The commercials make it sound so simple: “If it’s COVID, Paxlovid.”
But the slogan, catchy though it may be, belies a harsher reality that some public health and elected officials have long acknowledged and worked to rectify: For many, getting access to the therapeutic should be much easier than it has been.
The issue is not one of scarcity, as the antiviral is widely abundant. Nor is pricing a major barrier, as Paxlovid is cheap or even free for many. Nor even is it an issue of how well it works, as studies have shown it to be highly effective.
The drug’s biggest impediment has been, and remains, the simple fact that a number of doctors are still declining to prescribe it.
Some healthcare providers hinge their reluctance on outdated arguments, such as the idea of “Paxlovid rebound” — the chance that people who take the drug have a chance of developing COVID symptoms again, generally about two to eight days after they recover.
As it turns out, anyone who gets COVID-19 has a similar rare chance of rebound.
COVID “rebound can occur with or without [Paxlovid] treatment,” scientists with the Food and Drug Administration wrote in a study published in December. “Viral RNA rebound was not restricted to [Paxlovid] recipients, and rebound rates were generally similar to those in placebo recipients.”
When told about one patient who was declined a prescription to Paxlovid because of concern about “Paxlovid rebound,” UC San Francisco infectious-diseases expert Dr. Peter Chin-Hong groaned.
“Oh my God, that’s so, like, bogus,” Chin-Hong said. “Clinicians having this weird idea about rebounds, it’s just dumb.”
Data indicate that most people don’t get COVID rebound, Chin-Hong said. And while rebound can occur, the possibility should not dissuade people “who might really need it” from taking an antiviral.
Even if COVID rebound happens, and symptoms do occur, “they tend to be mild and do not require repeating the treatment,” according to the California Department of Public Health.
Officials at both the federal and state level have implored healthcare providers to properly prescribe Paxlovid and other antivirals when indicated.
“Antivirals are underused,” the Centers for Disease Control and Prevention said in a statement Thursday. “Don’t wait for symptoms to worsen.”
In its own advisory, the California Department of Public Health said, “Most adults and some children with symptomatic COVID-19 are eligible for treatments … Providers should have a low threshold for prescribing COVID-19 therapeutics.”
Aside from Paxlovid, one alternative oral antiviral treatment is known as molnupiravir. There’s also remdesivir, which is administered intravenously.
The CDC says Paxlovid and remdesivir are the preferred treatments for eligible COVID-19 patients.
“Paxlovid treatment should be initiated as soon as possible after diagnosis of COVID-19, even if symptoms are mild, and within five days of symptom start,” the FDA says.
A reference to Paxlovid and other antivirals is even in a musical radio ad from California health authorities that has been broadcast throughout the state: “Test it. Treat it. You can beat it,” with the ditty later continuing: “Medication is key / To slow the virus in your body.”
Yet there is wide documentation of the low frequency of prescribing Paxlovid and other antivirals, and that can have significant consequences for higher-risk COVID-19 patients. A report published by the CDC Thursday reviewed 110 COVID-19 patients considered high-risk and found that 80% of them were not offered antiviral treatment.
A big reason given by the patients’ providers, all of whom were under the Veterans Health Administration, was that their patient’s COVID symptoms were mild.
But as officials note, that’s exactly what antivirals are for.
“There is strong scientific evidence that antiviral treatment of persons with mild-to-moderate illness, who are at risk for…
Read More: Paxlovid can still be hard to get. Here’s what to know.