Coronavirus FAQ: Is Paxlovid the very best remedy? Is it underused within the U.S.?

It is the simplest remedy to stop extreme COVID – a capsule known as Paxlovid that research present may be near 90% efficient in lowering the danger of extreme illness.

And it is a world phenomenon. Pfizer, which manufactures the drug, simply signed an settlement to import the drug to China, which is going through an unprecedented COVID surge this winter.

But right here within the U.S., public well being specialists say Paxlovid is underused. A ballot taken in June and July by the COVID States Project, a consortium of a number of universities, discovered that amongst adults over 65 who examined optimistic since January 2022 and who’re eligible for the drug due to their age, solely 20% acquired a prescription.

What’s up?

The ABCs of Paxlovid

First, let’s assessment some fundamentals in regards to the drug, which got here in the marketplace in December 2021.

How does it work? As NPR reported in an earlier story: “The antiviral drug stops the virus from replicating in cells. And that would scale back the danger of lengthy COVID in addition to the danger of extreme illness. “We all know that one of many key elements that predict lengthy COVID is detectable virus within the bloodstream on the time of an infection,” Dr. Peter Chin-Hong, an infectious illness doctor on the College of California, San Francisco, wrote in an electronic mail. “So it stands to purpose that interventions that forestall the virus from making extra copies of itself would due to this fact result in a decrease threat of lengthy COVID.”

In accordance with the prescribing tips, the 5-day remedy course of three capsules, taken twice each day, must be began as quickly as potential after a analysis of COVID-19 and inside 5 days of symptom onset. Wait longer and the drug won’t be efficient.

Your physician may even must assessment with you all medication you are taking since Paxlovid can interact with over a dozen medications and probably trigger toxicity. The possibly regarding drugs embody most statin medication, which decrease ldl cholesterol, and the opioid ache reliever hydrocodone. Your physician will decide for those who can keep off any interacting medication for five days or probably take a decrease dose of sure medication whereas on Paxlovid.

Who can get Paxlovid?

Within the U.S., not each COVID affected person is eligible for a prescription. The Facilities for Illness Management and Prevention recommends remedy for sufferers liable to extreme illness, hospitalization and loss of life, which incorporates anybody who’s 50 and older (threat will increase with age), people who find themselves unvaccinated and other people with sure medical circumstances, similar to weight problems, continual lung illness, coronary heart illness or a weakened immune system.

However exceptions may be made. A colleague who’s below 50 instructed her physician she was feeling worse every day after her optimistic COVID take a look at and had a historical past of pneumonia. The physician wrote a Paxlovid prescription.

Even for those who’re eligible you may need to persuade a physician to prescribe the drug. “A whole lot of docs in the neighborhood and even main tutorial facilities are reticent to prescribe [Paxlovid] out of concern that there are going to be drug interactions or assume {that a} affected person can simply experience out the virus,” says Dr. Priya Nori, an affiliate professor of medication on the Albert Einstein School of Drugs in New York Metropolis.

There are additionally some negative effects from Paxlovid that sufferers fear about and that would discourage some from in search of a prescription: a metallic mouth style; abdomen misery, together with diarrhea.

However, says Michael Ganio, director of pharmacy follow and high quality on the American Society of Well being System Pharmacists, “a foul style for 5 days is a small value to pay for a drug that may save your life.”

One other trigger for concern within the public may very well be the so-called rebound impact. A small share of sufferers, a Mayo Clinic examine put it at 1%, can see COVID signs diminish throughout a course of Paxlovid however then return 2 to eight days after ending the remedy. Are you contagious once more? Presumably, says the CDC, however nonetheless unknown. So the CDC guidance is to isolate once more and/or put on a masks if you end up with others.

The testing problem

The necessity to have a optimistic take a look at for COVID may additionally be a purpose for the underuse of Paxlovid. Studies are that fewer individuals are testing in the event that they really feel symptoms similar to fever, chills, sore throat and congestion. Maybe it is as a consequence of COVID fatigue. Or individuals would possibly determine that it is flu season, so perhaps it is a case of the flu.

Nevertheless it’s not that tough to check for COVID. The do-it-yourself house antigen checks are as of this week once more obtainable without cost within the U.S. – 4 per family – through an online request. And insurance coverage nonetheless covers the price of eight kits for per thirty days for each particular person lined within the family.

What’s extra, the FDA not too long ago prolonged the use-by dates for some COVID checks which have reached their expiration. You’ll be able to check this chart to search out out in regards to the checks you’ve got readily available.

The federal authorities additionally has a “Test to Treat” locator to see the place you may be examined without cost and, for those who take a look at optimistic and are eligible, go away with the drug. Spots embody neighborhood well being facilities and a few pharmacies. However although pharmacists have been able to prescribe the drug since July, pharmacies usually do not challenge prescriptions until they’ve an inhouse medical clinic run by a nurse practitioner or physician. And getting your prescription from a pharmacist — however solely a pharmacist — requires some bloodwork performed throughout the previous yr.

Pharmacies may additionally ship the capsules to your private home for prescriptions the physician calls in. Walgreens simply introduced free Paxlovid supply through Door Sprint and UberEATS; CVS will ship it the identical day for a charge.

Precautionary prepping for paxlovid

For individuals who prefer to plan forward – simply in case COVID had been to strike – you may make life simpler by maintaining an up-to-date listing of any medication you are taking, together with dosages.

One other key issue is timing. Since Paxlovid must be taken inside 5 days of signs beginning to work, you would possibly contact your physician’s workplace to search out out what steps to take for those who take a look at optimistic and assume you want the drug.

No physician? Dr. Nori says to keep away from the ER or pressing care facilities until these are your solely decisions to acquire a prescription as a result of whereas there, you may be uncovered to different viruses now circulating like flu and RSV.

Different choices embody a telehealth go to along with your physician or an internet telehealth firm. Test your insurer’s web site to see in the event that they companion with one.

The most effective capsule may be free

For now, Paxlovid is free for everybody within the U.S. however that would change subsequent yr, says Jen Kates, senior vp and director of International Heath on the Kaiser Household Basis. And there is not any scarcity. Dr. Ashish Jha, White Home COVID-19 response coordinator, stated at a press convention on Thursday that he expects there will probably be loads of Paxlovid to take the U.S. by means of this winter.

However the drug won’t be free endlessly. Congress has been proof against including funds for COVID remedy, says Kates, so as soon as the present Paxlovid provide bought by the federal authorities is used up, people who find themselves insured might need to pay a copay and the uninsured should pay full value, “which will probably be costly,” says Kates.

However for the second, Paxlovid looks as if a cut price. And it’s certainly the best choice for lowering the danger of extreme illness. The final monoclonal antibody remedy for COVD-19 misplaced its FDA authorization final month as a result of it’s ineffective towards at the moment circulating variants. That leaves Paxlovid; remdesivir, which requires an outpatient infusion over three days at a hospital or remedy heart; and molnupiravir, which research put at solely 30% efficient in treating the virus. As well as, some docs are treating immunocompromised sufferers with convalescent plasma.

However for those who’re not within the Paxlovid demographic, remdesivir and molnupriavir are the opposite choices obtainable for most individuals proper now.

We often reply incessantly requested questions on life in the course of the coronavirus disaster. In case you have a query you would like us to contemplate for a future publish, electronic mail us at goatsandsoda@npr.org with the topic line: “Weekly Coronavirus Questions.” See an archive of our FAQs here.

Fran Kritz is a well being coverage reporter primarily based in Washington, D.C., and a daily contributor to NPR. She additionally reviews for the Washington Put up and Verywell Well being. Discover her on Twitter: @fkritz

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