RECOVER-VITAL: A Platform Protocol for Evaluation of Interventions for Viral Persistence, Viral Reactivation, and Immune Dysregulation in Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)

Zimmerman et al., NCT05965726, RECOVER-VITAL, NCT05965726, Mar 2026
Improvement, 25 day.. -8% improvement lower risk ← → higher risk Improvement, cognitiv.. 8% Improvement, autono.. -20% Improvement, exercis.. -11% Improvement, 15 day.. -1% Improvement, cogni.. b -5% Improvement, auton.. b -1% Improvement, exerci.. b 1% Paxlovid  RECOVER-VITAL  LATE TREATMENT RCT Is late treatment with paxlovid beneficial for COVID-19? Double-blind RCT 964 patients in the USA No significant difference in improvement c19early.org Zimmerman et al., NCT05965726, March 2026 0 0.5 1 1.5 2+ RR
RCT 964 patients showing no improvement in long COVID with 15-day or 25-day paxlovid.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
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risk of no improvement, 8.2% higher, RR 1.08, p = 0.26, treatment 121, control 110, 25 day, all symptom clusters.
risk of no improvement, 8.2% lower, RR 0.92, p = 0.68, treatment 46 of 110 (41.8%), control 46 of 101 (45.5%), NNT 27, cognitive dysfunction, 25 day.
risk of no improvement, 20.3% higher, RR 1.20, p = 0.33, treatment 45 of 121 (37.2%), control 34 of 110 (30.9%), autonomic dysfunction, 25 day.
risk of no improvement, 11.2% higher, RR 1.11, p = 0.25, treatment 83 of 112 (74.1%), control 76 of 114 (66.7%), exercise intolerance, 25 day.
risk of no improvement, 0.6% higher, RR 1.01, p = 0.94, treatment 121, control 101, 15 day, all symptom clusters.
risk of no improvement, 5.2% higher, RR 1.05, p = 0.79, treatment 58 of 121 (47.9%), control 46 of 101 (45.5%), cognitive dysfunction, 15 day.
risk of no improvement, 0.5% higher, RR 1.01, p = 1.00, treatment 32 of 103 (31.1%), control 34 of 110 (30.9%), autonomic dysfunction, 15 day.
risk of no improvement, 1.4% lower, RR 0.99, p = 0.89, treatment 69 of 105 (65.7%), control 76 of 114 (66.7%), NNT 105, exercise intolerance, 15 day.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zimmerman et al., 27 Mar 2026, Double Blind Randomized Controlled Trial, placebo-controlled, USA, preprint, 1 author, trial NCT05965726 (history) (RECOVER-VITAL). Contact: kanecia.zimmerman@duke.edu.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org March 2026 USA Russia Sudan Angola Colombia Kenya Mozambique Peru Philippines Vietnam Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Mexico South Korea Ghana Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Mongolia Czechia Israel Trinidad and Tobago Hong Kong Belarus North Macedonia Qatar Panama Serbia CAR USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org March 2026 USA Russia Sudan Angola Colombia Kenya Mozambique Peru Philippines Vietnam Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Mexico South Korea Ghana Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Belgium Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore Iceland New Zealand Mongolia Czechia Israel Trinidad and Tobago Hong Kong Belarus North Macedonia Qatar Panama Serbia CAR USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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