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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

With travel booming, office work resuming and social distancing seeming like a thing of the past, dodging COVID-19 — which health experts say is here to stay — has become increasingly difficult.

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

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In May, the Food and Drug Administration (FDA) granted full approval to the prescription medication Paxlovid for the treatment of COVID-19. A second antiviral pill, Lagevrio (molnupiravir), is also available through emergency use authorization, though treatment guidelines specify that Paxlovid is the preferred at-home option.

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 clinical trials, Paxlovid was found to be highly effective at reducing the risk of COVID-19 hospitalization and death in high-risk patients, and new research shows it still packs a punch when up against the latest omicron subvariants. An observational study published in September in JAMA Network Open found that compared to no treatment, Paxlovid lowered risk of death by 84 percent among patients diagnosed with COVID-19 at Cleveland Clinic between April 2022 to February 2023. Lagevrio reduced the risk by 77 percent.

Still, physicians and public health experts say Paxlovid is underused. Here’s what you need to know about the treatment.

Who should be seeking it?

Testing positive for COVID-19? 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 the double line appears.

With Paxlovid widely available and still free — at least until the government-purchased supply runs out — 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. 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., an infectious disease specialist and 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, like Lagevrio or remdesivir, an antiviral that’s administered by IV.

“[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,” 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.

“I think the biggest take-home point is don’t just blow it off. Talk to somebody about whether [you should 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.

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.

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“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.

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 covid.gov/tests. That way if you’re sneezing, wheezing or feeling crummy, you can quickly check to see if COVID is the culprit.

If you don’t have any tests and don’t have access to a health care provider, a Test-to-Treat site can administer a COVID-19 test, and if that test is positive, prescribe a treatment on the spot.

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.

Editor’s note: This story, originally published May 4, 2022, has been updated to include new information.

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