PAXLOVID: THE WONDER PILL
Sooner or later, everyone is going to catch Covid. This is what JoAnne and I have been saying for nearly three years. Well, It finally caught up with me. Ten days ago, I had a runny nose, had developed a cough, and felt a general lack of energy. I took the Covid do-it-yourself home test and, damn, it was positive. I immediately phoned my doctor. She didn’t waste a minute—and prescribed Paxlovid. JoAnne drove to the pharmacy, picked it up and I was soon taking my first dose. After 10 doses of three pills each—one dose in the evening, one in the morning—for 5 days, I felt 100% better. I now consider Paxlovid a wonder pill. And, luckily, JoAnne didn’t catch my Covid!
My biggest regret was having to cancel the 10K Holiday run I’d signed up for. Still, this morning, 10 days after my positive test and 5 days after completing my Paxlovid regimen, I was able to jog for 4 miles with no ill effects.
To give you detailed info on this wonder drug, here are excerpts from the December 16, 2022 NPR online article by Fran Kritz, Coranivirus FAQ: Is Paxlovid the best treatment? Is it underused in the U.S.?
It’s the most effective treatment to prevent severe COVID – a pill called Paxlovid that studies show can be close to 90% effective in reducing the risk of severe disease.
And it’s a global phenomenon. Pfizer, which manufactures the drug, just signed an agreement to import the drug to China, which is facing an unprecedented COVID surge this winter.
Yet here in the U.S., public health specialists say Paxlovid is underused. A poll taken in June and July by the COVID States Project, a consortium of several universities, found that among adults over 65 who tested positive since January 2022 and who are eligible for the drug because of their age, only 20% got a prescription.
What’s up?
The ABCs of Paxlovid
First, let’s review some basics about the drug, which came on the market in December 2021.
How does it work? “The antiviral drug stops the virus from replicating in cells. And that could reduce the risk of long COVID as well as the risk of severe disease. “We know that one of the key factors that predict long COVID is detectable virus in the bloodstream at the time of infection,” Dr. Peter Chin-Hong, an infectious disease physician at the University of California, San Francisco, wrote in an email. “So it stands to reason that interventions that prevent the virus from making more copies of itself would therefore lead to a lower risk of long COVID.”
According to the prescribing guidelines, the 5-day treatment course of 3 pills, taken twice daily, should be started as soon as possible after a diagnosis of COVID-19 and within 5 days of symptom onset. Wait longer and the drug might not be effective.
Your doctor will also need to review with you all drugs you take since Paxlovid can interact with over a dozen medications and possibly cause toxicity. The potentially concerning medications include most statin drugs, which lower cholesterol, and the opioid pain reliever hydrocodone. Your doctor will determine if you can stay off any interacting drugs for 5 days or possibly take a lower dose of certain drugs while on Paxlovid.
Who can get Paxlovid?
In the U.S., not every COVID patient is eligible for a prescription. The Centers for Disease Control and Prevention recommends treatment for patients at risk of severe disease, hospitalization and death, which includes anyone who’s 50 and older (risk increases with age), people who are unvaccinated and people with certain medical conditions, such as obesity, chronic lung disease, heart disease or a weakened immune system.
But exceptions can be made. A colleague who is under 50 told her doctor she was feeling worse each day after her positive COVID test and had a history of pneumonia. The doctor wrote a Paxlovid prescription.
Even if you’re eligible you might have to convince a doctor to prescribe the drug. “A lot of doctors in the community and even major academic centers are reticent to prescribe [Paxlovid] out of concern that there are going to be drug interactions or think that a patient can just ride out the virus,” says Dr. Priva Nori, an associate professor of medicine at the Albert Einstein College of Medicine in New York City.
There are also some side effects from Paxlovid that patients worry about and that could discourage some from seeking a prescription: a metallic mouth taste; stomach distress, including diarrhea.
But, says Michael Ganio, director of pharmacy practice and quality at the American Society of Health System Pharmacists, “a bad taste for five days is a small price to pay for a drug that can save your life.”
Another cause for concern in the public could be the so-called rebound effect. A small percentage of patients, a Mayo Clinic study put it at 1%, can see COVID symptoms diminish during a course of Paxlovid but then return 2 to 8 days after finishing the medication. Are you contagious again? Possibly, says the CDC, but still unknown. So the CDC guidance is to isolate again and/or wear a mask when you are with others.
The testing challenge
The need to have a positive test for COVID might also be a reason for the underuse of Paxlovid. Reports are that fewer people are testing if they feel symptoms such as fever, chills, sore throat and congestion. Perhaps it’s due to COVID fatigue. Or people might figure that it’s flu season, so maybe it’s a case of the flu.
But it’s not that hard to test for COVID. The do-it-yourself home antigen tests are as of this week again available for free in the U.S. – four per household – via an online request. And insurance still covers the cost of eight kits for per month for every person covered in the household.
Precautionary prepping for paxlovid
For those who like to plan ahead – just in case COVID were to strike – you can make life easier by keeping an up-to-date list of any drugs you take, including dosages.
Another key factor is timing. Since Paxlovid has to be taken within five days of symptoms starting to work, you might contact your doctor’s office to find out what steps to take if you test positive and think you need the drug.
The best pill might be free
For now, Paxlovid is free for everyone in the U.S. but that could change next year, says Jen Kates, senior vice president and director of Global Heath at the Kaiser Family Foundation. And there’s no shortage. Dr. Ashish Jha, White House COVID-19 response coordinator, said at a press conference on Thursday that he expects there will be plenty of Paxlovid to take the U.S. through this winter.
But the drug might not be free forever. Congress has been resistant to adding funds for COVID treatment, says Kates, so once the current Paxlovid supply purchased by the federal government is used up, people who are insured may have to pay a copay and the uninsured will have to pay full price, “which will be expensive,” says Kates.
But for the moment, Paxlovid seems like a bargain. And it is indeed the best option for reducing the risk of severe disease.
But if you’re not in the Paxlovid demographic, remdesivir and molnupriavir are the other options available for most people right now. Remdesivir, which requires an outpatient infusion over three days at a hospital or treatment center; and molnupiravir, which studies put at only 30% effective in treating the virus. In addition, some doctors are treating immunocompromised patients with convalescent plasma