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You Tested Positive for COVID: Should You Take Paxlovid?

Studies show the prescription pill can be lifesaving for older adults

spinner image close up of a box of Paxlovid antiviral medication
Bloomberg / Getty Images

Nearly four years into the pandemic, dodging COVID-19 has become increasingly difficult. In many settings, masks are no longer required and in-person events are back in full swing.

And while vaccines and newly updated boosters can help to curb the worst of a coronavirus infection, people at increased risk for severe illness due to their age or a range of health conditions have an additional tool to help ensure their symptoms don’t progress to a critical state: an antiviral pill.

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In December of 2021, the Food and Drug Administration (FDA) authorized the prescription medication Paxlovid for the treatment of COVID-19, along with another oral antiviral known as molnupiravir (Lagevrio), though guidelines specify Paxlovid is the preferred at-home treatment.

Conditions that increase risk for severe COVID-19

  • Cancer
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic lung diseases
  • Cystic fibrosis
  • Dementia or other neurological conditions
  • Diabetes (type 1 or type 2)
  • Some types of disabilities
  • Heart conditions
  • HIV infection
  • Immunocompromised conditions
  • Mental health conditions
  • Overweight and obesity
  • Physical inactivity
  • Pregnancy
  • Sickle cell disease or thalassemia
  • Smoking, current or former
  • Solid organ or blood stem cell transplant
  • Stroke or cerebrovascular disease
  • Substance use disorders
  • Tuberculosis

Source: CDC

In recent studies, it’s been shown to the reduce the risk of hospitalization or death by nearly half in highly vaccinated adults, and its effect has been shown to be even greater in high-risk individuals, including older adults and immunosuppressed patients. Still, physicians and public health experts say many people who could benefit from Paxlovid aren’t receiving it. Here’s what you need to know about the coronavirus treatment.

Who should be seeking it?

With COVID-19 cases once again on the rise, physicians and public health experts have a message for adults who come down with the illness: If you are 50 or older, have certain health conditions (heart disease, lung disease and diabetes are a few examples) or are unvaccinated, talk to a health care provider about getting treated as soon as your test strip turns positive.

With Paxlovid now widely available throughout the U.S., the approach at this phase in the pandemic should be, “Why shouldn’t you take this?” says William Garneau, M.D., an assistant professor of medicine at Johns Hopkins Medicine.

Of course, not everyone is a good candidate for Paxlovid, which is authorized for individuals 12 and older who are at high risk of getting seriously sick from COVID-19. People with severe liver and kidney problems should not take it. There are also several medications that can interact with Paxlovid, some of which preclude a patient from getting it.

“And there are other drugs that are what we would consider to be warning drugs, that we can adjust the dose of or we can withhold for a few days,” says Kelly Gebo, M.D., a professor of medicine at Johns Hopkins Medicine. Examples include certain statins, antidepressants and anticoagulants (blood thinners), so be sure the doctor or pharmacist prescribing Paxlovid is aware of every medication you are taking.

If you’re not eligible for Paxlovid, your health care provider may recommend another treatment option.

“I think the biggest take-home point is don’t just blow it off. Talk to somebody about whether you’re eligible for [Paxlovid] and could be treated,” says Steven Lawrence, M.D., a professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis.

Your symptoms don’t need to be severe

A common misconception is that you need to be experiencing severe symptoms in order to be a good candidate for Paxlovid, but that is not the case, health experts say.

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In fact, the medication works best when started right away (within five days of symptom onset for the oral antivirals), so don’t wait around for things to get bad before reaching out for help.

“I wouldn’t wait for the point where I was short of breath and thinking that I might need to be hospitalized. Because at that point, you’ve kind of missed your opportunity,” says Mark Rupp, M.D., a professor in the Department of Internal Medicine and chief of the Division of Infectious Diseases at University of Nebraska Medical Center. Starting treatment on the early side means “we’re going to be able to turn things around a little bit more easily,” he adds.

Testing is essential

Because time is of the essence, a prompt diagnosis is key. Kristin Mondy, M.D., chief of the Division of Infectious Diseases at University of Texas at Austin Dell Medical School, suggests keeping a stash of rapid COVID tests on hand — you can order another round of free tests from the government at or get them for free with Medicare and most insurance plans. That way if you’re sneezing, wheezing or feeling crummy, you can quickly test yourself for COVID-19.

If you test negative but your symptoms persist, take another rapid test the next day or get a more sensitive PCR (polymerase chain reaction) test at a health clinic or testing site. If you’re still negative, consider getting a flu test at your doctor’s office, since there are also effective treatments for influenza.

Another option: Check out a Test to Treat site, where you can get tested for COVID-19 and, if positive, get prescribed a treatment on the spot.

Other treatments are available

Paxlovid may be the most talked-about treatment, but it’s not the only option. Remdesivir, an antiviral that is administered by IV, can help to keep COVID-19 symptoms from progressing. There’s also molnupiravir for when Paxlovid and remdesivir are not available, and a type of prevention therapy known as Evusheld for people with weakened immune systems.

“[People] need to understand that there are some options and that they need to work with their providers in their clinics to explore what option is going to work the best for them,” Rupp says.

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At the same time, it’s important to continue with everyday efforts to help keep from getting sick in the first place. Doctors and health officials are urging everyone who is eligible to get the bivalent coronavirus booster, as studies show it provides significant protection against symptomatic COVID-19. Also, wear a mask when you are in a crowded indoor setting, and avoid poorly ventilated spaces.

If you feel sick, test for COVID-19, and if you test positive, ask your doctor about treatments. “If you take those steps, each of them is going to be additive, and your risk of having a consequence like [ending up] in the ICU or something like that is extremely, extremely low,” Garneau says.

Inequities in Access

COVID-19 oral antiviral treatments, like Paxlovid, are being dispensed at much lower rates in socially and economically disadvantaged communities compared to wealthier areas, a June 2022 report from the Centers for Disease Control and Prevention (CDC) shows. 

The CDC-led study found that while the number of COVID-19 oral antiviral treatments prescribed in the U.S. increased considerably from winter (December 2021) through spring (May 2022), dispensing rates in so-called high-vulnerability communities were substantially lower than those in medium- and low-vulnerability zip codes, even though the high-vulnerability zip codes had the most dispensing sites. 

One reason, the researchers found: People living in high-vulnerability zip codes might face challenges accessing health care providers on-site or via telehealth who can prescribe the treatments. The end of reimbursements for COVID-19 testing and assessments may have also contributed. “The findings in this report highlight an ongoing need to identify and eliminate barriers to oral antiviral access, particularly within socially and economically disadvantaged communities,” the study’s authors write. 

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.

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