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A box of the COVID antiviral treatment Paxlovid photographed from above, with several pink and white pills scattered on the box.
Paxlovid is a highly effective antiviral treatment for COVID, available free by prescription in California. The treatment is fairly simple, and entails taking a pill orally twice a day, for five days. (Joe Raedle/Getty Images)

Have COVID? Request Paxlovid Even if You're 'Not High Risk.' Here's Why

Have COVID? Request Paxlovid Even if You're 'Not High Risk.' Here's Why

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If you've had COVID in the last year, did you try to find Paxlovid to treat your symptoms?

If the answer is no, you may want to reconsider if you get COVID again.

Paxlovid (pronounced "pax-LOH-vid" or sometimes "PAX-loh-vid") is a highly effective antiviral treatment for COVID, available free by prescription in California. The treatment is fairly simple, and entails taking a pill orally twice a day, for five days.

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Back in December 2021, Paxlovid was the first oral antiviral treatment for COVID authorized by the Food and Drug Administration (FDA). But due to limited supply, Paxlovid was initially only used to treat the patients deemed most at risk from severe illness from COVID. Later in 2022, it was expanded to more pharmacies across the United States as part of a nationwide push to get Paxlovid to more COVID patients who could benefit from it due to existing health factors.

Because of how we all first learned about Paxlovid, many of us might still think of it as a treatment still reserved for only the most high-risk patients. But what you think you know about Paxlovid might well have changed in the last year. Keep reading for everything you need to know about taking Paxlovid in 2023.

Tested positive for COVID and want to try to get Paxlovid? Read our guide to finding a Paxlovid prescription.

Officials say: Go ahead and seek out Paxlovid

According to the FDA, all patients with "mild to moderate COVID-19 who are at high risk of disease progression" should be eligible for Paxlovid. And in the last few months, California has gone further to urge providers to consider prescribing the COVID treatment to even more people — not just the most at risk for severe illness.

In December, the state’s Public Health Officer Dr. Tomás J. Aragón sent a message to California health providers reminding them of "ample supply" of Paxlovid, and urging that "all symptomatic patients with a positive COVID-19 test of any type should be evaluated for treatments."

A provider should only refuse to prescribe Paxlovid, said the state, in "situations in which the risk of prescribing clearly outweighs the benefits of treatment in preventing hospitalization, death, and the potential for reduced risk of long COVID."

All of this means that as a patient, when it comes to Paxlovid, assume you could be eligible until you're told otherwise, and seek out that prescription, urges Dr. Peter Chin-Hong, infectious disease expert at UCSF.

"People aren't great about determining whether or not they're the highest risk or not," says Chin-Hong. "I think the assumption [should be]: You qualify." You may also not be familiar with all the conditions that put a person at higher risk for COVID: For example, the Centers for Disease Control and Prevention's list of possible risk factors includes mental health conditions and mood disorders like depression, and also lists being a current or former smoker.

Paxlovid could reduce your risks of long COVID and other long-term health impacts

In late 2022, the United States Department of Veterans Affairs released the results of a study that showed that COVID patients within the VA population who took Paxlovid within five days of their positive test had "a 25% decreased risk of developing 10 of 12 different Long COVID conditions studied" — which include fatigue, neurocognitive impairment, muscle pain, shortness of breath and liver, heart and kidney disease.

Chin-Hong says that he thinks the possible benefit of Paxlovid on long COVID could even exceed the findings of the VA study. The "biologic reason" for that, he says, is rooted in why people get long COVID in the first place.

In the simplest terms, "it's when the virus gets in the bloodstream, and your immune system gets super angry and whacked out," Chin-Hong explains. "So things that kick the virus out of the bloodstream earlier would therefore potentially lead to a lower probability of long COVID," he says — because your body has less time for the immune system to react badly.

Keeping COVID out of your bloodstream, says Chin-Hong, is also the reason why vaccination is so effective: "Because your T cells and B cells are super active [after the vaccine], even if your antibodies are waning, they would just kick the virus out."

This is also the reason why having a newer COVID variant, like omicron, can have an effect on how sick you get from COVID, and reduce your risks of long COVID. The original strain of COVID and the delta variant are "worse than omicron," says Chin-Hong, "because omicron preferentially sticks around in the throat, and doesn't seem to enter the body as efficiently as the other variants."

"So that's why Paxlovid, vaccination status and having a newer variant like omicron are generally protective against long COVID," he sums up.

Dr. Bob Wachter, professor and chair of the department of medicine at UCSF, echoed Chin-Hong's sentiments recently, telling The San Francisco Chronicle that while the VA study isn’t huge, it still shows Paxlovid can make "a meaningful difference" in the fight against long COVID. That's one of the reasons he himself would take Paxlovid if he had COVID, said Wachter.

You no longer need a positive PCR test to get a Paxlovid prescription

Previously, if you wanted to get a prescription for Paxlovid, you'd need to provide proof of a positive COVID test.

But as of Feb. 1, you no longer need to provide this positive test to get a Paxlovid prescription, removing another obstacle between you and a potential course of this antiviral treatment.

Just because you don't need to submit proof of a positive test to your provider doesn't necessarily mean that you should forget about testing altogether, says Chin-Hong. While it's great that "people don't feel encumbered by hoops they have to jump through," he says having a positive diagnosis is still a good thing "to know what you're dealing with," so that you're not, for example, assuming you have COVID when you actually have the flu.

Knowing you're COVID-positive is also important for being aware of the infection risk you're posing to others, especially those who are more vulnerable for severe disease.

It won't always be this (comparatively) easy to get Paxlovid

California's COVID state of emergency ended on Feb. 28, and the White House has announced that the federal state of emergency for COVID will end on May 11 — something that will have big effects upon nationwide funding for COVID vaccines, testing and treatment.

California has recently enacted several laws that force insurers to keep covering COVID care even after the state and federal states of emergency wind down, including State Bill 1473, which specifically requires insurers to keep covering the costs of COVID therapeutic treatments like Paxlovid. But this law only keeps the current situation in place until six months after the end of the federal emergency on Nov. 11. Which means that after that date, if you want Paxlovid and you're insured, you’ll have to make sure you are obtaining these services "in network" — and you could get stung by out-of-pocket costs if you don't.

As for those without insurance, free Paxlovid consultations and prescriptions are still available in California via the state's telehealth service, Sesame. But nationally, the White House’s COVID-19 Response Coordinator Dr. Ashish K. Jha has promised that in the longer term, "likely over the summer or early fall," the country will "transition from US government distributed vaccines and treatments to those purchased through the regular healthcare system," and that the White House is "committed to ensuring that vaccines and treatments are accessible and not prohibitively expensive for uninsured Americans." Which does not necessarily mean they will be free.

"Seriously, it's going to be very complicated," warns Chin-Hong. The last few years, he says, now feel like "we were living in a fantasy land, where — at least around COVID — it doesn't matter who you are and what you are: Everything was free."

But come Nov. 11, as a state "we're kind of going back to stratified land where the rules are complicated and people have to have different decisions based on how much cost sharing they're going to have," he says.

A box of the COVID antiviral drug Paxlovid, held up by two hands presumably belonging to a health care worker, because they're wearing blue scrubs. The box says "PAXLOVID 150 mg + 100 mg film-coated tablets".
A box of the COVID antiviral drug Paxlovid. (Europa Press/C.Lujan.POOL via Getty Images)

Don't be put off by 'Paxlovid rebound'

In a nutshell, the "Paxlovid rebound" is when someone tests positive for COVID and takes Paxlovid, and tests negative on an antigen test for COVID after several days — but then redevelops their COVID symptoms and tests positive again on an antigen test after that.

In 2022, Dr. Bob Wachter told KQED that, in these cases, the negative test comes on average on Day 7 or 8 of a COVID infection, and that the positive "rebound" test and return of symptoms happens around Day 11 or 12. Rebound infections, he said, "tend to be mild," even though they last roughly another five to seven days — and you should assume you're infectious again if you test positive that second time.

A lot of folks hear about the "Paxlovid rebound" and get discouraged from seeking out Paxlovid, says Chin-Hong. But he also says that what a lot of people don't know is that people can sometimes "rebound" with COVID anyway — even without taking Paxlovid.

Chin-Hong says he's "seen so many studies now" at this stage of the pandemic that show swabs of COVID patients both with and without Paxlovid with "very similar rates of the virus coming back, with and without symptoms." In short, "we don't have any evidence at this point that Paxlovid causes more rebound than natural infection, when you study people systematically," says Chin-Hong.

"Nobody really knows why" COVID rebounds happen, says Chin-Hong. But he says that there's a good chance that some folks are already getting a COVID rebound, without Paxlovid, and just aren't realizing it. After a COVID infection, "you're probably not paying attention beyond the first negative that you got," he suggests, and "you just dismiss that sniffling nose or whatever ... you're out of the five days and you're celebrating."

Ultimately, says Chin-Hong, there's "this probably biphasic aspect of COVID" that just hasn't been studied much yet. But all this is to say: Don't let the idea of a "Paxlovid rebound" dissuade you from taking Paxlovid when you might greatly benefit from it — because a rebound infection could hit you anyway even without the Paxlovid.

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And finally: Paxlovid remains highly effective for treating COVID

Antiviral medications like Paxlovid work by stopping viruses from multiplying in the body. Studies by Paxlovid's manufacturer, Pfizer, show that in unvaccinated people at serious risk of COVID complications, Paxlovid was nearly 90% effective at reducing the risk of hospitalization or death from COVID.

Paxlovid "attacks the virus in a mechanism that's different than your immune system," Wachter explained to KQED in 2022, when the treatment first became more widely available. The way Paxlovid works is particularly beneficial for immunosuppressed people whose immune systems didn't produce a good response after getting their COVID vaccine — because "the Paxlovid should still work fine," said Wachter.

While Pfizer's Paxlovid has become the more well-known COVID antiviral drug recently, a provider may still suggest the other major COVID antiviral: molnupiravir. While the FDA's data has shown that molnupiravir is a much less effective drug than Paxlovid, doctors may still prescribe it instead for several reasons, including the risk of Paxlovid's interactions with other medications you're taking.

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