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Should You Request Paxlovid If You Test Positive for COVID?

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Mask mandates are looking like a thing of the past and most in-person events have resumed, despite the US officially passing the mark of one million COVID deaths. As there are still highly contagious strains of COVID circulating, avoiding the virus feels harder than ever.

But there is some good news: If you test positive for COVID-19 and have risk factors that increase your chances of severe illness — such as age, heart or lung conditions, a weakened immune system, obesity, or diabetes — you may be eligible to start a COVID antiviral treatment known as Paxlovid. 

This medication is only available with a prescription, to people at higher risk from the disease, and it must be taken within the first five days of testing positive in order to be effective. While Paxlovid was initially in short supply following its authorization in December, it is now available in tens of thousands of pharmacies throughout the US.

What is Paxlovid?

Paxlovid is a treatment taken over the course of five days in the form of a pill swallowed twice daily. “Antiviral” medications like this one do exactly what they sound like they should: stop viruses from multiplying in your body. Studies by Pfizer (Paxlovid’s manufacturer) have shown that in unvaccinated people at serious risk of COVID complications, Paxlovid was almost 90 percent effective at reducing the risk of hospitalization or death.

Although Paxlovid is currently the best-known COVID antiviral drug, there is another called molnupiravir that’s available to people 18 and over. Data collected by The US Food and Drug Administration’s proved molnupiravir to be a much less effective drug than Paxlovid, but doctors may still prescribe it if Paxlovid has interactions with other medications a patient is taking.

While Paxlovid does not typically have any serious side effects, common mild side effects can include an altered or impaired sense of taste, diarrhea, increased blood pressure, and muscle aches. Dose adjustments may also be required for patients with mild-to-moderate kidney disease.

Should you take Paxlovid?

If you’re eligible for the prescription and it won’t interfere with any of your other medications, it’s a worthwhile option. At the moment, the drug is only recommended for people who are “high risk” or more likely to require hospitalization or die from COVID. But the list of factors that put you in a high risk category may be more extensive than you think. 

According to the CDC, high risk candidates can include people over 65, people who are immunocompromised, people who are disabled, people with chronic liver, kidney, or lung disease (including asthma), and people with heart conditions. If you aren’t sure whether you’re eligible, speak to your healthcare provider about your risk factors. The CDC lists some unexpected factors — such as smoking or mental health conditions like depression — that may in fact put you at increased risk of severe illness.

If you are over the age of 65 (older people have a much greater chance of dying from a COVID infection!), have a chronic disease, or suffer from any other condition that may qualify you, talk to your primary care doctor about whether Paxlovid is the right choice for you. If you test positive — even when your symptoms are mild — this drug could be a life-saver. Paxlovid may even decrease your chances of developing long COVID, because it lowers the amount of virus in the body.

A prompt diagnosis is essential to begin treatment, so always keep some COVID tests on hand (order at-home tests free here).

What is the “rebound effect”?

If you’ve heard of Paxlovid, you may have also heard about something called the “rebound effect.” This refers to reports of rebound symptoms in people who’ve completed the five-day Paxlovid course. In these cases, COVID symptoms return four or five days after finishing the treatment. Some patients have also reported getting a positive COVID test after being treated with the drug.

Pfizer confirmed that in Paxlovid’s clinical trial, a few participants appeared to have a rebound in virus levels around day 10 or day 14, although this also occurred in some people who were given a placebo.

In guidelines released for clinicians, the CDC explained that a brief return of symptoms may be part of the natural history of SARS-CoV-2 infection in some patients, whether or not they’ve been treated with Paxlovid. They agree there is no evidence that additional treatment is needed for those experiencing a second round of symptoms.

According to a Mayo Clinic study out yesterday, the phenomenon appears to be relatively rare. In the study, only four patients (less than 1 percent) experienced a return of symptoms after the antiviral regimen, plus their symptoms were “generally mild” and resolved without additional therapy. So, the possibility of a rebound effect should not prevent you from trying Paxlovid. Remember: Mild symptoms are certainly preferable to severe illness, which Paxlovid has been proven to reduce the risk of!

As of now, scientists do not recommend extending the duration of Paxlovid treatment to decrease rebound cases. “The hypothesis is that the immune system didn’t have a chance to see the full extent of the virus, since Paxlovid suppressed replication early in disease,” says Scott Roberts, MD, a Yale Medicine infectious diseases specialist, of the science behind the rebound effect. He adds that scientists are currently studying the effects of longer treatment durations and alternate ways of managing the problem.

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