| For years, people have taken antiviral medications to fend off the flu and HIV, and more recently, the antibiotic doxycycline has been shown to help prevent some sexually transmitted infections. Now, researchers say a daily pill could do the same for Covid — at least for people exposed to an infected household member. Shionogi's ensitrelvir cut the risk of catching Covid by 67% over 10 days when taken within 72 hours of someone in the same household developing symptoms. The five-day treatment was tested in a late-stage trial, and the results were presented at a scientific meeting in San Francisco in March. This is the first time an oral drug has been shown to work for post-exposure protection, according to Frederick Hayden, a professor emeritus of clinical virology and medicine at the University of Virginia School of Medicine who helped design the study. The key? Taking it fast, said Hayden, who has led multiple trials of antiviral treatments for respiratory infections. The drug — sold as Xocova in Japan and Singapore, where it's approved as a Covid treatment — works best when started soon after exposure (or after symptoms appear). This year, the US Food and Drug Administration granted ensitrelvir "fast track" designation for post-exposure prophylaxis following contact with an infected individual, signaling its potential as a valuable preventive tool. It is yet to be approved as a drug to prevent Covid post-exposure. Shionogi continues "to interact with regulatory authorities worldwide to determine the best path forward for ensitrelvir," said Takeshi Tsuge, a spokesman for the Osaka, Japan-based drugmaker, who declined to elaborate. While vaccination remains the best defense against severe illness from Covid, it's not a perfect shield. Older adults and people with weakened immune systems are still at risk, making them prime candidates for a Covid-prevention pill like ensitrelvir after exposure. Covid is still killing thousands of Americans, with the virus claiming more than 8,000 lives this past winter alone.
Other antivirals like Paxlovid have been shown to reduce the severity of illness when taken early — but none are approved for post-exposure prevention. "A lot of risk groups could potentially benefit, even if they're immunized," Hayden told me. Nursing home patients and people receiving life-sustaining kidney dialysis come to mind. As for my friend? So far, he's dodged the scratchy throat, fatigue, and congestion that sidelined me for a couple of days. I've stayed up to date with booster shots, which likely blunted Covid's impact while reducing my chances of spreading it. — Jason Gale | 
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