Trending
Paxlovid was given an Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) in December 2021 for the treatment of mild to moderate COVID-19 in certain patients.
By the end of February 2023 an estimated 48,000 people with COVID died in the U.S. because they didn't get Paxlovid. Why didn't they?
Paxlovid is an anti-viral treatment combining two medicines, nirmatrelvir and ritonavir. Taken together, they prevent mild to moderate COVID from progressing to severe disease leading to hospitalization or death. Nirmatrelvir keeps the SARS-CoV-2 virus from spreading within the body. Ritonavir slows nirmatrelvir's breakdown, giving it more time to work.
Paxlovid is fully approved by the FDA for adults with mild to moderate COVID-19 who are at high risk of getting seriously ill. You are high-risk if you are age 50 or older. You are also high-risk, regardless of age, if you have certain chronic (long-term) conditions, including cancer, diabetes, kidney disease, liver disease, lung disease, heart conditions, obesity (overweight), and immune system conditions, or if you have had a transplant, or if you are pregnant.
The EUA authorizes Paxlovid use for children ages 12-17 who weigh at least 88 pounds and who are at high risk because of health conditions such as those mentioned above.
Paxlovid treatment needs to begin within five days from the first symptoms, before you have too much virus for it to handle. There is no evidence that Paxlovid will work before you have symptoms (or a positive test), so it's not approved for preventing infection. That's what the vaccines are for.
Paxlovid can affect how other medicines work, either by reducing or increasing their effects. You should not take certain drugs with Paxlovid, and others may require adjusting dosages. Asking your health care provider about Paxlovid as soon as you notice symptoms gives them time to make the right decision for you.
Paxlovid helps you feel better. More importantly, it can keep you out of the hospital and reduce your chance of dying from COVID. Research is ongoing and results can vary, but the reduction in hospitalizations and deaths with Paxlovid has been almost 90% in some studies. Getting vaccinated helps to keep you from getting COVID; Paxlovid helps if you when infected. Like a one-two punch, vaccination plus treatment gives you your best chance of knocking out this dangerous opponent.
Some studies suggest that Paxlovid may reduce the likelihood of long COVID, although a new study getting plenty of attention right now found no relation. The jury is still out.
Paxlovid's side effects are generally mild and disappear once you finish taking the pills. Many people report an unpleasant metallic taste. Diarrhea, an increase in blood pressure, muscle aches, and nausea are fairly common and temporary. Less common but serious effects include liver problems and allergic reactions. You should report hives; trouble breathing; swelling of the mouth, lips, or face; throat tightness; hoarseness; or trouble swallowing; or skin rash to your health care provider immediately.
Paxlovid works, most side effects are mild and don't last long, and serious side effects are rare. Yet, only about 15% of high-risk patients eligible for Paxlovid treatment got it, according to a large study last year. Why have so many people not taken this effective, safe medicine?
People are tired of hearing about COVID, and many still think it's "just like the flu." It isn't. COVID is causing more hospitalizations and deaths than flu and RSV combined. and killing about 1,500 Americans per week in the current surge.
People worry about side effects, especially the bitter, metallic taste that has gotten more attention than it should. Sure, it's unpleasant for some, but it's tolerable for five days.
People also worry about "rebound." Twenty percent of people taking Paxlovid report that symptoms and testing positive returned after the patient recovered. The jury is still out on this, too. Rebound symptoms are usually mild and sometimes occur without taking Paxlovid.
Price is another concern. Paxlovid will be free for Medicare and Medicaid patients through 2024, and private insurance should cover part of the cost. Pfizer offers help: https://www.paxlovid.com/enroll-in-co-pay-program
Surprisingly, many doctors are reluctant to prescribe Paxlovid, perhaps because of concern about drug interactions and managing high-risk patients. If you think you should be taking Paxlovid and your provider doesn't offer it, you should push them to discuss it.
A local family physician we asked reiterated the advice above:
• "Paxlovid is associated with reduction in hospitalization caused by COVID-19 and a reduction in all-cause mortality. Clinicians should consider prescribing the Paxlovid or molnupiravir (Lagevrio) for symptomatic outpatients with confirmed mild to moderate COVD-19 who are within 5 days of symptom onset and who are at high risk for progression to severe disease.
• "Treatment should be personalized and based on risk stratification and informed decision-making."
Michael Heyd, a retired medical librarian from Fairfield Township who spent more than forty years searching the literature for professional hospital staff, is a member of Let's end COVID!, a group of concerned people in Northcentral PA working to overcome the COVID-19 pandemic through education, outreach and mitigation.