Deciding whether to take Paxlovid
May 21, 2024 7:27 AM   Subscribe

Just tested positive for Covid for the first time. I'm deciding about Paxlovid and want to know whether it decreases my risk for the particular concern I have. Also would like any other advice about how to come out of this fully healthy.

I was exposed last Tuesday night, and I've been isolating to the degree possible since then, and testing daily. Just got a positive result. No symptoms to speak of.

I'm deciding about Paxlovid, and I want to decide based on whether it reduces my risk of certain long covid symptoms.

I'm in my mid 50's, with no risk factors, and good general health. I'm fully vaxxed and boosted.

I'm not too worried about terrible outcomes right now -- I think that's unlikely. I am worried about long covid. Lots of very different things all seem to be called long covid, though, and the kind of long covid I'm worried about is stuff like: months later, still have brain fog/cognition issues, fatigue, smell/taste changes, other significant issues.

What I really want to know is whether Paxlovid decreases the risk of 1. that kind of long covid, for 2. my demographic. I'm guessing that's unknowable, but what can you tell me?

What else is known about what I can do now to avoid those concerns? I know to rest, I'll take some can't-hurt/might-help supplements and vitamins (but nothing wacky).
posted by daisyace to Health & Fitness (20 answers total) 3 users marked this as a favorite
Research says "no" it does not help reduce risk of long covid. However, I was just at a superspreader event and those of us infected who started Paxlovid the day we tested positive for Covid are doing great, those who didn't are still recovering and in a lot of pain and discomfort, and based on what I've seen from others in recent months - it'll take them several weeks to fully recover. So, I'd recommend it anyway.
posted by Toddles at 7:38 AM on May 21 [5 favorites]

Right now, the answer is a Bjork-esque "Definitely Maybe," and not the clear "no" mentioned above (which comes from a single study published this January).

Here's a more nuanced view that incorporates the above-referenced study.

More and more, it looks like metformin has a protective effect against long Covid.

Sticking with UMN pages, here's one that talks about some of the research. There was a bunch that came out last year and some more that came out this year.
posted by yellowcandy at 7:48 AM on May 21

There are more recent studies ;

18 Apr 2024 How useful is Paxlovid in 2024?
Plain Language Summary
Should I take PaxlovidTM for COVID-19?

For most people with COVID-19, PaxlovidTM will:
NOT make you feel better faster
NOT lower your chance of dying or going to the hospital
Pfizer' own study Apr 4 2024;
The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ
significantly between participants who received nirmatrelvir–ritonavir and those
who received placebo
news story cbc
Who needs Paxlovid now
posted by yyz at 8:00 AM on May 21 [3 favorites]

I have had covid twice, despite being more careful than the average bear. I was vaccinated both times. I took Paxlovid both times, and I began to feel better within six to eight hours each time, with a marked turnaround within 24 hours. Now, that might have happened anyway, but my brother got long covid and I know a lot of people who took a long time to recover and I was back to normal (except for exercising) within a couple of days.

If I get covid again and can access Paxlovid, I will definitely take it because man I felt lousy until about six hours after the first dose. Just not feeling lousy was worth it to me.

Also, that whole "paxlovid rebound" thing has proved to be a covid rebound - some people get one, some don't, it's not the medication.

The worst side effect I had was a metallic-aspiriny taste in my mouth that peaked about two hours after taking the pills and tapered off.

I highly, highly recommend it even if it is truly proved to do nothing to prevent long covid.

Woo things I believe:
1. I got it from my partner last time; I got it and my partner didn't this time. I believe that this was in part because there was less viral replication due to paxlovid and thus I was less infectious.

2. I believe that it does reduce long-term risk because you get less sick and have a smaller viral load. Whether this literally translates into "reduces the risk of long covid as we know it" or not, covid is a dangerous virus and being less sick for a shorter period seems likely to be good.
posted by Frowner at 8:04 AM on May 21 [5 favorites]

One more woo thing: It is in the interests of insurance companies and employers to claim that you don't need paxlovid, then they don't have to pay and can blame you for any down-the-road health problems you develop. Now, that doesn't prove that you do need paxlovid, but seriously, I was masking really, really carefully and got covid like the minute I decided to go partially back to normal. In theory, I'm not unusually at risk for an American - I'm fat and middle-aged but not in bad health generally, I exercise, am not immunocompromised, etc. And yet! My belief is that a lot of us don't meet the theoretical threshold for paxlovid and are not theoretically at risk, but our individual weird medical histories and genetics put us at risk in ways that aren't identified at the public health level.
posted by Frowner at 8:08 AM on May 21 [3 favorites]

Some anecdata for you: I am 41 and got COVID for the first time a couple weeks ago. My symptoms were mild (post-nasal drip and sore throat), so I was unsure about taking Paxlovid. I, like you, am very concerned about long COVID.

I ended up taking the Paxlovid, and it stopped my mild COVID symptoms within hours. It’s too soon to tell about long COVID, but I have to say that I had every common Paxlovid side effect, and it was so much worse than I expected. I stuck it out in the hope that it would reduce my long COVID risk, but the Paxlovid was super harsh. It was a very long 5 days. I’d probably do it again, though, just in case. No one else in my household got COVID, which I attribute to the Paxlovid, isolating in the basement, and masking in common spaces after isolation ended. I also only tested positive on one test the entire time (negative on 6 other tests), which I attribute to low viral load, newer variants, and old government tests.
posted by Maarika at 8:21 AM on May 21

I'm also 41. I had COVID for the second time this past March. When I asked a provider about paxlovid they said I wasn't a candidate for it because I wasn't elderly, I didn't have any preexisting medical conditions, and my mild symptoms--though annoying--were not considered severe enough to outweigh the risk of potential side effects from taking paxlovid.

I have a relative about ten years younger than me who had COVID a few months earlier. They also didn't have any preexisting medical conditions, but their symptoms were so bad that their breathing was seriously impaired and they were unable to even stand up without assistance. They were prescribed paxlovid (and recovered almost immediately, I might add)
posted by RonButNotStupid at 8:35 AM on May 21

I did want to add this: The insurance company, the politicians and even your doctor don't really care if you get back to work quickly or if you're out sick for two weeks - that's your problem. Burn up all your PTO for the year? Lose your job? Too sick to care for your kids? Your problem, not theirs. They have no interest in prescribing something that is expensive but that shortens your recovery time, because unless you're sick enough to need the hospital, they don't have to care about your recovery time.
posted by Frowner at 8:47 AM on May 21 [3 favorites]

If we're anecdata-ing here, I'm over 50, had Covid twice (May '22, March '24) and never took Paxlovid. My doctor said I wouldn't need it and I rolled with it. In March, I didn't give it to anyone in my household (lots of open windows and masking when I went into common spaces) and went from positive test to negative test in seven days - about what it takes for me to clear a bad cold.

Out of my whole family -- small to tall, inlaws to outlaws -- only my 77yo father took Paxlovid. None of us have Long Covid. If you're vaxxed and boosted (and even if you aren't) it's a whole different ball game from 2020. Thankfully!!

even your doctor don't really care if you get back to work quickly or if you're out sick for two weeks - that's your problem.

I've been with my doctor for 25 years. He wants us all to be well as quickly as possible.
posted by kimberussell at 9:47 AM on May 21 [2 favorites]

If logistics or cost are playing into your decision at all, please know that Massachusetts still has free telehealth specifically for getting a Paxlovid prescription. It is very quick and easy.
posted by dusty potato at 11:08 AM on May 21 [1 favorite]

Another thing for you to look into: a doctor friend of ours was just talking about how helpful a prescription for metformin is, for reducing the risk of long covid. E.g., look here.
posted by metonym at 11:30 AM on May 21

I've been watching the research for all the years now, and several studies have replicated the decrease in incidence of long covid from Paxlovid. Yes, the one study failed to do so. Yes, there are buts and ands and caveats and limitations with all studies. And yet.

I will absolutely, 100% take Paxlovid (and metformin) and expect that it will reduce my risk of developing long covid. I don't think it can get as granular as you're asking (your demographic, *that* kind of long covid). But I fully expect that Paxlovid will help.

In the "other things" category, all the long-covid people seem to say, take your sweet time to rest and recover.
posted by Dashy at 11:48 AM on May 21 [3 favorites]

When I got COVID, I started taking Paxlovid within hours of the first symptoms appearing. Within a few hours I was feverish and nauseous to the point of misery -- and then Paxlovid crushed it back to sore throat territory in just a few more hours. It ended up taking almost two weeks to reach COVID-negative, but I felt like I basically had been given a get-out-of-jail-free for the worst part of it all -- I spent those two weeks with, at worst, a very annoying sore throat.

FWIW, I didn't get any long COVID symptoms.
posted by etealuear_crushue at 1:06 PM on May 21

I am taking Paxlovid right now. It is giving me metal mouth and diarrhea and is very much not my favorite, but I would take it again in a heartbeat given even the possibility, however slight, that it minimizes my chances of Long Covid symptoms. Good luck!
posted by jeszac at 2:34 PM on May 21 [1 favorite]

Oh: Here are the supplements I'm taking: Fish oil, Zinc L Carnosine, Lactoferrin, Famotidine, NAC, Melatonin at night. They all have some hand-wave-y evidence behind them so why not. My doctor prescribed Metformin as well, but my stomach can't handle that + Paxlovid, so I'll start once I'm done with my five days.
posted by jeszac at 2:37 PM on May 21

My wife and I got Covid last August. Due to a combination of prescription meds I could not take Paxlovid. She started taking it and started feeling worse pretty much immediately and ended up in the ER severely dehydrated. It probably wasn’t entirely Paxlovid’s fault, but the ER doc told her to stop using it at once. We both recovered without issues.
posted by lhauser at 2:56 PM on May 21

Paxlovid lowers your viral load by a lot. Lower viral load means less inflammation and less risk of the dreaded "cytokine storm", as well as less risk of long covid bc as far as we know long covid is caused by duration and severity of inflammation. So yes, if it were me, and it has been me, id do everything in my power to get it as soon as possible and take it. I think its nits that it is not an automatic thing the fda is recommending.
posted by elgee at 10:03 PM on May 21 [1 favorite]

Response by poster: Thanks for all the input, and more is still welcome. I now have Paxlovid in hand, but I haven't taken it yet. Yesterday was my first positive test, and I had no symptoms, so I thought I'd risk waiting until today to decide. This morning, I still have no symptoms. I think if I stay asymptomatic, I may pass. I generally feel worst in late afternoons whenever I'm sick, so we'll see what today holds. If I start having symptoms, I'm thinking I'll take it. I'm caught between "the sooner the better" and "I don't know yet." Gonna read through the links more thoroughly today, too.
posted by daisyace at 5:05 AM on May 22 [1 favorite]

Your question was about long covid, and the situation with that is unclear. I have no comment on that, so I did not respond initially.

But given this thread has several people giving their "I took Paxlovid and got better" anecdote (none of which mention the word "placebo"!), I want want to reiterate what I posted on the previous thread for the record:

Based on the results of the largest, most recent clinical trial of Paxlovid, which was conducted by its manufacturer, there is essentially no evidence at all that it reduces the severity or duration of the acute phase of a covid infection in vaccinated people with current strains of covid.
posted by caek at 8:53 AM on May 23

Response by poster: Update: Still no symptoms, still testing ever-so-slightly positive. After talking with my doctor, I'm not going to take Paxlovid, and I am going to see if I can tolerate Metformin. So thanks very much for all the input, and especially for pointing me towards the Metformin research.
posted by daisyace at 2:01 PM on May 24

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