Your One-Stop Resources Guide for the Latest on Coronavirus in Cincinnati

Two Pills to Treat Covid-19 as Omicron Now Dominates

Our warnings just seven days ago about the rising tide of the Omicron variant insufficiently gaged the rapidity of the surge, now present in all fifty states.  It is the dominant strain in 73% of the specimens sequenced across our country and is known to represent 95% of the cases in the Southeast and Northwest. Nevertheless, there remains hopeful news about the diminished severity of the Omicron variant in communities of high immunity (vaccination).  A just released study of 500,000 cases caused by Omicron in the United Kingdom revealed that there was a 40% less chance of having to go to the emergency unit after being diagnosed and between 50% and 70% less chance of being hospitalized with Omicron compared to the Delta variant.  The study further confirms the analysis of studies from South Africa and Scotland as well as the still anecdotal experiences of cases in the US. The Scotland study of the health records of 5.4 million people showed that the risk of hospitalization was two-thirds lower with Omicron compared to Delta.

In spite of this bit of good news about Omicron we must still keep up our guard, more correctly, our masks, vaccinations, boosting, and social distancing. Omicron is extremely contagious and it is wreaking havoc.  We have lost more than 816,000 Americans to COVID-19 and over 52.2 million US citizens have become infected. Hamilton County continues to experience rising hospitalization and death rates while the 7-day average case infection rate is up 46% over the last two weeks as of yesterday, Christmas 2021. Our 14-day test positivity rate is 11% signaling that the unvaccinated are at extremely high risk because of this “extremely high” level of Covid-19 transmission. As a result of the Omicron variant’s rapid spread, over 2,000 flights were canceled in the US yesterday and nearly 1500 flights canceled today. Flight crews and airline support personnel are out sick.  The impact of their being away from their jobs will be blunted by their necessary quarantine having been reduced from ten days to seven days, by the Biden Administration.

We were given a huge Christmas gift by the FDA giving emergency use authorization (EUA) for two medications in pill form to treat COVID-19 just a few days before Christmas.  The first medication by Pfizer, named Paxlovid, is indicated for adults age 18 or over who are at high risk of progression to severe Covid-19 disease.  It needs to be started within the first five days of a positive COVID-19 test.  Each dose is two tablets of nirmatrelvir which actually stops the virus from replicating and one tablet of ritonavir, which slows the breakdown of nirmatrelvir thus keeping it in the body longer.  Each dose is taken twice a day for five days only, a total of thirty tablets. This regimen was 88% effective at reducing hospitalization and death in trial participants with COVID-19. The second drug which received a EUA is by Merck and named molnupiravir.   It too needs to be used within five days of diagnosis in individuals age 18 or over with mild to moderate disease and not hospitalized. In order to qualify, they should be at high risk of hospitalization, severe disease, or death.  Molnupiravir works by preventing virus replication. The dosing is four 200mg pills twice a day for five days, a total of forty capsules. It was found to be 30% effective at preventing hospitalization and death from COVID-19.  It is not authorized in individual under the age of 18 because molnupiravir may affect bone and cartilage growth. Our government has contracted for 10 million courses of the Pfizer drug and 5 million courses of the Merck drug.  Since the effectiveness of both of these oral medications is dependent upon their being used within five days of disease onset, a timely Covid-19 test is essential.  The current testing availability issues must be solved by the time these oral medications become available in January 2022.

No treatment or mitigation measure is as good as the safe and effective vaccines. You are ten times as likely to be hospitalized from COVID-19 and thirteen times as likely to die if you are unvaccinated. Get vaccinated and Save yourself and those around you!

Clyde E. Henderson, MD

Cincinnati Medical Association