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Ziyad Al-Aly, MD Profile picture
@zalaly
Mar 23, 2023 • 14 tweets • 9 min read • Read on X
Paxlovid can prevent #LongCovid

The latest from our team in @JAMAInternalMed

by @Biostayan @TaeyoungChoi93 @zalaly

A thread

jamanetwork.com/journals/jamai…
In this study of 281,793 people with SARS-CoV-2 infection who are eligible for Paxlovid

35,717 received Paxlovid

246,076 received no antiviral treatment

We show that people who got treated with Paxlovid had 26% reduced risk of developing Long Covid

jamanetwork.com/journals/jamai…
Paxlovid reduced risk of 10 of 13 components of Long Covid including

Dysrhythmia
Ischemic heart disease
Pulmonary embolism
Deep vein thrombosis
Fatigue & mailaise
Acute kidney disease
Muscle pain
Neurocognitive impairment
Dysautonomia
Shortness of breath

ja.ma/ziyad
Paxlovid use was also associated with

47% reduced risk of post-acute death

and

24% reduced risk of post-acute hospitalization

jamanetwork.com/journals/jamai…
The reduced risk of #LongCovid was evident in people who were

Unvaccinated
Vaccinated
Boosted

and in people with

Primary SARS-CoV-2 infection
&
Reinfection

jamanetwork.com/journals/jamai…
The risk reduction was also evident in people with

1-2 risk factors

3-4 risk factors

5 or more risk factors

jamanetwork.com/journals/jamai…
Risk reduction was evident in subgroups based on age, race, sex, and other common conditions

jamanetwork.com/journals/jamai…
How might Paxlovid reduce risk of #LongCovid ?

It is possible that hitting the virus early with an antiviral might reduce inflammation/organ damage and reduce chance of viral persistence leading to less risk of Long Covid

jamanetwork.com/journals/jamai…
What does this mean for you?

Paxlovid use in the early days after infection can reduce risk of Long Covid

The decision to use Paxlovid should consider its effectiveness in reducing risk of death & disease in both acute and post-acute phases of COVID-19

jamanetwork.com/journals/jamai…
We also learned that among people who are eligible for Paxlovid

12.67% were prescribed Paxlovid

87.33% received no antiviral treatment

This suggests the need to improve uptake of antiviral treatment

jamanetwork.com/journals/jamai…
These results apply to people who are eligible for Paxlovid under the current FDA EUA - that is people with at least 1 risk factor for progression to severe COVID-19

Whether Paxlovid reduces risk of #LongCovid in people at low risk remains to be studied

jamanetwork.com/journals/jamai…
Thanks to the amazing @sourwine for developing this press release (link below).

A clear accounting of the findings.

@WUSTLnews

@WUSTLmed

medicine.wustl.edu/news/paxlovid-…
Thank you to our reviewers, editors, and those who supported us in this project

jamanetwork.com/journals/jamai…

@WUSTL
@WUSTLmed
@WUSTLnews
@VREFSTL
@VAResearch
@vahsrd
Editorial by @DrKatzNYCHH

jamanetwork.com/journals/jamai…

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More from @zalaly

Ziyad Al-Aly, MD Profile picture
Feb 22
📣 New in @ScienceMagazine

I teamed up with @EricTopol to write this #SciencePerspective on Long Covid

Solving the puzzle of #LongCovid

A long 🧵

science.org/doi/10.1126/sc…
First, what is Long Covid?

It is a complex nonmonolithic multisystemic disease with sequelae across almost all organ systems

It can manifest across the life span (from children to older adults) and across race & ethnicity, sex, & baseline health status

science.org/doi/10.1126/sc…
Long Covid is likely a disease with many subtypes that may have different risk factors (genetic, environmental, etc.) and distinct biologic mechanisms that may respond differently to treatments.

science.org/doi/10.1126/sc…
Read 19 tweets
Ziyad Al-Aly, MD Profile picture
Dec 24, 2023
3 key messages from our recent paper in @TheLancetInfDis

1. Covid is worse than flu

Covid remains a much more serious threat to human health than the flu

thelancet.com/journals/lanin…
2. Comparing the two:

COVID is more multisystemic
Flu is more respiratory

thelancet.com/journals/lanin…
3. Both covid and flu cause more health loss in the long-term than what is evident around the time of the infection

Trivializing these illnesses as inconsequential ignores the large burden of health loss that occurs in the post-acute/chronic/long phase

thelancet.com/journals/lanin…
Read 4 tweets
Ziyad Al-Aly, MD Profile picture
Dec 16, 2023
Some people objected to use of the term “long flu”

Let me explain

A thread

thelancet.com/journals/lanin…
Lets start with the evidence about health loss

higher in post-acute flu than acute flu

higher in post-acute covid (long covid) than acute covid

In both acute and post-acute phases, burden of health loss was higher in covid than flu

thelancet.com/journals/lanin…
For me, a big revelation from the study was:

the realization that when you measure it, the burden of health loss is higher in post-acute (long) phase of illness than acute phase of illness

I knew this about covid
I did not know this about flu
Read 10 tweets
Ziyad Al-Aly, MD Profile picture
Dec 14, 2023
📣 New from my team in @TheLancetInfDis

Long-term outcomes of people hospitalized for COVID-19 vs seasonal influenza

A 🧵

thelancet.com/journals/lanin…
The study included:

81,280 individuals hospitalized for SARS-CoV-2
&
10,985 individuals hospitalized for seasonal influenza

We followed them for 1.5 years to characterize the risks of death, health care utilization & 94 health outcomes

thelancet.com/journals/lanin…
Covid had higher risk of death, healthcare utilization and sequelae in most organ systems than flu

This was evident in pre-delta, delta, and omicron; and also evident in vaccinated and unvaccinated individuals.

thelancet.com/journals/lanin…

Image
Image
Read 9 tweets
Ziyad Al-Aly, MD Profile picture
Aug 21, 2023
1/ 📣 New from my team in @NatureMedicine

In a study of 6 million people, we examined risk trajectories of 80 components of Long Covid over 2 years post-infection

📌 Risks remained elevated for many Long Covid conditions even 2 years infection

A 🧵

nature.com/articles/s4159…
2/ The study included:

138,818 individuals with SARS-CoV-2
&
5,985,227 non-infected controls

We followed them for 2 years to characterize the risk trajectories of death, hospitalization and 80 components of Long Covid

nature.com/articles/s4159…
3/ In people who were not hospitalized during the acute phase of COVID (the majority)

risk of death remained elevated up to 6 months

risk of hospitalization remained elevated up to 19 months

risks remained elevated for 31% of sequelae during the 2-year

nature.com/articles/s4159…
Image
Read 22 tweets
Ziyad Al-Aly, MD Profile picture
May 10, 2023
My piece in @TheLancetInfDis

Reflections on Long Covid prevention: progress and challenges

A thread

thelancet.com/journals/lanin…
LongCovid does not only affect patients and their life expectancy, but also societal wellbeing and economic indicators (labour participation and economic productivity).

Preventing long COVID should be a public and a global health priority.

thelancet.com/journals/lanin…
All evidence points in the same direction—SARS-CoV-2 antivirals might be important tools for prevention of Long Covid

Paxlovid reduced the risk by 26%

Molnupiravir reduced the risk by 14%

Ensitrelvir may also reduce the risk

thelancet.com/journals/lanin…
Read 12 tweets

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