Can everyone who tests positive for COVID get Paxlovid medication? We asked a KU doctor
Those who test positive for COVID-19 have more treatment options available to them now than at any point in the pandemic so far. Among them is Paxlovid, Pfizer’s antiviral medication that’s currently available as a five-day course of pills.
But despite this drug’s availability in the Kansas City area, we’ve heard from readers that some infected with COVID-19 have been unable to access it.
The FDA has only released broad criteria for when the drug should be prescribed in its Emergency Use Authorization, which leaves a lot up to the discretion of prescribing doctors. Policies for who is prescribed the medication can vary from hospital to hospital, and even doctor to doctor.
We spoke with a doctor at The University of Kansas Health System to clear up who qualifies for this new drug, who it helps and who it doesn’t.
Who is eligible for Paxlovid?
According to the FDA, a patient must meet a handful of criteria in order to be eligible for Paxlovid. These qualification include:
Being over age 12
Receiving a positive COVID-19 test result
Having mild to moderate symptoms not requiring hospitalization
Having “one or more risk factors for progression to severe COVID-19”
That last one has proven tricky for doctors looking to prescribe Paxlovid, as it can be interpreted in a number of ways. Many people have “risk factors” for COVID-19 as defined by the CDC, such as a high BMI or asthma, but not all people with these risk factors will necessarily benefit from this new drug. For this reason, many hospitals have released their own guidance on when to prescribe it, on top of the FDA’s criteria.
What additional guidance is used to prescribe Paxlovid?
The additional guidance varies among hospital systems and even among individual doctors. That means the same COVID-19 patient could visit two different providers and be prescribed Paxlovid by one and not by the other.
“We lay out a lot of risk factors (for who can qualify for Paxlovid),” said Dr. Nathan Bahr, an infectious disease specialist at the University of Kansas Health System. “Things like age over 60, a BMI over 30, we have really a very long and an exhaustive list for our doctors and providers so that they can look at their patients and try to see how they might fit in.”
The full list of additional qualifications is usually long and complex, but Bahr added that patients may only need to check one of these extra boxes in order to qualify for the medication.
In general, a provider needs to believe that the benefits Paxlovid gives to a patient will outweigh its side effects, which include interactions with many medications, a persistent bad taste in the mouth, nausea, vomiting and more.
Who benefits from Paxlovid treatment, and who doesn’t?
The initial Paxlovid trials that delivered promising results were all conducted on unvaccinated, high-risk patients. Since then, researchers have been studying its effects on other groups. On Tuesday, Pfizer issued a press release about a new study measuring the medication’s effectiveness for other high-risk individuals.
“Among people that were either unvaccinated with no risk factors or vaccinated with a risk factor, there really didn’t seem to be a whole lot of improvement in their resolution of symptoms,” Bahr told The Star.
That means vaccinated people and those in good physical health are unlikely to see a significant effect from Paxlovid because their immune systems are already at work protecting them from the virus’s worst effects.
For this reason, doctors are likely to continue prescribing the drug primarily to unvaccinated people with high-risk conditions.
Should immunocompromised COVID-19 patients seek out Paxlovid?
Yes. Bahr added that immunocompromised people are good candidates for Paxlovid— even when they have been vaccinated— because these patients’ weakened immune systems may not experience the full effects of the vaccines they received.
“You should assume anyone with a significant immune compromise wouldn’t get quite as much benefit, potentially, from the vaccine,” Bahr said. “So those would be people that I definitely would still look at and say, I think they probably could still benefit from Paxlovid.”
Do you have more questions about COVID-19 prevention and treatment in Kansas City? Ask the Service Journalism team at kcq@kcstar.com.
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