Should you take Paxlovid if you are mildly ill?
新冠轻症患者需要吃Paxlovid吗？
It is becoming harder to avoid infection, and reinfection, from the coronavirus with each variant that emerges. Omicron offshoots like the latest one, the XBB.1.5 subvariant, are better at dodging antibodies. But Covid cases also seem to be growing milder, either because new variants are less likely to go deep into the lungs or because most people have been vaccinated, exposed or both.
随着新冠病毒各个变种的出现，越来越难以避免感染和再感染。奥密克戎的最新分支XBB.1.5亚变体更擅长躲避抗体。但新冠病例症状似乎也变得更轻，这要么是因为新的变种不太可能深入肺部，要么是因为大多数人都接种了疫苗或接触了病毒，或两者都有。
Which raises the question: Do mild cases of Covid warrant treatment with an antiviral medication like Paxlovid?
这就提出了一个问题：新冠轻症病例是否需要使用像Paxlovid这样的抗病毒药物进行治疗？
In many cases, they do. Paxlovid is known to reduce the severity of illness and even lower the risk of developing long-term symptoms such as chronic fatigue, muscle pain, kidney disease, heart disease, blood clotting problems and neurocognitive impairments. Research has shown that it can offer these benefits for both vaccinated and unvaccinated people, those who are experiencing their first infection and those who have had a reinfection.
在许多情况下，确实需要。众所周知，Paxlovid可以减轻疾病的严重程度，甚至可以降低出现长期症状的风险，如慢性疲劳、肌肉疼痛、肾脏疾病、心脏病、凝血问题和神经认知障碍等。研究表明，无论是接种疫苗还是未接种疫苗的人、初次感染的人还是再次感染的人，都能从Paxlovid获得这些好处。
Paxlovid’s ability to lower the odds of hospitalization and death is well documented. Studies conducted before the drug was authorized in December 2021 showed that Paxlovid reduced these severe outcomes by up to 89 percent in unvaccinated people. While data from last year was slightly less impressive in vaccinated people, Paxlovid still decreased the odds of hospitalization and death by about 57 percent.
Paxlovid降低住院和死亡几率的能力已得到充分证明。在该药物于2021年12月获得批准之前进行的研究表明，在未接种疫苗的人群中，Paxlovid将这些严重后果减少了高达89%。虽然去年的数据在接种疫苗的人群中略显逊色，但Paxlovid仍将住院和死亡的几率降低了约57%。
Paxlovid stops the coronavirus from replicating in cells. Scientists hypothesize that by reducing the viral load in the body quickly, Paxlovid hinders many problems linked to severe outcomes and long-lasting symptoms, like damage to blood vessels, widespread inflammation and overactivation of the immune system.
Paxlovid阻止新冠病毒在细胞中复制。科学家们假设，通过快速降低体内的病毒载量，Paxlovid可以阻止许多与严重后果和长期症状相关的问题，例如血管损伤、广泛炎症和免疫系统过度刺激。
In a study published online in November and currently undergoing peer review, researchers found that among patients in the Veterans Health Administration system who had at least one risk factor qualifying them for antiviral treatment, those who took Paxlovid within five days of testing positive were 26 percent less likely to develop long Covid symptoms. Yet only about 15 percent of patients eligible for the drug took it. Other studies have suggested an even lower uptake.
在一项11月在网上发表、尚在接受同行评审的研究，研究人员发现，在退伍军人健康管理局系统里，在因至少一项风险因素而获得资格接受抗病毒治疗的患者群体中，在检测呈阳性后五天内服用Paxlovid的患者可能出现长新冠症状的几率降低了26%。然而，适用该治疗的患者只有大约15%服用了该药物。其他研究中的服用比例更低。
Who should take Paxlovid?
谁应该服用Paxlovid？
Many experts agree that more people should be taking Paxlovid and that the treatment should be considered even for mild cases of Covid-19.
许多专家一致认为，更多人应该服用Paxlovid，即使是新冠轻症病例也应该考虑该药物治疗。
“A drug that you don’t take surely can’t prevent long Covid or reduce your likelihood of serious illness, hospitalization or death,” said Michael Osterholm, an epidemiologist and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“这种药物，如果你不服用，肯定不能预防长新冠或降低你患重症、住院或死亡的可能性，”明尼苏达大学传染病研究与政策中心主任、流行病学家迈克尔·奥斯特霍尔姆说。
“The threshold for giving Paxlovid should be lower and more people should be getting it, because it’s really not harmful,” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco.
“服用Paxlovid的门槛应该更低，应该让更多人获得该药，因为它真的没有害处，”加州大学旧金山分校的传染病专家彼得·陈洪（音）博士说。
All adults over 65 are eligible for the drug, as are children and adults 12 years and older who weigh at least 88 pounds and have one or more risk factors for severe Covid. People in these categories should talk to their doctor about taking Paxlovid if they test positive. The antiviral treatment is only given if a prescription can be filled within the first five days of symptom onset. In particular, studies show that adults over 65 benefit the most from taking Paxlovid. Their age puts them at higher risk for poor outcomes regardless of whether they have other medical conditions, Dr. Chin-Hong said.
该药物适用的人群包括65岁以上的成年人，以及12岁及以上、体重至少40公斤且具有一种或多种新冠重症风险因素的儿童和成人。这些人如果检测呈阳性，应该与他们的医生讨论服用Paxlovid的问题。只有在症状出现的前五天内可以配药时，才会给予抗病毒治疗。具体而言，研究表明，65岁以上的成年人从服用Paxlovid中获益最多。陈洪说，无论他们是否患有其他疾病，他们的年龄让他们面临不良后果的风险更高。
The evidence is less clear on whether Paxlovid is worth taking for people under 65 who are not immunocompromised and do not have medical conditions like cancer, chronic lung disease, diabetes or many others.
对于65岁以下、没有免疫功能低下且没有癌症、慢性肺病、糖尿病或许多其他疾病的人群，Paxlovid是否值得服用的证据尚不明确。
“It is a personal decision between the person who’s affected and their provider whether to take Paxlovid or not,” said Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis and chief of research at the Veterans Affairs St. Louis Healthcare System. When a younger colleague recently had Covid, for instance, Dr. Al-Aly, who led the November study on long Covid, recommended that the person take the antiviral because it might still provide some of the same benefit against long-term symptoms.
“是否服用Paxlovid是受感染者和他们的医生之间的个人决定，”圣路易斯华盛顿大学临床流行病学家、圣路易斯医疗保健系统退伍军人事务部研究主任齐亚德·阿尔阿里博士说。例如，当一位年纪较轻的同事最近感染了新冠病毒时，阿尔阿里建议他服用抗病毒药物，因为这仍然有可能带来对抗长期症状的某些好处。阿尔阿里主导了11月发表的长新冠病毒研究。
So why are so few people taking it?
那为什么很少有人服用它呢？
Many doctors aren’t prescribing Paxlovid. And patients who do have access to the drug are refusing it.
许多医生不开Paxlovid。而能够使用这种药物的患者又拒绝服用。
“It is really baffling,” Dr. Al-Aly said. “But that’s what’s happening in the U.S. — Paxlovid is being remarkably underutilized.”
“这真是令人困惑，”阿尔阿里说。“但这就是美国正在发生的事情——Paxlovid的使用显著不足。”
The treatment, which has been available for more than a year and is provided free by the federal government, has been plagued with public relations problems from the beginning.
这项由联邦政府免费提供的治疗已经提供了一年多，但从一开始就受到公众关系问题的困扰。
For the first few months after it received emergency-use authorization from the Food and Drug Administration, Paxlovid supplies were hard to find. Then, patients who took the drug began reporting a bitter or metallic taste that stuck with them throughout the treatment. Several high-profile cases of Paxlovid rebound, or the recurrence of Covid symptoms, also led to the speculation that this unwanted side effect was fairly common.
在获得美国食品药品监督管理局(FDA)的紧急使用授权后的前几个月，Paxlovid供应难寻。然后，服用这种药物的患者开始报告说在整个治疗过程中他们口中都有一种苦味或金属味。几起备受瞩目的Paxlovid复阳病例——新冠症状复发——也导致人们猜测这种不良副作用相当普遍。
“There have now been several studies, and there’s such good information that there’s very little difference in the rate of rebounds among those who take Paxlovid and those who don’t. Yet that myth continues,” Dr. Osterholm said.
“现在已经有几项研究，而且有可靠的信息显示服用Paxlovid的人和不服用Paxlovid的人的复阳率差别很小。然而，这个传言仍在继续，”奥斯特霍尔姆说。
Who should get the antiviral treatment has also remained a source of confusion for both patients and health care providers, Dr. Osterholm said. Because the drug is provided under an emergency-use authorization by the F.D.A., doctors don’t typically prescribe it outside of the stated eligibility criteria. (Prescribers tend to be more flexible with a fully approved drug. Some approved medicines can be prescribed or refilled early if you are going on vacation, for instance, but many people traveling abroad, including Dr. Osterholm, have found it difficult to get a hold of Paxlovid in advance.)
奥斯特霍尔姆说，什么样的人应该接受抗病毒治疗也一直让患者和医务人员感到困惑。由于该药物是根据FDA的紧急使用授权提供的，因此医生通常不会给规定适用人群之外的人开处方。（对于全面批准的药物，医生在开具处方时往往更灵活。例如，如果你要去度假，可以提前开一些获批的药物或提前补药，但是包括奥斯特霍尔姆在内的许多出国旅行的人发现很难提前获得Paxlovid。）
Another source of confusion is interactions that Paxlovid can have with many drugs, including statins, beta blockers, blood thinners, antipsychotic medicines, seizure medicines, certain migraine medicines and hormonal birth control. It is likely that the long list of potential interactions puts many people off. But a doctor can help patients take Paxlovid safely and avoid side effects in several cases, Dr. Osterholm said. For example, patients can stop taking statins while on Paxlovid, he said, and that is “not going to have a material impact on your health.”
另一个导致困惑的原因是Paxlovid可能与许多药物发生相互作用，包括他汀类药物、β受体阻滞剂、血液稀释剂、抗精神病药物、癫痫药物、某些偏头痛药物和激素避孕药。一长串潜在的相互作用可能会让很多人望而却步。但奥斯特霍尔姆说，医生可以帮助患者安全地服用Paxlovid并在某些情况下避免副作用。例如，患者可以在服用Paxlovid期间停止服用他汀类药物，他说，这“不会对你的健康产生实质性影响”。
Several experts said they knew of cases where primary care providers dissuaded patients from taking Paxlovid because the doctor thought that the patient either did not qualify or did not need the treatment. Many may be under the false impression that you can take Paxlovid only if you have severe disease, Dr. Chin-Hong said, when, in fact, the drug is for anyone at risk of such disease.
几位专家表示，他们知道基础医疗提供者劝阻患者不要服用Paxlovid的案例，因为医生认为患者不符合条件或不需要治疗。陈洪说，许多人可能误以为只有患有严重疾病才能服用Paxlovid，而事实上，该药适用于任何有患此类疾病风险的人。
In July, the F.D.A. revised Paxlovid’s emergency-use authorization so that pharmacists could prescribe the drug. But that has not had a significant impact on Paxlovid use, Dr. Chin-Hong said.
7月，FDA修改了Paxlovid的紧急使用授权，让药剂师也可以开出此药处方。但这并未对Paxlovid的应用产生重大影响，陈洪说。
The problem is about to become much worse, Dr. Chin-Hong said. The U.S. government bought millions of Paxlovid pills at about $530 per course, a discount the drugmaker Pfizer gave them for purchasing in bulk. But government support for the medication is expected to run out in the middle of this year. When the drug enters the private insurance market, Pfizer could increase the price, making it inaccessible for the people at highest risk of severe Covid and the least able to afford treatment: seniors and the uninsured.
他说，问题即将变得更糟。美国政府以每疗程约530美元的价格购买了数百万粒Paxlovid药片，这是制药商辉瑞公司给予他们的批量采购折扣。但预计政府对这种药物的支持将在今年年中结束。当该药物进入私人保险市场时，辉瑞可能会提高价格，使重症新冠风险最高和最无力负担治疗费用的人——老年人和未投保的人——无法获得该药物。
To improve access and uptake of the drug, Dr. Chin-Hong said, “we’re going to need systemic changes.”
陈洪说，要改善药物的获取和服用，“我们需要进行系统性改变。”
来源：好英语网
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