Mississippians Under-using Anti-Viral Pills, COVID-19 Subvariant BA.2 Growing Slowly

A man in a mint green Pfizer jumpsuit overlooking pink pills pouring out of a machine
Mississippians continue to underuse anti-viral pills that studies have shown to be extremely effective against serious infections of COVID-19. Additionally, studies on a potentially dangerous subvariant of omicron show that vaccination and prior infection are still protective. Photo courtesy Pfizer

COVID-19 is still continuing a sharp decline in Mississippi following the severe omicron wave. Just before press time, the Mississippi State Department of Health released the four-day total from the long holiday weekend, indicating 1,868 new cases and 22 new deaths. 

MSDH Communications Director Liz Sharlot confirmed the case decline today to  the Mississippi Free Press today shortly before the agency released the consistent four-day total of 467.

The contraction in new cases means that more new infections than ever before can be treated with powerful anti-viral medicines, like Paxlovid and molnupiravir, reducing the severity of outcomes through arresting the growth of the virus after infections.

In today’s statement, Sharlot explained that the state continues to under-use the available supply of oral antivirals, meaning that even more preventable death—especially in unvaccinated individuals—is occurring.

“Our cases are declining, which is good news—however uptake with the oral antivirals remains slow,” Sharlot wrote in an email. She added that physician education and patient awareness is key in fully taking advantage of the powerful protection of the anti-viral pills.

After press time, Dr. Bhagyashri Navalkele, an infectious disease specialist at the University of Mississippi Medical Center, told the Mississippi Free Press in an interview that, per her last examination, only around 10% of the hospital’s supply of Paxlovid was administered. The enormous remainder of unused doses, Navalkele added, may reduce the size of future shipments.

The limited window in which the drug is considered effective is another part of the difficulty of matching drugs like Paxlovid to eligible, newly infected patients. The Food and Drug Administration states in the medicine’s emergency use authorization that “Paxlovid treatment should be initiated as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset.”

Only five days: to self-identify symptoms of COVID infection, confirm the infection through a rapid test or PCR, schedule a visit with a physician, receive a prescription and begin the treatment. The result is a strict timeline that likely leaves many individuals who could benefit from the drug outside its range of effectiveness.

COVID-19 hospitalizations have contracted significantly with omicron on the downturn. Chart courtesy MSDH

The many drugs with which Paxlovid may harmfully interact are another serious confounding factor. Numerous types of corticosteroids, sedatives, analgesics, immunosuppressants, birth control, antipsychotics, anti-HIV, antidepressants, anti-coagulants, cancer drugs, and other treatments can have severe side effects when combined with Paxlovid. This effectively precludes some of the patients whose pre-existing conditions would make the drug particularly attractive.

The human trials of Paxlovid presented unequivocal evidence that the drug saves lives despite the challenges to its use. Participants taking the pill suffered serious cases of COVID-19 89% less often than those taking the placebo, an effect so painfully clear that the independent data monitor overseeing the study ceased enrollment in further trials.

Molnupiravir, another COVID-19 anti-viral pill, showed disappointing lower effectiveness in preventing serious outcomes. But the same data suggest that it is better than a naive infection with no interventions whatsoever.

BA.2 Growing, But Prior Infection Strong Protection

BA.2, a further complication of the omicron variant, has caused alarm across the globe, with some observers worried the more infectious strain may challenge the ongoing recovery. The omicron descendent is both more infectious than omicron and potentially more harmful, with some experts concerned it may combine the infectiousness of the rapid omicron variant with the standard severity of earlier variants.

But a growing body of evidence is suggesting that the massive surge of omicron cases over the winter may blunt any impact BA.2 might have had.

A preliminary study from Denmark, where the strain has become the dominant variant, suggests that BA.2 reinfection in unvaccinated adults who previously had omicron is possible, but unlikely, and quite likely to be mild.

“From a total of 187 reinfection cases,” the preprint concludes, “we identified 47 instances of BA.2 reinfections shortly after a BA.1 infection, mostly in young unvaccinated individuals with mild disease not resulting in hospitalization or death. In conclusion, we provide evidence that Omicron BA.2 reinfections do occur shortly after BA.1 infections but are rare.”

None of the BA.2 reinfections in the Danish study resulted in hospitalization or death, a good sign that prior infection with the original variant, as well as other forms of immunity like vaccination, offer durable protection. The study also provides yet another piece of evidence that hybrid immunity—derived from both recovery from infection and vaccination—provides extremely strong, lasting defense against reinfection.

Sharlot told the Mississippi Free Press today that the BA.2 subvariant is indeed present in Mississippi, but that as of now genomic sequencing has not identified a sudden or concerning spike in the variant.

“As far as the BA.2, we have documented a few cases, but we are not seeing a rapid or dramatic spread,” Sharlot wrote.

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