COVID is still with us. Currently, there are more Americans hospitalized for COVID than for the flu.
Is there a way to improve this? Yes, there is. People with mild to moderate COVID who are at risk of getting sicker and requiring hospitalization can take Paxlovid and significantly reduce the risk of hospitalization and death.
Who is at risk? Anyone age 50 or older (especially if age 65 or older), or not up to date on COVID vaccination, or have an illness such as diabetes, cancer, heart disease, chronic lung disease, being pregnant or were recently pregnant, or taking immunosuppressive medication.
To be clear, Paxlovid does not prevent you from getting COVID. What it does do is prevent a mild or moderate case progressing to severe COVID requiring hospitalization or even death.
To be effective Paxlovid must be taken within 5 days of symptom onset. The sooner, the better.
What about rebound in people who used Paxlovid? Rebound means that there is a return of symptoms a few days after finishing treatment, and the patient had appeared to have recovered.
This happens in a minority of patients, and the symptoms are brief and mild. In one major study, there were no hospitalizations or deaths among patients with rebound.
Also, rebound is seen in people with COVID who have not taken Paxlovid. So, we don’t know for sure if Paxlovid increases the risk of rebound or not.
There is no data to support restarting Paxlovid if you have rebound symptoms. In any case, it seems unnecessary since the symptoms are mild and short-lived.
What is the bottom line? If you develop COVID and are in a high risk group for progression to severe disease, it would be wise for you to start Paxlovid within 5 days of symptom onset.
The information for this blog comes from an excellent article by Rita Rubin, MA in JAMA.2024; 331(7): 548-551.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
