Paxlovid, an antiviral medication designed for Covid-19 and with an excellent track record in  preventing severe disease, has been approved for use by the South African Health Products Regulatory Authority (Sahpra).

Paxlovid is used to treat mild to moderate Covid-19 in adults who do not require supplemental oxygen but are at increased risk for progression to severe Covid, like the elderly and people with high-risk comorbidities.

The medication has been in use in several countries. It has an excellent track record in reducing the risk (a clinical trial to support an application for emergency use put this at an 89% reduction) of vulnerable people developing severe Covid-19. 

However, it cannot be taken with a long list of medications and St John’s wort, and can have severe or life-threatening side-effects. These medicines include anti-rejection drugs for organ recipients, some medications used to treat heart arrhythmias, some blood thinners, and some medication for high cholesterol. 

Paxlovid consists of tablets for a five-day oral treatment regimen, with morning and evening doses. The treatment consists of two antivirals: nirmatrelvir, which inhibits a key enzyme that the virus needs to make more virus particles, rendering it unable to enter healthy cells; and ritonavir, a booster.

Sahpra noted that side-effects include hypersensitivity reactions, diarrhoea, vomiting and altered taste.

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“Sahpra is committed to fast-tracking the registration of all health products that are of an urgent nature, such as HIV-Aids, cancer and Covid-19. As Covid-19 is a looming threat, the registration of Paxlovid heralds a welcome signal in the fight against this pandemic,” the regulator’s CEO, Dr Boitumelo Semete-Makokotlela, said.

Does it work?

In December, the US Centers for Disease Control, in an early-release mortality and morbidity report for Covid-19, reported that people who took Paxlovid within five days of being diagnosed with Covid-19 had a 51% lower hospital admission rate in the next month. The study included both vaccinated people and people who had a prior infection. 

Read in Daily Maverick: “Pfizer’s Paxlovid antiviral lowered long-Covid risk in study”

Pfizer has also published information showing that Paxlovid is effective against the highly contagious Omicron variant.

The teams tracking variants in South Africa said in their latest report, published late last week, that Omicron is still the dominant variant. BQ.1 and its sublineages increased in prevalence in October (6%), November (18%) and December (46%) and are currently the dominant Omicron lineage in January (51%).

Paxlovid has an excellent track record in reducing the risk of vulnerable people developing severe Covid-19. (Photo: Joe Raedle / Getty Images)

XBB.1.5 was detected in December 2022 and January 2023 but only in 20 samples from the Free State, Gauteng, KwaZulu-Natal and the Western Cape. This variant has been described as the most transmissible version of Omicron yet.

The National Institute for Communicable Diseases’ latest epidemiological report, published in the third week of January, shows that 2,419 new Covid-19 cases had been reported since 14 January. 

In the second week there were 1,506 cases, and in the first, 1,855 cases. 

Read in Daily Maverick: “Anti-vax appeal – court asked to stop South Africa’s Covid vaccination campaign pending an investigation”

The incidence risk is the highest in the Western Cape, followed by KwaZulu-Natal and Gauteng, but all indicators are still within limits set by the World Health Organization to show that the pandemic is under control.

Older people remain at the highest risk of the disease.

On Monday, the International Health Regulations Emergency Committee decided to keep its declaration of a global public health emergency in place for now, but advised the WHO to start plans for a careful transition out of a state of emergency since the pandemic had reached a turning point. 

In response, the WHO issued the following temporary recommendations:

• Make sure high-risk groups receive a booster dose of the vaccine;
• Covid-19 vaccination must be integrated with immunisation programmes;
• Regular data collection and reporting on vaccine coverage should include both primary and booster doses;
• Improve reporting of SARS-CoV-2 surveillance data to WHO;
• Increase uptake and ensure long-term availability of vaccines, diagnostics and therapeutics;
• Maintain a strong national response capacity and prepare for future events;
• Maintain work within communities to address misinformation;
• Continue to adjust any remaining international travel-related measures based on risk assessment, and do not require proof of vaccination against Covid-19 as a prerequisite for international travel; and
• Continue to support research for improved vaccines that reduce transmission and have broad applicability and research to understand the entire spectrum, incidence and impact of long Covid. DM/MC