We’ve known that Paxlovid, the antiviral treatment used to treat COVID-19, can drastically improve protection against severe illness or hospitalization. Now it seems the drug combo may help reduce the risk of long COVID after an infection, too.
A new study, which was published online but has not yet been peer-reviewed, found that eligible people who took Paxlovid within five days of being diagnosed with COVID-19 had a significantly lower chance of experiencing long-term symptoms like fatigue, shortness of breath, cognitive issues and muscle pain, plus kidney, liver and heart problems.
Scientists have wondered whether Paxlovid might have this effect, but evidence on the treatment’s ability to prevent long COVID has been limited until now. Approximately 1 in 5 people who get COVID-19 experience lasting symptoms, and scientists have been eager to develop long COVID treatment options that can effectively prevent and treat the condition that has been disabling millions of people.
“It’s very exciting, because it suggests that there is a way to decrease the incidence of long COVID, and obviously that’s become one of the scariest aspects of COVID,” Dr. Betty Diamond, the director of the Institute of Molecular Medicine at the Feinstein Institutes for Medical Research, told HuffPost.
For the study, the researchers evaluated medical records sourced from the U.S. Department of Veterans Affairs of 56,340 patients who had tested positive for COVID-19 between March and June 2022 and had at least one risk factor for severe COVID-19.
Of the group, 9,217 patients were treated with Paxlovid within five days of being diagnosed and 47,123 did not receive the medication. The research team then calculated how effective the treatment was up to 90 days after the infection and found that those who took Paxlovid — three pills taken twice a day for five days — had a 26% lower risk of long COVID.
Paxlovid was associated with a lower risk for a range of long-COVID symptoms. People who took Paxlovid were also 30% less likely to be hospitalized and 48% less likely to die. The antiviral was beneficial regardless of vaccination status —people who were unvaccinated, vaccinated and boosted all had a lower risk of developing long COVID if they took Paxlovid. The same was true for people who were previously infected or reinfected.
The new findings suggest that Paxlovid can significantly lower the risk of long COVID among people who are at risk of severe diseases, and the researchers hope the report will encourage more doctors to prescribe the pills to eligible patients. “At the time you get COVID, this can diminish your likelihood of getting long COVID,” Diamond said.
Despite the fact that Paxlovid is widely available, the drug has been underused, particularly among people of color. This has likely led to hundreds of thousands of preventable deaths or severe illnesses.
“Part of the underuse may be due to clinicians having misperceptions about how it works, who it works for, and the possibility that individuals who receive Paxlovid may be at higher risk for ‘COVID-19 rebound,’” said Dr. Prasanna Jagannathan, an infectious diseases specialist with Stanford Health Care. COVID-19 rebound — or the recurrence of symptoms — is common, even among people who don’t take Paxlovid, so this shouldn’t be a reason why it’s not being prescribed, Jagannathan added.
How Paxlovid works and who should take it
Paxlovid works by inhibiting the virus’s ability to replicate in the body, which essentially prevents the pathogen from wreaking as much havoc as it could. This reduces the odds that people will wind up severely sick or in the hospital. Even as new variants have emerged, the drug has held up well, according to Diamond, who expects it to continue to work as the coronavirus continues to evolve.
There are a couple theories as to why Paxlovid may lower the risk of long COVID, too. The first is that by inhibiting viral replication and reducing the viral load, the medication can lower the likelihood that people’s immune systems will produce auto-antibodies, which can damage healthy tissues and organs and cause a range of problematic symptoms. The second theory is that the drug may hasten how quickly the body clears out the virus, reducing the chance that lingering virus can continue to cause symptoms, Diamond said.
The evidence shows that the drug works best in people who are most at risk. Whether it’s as effective in people who are generally healthy is unknown — we just don’t have the data. There need to be more studies to see whether people who aren’t at risk may also benefit from taking Paxlovid, Jagannathan said. For now, only higher-risk individuals are eligible for the treatment. To find out if you qualify for Paxlovid, you can talk to your primary care doctor, visit a test-to-treat health clinic, or contact a pharmacy in your area that has it in stock.
Keep in mind that there are many other questions that need to be answered about Paxlovid — like whether people may benefit if they start taking it more than five days after being diagnosed, if it can be taken for shorter or longer periods of time, if the findings can be generalized to all races and ethnicities, and if there’s a certain viral load that needs to be reached in order to reduce the risk of long COVID, Diamond said. The findings also need to be validated in future studies.
But, ultimately, the new study offers a compelling reason for more people to take Paxlovid.
“We need to understand a lot more about this because we need to decrease the incidence of long COVID, and here we have our first real handle,” Diamond said.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.