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You Tested Positive for COVID: Should You Take Paxlovid?

With supplies increasing, more people now have access to the antiviral pill 

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

 

With mask mandates fading, in-person events resuming and highly contagious strains of the coronavirus circulating, avoiding COVID-19 is becoming increasingly difficult.

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.

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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.​

Paxlovid is pouring into tens of thousands of pharmacies throughout the U.S., according to  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 

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 12 and older.  

Conditions That Increase Risk for Severe COVID-19

  • Cancer
  • 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
  • Stroke

This list is not exhaustive but includes many of the chronic conditions that affect older adults.

Source: CDC

A number of factors can put a person at high risk for getting seriously ill from COVID-19. Age, starting at 50, is the highest risk factor, according to the Centers for Disease Control and Prevention (CDC), and that risk increases "substantially" once you hit 65.

More than 90 percent of deaths from COVID-19 in the U.S. have been among adults 50 and older, according to federal data; about 75 percent of deaths have been among adults 65 and older.

long list of conditions can also put someone at high risk, including heart disease, kidney disease, obesity and diabetes.

Bottom line: If you are considered high risk for severe COVID-19 and you test positive for an infection, talk to your primary care physician immediately about Paxlovid.

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.

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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.

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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. Kristin Mondy, M.D., chief of the Division of Infectious Diseases at University of Texas at Austin’s Dell Medical School, 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 age and 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.

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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.

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 new 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. 

Editor's note: This story, originally published May 4, 2022, has been updated to include new information on access to Paxlovid and risk factors for severe disease.

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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