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Paxlovid’s Benefits in Treating COVID-19: More Effective in Older Adults

Paxlovid is a drug authorized by the Food and Drug Administration (FDA) to treat COVID-19 in adults and children 12 years and older who have certain high-risk factors.

A new study is now reporting that this medication can also reduce severe illness and hospitalizations in people over the age of 65, although the benefits for younger adults may be limited.

The researchers examined information on more than 100,000 people compiled from an Israeli health system. All those studied were at least 40 years old. The study results include:

  • There were 42,821 patients 65 and older. Among them, there were 11 people treated with Paxlovid who required hospitalization and 766 who did not receive Paxlovid who required hospitalization. Only two people who received treatment died from COVID-19, while 158 of those who did not receive treatment died.
  • There were 66,433 patients 40 to 64 years old. Seven people who received treatment required hospitalization, and 327 untreated patients required hospitalization. One person died in the treated group, compared to 16 in the untreated group.

People who did not have a previous COVID-19 diagnosis or hospitalization were most likely to need hospitalization in both groups.

The researchers concluded, “Our study suggests that during the Omicron surge, the rates of hospitalization and death due to COVID-19 were significantly lower among adults 65 years of age and older who had received treatment with nirmatrelvir [Paxlovid] than among younger adults who had received such treatment, regardless of previous immunity.”

“One important aspect to consider is what the study evaluated,” Dr. Maria Mora Pinzon, a preventive medicine physician and fellow at the American College of Preventive Medicine, told Healthline. “It evaluated the effect of nirmatrelvir on hospitalization and death. They did not examine the severity of symptoms or time to recovery, which are some of the things that patients and clinicians consider when deciding on medication for their patients.”

Some doctors believe the positive outweighs the negatives.

“Based on anecdotal evidence from my practice, I am still likely to prescribe,” Dr. Neal Patel, a family physician with Providence St. Joseph Hospital in Orange County California, told Healthline. “I felt it was still effective for people under 65 who had a sore throat, cough, congestion, body aches, and fever.”

The FDA authorization

The FDA granted PaxlovidTrusted Source an emergency use authorization in December 2021 for treating mild or moderate COVID-19 in adults and children 12 and older with high-risk factors. High-risk factors include comorbidity health conditions, such as obesity, diabetes, and heart disease.

At the time of authorization, there was no other home treatment option for COVID-19.

The FDA gave Paxlovid the go-ahead based on a study of high-risk patients who hadn’t been vaccinated or treated for a prior COVID-19 infection. Since then, the government has distributed nearly 4 million treatment dosesTrusted Source and 1.8 million have been administered.

“I use Paxlovid for patients with a high chance of progression for severe disease,” says Dr. Mahdee Sobhanie, an infectious disease physician at The Ohio State University Wexner Medical Center. “People over the age of 65 are at risk for severe illness, but other medical problems, such as diabetes, chronic heart, lung, kidney disease, liver disease, cancer, and weakened or impaired immune systems, would also benefit from Paxlovid.”

White House officials have authorized thousands of sites where people who test positive for COVID-19 can fill a prescription. Last month, the FDA authorized state-licensed pharmacists to prescribe the medication.

What to do if you test positive

“Living with COVID means we must be aware of our surroundings and the tools available to us. Continue to keep testing kits at home, talk to your doctor ahead of time and ask about treatment options should you get COVID,” Sobhanie told Healthline.

“All of the treatments work best when taken within five days of the start of symptoms, so if you think you have COVID, act fast by testing at home and calling your doctor,” he added. “Make sure you are up to date on the vaccines – meaning you had the original doses plus the boosters. Having this knowledge can help prevent you from going to the hospital.”

Experts say it’s important to stay abreast of the different variants.

“Remember the Omicron variant is highly transmissible,” Patel noted. “And even though the symptoms are less severe, you should contact your doctor for guidance.”

Guidelines for COVID-19 by the Centers for Disease Control and Prevention (CDC) can change based on updated information.

At the moment, the CDC’s current guidelinesTrusted Source for people who test positive are:

Stay home for at least five days. If you live with other people, try to isolate by limiting yourself to one room. It would be best if you did not leave your home except for medical care.
Contact your doctor. You should contact your doctor by phone and ask for guidance on whether you need an appointment. Paxlovid is most effective when used shortly after infection.
Monitor your symptoms and understand emergency warning signs. According to the CDCTrusted Source, these include trouble breathing or shortness of breath, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, or pale, gray, or blue-colored skin, lips, or nail beds (the coloring depends on your skin tone).
Tell close contacts. Let people you have had close contact with within the past two days know that you have COVID. They should be aware of any possible symptoms in themselves and their families.
Wear a mask if you are around other people, including those in your home.
Wash your hands or use hand sanitizer often.
Clean and disinfect surfaces regularly, and do not share dishes, drinking glasses, or utensils without thoroughly washing them first.

“I recommend having a conversation with your primary care provider about your risk of severe illness and discussing if you are eligible for Paxlovid or another antiviral medicine. There are many conditions that put people in the high-risk category that are often not discussed,” said Pinzon. “Besides the ones already mentioned, hypertension and smoking can affect the severity of your symptoms.”


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