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Questions remain about Paxlovid eligibility and use

When the antiviral drug Paxlovid was approved by the Food and Drug Administration in late 2021, many experts hailed it as a game-changing treatment for high-risk patients battling COVID-19. But the rollout has been hampered by concerns about side effects, and confusion about just who is eligible to receive the drug. 

Paxlovid is meant to be taken within several days of developing COVID-19 symptoms. The treatment was designed to keep patients from having to be hospitalized.

The FDA granted an emergency use authorization for anyone ages 12 and older at high risk for severe disease.

But some experts believe the treatment has been underused. A lack of public awareness, along with polarized reactions to vaccines and treatments, may have played a part.

According to The New York Times, physician resistance is another factor in stagnant prescription rates.

Some doctors are concerned about potential side effects from Paxlovid, including how it may interact with other drugs, along with what has become known as “COVID-rebound,” when some symptoms return after seemingly subsiding.

Dr. Brent McQuaid is the director of critical care medicine for Cone Health.

He questions whether COVID rebound can solely be attributed to use of the drug.

"That concern for rebound of COVID after taking Paxlovid, I believe has a story that has taken on a life of its own without a robust base of data to support it," says McQuaid. 

McQuaid says he witnessed symptom rebound in patients before Paxlovid came along and that it may just be COVID taking its natural course.

One issue for those seeking Paxlovid has been eligibility, with many patients who request the treatment being told simply they do not qualify.

Dr. McQuaid says this might be traced back to the language in the emergency use authorization (EUA), which he believes is open to interpretation.

"The way the EUA reads, it's hard to find somebody in the United States who's not eligible," says McQuaid. "I mean, the criteria are pretty broad."

McQuaid believes many providers are interpreting the EUA in a literal fashion, and for the most part, limiting prescriptions to those 65 and older, and/or considered high-risk. He says that patients should have a conversation with their provider if they believe they deserve access to a prescription.

And McQuaid offers one more message for those looking to temper a potential bout with COVID.

"Vaccination, vaccination, vaccination," says McQuaid.  "It's really the best first-line therapy to prevent things from getting worse."

Neal Charnoff joined 88.5 WFDD as Morning Edition host in 2014. Raised in the Catskill region of upstate New York, he graduated from Sarah Lawrence College in 1983. Armed with a liberal arts degree, Neal was fully equipped to be a waiter. So he prolonged his arrested development bouncing around New York and L.A. until discovering that people enjoyed listening to his voice on the radio. After a few years doing overnight shifts at a local rock station, Neal spent most of his career at Vermont Public Radio. He began as host of a nightly jazz program, where he was proud to interview many of his idols, including Dave Brubeck and Sonny Rollins. Neal graduated to the news department, where he was the local host for NPR's All Things Considered for 14 years. In addition to news interviews and features, he originated and produced the Weekly Conversation On The Arts, as well as VPR Backstage, which profiled theater productions around the state. He contributed several stories to NPR, including coverage of a devastating ice storm. Neal now sees the value of that liberal arts degree, and approaches life with the knowledge that all subjects and all art forms are connected to each other. Neal and his wife Judy are enjoying exploring North Carolina and points south. They would both be happy to never experience a Vermont winter again.

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