Covid continues to be associated with hundreds of deaths per day in the US. We have a treatment that could reduce those deaths: a prescription pill called Paxlovid, which reduces the severity of a Covid infection, especially among older and more frail Americans.
However, this treatment remains underused. According to White House data, doctors prescribed it in about 45 percent of recorded Covid cases nationwide during the first two weeks of January. In some states, Paxlovid is given in less than 25 or even 20 percent of recorded cases. (Those are probably overestimates because cases are underreported.)
Why is Paxlovid still relatively unexplored? Part of the answer lies in a lack of public awareness. Some Covid patients may also decide they don’t need Paxlovid because they are already vaccinated, have had Covid before or are younger. (My colleagues explained why even mild cases are common still warrant a dose from Paxlovid.) The political polarization of the virus also plays a role: people in blue states use Paxlovid more often than in red states.
Experts have increasingly pointed to another explanation for Paxlovid’s underuse: doctors still resist prescribing it. That is the focus of today’s newsletter.
Doctor resistance
Some doctors are concerned about real problems with Paxlovid and are reluctant to prescribe it. But experts aren’t convinced those fears are enough to prevent Paxlovid from being prescribed altogether, especially to older patients and those at higher risk.
“What I do for a living is weigh the benefits and risks of everything,” says Dr. Robert Wachter, the chair of the department of medicine at the University of California, San Francisco. In deciding to prescribe Paxlovid, he said, the benefits significantly outweigh the risks.
Some of the doubts of doctors will sound familiar to you regular readers of this newsletter. The medication is relatively new (in a field that typically takes years to adopt new treatments). They worry about side effects, including diarrhea, muscle aches, and altered taste. They also point to “rebound” Covid cases, which can cause symptoms to come back after they subside, as happened with Dr. Anthony Fauci and President Biden after taking Paxlovid. (Though Covid symptoms can return without Paxlovid.)
Doctors also sometimes think that a patient is not sick enough to prescribe Paxlovid. But Paxlovid’s goal is to prevent Covid from becoming serious. The drug works best when prescribed in the first few days after a patient shows symptoms, so a doctor doesn’t have time to wait to see how bad an infection gets.
Another concern surfaced a recent survey from medical professionals by the healthcare website Medscape: Possible interactions between Paxlovid and a long list of other medications. Doctors can see their patients taking one of those drugs and choose not to prescribe Paxlovid.
That justification is especially concerning to experts because it’s more likely to be used to refuse Paxlovid to elderly patients and people with other health conditions because they’re more likely to be on multiple medications. But these two groups are also among the most vulnerable to hospitalization and death from Covid.
To avoid harmful drug interactions, experts said, doctors can temporarily wean a patient off a drug or offer an alternative during a course of Paxlovid – something they already often do with other treatments. “This is not something extraordinary that doctors don’t know how to do,” said Dr. Ashish Jha, the White House Covid Response Coordinator.
Only two of the 100 most commonly prescribed medications, rivaroxaban (usually prescribed for blood clots) and salmeterol (for lung disease), cause interactions so serious that Paxlovid should be avoided altogether, according to the Infectious Disease Society of America.
Some doctors would also like to see more evidence for Paxlovid. The arc of Covid has changed since Paxlovid began rolling out in early 2022, with more widespread vaccinations and the emergence of new variants. Some doctors want data showing which patients still benefit from the drug, said Dr. Lindsay Petty, an infectious disease physician at the University of Michigan.
Wachter agreed that more data would be good, but argued that the existing studies provide compelling evidence of Paxlovid’s benefit. “If you’re an impartial reader and you sit down to look at the study and compare it to other research we used to decide whether people should take statins or get their blood pressure treated, Paxlovid feels like it falls into the same category, ” he said.
Breaking through
The White House and health organizations are working to get more doctors to prescribe Paxlovid. They’ve made some progress in increasing usage and closing gaps based on race and class, Jha said.
But with Covid still tied to hundreds of deaths and thousands of hospitalizations a day, that progress is slower than anyone would like. As with vaccines and boosters, it’s hard to see what will lead more Americans to embrace one of the most effective treatments we have for Covid.
lives lived: Cindy Williams was an actress best known for her role in the 1970s slapstick sitcom ‘Laverne & Shirley’. died at the age of 75.
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ART AND IDEAS
With grandma in the kitchen
In a recent episode of “Grandmas Project,” a web series in which movie directors document their grandmothers cooking at home, a star of the show, Munise Bostanci, wonders who would see her go about her day.
“How typical of a grandmother to underestimate her popularity and reach!” Tejal Rao of The Times writes. It turns out that the Internet is a boundless hunger for watching healthy grandmothers live their life.
Grandfluencers, as they are called, draw large audiences on TikTok, Instagram and YouTube. Watching a grandmother cook can be educational and entertaining. It can also be deeply nostalgic — it’s no coincidence, Tejal notes, that high-beam traffic tends to peak around the holiday season.