It had no measurable effect in the measured group. You can't say that it works based on that. If it had a measurable effect in that group, you would expect to see improvement in the treatment group between the two scenarios.
If (65-69 no treatment) == (70-74 no treatment) and also (65-69 no treatment) == (70-74 treatment), then (70-74 treatment) == (70-74 no treatment) by the transitive property of equality.
Now the reason for (65-69 no treatment) == (70-74 no treatment) may be its own mystery, but we expect to see at least _something_ happen anyway between (70-74 no treatment) and (70-74 treatment) if the treatment had some benefit for that group, and apparently they didn't see that.
If X == Y and also X == Z, then Y == Z
There was no significant different before or after Paxlovid became available to the early 70s patients. This updates us against Paxlovid being effective in this patient population, for the specific outcome metrics.
Derek doesn't have to take Paxlovid next time, but I will.
Anecdotes aren’t usually helpful for effectiveness testing. My experience can vary greatly between my neighbor even with identical demographics and characteristics.
Plenty of people don't get long Covid, why were you sure you'd get it if you didn't take paxlovid? Same with brain fog?
Sure, you need to run a study to be absolutely certain, but it just takes one experience to notice the effect.
Does that mean we should all absolutely take Paxlovid? No, quite likely not. But the question is more "how close to the high risk group are you" than "are you high risk".
For e.g. 20-yo white men, the answer in both cases is roughly the same. But say they're 55 (or 65 and healthy as a horse) it probably deserves a bit more thought
It's a lot easier and less risk to just pop the pills and put up with the disgusting taste and maybe being sicker a bit longer, than it is for you and your doctor to sit down and try to do a whole bunch of fuzzy calculations to figure out just exactly how high-risk you might be and whether that meets the threshold for using paxlovid.
Particularly given we almost certainly don't know all the high risk factors, not every doctor is able to keep up with all the latest research, and the patient and/or treating physician might not even be aware the patient has a particular risk factor.
Depending on how far down the rabbit hole you go - there's an opportunity cost to a physician's time, too, and them spending more time trying to figure out if someone REALLY needs paxlovid means they have less time to spend with other patients.
Thanks.
I really think treating Covid for older people is a very different than treating young people.
That said, when I took PAXLOVID my daughter, son in law and grandson had the same Covid strain I did at the same time and their symptoms were very bad and lasted ten days to over two weeks.
https://www.nejm.org/doi/full/10.1056/NEJMoa2309003
I was surprised to read it.
~48 hours after beginning Paxlovid I felt almost back to normal. spO2 returned to typical wake / sleep levels, lungs clearing, little fatigue, etc.
Based on how sick I was when I started treatment, if historical patterns of recovery from respiratory illness are any indication I would have expected an additional ~9-14 days of tapering symptoms at minimum.
Instead I was basically totally normal again after ~5-6 days.
If I get COVID again I will absolutely ask for Paxlovid.
Anyhow I got the first dose at about 6pm and went to sleep, and when I woke up I felt pretty good and went down to my office to start catching up on my email. It was an amazing turnaround.
So I wouldn't put much confidence in your experience being down to the drug, personally.
I don't know about "potentially no effect." It sure seemed to work well for me, and I've had covid with and without it. The difference was pretty big. I'm fairly certain the more profound difference is for those who are older or otherwise at risk, of course.
I was vaccinated, got COVID. At no point were my symptoms serious. Because of age and past heart issues I was given paxlovid. Two weeks after the paxlovid (or something like that) I became sick again, more seriously. With COVID. The symptoms I experienced were much worse but not life threatening and I recovered fully. However, it was odd that the COVID came roaring back. My conjecture is that the paxlovid suppressed COVID, but that caused my body to falter in terms of building immunity. So when the paxlovid wore off, I was actually worse off. In the same situation I would NOT take the paxlovid again unless it was clear I had serious symptoms - like I was going to end up hospitialized. I acknowledge there is no science here, but on the other hand none of the doctors were able to suggest why I had a second episode so quickly and why it was more severe.
My conclusion is that there was a lot of guessing, placebo, reassuring, best guessing going on. I think that is the take away if we face such a thing again.
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!
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.
Notable because while the chance of him just catching it again from someone are not 0, but about as low as it can go (an elderly POTUS under intense medical supervision and quarantine procedures).
There's some talk that maybe the course should really be for 10 days, but the pharma companies are charging insane prices for it far beyond their costs.
How is this possible?
To start with, I'm pretty sure it was established early on that the various vaccines don't prevent infection necessarily, but rather reduce the severity of the symptoms.
Vaccines are always one step behind, like they are for Influenza. You can get vaccinated against last years, and still catch this years.
Maybe the vaccine that was given was not given or stored correctly. There were also stories of anti-vaxxer medical staff giving fake vaccinations to people.
And biology is weird and complicated. Given the large human population and diversity, at some point there'll be an exception.
n=1 here, though I've heard others say the same -- but I (fairly healthy 30s male, vaccinated) found Paxlovid massively reduced symptom intensity for me. Within a day my symptoms went from "top 5 fevers I've ever experienced, normal function significantly impaired" to "feels like a cold; can reasonably handle myself around the house and even take a software engineering interview".
I most likely would not have got a severe infection and probably would not have got Long Covid, given my age / health / vaccine status, even if I hadn't taken it; but nonetheless I'm glad I was able to get it. Definitely worth it for the weird taste (hard candy helps).
I'm not saying Paxlovid didn't help you, just that it's tricky to distinguish from placebo without a study.
So about 24 hours? I took nothing when I got COVID, and the major fever and body/head aches only lasted about that long. One day I started feeling absolutely awful, and I woke up the next day feeling substantially better but unable to smell anything but smoke for the next week.
It is possible that the paxlovid helped you, but given the few details you've shared so far it's also possible that it didn't do much that wasn't already going to happen.
My doc advised to stop taking it, but after reading on Reddit that a few others had had similar experience, decided to finish the entire treatment.
Obviously I don’t know for sure how much I can attribute to the medication, but I will be taking it again if I catch Covid.
Edit to clarify: I didn't take anything other than paracetamol and ibuprofen.
This is why properly controlled trials are needed for stuff like that. It is easy to attribute the change to whatever random thing I tried at that point out of desperation.
maybe technically n=3 since I've taken it twice!
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.
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.
And next gen Paxlovid is already on an accelerated approval path and showed great results at IDWeek. https://clinicaltrials.gov/study/NCT06679140#study-plan
It is odd to me because he even wrote a piece about the next gen Paxlovid? Why didn't he reference it! It's in phase 3... https://www.science.org/content/blog-post/next-paxlovid
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.
my general thoughts on this article and science "journalism" lately: https://x.com/atranscendedman/status/1856467031157289327
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.
Fuck me! Only for rich muppets then?
In my local Boots chemist Aspirin is about £2.00 for 28 tablets.
Paxlovid is a combination of 2 medicines called nirmatrelvir and ritonavir. Nirmatrelvir stops the virus from growing and spreading, and ritonavir helps nirmatrelvir from being broken down in your body long enough to do its job.
Fuck me! again.
so if banning this med is the only way to make the world more equal, I'm all for it.
I find it wholly consistent with the entire "Have Faith in Science" trend of the COVID years for someone to say something like this.
I think it very likely that we don't know and shouldn't assume.