We're spending millions on Covid antivirals, but do they work?

The New Year opens auspiciously with one new antiviral drug, molnupiravir, already approved for treating the elderly and other vulnerable groups who contract Covid and two more in the pipeline. Big Pharma, bless it, has come up trumps again – though at a price. The Government, keen to be seen as proactive in obtaining sufficient supplies (as with the AstraZeneca vaccine), has purchased 450,000 courses of treatment for an undisclosed sum – though probably in excess of £200 million.

It is quite a gamble as so far there is not a lot of evidence for the drug’s efficacy. The initial trials conducted last year in 700 unvaccinated subjects (thus likely to skew the results in its favour) found it halved the proportion requiring hospital treatment or dying within a month (seven per cent) compared to those given a placebo (14 per cent). It has however subsequently transpired (though the details are hazy) that in the long term there turned out to be “no significant difference” in the outcome between those who did or did not receive the drug.

Meanwhile the substantial financial investment by the manufacturers in development and testing – anticipating it will prove to be highly profitable – is in marked contrast to that of another far simpler remedy that costs practically nothing. It was clear within a couple of months of the start of the pandemic that ethnic minority groups were disproportionately severely affected with a much higher likelihood of contracting the virus or developing complications warranting treatment in intensive care. The several possible explanations, as mentioned in this column before, included the higher risk in large multigenerational families, perhaps a genetic predisposition, but also their being more prone to Vitamin D deficiency. This is because its synthesis in the skin by exposure to the sun is relatively impaired in those with darker pigmentation. The “sunshine” vitamin,as it is known, is primarily involved in bone metabolism but as with all vitamins has many ancillary functions including enhancing the immune response to infection, particularly of the lungs – a prime target of the Covid virus.

Logically then it seemed sensible, as vigorously advocated by researchers at Birmingham University and others, to encourage particularly those of ethnic minority background to take supplements of Vitamin D while its role in protecting against Covid was formally investigated. But, if inexplicably, this has never really happened and in the absence of any persuasive evidence of its efficacy, this (very cheap) opportunity to protect this group from the ravages of Covid has gone by default.

In defence of plumpness

The scope for making worthy resolutions customary at this time of year has certainly narrowed in recent times now that virtually everyone (or so it seems) has quit smoking, cut down on their alcohol consumption and been compelled by travel restrictions to reduce their carbon footprint.  

There is always the option of resolving to lose a few kilos but, other than for the seriously overweight, the benefit is equivocal. Plumpness, after all, has much to commend it.  

The plump in middle age are less prone to infection and more likely to survive a heart attack.  Plumper oldies are less prone to brittle bones or, if unable to pay their heating bills, suffer from hypothermia. Further, it now appears that any putative advantage of losing weight is more than eclipsed by the cardio-respiratory fitness associated with regular physical activity.

Specifically, Dr Glenn Gaesser of Arizona State University, writing in the journal iScience, draws attention to how the health outcomes in the fit – whether “normal” or “over” weight – are virtually identical, whereas they are considerably worse for the “unfit” in both categories. To be sure he acknowledges many might wish on aesthetic grounds to be slimmer than they are, but they should be aware the pleasures of simple, not overly strenuous exercise are just as advantageous.