Covid Pills May Save Lives, But They Won’t End the Pandemic


The promise of new Covid-19 pills from Pfizer Inc. and Merck & Co. gives rise to the hopeful question: Is this how the pandemic ends? The best answer anyone can muster is “maybe.” No matter how effective the antiviral pills are, it will be months before we can say we’re near the end.

The pills have been shown in studies to substantially reduce the chances that a high-risk, unvaccinated person with Covid will need hospitalization. The results rightly raised hopes. Pfizer’s drug was 89% effective, and Merck’s succeeded in about 50% of patients—potentially powerful scientific breakthroughs.

Yet right around this time last year, we were celebrating another astounding scientific achievement: Pfizer and Moderna Inc. announced vaccine results that were even more remarkable, both in how well the shots worked and how quickly they’d been developed. Of course plenty more devastation followed. More Americans have died of Covid so far in 2021 than in 2020, despite the widespread availability of shots. A problematic mutation, low vaccination rates, and patchy adherence to preventive measures such as masking allowed the virus to rage on. Weary forecasters won’t bring themselves to say Covid pills will stop the virus, at least not yet.

The new treatments have limitations. The pills were mainly tested in high-risk, unvaccinated people and proved useful only for people who learn they’ve contracted Covid and get a prescription filled within days of exhibiting symptoms. But testing isn’t always that quick, and the unvaccinated—the most likely to get Covid and need the pills—may not prove eager to get tested.

Vaccinations are still the best way to prevent Covid from occurring and spreading. If vaccine-wary people can point to a new drug as reducing the threat of the disease, they may be less likely to get a shot. And Pfizer and Merck will have to make millions, if not billions, of pills quickly if they’re going to be widely available this winter when cases are predicted to rise again.

Rates of vaccination vary widely across the globe. Within the U.S., they range from 41% of the population in West Virginia being fully immunized to 72% in Vermont, according to Bloomberg’s Covid-19 Vaccine Tracker. Clusters of unvaccinated people allow the virus to continue spreading, potentially spawning mutations.

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Frieden at a congressional hearing on the Covid-19 response in May 2020.
Photographer: Alex Wong/Getty Images

“These antiviral drugs serve as another tool in our arsenal against this virus but are certainly no replacement for vaccines, particularly because they need to be given so early after infection,” says Tom Frieden via email. He’s the former director of the Centers for Disease Control and Prevention who’s now chief executive officer of the public-health initiative Resolve to Save Lives. “Our best opportunity to change the course of the pandemic is to rapidly expand the production of highly effective vaccines to prevent potentially more dangerous variants from developing.”

There are no official criteria for declaring the end of a pandemic. For this one, the end might be when a combination of drugs, vaccines, and natural immunity has become sufficient to suppress serious complications from the virus, allowing people to go about their normal life without needing to take precautions, says Arnold Monto, an epidemiologist and influenza expert at the University of Michigan. With society opening up, we may be approaching that point in some parts of the U.S. where the virus isn’t getting worse.

Colder weather could change that calculus. The Institute for Health Metrics and Evaluation, a leading population health research center, is projecting another U.S. Covid surge this winter, beginning toward the end of November and peaking in January or early February, with an estimated 120,000 deaths between now and March 1. The flu, by comparison, kills around 30,000 people a year.

For Covid to turn into something more like the flu, or even the common cold, people will need to be exposed to it time and again, says Benjamin Cowling, a professor of epidemiology at the University of Hong Kong. “After you have had a number of experiences with the virus, whether it’s through vaccines or infections, I think any subsequent exposures, subsequent infections, will tend to be very mild,” he says. “That’s how it’s going to turn into a seasonal coronavirus. It’s through a process of our immune systems getting used to seeing it.” That possibility is still a few years away by his estimation.

Covid remains very much a fact of life. About 70,000 cases are diagnosed in the U.S. every day. Pills may be able to reduce the death rate and make the virus easier to live with, says virologist David Ho at Columbia, a veteran researcher who spearheaded the HIV drug cocktails that finally cut the death rate.

Covid has killed about 1.6% of those who’ve been diagnosed in the U.S. The combination of potent vaccines and drugs with 90% efficacy in reducing severe cases could bring the death rate closer to that of the flu. “That will take away the fear factor and help return society to normal,” Ho says.

The next chapter, when it arrives, will be one in which the virus has scattered and low levels of transmission don’t jam up hospitals, says David Hamer, a professor of global health and medicine at Boston University. “I’m not sure any part of the country is quite there yet, though some may be going that direction,” including New York and New England, he says.

That doesn’t mean occasional flareups won’t happen. “It’s never really going to disappear completely,” says Ian Lipkin, director of the Center for Infection and Immunity at Columbia’s Mailman School of Public Health. “It is something we’re going to be living with for a long period of time. Depending on how it evolves, we’re going to have to be vaccinated continually as new people are born and as immunity wanes and as new mutations of this virus emerge.” —With Michelle Fay Cortez