Vaccination and antiviral treatment with nirmatrelvir (a component of Paxlovid) lower risks for hospitalization and death due to COVID-19 (NEJM JW Infect Dis Jun 2022 and BMJ 2022; 377:69317; NEJM JW Gen Med Oct 1 2022 and N Engl J Med 2022; 387:790). Do vaccination and nirmatrelvir prevent post–COVID-19 condition (“long COVID”)? Two recent reports provide some answers to this question.
In a meta-analysis of 41 studies that involved 861,000 patients, researchers identified demographic and other factors associated with significant excess risk for long COVID in adults: female sex; older age; body-mass index (BMI), ≥30 kg/m2; current smoking; comorbidities (e.g., asthma, diabetes, heart disease, immunosuppression); and previous hospitalization for COVID-19. In contrast, prior two-dose vaccination for COVID-19 was associated with significantly lower risk for long COVID (by 43%).
In a cohort study involved 282,000 U.S. Veterans Affairs patients (mean age, 62) who had positive SARS-CoV-2 test results and one risk factor for progression to severe COVID-19 (e.g., age >60; high BMI; current smoker; or various comorbidities). The 13% of patients who received nirmatrelvir within 5 days after a positive test result had significantly lower risk for long COVID (by 26%) and lower risks for postacute hospitalization and death. Nirmatrelvir was associated with lower risk for long COVID in people who were unvaccinated, vaccinated, or boosted and in people with either primary infections or reinfections.