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0 0.5 1 1.5 2+ Time to viral- 20% Improvement Relative Risk Paxlovid for COVID-19  Shao et al.  EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? Retrospective 131 patients in China (April - May 2022) Study compares with lianhuaqingwen, results vs. placebo may differ Faster viral clearance with paxlovid (p=0.00056) Shao et al., medRxiv, July 2022 Favors paxlovid Favors lianhuaqingwen

Clinical advancement of patients infected with SARS-CoV-2 Omicron variant in Shanghai, China

Shao et al., medRxiv, doi:10.1101/2022.07.03.22277169
Jul 2022  
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Retrospective 17 paxlovid and 114 lianhuaqingwen patients in China, showing faster viral clearance with paxlovid.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid Hoertel. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid" FDA.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
time to viral-, 20.0% lower, relative time 0.80, p < 0.001, treatment 17, control 114.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Shao et al., 6 Jul 2022, retrospective, China, preprint, median age 52.0, 12 authors, study period 6 April, 2022 - 11 May, 2022, this trial compares with another treatment - results may be better when compared to placebo. Contact:,
This PaperPaxlovidAll
Clinical advancement of patients infected with SARS-CoV-2 Omicron variant in Shanghai, China
Jiasheng Shao, Rong Fan, Tiejun Zhang, Catherine Lee, Xuyuan Huang, Fei Wang, Haiying Liang, Ye Jin, Ying Jiang, Yanhua Gu, Jianrong Hu, Gang Huang
All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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{ 'DOI': '10.1101/2022.07.03.22277169', 'URL': '', 'abstract': '<jats:p>Background\n' '\n' 'Studies on the Omicron variant infection have generally been restricted to descriptions of ' 'its initial clinical and epidemiological characteristics, we investigated the ' 'timeline-related advancement in individuals with Omicron variant.\n' '\n' 'Methods\n' ' \n' 'We conducted a retrospective, single centered study including 226 laboratory confirmed cases ' 'with Omicron variant between April 6th and May 11th, 2022 in Shanghai, China. Final date of ' 'follow-up was May 30, 2022.\n' '\n' 'Results\n' '\n' 'Among 226 enrolled patients, the median age was 52 years old, and 118 (52.2%) were female. ' 'The duration from onset of symptoms to hospitalization was 3 (IQR, 2-4) days for symptomatic ' 'patients. Cough occurred in 168 patients (74.3% ). The median interval to negative ' 'reverse-transcriptase PCR tests of nasopharynx swab was 10 days (interquartile range [IQR]: ' '8-13 days). No radiographic progressions were found in 196 patients on the 7th day after ' 'onset of symptoms. The median duration of fever in all participants was 5 days (IQR: 4-6 ' 'days). The median PCR conversion time of Paxlovid-treated patients was 8 days (IQR: 7-10 ' 'days) compared with that of Lianhuaqingwen (10 days, IQR: 8-13 days) (p=0.00056). Booster ' 'vaccination can significantly decrease the severity of Omicron infection when compared with ' 'unvaccinated, partially or fully vaccinated patients (p=0.009). The median time of PCR ' 'conversion in individuals aged under 14 recovered significantly faster than older patients ' '(median 8 days versus 11 days, P &lt; 0.0001). In multivariate logistic analysis, erythrocyte ' 'sedimentation rate (ESR) (OR=1.05) was independently related to the severity of the ' 'infection.\n' ' \n' 'Conclusions\n' '\n' 'The majority clinical symptoms of Omicron infection were not severe. Early and aggressive ' 'administration of Paxlovid can significantly reduce the PCR conversion time. Booster ' 'vaccination should also be highly recommended in population over 14 years old.</jats:p>', 'accepted': {'date-parts': [[2022, 7, 5]]}, 'author': [ {'affiliation': [], 'family': 'Shao', 'given': 'Jiasheng', 'sequence': 'first'}, {'affiliation': [], 'family': 'Fan', 'given': 'Rong', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Zhang', 'given': 'Tiejun', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Lee', 'given': 'Catherine', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Huang', 'given': 'Xuyuan', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Wang', 'given': 'Fei', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Liang', 'given': 'Haiying', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Jin', 'given': 'Ye', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Jiang', 'given': 'Ying', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Gu', 'given': 'Yanhua', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Hu', 'given': 'Jianrong', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Huang', 'given': 'Gang', 'sequence': 'additional'}], 'container-title': [], 'content-domain': {'crossmark-restriction': False, 'domain': []}, 'created': {'date-parts': [[2022, 7, 6]], 'date-time': '2022-07-06T14:30:14Z', 'timestamp': 1657117814000}, 'deposited': { 'date-parts': [[2022, 7, 6]], 'date-time': '2022-07-06T14:30:15Z', 'timestamp': 1657117815000}, 'group-title': 'Infectious Diseases (except HIV/AIDS)', 'indexed': {'date-parts': [[2022, 7, 6]], 'date-time': '2022-07-06T15:17:16Z', 'timestamp': 1657120636413}, 'institution': [{'name': 'medRxiv'}], 'is-referenced-by-count': 0, 'issued': {'date-parts': [[2022, 7, 6]]}, 'link': [ { 'URL': '', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'member': '246', 'original-title': [], 'posted': {'date-parts': [[2022, 7, 6]]}, 'prefix': '10.1101', 'published': {'date-parts': [[2022, 7, 6]]}, 'publisher': 'Cold Spring Harbor Laboratory', 'reference-count': 0, 'references-count': 0, 'relation': {}, 'resource': {'primary': {'URL': ''}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subtitle': [], 'subtype': 'preprint', 'title': 'Clinical advancement of patients infected with SARS-CoV-2 Omicron variant in Shanghai, China', 'type': 'posted-content'}
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