The COVID Scoreboard

What a difference three years make. On January 21, 2019, when the first U.S. case of COVID 19 was confirmed, we knew literally nothing about what it was, how we got it and how to treat the symptoms.

1,394 days and 99.9 million cases later there are definite pathways to prevention and treatment.

First up, the hits. No, vaccines don’t offer perfect protection against infection, but complete the series and if you run into a working virus the result will be more like a really bad cold than a month in the hospital. Nationwide, nine in every ten of us older than 12 have had at least one dose; nearly three quarters of us are fully vaccinated.

Even so, if you wake up one morning testing positive, Pfizer’s antiviral Paxlovid not only reduces the risk of hospitalization and death, it keeps working after the original illness recedes. In one major study of 56,340 Veterans’ Administration patients, medicating within five days after testing positive lowered the risk of the lingering fatigue, shortness of breath, muscle pain, cardiovascular problems and “brain fog” called long COVID. Yes, Paxlovid leave a metallic taste in your mouth. Yes, there’s a slight chance of rebound after a seeming cure. But as Dr. Ziyad Al-Aly, the senior author of the VA study told various reporters, “For me, really the choice is clear.”

Next med in sight: Naltrexone, an anti-inflammatory used to treat the fuzzy thinking and exhaustion liked to alcohol and drug addiction and a bunch of other baddies such as Crohn’s disease and multiple sclerosis. In a University College Dublin School of Medicine clinical trial low-dose naltrexone (LDA) did so well against COVID that infective disease people in Canada, Australia and the University of Alabama have already scheduled their own trials.

The miss. Catching COVID may be depressing, but a Duke and Vanderbilt University researchers say their recent study looking for “sustained relief” (that’s three days without symptoms) shows that the antidepressant fluvoxamine, temporarily touted as a way to soothe symptoms, doesn’t do the job.

Finally, the “maybes.” Viruses are nasty little buggers that mutate at the drop of a blood cell. The latest Pfizer and Modern co-valent vaccines protect against at least two new mutants, but researchers at the Duke Human Vaccine Institute (DHVI) have bigger goals. In an initial clinical trial, three doses of their new “pan-coronavirus vaccine” appeared to trigger antibodies against SARS-CoV-2 viruses and their offspring, including Beta, Delta and Omicron variants. As DHVI Director Barton F. Haynes explains that “[w]hile SARS-CoV-2 continues to mutate during the ongoing pandemic, there are conserved regions on the virus that our vaccine will continue to successfully bind to, regardless of mutations.”

And there’s this: When COVID hit, Pfizer researchers were working on a potential cancer vaccine based on the MRNA technique they put to use against COVID. Given how well it worked there, it’s likely they may swing back to the original goal.

In short, an anti-cancer vaccine might someday be the silver lining in the COVID cloud.