Should you use Paxlovid if you have asymptomatic COVID?


Paxlovid – the antiviral drug that reduces the risk of hospitalization and death from COVID by 89% – has been touted for those most at risk, such as the elderly and those with comorbidities. However, there is confusion about who can access the pills and what benefits they may have.

Vice President Kamala Harris was prescribed Paxlovid earlier this week while asymptomatic, raising the question of whether people with asymptomatic or mild COVID should take the drug.

This is where it gets complicated, as eAnyone who contracts COVID is initially asymptomatic. Some people remain asymptomatic, while others have mild symptoms and some develop severe disease. But Paxlovid is effective only if you start taking it within the first five days of illness.

“You can imagine a world where there are a lot of people who may be in a pre-symptomatic phase of the disease, where they consider themselves asymptomatic but they just haven’t started having symptoms yet, but are still in this five-day window and we have to make a decision whether or not to treat them,” said Arjun Venkatesh, an emergency physician at Yale Medicine and an associate professor at the Yale School of Medicine.

Should asymptomatic people take Paxlovid?

The drug is currently recommended for high-risk patients because it can make the biggest difference in them, said Thomas Levhospitalist and clinical assistant professor of medicine at Stanford Health Care.

When started within the first few days of illness, Paxlovid can prevent the coronavirus from replicating inside your body. For those most at risk – including people with cancer or kidney or lung disease, who are obese or who have had an organ transplant – it could be lifesaving.

But that doesn’t necessarily mean the drug is useless in people who aren’t at high risk or have only mild cases. Paxlovid can further ease these symptoms, Lew said, which would mean less strain on the healthcare system. We also don’t know if Paxlovid could help protect people against long COVIDs, whether or not they have symptoms.

Unfortunately, we have no way of predicting exactly how the disease will manifest in each person. Most doctors make the call based on a person’s risk factors and the number of days since they tested positive. It’s less about whether they’re symptomatic at the time because it’s difficult to determine whether a person will remain completely asymptomatic or develop more moderate to severe symptoms within a few days.

And Paxlovid has been in the spotlight this week because some people are experiencing a resurgence of symptoms – and positive test results after being negative – after completing the five-day course of the pills. Doctors are studying why this may be happening, and it’s unclear whether the severity of symptoms (or lack thereof) may play a role.

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Doctors say Paxlovid can help high-risk people battle COVID hospitalization or serious illness.

There will be enough supply to prescribe more Paxlovid

Until now, it has been nearly impossible for many, even those at risk, to get a prescription for the antiviral. That seems to be changing, and President Joe Biden announced this week that there is “sufficient supplyof the medicine.

“We were very restrictive about who we used them because we wanted to use them in people with the highest absolute risk of severe disease,” Venkatesh said. This meant that many people, even those at moderate risk of severe disease, did not receive treatment due to supply issues.

But we’re heading to a different place now. Finished 630,000 packets from Paxlovid are currently available.

Many doctors are still prescribing these treatments out of a scarcity mindset, Venkatesh said, when they need to adopt a more regular treatment mindset. The recommendations can be readjusted if the supply is again insufficient, he added.

“We should be in a place — both nationally and in any given state — where anyone who meets the criteria can be treated, but we need to rebalance our thinking about that,” Venkatesh said.

Make your decision as soon as possible

There is currently no definitive guidance on whether asymptomatic people should take Paxlovid. Some doctors believe that all at-risk people with asymptomatic COVID should start Paxlovid immediately to prevent the disease from getting worse. Others argue that Paxlovid only has an impact in people who are already symptomatic.

Doctors generally agree that many people will be fine without the drug. “Young, healthy, vaccinated, low-risk people who aren’t symptomatic probably don’t need Paxlovid,” Lew said.

Whatever you decide, you will want to make that decision quickly because Paxlovid works best when taken as close to the start of the infection as possible. Based on data from clinical trials of Paxlovid and antiviral drugs used for other infectious diseases like the flu, it’s widely accepted that antivirals become less effective the longer people wait to start taking them, according to Venkatesh.

If you’re not sure if you should take Paxlovid, talk to your doctor or visit a local urgent care center (which can be done virtually). Keep in mind that Paxlovid interacts with a handful of other drugs including statins, protease inhibitors, some immunosuppressants, and antipsychotics which are generally taken for the exact conditions that put people at risk for COVID in the first place. For those who are at risk but cannot take Paxlovid due to other medications, alternative treatments exist.

And remember: Paxlovid is not 100% effective – some people will take the full five day course, feel better, then test positive again and need different treatment.

“Recommendations can be very different depending on your age, medical conditions, other medications you take, and whether you know where and when you were exposed,” Lew said.

Experts are still learning about COVID-19. The information in this story is what was known or available at the time of publication, but advice may change as scientists discover more about the virus. Please consult the Centers for Disease Control and Prevention for the most current recommendations.




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