It is becoming increasingly difficult to avoid infection and re-infection of the coronavirus with each variant that emerges. Omicron offshoots like the latest, the XBB.1.5 subvariant, are better at dodging antibodies. But COVID cases also appear to be easing, either because new variants are less likely to penetrate deep into the lungs or because most people have been vaccinated, exposed, or both.
Which begs the question: Do mild cases of COVID warrant treatment with an antiviral drug like Paxlovid?
In many cases they do. Paxlovid is known to reduce the severity of the disease and even reduce the risk of developing long-term symptoms such as chronic fatigue, muscle pain, kidney disease, heart disease, blood clotting problems, and neurocognitive disorders. Research has shown that it can provide these benefits to vaccinated and unvaccinated people, those experiencing their first infection and those who have had a reinfection.
Paxlovid’s ability to reduce the risk of hospitalization and death is well documented. Studies carried out before the drug’s authorization in December 2021 showed that Paxlovid reduced these serious consequences by up to 89% in unvaccinated people. While last year’s data was slightly less impressive among those vaccinated, Paxlovid still reduced the risk of hospitalization and death by around 57%.
Paxlovid prevents the coronavirus from replicating in cells. Scientists hypothesize that by rapidly reducing the viral load in the body, Paxlovid prevents many problems linked to serious results and long-lasting symptoms, such as damage to blood vessels, widespread inflammation and overactivation of the system immune.
In a study published online in November and currently undergoing peer review, researchers found that among patients in the Veterans Health Administration system who had at least one risk factor qualifying them for a antiviral treatment, those who took Paxlovid within five days of testing positive were 26% less likely to develop long COVID symptoms. Yet only about 15% of patients eligible for the drug took it. Other studies have suggested even lower absorption.
Who should take Paxlovid?
Many experts agree that more people should take Paxlovid and that treatment should be considered even for mild cases of COVID-19.
“A drug you’re not taking surely can’t prevent long COVID or reduce your risk of serious illness, hospitalization, or death,” said Michael Osterholm, public health researcher and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“The threshold for giving Paxlovid should be lower, and more people should get it, because it really isn’t harmful,” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. Francis.
All adults over 65 are eligible for the drug, as are adults and children 12 and older who weigh at least 88 pounds and have one or more severe COVID risk factors. People in these categories should talk to their doctor about taking Paxlovid if they test positive. Antiviral treatment is only given if a prescription can be filled within the first five days of the onset of symptoms. In particular, studies show that adults over the age of 65 benefit the most from taking Paxlovid. Their age puts them at higher risk for poor outcomes, whether or not they have other health conditions, Chin-Hong said.
The evidence is less clear about whether Paxlovid is worth taking for people under 65 who are not immunocompromised and who do not have health problems such as cancer, chronic lung disease, diabetes or many others.
“It’s a personal decision between the person who is affected and their provider whether or not to take Paxlovid,” said Dr. Ziyad Al-Aly, clinical researcher in public health at Washington University in St. Louis and chief of research at Veterans Affairs. Saint Louis Health System. When a younger colleague recently had COVID, for example, Al-Aly, who led the November Long COVID study, recommended that the person take the antiviral because it might still provide some of the same benefits. against long-term symptoms.
So why do so few people take it?
Many doctors do not prescribe Paxlovid. And patients who have access to the drug refuse it.
“It’s really disconcerting,” Al-Aly said. “But that’s what’s happening in the United States: Paxlovid is remarkably underutilized.”
The treatment, which has been available for more than a year and is provided free by the federal government, has been plagued with public relations issues from the start.
For the first few months after receiving Emergency Use Authorization from the Food and Drug Administration, Paxlovid supplies were hard to come by. Then, patients who took the drug began to report a bitter or metallic taste that stuck with them throughout treatment. Several high-profile cases of Paxlovid rebounding, or the recurrence of COVID symptoms, have also led to speculation that this unwanted side effect is quite common.
“There are now several studies, and the information is so good that there is very little difference in the rebound rate between those who take Paxlovid and those who don’t. Yet this myth continues,” Osterholm said.
Who should get the antiviral treatment also remained a source of confusion for patients and healthcare providers, Osterholm said. Because the drug is provided under emergency use authorization by the FDA, doctors generally do not prescribe it outside of the stated eligibility criteria. (Prescribers tend to be more flexible with a fully approved drug. Some approved drugs can be prescribed or renewed sooner if you go on vacation, for example, but many people traveling abroad, including Osterholm, have had hard to get Paxlovid in advance.)
Another source of confusion is the interactions Paxlovid can have with many medications, including statins, beta-blockers, blood thinners, antipsychotic medications, antiepileptic medications, some migraine medications, and hormonal contraceptives. It’s likely that the long list of potential interactions puts off many people. But a doctor can help patients take Paxlovid safely and avoid side effects in several cases, Osterholm said. For example, patients can stop taking statins while on Paxlovid, he said, and it “won’t have a material impact on your health.”
Several experts said they were aware of cases in which primary care providers dissuaded patients from taking Paxlovid because the doctor thought the patient was ineligible or did not need the treatment. Many may be under the false impression that you can only take Paxlovid if you have a serious illness, Chin-Hong said, when in fact the drug is for anyone at risk for such an illness.
In July, the FDA revised Paxlovid’s emergency use authorization so that pharmacists could prescribe the drug. But it didn’t have a significant impact on Paxlovid use, Chin-Hong said.
The problem is about to get worse, Chin-Hong said. The US government bought millions of Paxlovid pills at around $530 per course, a discount that drugmaker Pfizer gave them for buying in bulk. But government support for the drug is expected to run out by the middle of this year. When the drug enters the private insurance market, Pfizer could raise the price, making it inaccessible to those most at risk of severe COVID and least able to afford treatment: the elderly and the uninsured. .
To improve drug access and absorption, Chin-Hong said, “we’re going to need systemic changes.”