COVID-19Drugs & MedicationsInfectious DiseasesPreventive Medicine


In recent weeks, two new anti-viral drugs have received emergency use authorization from the Food and Drug Administration. The two oral drugs are trade-named PAXLOVID and LAGEVRIO. Both have long generic names which will be shared later. Suffice it to say, they are welcome additions to the list of treatments for COVID-19. 

Nirmatrelvir-ritonavir (Paxlovid) and molnupiravir (Lagevrio) must be started within 5 days of onset of COVID-19 symptoms. They are dosed at 1 tablet twice daily for 5 days started as soon as possible after the onset of symptoms. Patients who have severe liver or kidney disease or are pregnant should not take either drug. 

These drugs “reduce the ability of SARS-CoV-2 to multiply and spread through the body.” Although these drugs are effective at reducing hospitalizations for COVID-19, they do not shorten the course of the illness. However, patients report feeling better often as soon as 2 days to 2 weeks after starting one of the anti-virals. These drugs are provided free of charge to patients who test positive and are symptomatic. 

Testimonials heard after a course(s) of Paxlovid state that symptoms improved while taking the drug, but soon after finishing a five-day course, they returned. After finishing a 5-day course of the drug, the symptoms are back? It sounds to me like these anti-virals are suppressing, but not killing, the virus. That’s not good news. Suppressing the virus helps, sure, but more is needed. The virus needs to be killed, if that’s possible (and it is). 

I’m disappointed to hear this about two promising anti-viral drugs. These drugs got past FDA scrutiny but are clinically only partially effective. Just as the COVID-19 vaccines don’t prevent COVID 100%, COVID-19 anti-virals don’t kill the virus. In fact, I’m sure you know, or are related to, several people who were fully vaccinated, boosted, and still got COVID-19. That wasn’t supposed to happen. Now we hear patients who took Paxlovid say symptoms returned after finishing it. COVID-19 is either a different “breed” of virus, or scientists have failed to find the right formula. Have you heard of any children vaccinated against polio who still got polio? I haven’t! Polio vaccine has been around for almost 70 years and still works. Jonas Salk got it right. COVID-19 vaccines reduce hospitalizations and deaths, but people still get COVID and are less sick. Also, people who take anti-viral drugs, get sick again after finishing a course of the drug. It’s frustrating! We need better drugs and better vaccines or this pandemic will never end.  Either that, or we need the virus to start behaving in the usual manner and not mutate right and left.

Reference: Petty LA, Malani PN. Oral Anti-Viral Medications for COVID-19. JAMA 2022 April 25;doi:10.1001/JAMA.2022.6876.

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