Opinion | Paxlovid is still underutilized. That must change.

Ella Castle

Comment on this storyComment You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research. Just 1 in 4 nursing […]

You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research.

Just 1 in 4 nursing home residents who were diagnosed with covid-19 between May 2021 and December 2022 were prescribed an antiviral medication such as Paxlovid to treat the disease. In fact, an astounding 40 percent of nursing home facilities said they had no residents who received antiviral treatments.

That’s according to a new study published in JAMA, which should prompt urgent action to educate providers and the public about the effectiveness of antiviral treatments in reducing hospitalization and death from covid-19.

Specifically, people vulnerable to severe disease because of the coronavirus should know whether they can take Paxlovid, and if so, how to obtain it. Several pivotal trials have cemented the medication as the first-line treatment to prevent progression of covid-19. In its initial trial involving unvaccinated, high-risk patients with covid, Paxlovid reduced hospitalization or death by 86 percent.

A subsequent study, which published in Lancet Infectious Diseases and focused on vaccinated patients, found that Paxlovid was 80 percent effective against covid hospitalization or death when taken within five days of symptom onset. In addition, some research shows Paxlovid decreases the risk of long covid by as much as 26 percent.

The other antiviral pill available, Lagevrio, has not consistently demonstrated efficacy. One randomized controlled trial in the Lancet found that it doesn’t reduce hospitalizations or death, but it can shorten the time to recovery. Remdesivir is another antiviral that, as documented in a 2022 New England Journal of Medicine paper, can reduce hospitalization or death by 87 percent. But it is only available as an infusion or injection, limiting access.

Everyone 65 and older should take Paxlovid unless they have a specific reason for why they cannot do so (for example, if they are taking another medication that would interact poorly with it). And those 50 to 64 should consider taking the treatment if they have medical conditions such as hypertension or diabetes that make them more susceptible to severe illness. People younger than 50 with serious medical conditions such as cardiovascular disease or cancer could benefit from it, too. If in doubt, they should speak with their physician.

If you have decided you will take Paxlovid in the event of infection, know how and where you will obtain it. There is no shortage of the drug, and most pharmacies in the United States carry it. The key is to start the antiviral as soon as you are diagnosed. This medication works by stopping viral replication, and studies have shown that it is most effective when started within five days of symptoms showing up.

If you are traveling out of the country, discuss with your physician about whether you could have a “just in case” prescription. Some readers have said their doctors aren’t willing to do this. “I’ve been told by my internist that Paxlovid can only be prescribed if covid positive,” Lisa from Michigan wrote. “Has the protocol changed?”

The Food and Drug Administration first made Paxlovid available through emergency use authorization, meaning there were strict parameters for its use, including that it could only be given to someone with a positive coronavirus test. Many providers interpreted this to mean that there needed to be proof of a positive test before a prescription could be written.

Still, some providers have made Paxlovid available for higher-risk patients if they were traveling to places where the medication might not be easily available, with the understanding that people should take rapid tests with them and that Paxlovid would not be taken unless they test positive.

(This is an important point to emphasize: This antiviral is not authorized for use to prevent infection. If someone around you has covid, they could take Paxlovid, but you shouldn’t take it in an attempt to prevent contracting the virus from them.)

As of late May, Paxlovid has been fully approved by the FDA. More doctors will probably be willing to prescribe it in case of a positive test result.

In the discussion with her internist, Lisa could mention that Paxlovid’s status has changed. If her physician is wavering, she could ask whether they would prescribe an inhaler in case she has an asthma exacerbation or antibiotics in case she got bronchitis or a sinus infection. Paxlovid should be no different.

If that doesn’t convince your doctor, develop an alternate plan. Many countries will accept a prescription from a U.S. doctor. Will your physician be easily reachable and willing to call in a script internationally? In some countries, urgent care is convenient and inexpensive. Can you find a clinic where you’ll be visiting and confirm in advance that they carry the medication?

The combination of vaccines and antiviral treatments has turned covid-19 into a disease that is manageable for most people. It is a shame these lifesaving tools remain so underutilized.

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