Does Paxlovid decrease the risk of hospitalization and death from COVID-19 infection even if you are fully vaccinated?


The short answer is YES. Paxlovid remains an important treatment option for people at high risk for bad outcomes from COVID-19 infection, specifically people over age 50.

If you have COVID-19 and are at high risk for complications, Paxlovid is definitely worth discussing with a clinician. While the original Paxlovid clinical trials were conducted in people who were unvaccinated, we now have evidence that Paxlovid reduces the risk of hospitalization in vaccinated people as well.

The longer answer requires consideration of study methodology, relative versus absolute risk of COVID-19 hospitalization and death, and individual versus population decisions (we have you covered – keep reading).

Paxlovid is an antiviral pill with FDA emergency use authorization to treat mild to moderate COVID-19 infection in people over age 12 who are at high risk of progressing to severe disease. You need a prescription to get the medication in the US. Despite the documented effectiveness of Paxlovid, it is underused in the treatment of COVID-19.

A new study looked at the effectiveness of Paxlovid in people who were vaccinated. People over the age of 50 who were prescribed Paxlovid to treat COVID-19 were THREE TIMES less likely to be hospitalized when compared to people who were not prescribed Paxlovid. Paxlovid provided additional protection against hospitalization and death in people who were fully vaccinated and boosted. The study was completed in the age of Omicron. This is good news!

Like all studies, there are limitations that should be pointed out to put the results into context. The graphs in the study present relative risk and not absolute risk. Paxlovid decreased the risk of hospitalization and death, but those outcomes are rare in some of the age groups. At a population level, you would need to treat (also known as number needed to treat or NNT) roughly 100 people over age 50 to prevent one hospitalization. It would cost approximately $53,000 (cost of one course of treatment x number needed to treat) to prevent one hospitalization. From a health economics perspective, that’s pretty good. This was a large study of more than half a million people using real world electronic medical record data. There is a tradeoff between the timeliness of the data for use in an evolving pandemic and the ability to control all variables as you would in a randomized control trial.

The bottom line: Paxlovid dramatically reduces the risk of hospitalization for those infected with COVID-19 over age 50, even if you are fully vaccinated.

People who are at high risk for COVID-19 complications (people over 50, we are looking at you) should discuss Paxlovid with their clinician. Age is the strongest risk factor for serious COVID-19 outcomes. If you are over 50, you are at higher risk. Too many people continue to die from COVID-19. It’s worth the discussion. Call early in the course of illness and don’t wait. If you haven’t been vaccinated or boosted, COVID-19 vaccines are VERY valuable tools to decrease hospitalization and death. Go get your doses as soon as possible.

Those Nerdy Girls

Additional Resources:

Original Research Brief

Twitter thread study breakdown by Dr. Michael Lin

What is Paxlovid by Those Nerdy Girls

Link to Original FB Post