What the latest data says.

You probably know of Paxlovid as an antiviral drug that can help make COVID infections less severe. Now, a new study found that Paxlovid reduces the risk of long COVID as well. The study, out March 23 in the Journal of the American Medical Association, found that Paxlovid treatment reduced the risk of developing key long COVID symptoms by 26 percent. (A pre-print version of this paper received some media attention in November.)

Even in 2023, getting COVID can be a game of health roulette. Paxlovid “can reduce the risk that that roulette goes the wrong way for you,” said study author Ziad Al-Aly, calling the apparent effect of Paxlovid on Long COVID an “added bonus.” Al-Aly is the Chief of Research and Development at the VA St. Louis Health Care System and is also a clinical epidemiologist at Washington University in St. Louis. His team looked at Paxlovid treatment across the entire Veterans Affairs health system. They compared outcomes in people who received Paxlovid within 5 days of COVID symptoms with people who did not receive Paxlovid.

The researchers started with a list of possible long COVID symptoms from the Centers for Disease Control and chose 13 of the most potentially consequential symptoms to evaluate. “Long COVID is not one thing,” Al-Aly said. “It could be fatigue, brain fog, it could have metabolic or heart manifestations.”

Any way the researchers sliced the data, whether by age, race, vaccination status, or underlying health condition, they found that fewer the Paxlovid group developed long COVID symptoms than the control group, and they developed fewer symptoms. “It’s not the panacea that’s going to eliminate long COVID,” Al-Aly said, “but it’s not nothing. It’s important; it’s still substantial.”

Paxlovid is authorized by the FDA under emergency approval for anyone at risk of developing severe COVID; that includes a good chunk of Americans. Anyone over 50 qualifies automatically, as does anyone who has not been vaccinated. A long list of health conditions—everything from diabetes and depression to being physically inactive—can also make people eligible.

“I personally would advise my patients, my family to take it if they qualify for it,” Al-Aly said. “Even if you anticipate that your second or third infection might be milder than the first and, even if you’re vaccinated and boosted.”

Currently, Paxlovid is free, regardless of insurance status. But when the research team looked into Paxlovid’s impact on long COVID, they noticed something else, too: of more than 281,000 people who were eligible for Paxlovid, only 13 percent got prescriptions. “That’s not good enough,” said Al-Aly.

There are all sorts of reasons for that gap. Some of it comes down to awareness; many people get COVID and don’t check in with a doctor, and might not know they are eligible for the drug. Paxlovid also isn’t exactly fun to take. “It actually tastes horrible,” Al-Aly said, and symptoms can rebound briefly after the five-day course of pills. But Al-Aly called those inconveniences “clinically inconsequential.”

Another barrier, says Al-Aly: Paxlovid can have negative interactions with other drugs, and doctors may be hesitant to pause those other drugs while patients are taking Paxlovid. But pausing drugs is often very doable, says Al-Aly. “We know how to manage these things,” he said. If you are eligible and your doctor is hesitant to prescribe, he said, “You should push back.”

Other research has found clear disparities in Paxlovid access based on race, ethnicity, and poverty. In an email, a CDC spokesperson said that between April and June 2022, Black patients were prescribed Paxlovid at rates 36 percent lower than white patients, and patients of other races and ethnicities were prescribed Paxlovid at rates 19 to 25 percent lower.

“It’s not surprising that Paxlovid could potentially help reduce long COVID and the symptoms associated with long COVID,” said Latoya Hill, a senior policy analyst with Kaiser Family Foundation. But, she said, “If we continue to see these disparities in prescribing, we may see widening disparities in those Long COVID impacts.”

Hill analyzed Paxlovid access for Kaiser Family Foundation in June 2022. “What we found was that counties with the highest poverty rates and those that were majority black, Hispanic and American, Indian and Alaskan Native were less likely to have COVID-19 treatment facilities,” she said, “thus reducing access for people who reside in those areas.”

Paxlovid needs to be taken within five days of symptom onset, so being able to access care quickly is important. “Limited access to treatment is particularly detrimental when patients need timely services,” said a CDC spokesperson over email.

After those studies came out, the FDA authorized pharmacists to prescribe Paxlovid. A federally sponsored “Test-to-Treat” program was designed to make it easier to get Paxlovid prescriptions at more locations, like CVS Minute Clinics. But that rollout saw logistical hurdles like difficulties in scheduling appointments, and it replicated many of the rural access issues that Hill’s research found.

“Even as we move into this new phase of the pandemic, disparities in access to Paxlovid and to other treatments persist,” said Hill. “It’s still important to prioritize racial equity in access to Paxlovid and to other COVID-19 treatments.”

One solution is to eliminate scheduling altogether: LA County implemented its own test to trace telehealth solution with instant access to consultations; in their program, almost all the patients in high poverty areas who requested prescriptions got them filled. “Equitable public health solutions targeting underserved communities are unlikely to come from the same inequitable health care infrastructure that initially created them,” wrote the authors of a recent case study on the program.