Paxlovid Cuts Covid Death Risk. But Useage is Low --studies

As Covid rises again, killing about 1,500 Americans each week, medical researchers are trying to understand why so few people are taking Paxlovid, a medicine that is stunningly effective in preventing severe illness and death from the disease.

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A study of a million high-risk people with Covid found that only about 15 percent who were eligible for the drug took it. If instead half of the eligible patients in the United States had gotten Paxlovid during the time period of the research, 48,000 deaths could have been prevented, the authors of the study, conducted by the National Institutes of Health, concluded.

It’s not because people don’t know about the drug — most do — but the reluctance seems to come from doctors worried about interactions with other drugs and people wary of a possible rebound case or the metallic aftertaste.

Regional differences offer a clue, with uptake highest in the Democratic strongholds of the Northeast and Pacific Northwest regions of the United States and lowest in deep red areas including Florida and Indiana. Yet no careful study has clarified why so few people used the medication, which cut the risk of death by 73 percent for high-risk patients in the N.I.H. study.

“I don’t know why there is such variability and why uptake isn’t higher across the board,” said Dr. Josh Fessel, a senior clinical adviser on the National Institutes of Health team that studied the drug’s use. “If you can take Paxlovid and you do take Paxlovid within the recommended time frame, the likelihood of death or hospitalization are significantly reduced. That’s a big deal.”

Covid deaths have been elevated since September at about 1,200 to 1,300 deaths per week, inching up to about 1,500 per week in December. Researchers say they will most likely continue to rise unless more people get the updated Covid vaccines and antiviral treatments.

Dr. Fessel said that over the course of the entire million-person N.I.H. study, about 10 percent of high-risk patients eligible for Paxlovid took it, though the rate rose to about 15 percent toward the end of the study period in early 2023. All told, the N.I.H. authors estimated that about 135,000 hospitalizations and 48,000 deaths could have been avoided if half of the patients eligible for the antiviral got it.

Paxlovid, made by Pfizer, is a two-medication treatment meant to be taken within five days of the onset of Covid symptoms to quash viral spread within the body. It was approved for adults who are at high risk for severe Covid, which tends to include those 65 and older and people with diabetes, obesity, asthma and other conditions.

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