Paxlovid reduces the risk of death from Covid. But those who need it don’t take it.

As Covid surges again, killing about 1,500 Americans every week, medical researchers are trying to understand why so few people are taking Paxlovid, a drug that is astonishingly effective at preventing serious illness and death from the disease.

A study of one million people at high risk for Covid found that only about 15 percent of people eligible for the drug were taking it. If half of eligible patients had received Paxlovid, 48,000 deaths could have been prevented, the authors of the studyconducted by the National Institutes of Health, concluded.

It’s not because people don’t know about the drug – most do – but the reluctance seems to come from doctors concerned about its interactions with other medications and from people wary of a possible rebound case or the metallic aftertaste.

Regional differences offer a clue, with uptake being highest in the Democratic strongholds of the Northeast and Pacific Northwest regions of the United States and lowest in deep red areas, including Florida and Indiana. Yet no rigorous study has clarified why so few people took the drug, which reduced the risk of death by 73 percent for high-risk patients in the NIH study.

“I don’t know why there is such variability and why uptake isn’t higher across the board,” says Dr. Josh Fessel, a senior clinical advisor on the National Institutes of Health team that studied the drug’s use. “If you can take Paxlovid and you take Paxlovid within the recommended period, the risk of death or hospitalization is significantly reduced. That is a big problem.”

Covid deaths have risen to around 1,200 to 1,300 deaths per week since September, rising to around 1,500 per week in December. Researchers say they will most likely continue to rise unless more people get the updated Covid vaccines and antiviral treatments.

Dr. Fessel said that over the course of the entire million-person NIH study, about 10 percent of high-risk patients eligible for Paxlovid took it, although this percentage rose to about 15 percent by the end of the study period in early 2023. All told, the NIH authors estimate that about 135,000 hospitalizations and 48,000 deaths could have been avoided if half of the patients eligible for the antiviral drug received it.

Paxlovid, made by Pfizer, is a two-drug treatment intended to be taken within five days of the onset of Covid symptoms to suppress the viral spread in the body. It was approved for adults at high risk of severe Covid-19, which mostly includes people over 65 and people with diabetes, obesity, asthma and other conditions.

The reasons for not prescribing or taking it vary: Doctors are cautious about the long list of medications that shouldn’t be mixed with Paxlovid, including common medications intended to lower blood pressure or prevent blood clots. Patients tend to complain about the metallic aftertaste of the drug. Many stop taking the drug in the early days of Covid, when symptoms are typically mildest, bypassing the opportunity to limit early virus growth.

“They want to wait and see if things get worse, but if you wait and see, that’s not effective,” said Dr. David Gifford, chief medical officer of the American Health Care Association, which represents nursing homes. People think, ‘It’s just a cold and I’ll handle it,'” he said. “And that has to change.”

Price has also become a factor. The federal government has provided the five-day course of the drugs for free in the months since the first emergency authorization in December 2021. (The Food and Drug Administration fully approved the drug in May.) Federal officials still have more than a million free doses to pharmacies, and the medication will be free for Medicaid and Medicare patients through 2024. But in recent weeks, officials have turned over distribution of the drug to Pfizer, which has priced it at about $1,400 per course of treatment, though private insurers are expected to cover some of the price and Pfizer is offering deals help with your own contribution.

No research has been done into the effect of the transfer. The NIH study period ended early last year. Wide regional variation was found in Paxlovid use, with as many as 50 percent of eligible patients receiving the medication in Utah and the northeastern and northwestern regions of the United States. However, in states in the Southeast and parts of the lower Midwest, interest rates fell to near zero.

Dr. The NIH’s Fessel said he would be curious to see whether concerns about the so-called Paxlovid rebound would contribute to this. The doubt was that the medication initially dampens the symptoms and then leads to a second stage of the disease.

In a recent one judgement Across a large body of research, the Centers for Disease Control and Prevention found “no consistent link” between Paxlovid use and Covid rebound. Research shows that rebound can also occur without treatment.

Denis Nash, professor of epidemiology at the City University of New York, has also studied the use of Paxlovid. In a far smaller studyHis team also found that medication use was nearly 14 percent, although lower among some, including 7 percent among people who are black and nearly 11 percent among those at the lowest income levels.

He said his team has been working on a nationally representative survey of 4,000 people to dig deeper (the results have not yet been published or peer-reviewed). An interesting finding, he said, was that awareness of Paxlovid was high, with about 80 percent of respondents saying they knew it was available.

Yet respondents showed a lack of recognition of their own risk: Only about a third of people over age 65 considered themselves at high risk for severe Covid-19, even though the CDC considers everyone in that age group to be at high risk. The finding was similar for patients with asthma or diabetes, although half of the overweight or obese patients recognized their risk.

“People don’t necessarily see that they are in danger,” said Dr. Nash.

Another recent research found that starting Paxlovid very early, or on the first day of symptoms, improved chances of survival or avoiding a hospital admission, compared to starting the drug a day or two later.

Studies also looked at the use of another antiviral drug, molnupiravir, made by Merck, which was less effective and less commonly used. Gilead, which makes the antiviral infusion remdesivir, is also studying a Covid antiviral pill called obeldesivir and plans to seek FDA approval. The NIH is studying yet another antiviral optionensitrelvir, from the company Shinogi, which also appears to shorten the duration of the disease.

Researchers have also reported low Paxlovid use in nursing homes, given the risk patients face of serious illness or death. About one in four nursing home residents received an antiviral prescription for the treatment of Covid by the end of 2022. found a study. The data showed that percentage had risen to nearly a third of nursing home residents by May 2023, said one study author, Brian McGarry, assistant professor of medicine at the University of Rochester.

After that, federal officials stopped asking about Paxlovid use in their weekly Covid questionnaire in nursing homes.

“I think things are a little better,” said Dr. McGarry, “but at the same time, the facilities are now dealing with Covid, plus RSV, plus flu.”