In a matter of only a few weeks the Covid subvariant JN.1 has become the dominant Covid strain in Canada and the U.S. Although the WHO declared it a variant of interest it is not thought to pose a new high risk. However it does seem to be spreading quickly.
JN.1 Here’s what to know
There is waning immunity to Covid in the population but only about 15% of people have gotten one of the updated XBB.1.5 vaccines that became available in September 2023. Fewer and fewer people are taking personal precautions to minimize contact. I have been amazed at the number of people, especially seniors, who no longer wear masks in enclosed spaces like stores, theaters and public transit.
In Canada an increase in hospitalizations has not shown up in the December statistics but a year ago a large spike in hospitalizations occurred in January/February.
Canada Covid-19 epidemiology update
In the U.S. there has been a 50% increase in hospitalizations among people age 70+ since November.
New York Times Covid-19 Tracker
Anybody who is 65 or older or has underlying health conditions is at risk for severe Covid. Many of these people know about Paxlovid, an antiviral drug that can be taken to combat Covid if you test positive. However only 10% of these people at risk take Paxlovid.
Paxlovid does not kill the Covid virus. It prevents the virus from replicating, thereby reducing the severity of the infection. To be effective it must be started very early before the Covid virus has replicated widely and is causing serious illness.
Paxlovid received FDA emergency use authorization in December 2021 based on clinical trial data that significantly reduced hospitalization and death. In a very large study in the U.S. there was a 26% reduction in hospitalization and 73% reduction in death for patients who took Paxlovid. The study used an extremely large sample of one million cases from the National Covid database, so the results are statistically very significant. If half of the patients eligible for Paxlovid had taken it during the period of the study 135,000 hospitalizations and 48,000 deaths could have been prevented.
Paxlovid effectiveness against hospitalization and death
The procedure to get Paxlovid varies by location. In Ontario it couldn’t be easier. If you test positive for Covid and it is within five days of your first symptoms, all you need to do is call your pharmacy. The pharmacist will ask you a short screening questionnaire over the phone. If you meet all the conditions and are not taking a medication that is contraindicated, she will issue a prescription that you can probably get in an hour.
Why did so many people choose not to use Paxlovid?
There seem to be a number of reasons that people who tested positive for Covid did not opt for Paxlovid.
– Some people delayed because they thought their Covid was mild. Then when Covid really came on in the second week, it was too late to use Paxlovid.
– Some people were wary of a “Paxlovid rebound” – initially the medicine worked but later on there was a resurgence of Covid. This was an early observation but it has not been borne out by more recent studies.
– Many people do not consider that they are at high risk for severe Covid even though they are 65+ or have a health condition like asthma, diabetes or obesity.
– Other people are worried about the side effects such as an unpleasant aftertaste, stomach upset or muscle aches. None of the side effects are very serious and the Paxlovid treatment is only 5 days.
People Who Need Paxlovid Are Not Taking It
Altogether these don’t seem to be very good arguments for not using Paxlovid compared to the very significant reduction of risk of hospitalization and death. But then we are living in an age where science is not trusted and people don’t make rational decisions.
When I last checked about a year ago, there had only been one double blind prospective trial using Paxlovid and that trial only included patients who had never been vaccinated. However, the vast majority of people have been vaccinated (or had previously had Covid). Are you aware of any randomized trials using Paxlovid in patients who have been vaccinated?
I didn’t find any randomized trials using vaccinated subjects. But there are a lot of “real world” studies where patient records are used to simulate a randomized trial. I think the real world study referred to in the blog article is probably one of the best because of the very large data sample – over one million patients (includes vaccinated). There are quite a few other such studies. For eample, in this study 75% of subjects were vaccinated and no significant interaction was detected between Paxlovid treatment and vaccination status.
https://pubmed.ncbi.nlm.nih.gov/35653428/