And while vaccines and boosters can help to curb the worst of the disease, people at high risk for severe illness from their age or an underlying health condition now have an additional tool to help ensure their symptoms don’t progress to a scary state: an at-home antiviral pill.
Following its authorization in December, this pill, called Paxlovid, was initially in short supply and therefore out of reach for many Americans. “But that equation has changed pretty radically over the last few months,” 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.
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Paxlovid is now pouring into tens of thousands of pharmacies throughout the U.S., according to a recent news briefing from White House COVID-19 Response Coordinator Ashish Jha, M.D. And health officials are letting physicians know that they no longer need to restrict prescriptions to the highest-risk patients.
Who should be seeking Paxlovid now? Here’s what the experts say.
Older adults, people with underlying conditions qualify
Medical conditions that increase risk for severe COVID-19
- Chronic kidney disease
- Chronic liver disease
- Chronic lung disease
- Dementia and other neurological conditions
- Diabetes (type 1 or type 2)
- Heart conditions
- Weakened immune system
- Overweight and obesity
This list is not exhaustive but includes many of the chronic conditions that affect older adults.
The Food and Drug Administration (FDA) authorized Paxlovid for adults at high risk for severe COVID-19, as well as for high-risk pediatric patients ages 12 and up.
A long list of conditions can put someone at high risk, including heart disease, kidney disease, obesity and diabetes. Age is another factor that increases one’s odds of developing complications from a coronavirus infection. More than 70 percent of deaths from COVID-19 in the U.S. have been among people 65 and older, according to federal data.
Bottom line: If you have a chronic disease that puts you at risk for severe COVID-19 and you test positive for an infection, talk to your primary care physician immediately about Paxlovid. Adults ages 60 and older who don’t have any underlying illnesses should be doing the same, based on the population studied in the drug’s clinical trials, says Kristin Mondy, M.D., chief of the Division of Infectious Diseases at University of Texas at Austin’s Dell Medical School.
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, experts say.
You likely don’t need the treatment if you are asymptomatic, Rupp says. “But I would certainly be liberal with my definition of symptomatic,” he adds. If COVID-19 is causing fatigue, low-grade fevers, or aches and pains, reach out to your doctor.
“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,” Rupp says.
To that, it’s important to take action quickly. The drug works best when started right away or at least within five days of symptom onset. “You don’t want to sit at home waiting three or four days and then try to squeak in under the deadline,” Rupp says. If you start treatment on the early side, “we’re going to be able to turn things around a little bit more easily.”
Because time is of the essence, a prompt diagnosis is key. Mondy suggests keeping a stash of rapid tests on hand — you can order free tests on covidtests.gov or get them for free from participating pharmacies with your Medicare card. That way if you’re sneezing, wheezing or feeling crummy, you can quickly test yourself for an infection. 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. The turnaround time for PCR results is usually a day or two.
“What I am recommending to family and friends is if you get COVID, you should see a provider and make that assessment with your provider. A lot more people are eligible and would benefit [from Paxlovid] than I think people think,” Jha said.
Know that some meds don’t mix with Paxlovid
Paxlovid has been shown to be highly effective at keeping vulnerable individuals out of the hospital, but there are some risks associated with the drug, including a number of potential drug interactions. “And of course, people that are older might be on more drugs,” Mondy says.
Some of the more common medications on Paxlovid’s drug-interaction list include anticoagulants like warfarin (Jantoven), antidepressants like bupropion (Wellbutrin), cholesterol-lowering medications like atorvastatin (Lipitor), some calcium channel blockers used to treat high blood pressure, and some antiarrhythmics that treat abnormal heart rhythms.
“Also, if you have any type of compromised kidney function, there needs to be a dose adjustment,” Mondy adds.
With so many factors to consider — from underlying illnesses to potential drug interactions — both Mondy and Rupp say it’s ideal to discuss Paxlovid with a doctor who is familiar with your medical history. If you don’t have an established physician, or you end up getting Paxlovid at a test-to-treat site (a pharmacy or clinic that tests individuals for COVID-19, and if positive, prescribes qualifying patients Paxlovid on the spot — find one here), be sure to bring your prescriber up to speed on all of the medications you take, including over-the-counter drugs and supplements, and any chronic conditions you have, including a history of compromised kidney function.
Even if you wind up at your regular pharmacy for test-to-treat, don’t assume the pharmacist has a current list of your medications, Mondy says. Your primary care doctor may also be in the dark when it comes to medications prescribed by a specialist, so double-check their list as well.
Other treatment options
Paxlovid may be the latest treatment available, but it’s not the only option. Remdesivir, an antiviral that is administered by IV, can help to keep symptoms from progressing. There are also a few monoclonal antibodies that are effective. What’s more, molnupiravir, a pill from Merck, has FDA authorization for adults, though studies have found it less effective than Paxlovid.
“[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.
Paxlovid does not prevent COVID-19 if you’ve been exposed to an infected person, a new study shows, but Rupp says the tried-and-true measures that do lower infection risk shouldn’t go ignored.
Vaccines can lower your odds of contracting COVID-19, federal data shows. So can “continuing to be a little bit careful,” Rupp says.
“It makes a lot of sense to me to just have that ounce of prevention. So get yourself vaccinated, get boosted; and when you’re in a high-risk setting, I think it still makes great sense to be wearing a mask that is well constructed, tight fitting and very functional,” he adds.
What happens if your symptoms come back?
There have been a handful of cases where people who take Paxlovid finish up the five-day course and become symptomatic again. The reason for the return in symptoms is unclear, says Kristin Mondy, M.D., chief of the Division of Infectious Diseases at University of Texas at Austin’s Dell Medical School.
It may be that five days of Paxlovid isn’t enough to squash the virus in people with higher viral loads, “but we don’t know,” she says about the rare cases. The important thing to note is that people who have had this so-called viral rebound didn’t get sicker when the treatment stopped and the symptoms reemerged.
“I want to reassure people that they're not going to just all of a sudden get much worse disease,” Mondy says. “It's just that when they stopped it, they had kind of these cold symptoms again. And when they tested themselves again, they still had COVID.”
Research on the issue is ongoing. If you experience a return in COVID-19 symptoms after taking Paxlovid, contact your doctor.
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.