Post-COVID-19 condition (also known as long COVID)—the term that encapsulates the long-term health effects caused by SARS-CoV-2 infection—is a complex multisystemic chronic disease with profound consequences.
By Ziyad Al-Aly
Extracts
Shortly after long COVID was first reported, the search begun to find pharmaceutical agents to prevent and treat it. Because SARS-CoV-2 itself is the causative agent of long COVID and because viral persistence is postulated to play a major role in the pathogenesis of the condition, antivirals, which block viral replication, were seen as potential candidates for the prevention and treatment of long COVID.
Early promising evidence of effectiveness came from observational analyses that showed that among non-hospitalised individuals (with mild to moderate COVID-19) who have at least one risk factor for the development of severe COVID-19, use of the SARS-CoV-2 antivirals (ritonavir-boosted nirmatrelvir and molnupiravir) in the acute phase could reduce the risk of long COVID.
In this issue of The Lancet Infectious Diseases, Victoria Harris and colleagues report results of extended follow-up from the PANORAMIC trial, which to the authors' knowledge is the first randomised controlled trial to evaluate the effects of molnupiravir on long-term health outcomes at 3 months and 6 months after randomisation This open-label trial included people with SARS-CoV-2 infection in the community and at least one risk factor for progression to severe COVID-19 illness.
The results of a pre-specified analysis show that people who were randomly assigned to molnupiravir during the acute phase of COVID-19 had better outcomes at 3 months and 6 months than those randomly assigned to usual care, including better self-reported wellbeing, fewer and less severe COVID-19 associated symptoms, less health care utilisation, less absenteeism from work or study, and improved quality of life.
MEA Comment
Dr Charles Shepherd says:
“New research findings from the US suggest that giving antiviral drugs during the acute infection stage can help to reduce the risk of a person developing Long Covid. But there's no clear evidence so far that antiviral drugs can be used to successfully treat Long Covid.
Overall, the evidence base is growing for a role of SARS-CoV-2 antivirals in the prevention of long COVID. The hypothesis that patients with established long COVID and evidence of viral persistence could also respond to antiviral therapy is plausible and should be thoroughly evaluated. We have made substantial progress during the past several years in characterising the epidemiology and mechanisms of long COVID, but much remains to be done in preventing and treating the condition.
Addressing the research and care needs of people with long COVID must remain a high priority for governments. The health and wellbeing of millions of people now and in the future depends on us making this progress.”
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE Guideline Committee,
Member of the 2002 Independent Working Group on ME/CFS
Information
The ME Association has been campaigning for some time for people with ME/CFS to have access to antiviral drugs if they catch COVID-19. This is on the basis that they are more vulnerable to infections and catching COVID-19 is highly likely to exacerbate pre-existing ME/CFS or cause a relapse. Unfortunately, we have not been able to persuade the DHSC or NHS that this is the case. We will return to this when the APPG on ME is reconstituted and the DHSC Delivery Plan is published. The MEA has the following, To Whom It May Concern letter regarding vulnerability to COVID-19 and the use of antiviral drugs:
Further coverage
Template: Covid-19 ME/CFS Clinically Vulnerable
This template letter explains why people with ME/CFS are more vulnerable and should receive extra help in relation to COVID-19.