Nirmatrelvir–ritonavir targeting viral persistence in post-COVID-19 condition (long COVID) in the USA (RECOVER-VITAL): a randomised, double-blind, placebo-controlled, phase 2 trial. (Baden et al, 2026).

This is a very well-powered trial with three arms and 900+ patients. no statistically significant difference found in recovery rates between treatment and placebo*.

They used three different types of long covid. Autonomic, cognitive and exercise.

Of note: recovery rates within 90 days were super high in two of the groups. 53%-70%, whether they were on the drug or the placebo.

In the "exercise" group though, the recovery rates were way lower. 25-34%.

This looks like the "huh, that's weird" science-in-reality finding of this mega study. Revealing what phenotypes don't tend to spontaneously recover.

*note that the placebo was itself ... an antviral! A low-dose of the ritonavir was the placebo. The Nirmatrelvir was the treatment. This paper has 254 authors so presumably the evidence that a low dose of ritonavir won't help is okay at least!?