often struggle to articulate symptoms. Pediatric Long COVID has been ignored despite millions suffering debilitating effects.
Note: I work on NIH efforts to cure Long COVID called RECOVER, RECOVER-TLC, and help non-profits dedicated towards viral persistence/immune dysfunction hypotheses.
given lack of success with ME/CFS, do you think we'll fare any better this time?
post-viral syndromes have been with us for a long time.
outside of very clear sequelae like definitive texbook case of autoimmune disease or something obvious like that - we don't really know how to treat them?
absolutely, in fact many of the top ME/CFS researchers have converged their research and are teaming up with the Long COVID researchers to tackle this once and for all.
we now have novel technology being used like PET scanning, T cell biosensors, and single molecule ultrasensitive assays.
Antigen/superantigen persistence is shared and may be treated with extended courses of antivirals, monoclonal antibodies, immune modulators, and even trying checkpoint inhibitors to reverse T cell exhaustion.
the textbook is being rewritten and a key publication on how to treat at least Long COVID based on what I mentioned above will come out next week. NIH will launch their trials very soon likely announcing in March.
