5,000 US COVID deaths may have been averted in winter 2022 under higher Paxlovid use

About 4,800 US lives could have been saved during the winter 2021-22 SARS-CoV-2 Omicron wave if 5% of COVID-19 patients had taken the antiviral drug Paxlovid, estimates a modeling study published late last week in JAMA Health Forum.

Brown University and Stanford University researchers modeled declines in hospitalizations and deaths under 5% Paxlovid uptake (the current rate) from December 2021 to March 2022. Paxlovid was authorized for use in high-risk adults and children 12 years and older in December 2021.

The team conducted sensitivity analyses by building models to estimate decreases in hospital admissions and deaths (models 2 and 3), subpopulation analyses (models 4 to 6), projections if even more patients had taken Paxlovid (models 7 and 8), and required tests and Paxlovid courses to avert severe outcomes (models 9 and 10).

Just 5% uptake may have cut deaths by 3%

Assuming 78% of infections requiring hospitalization were detected within 5 days, 5% Paxlovid uptake, effectiveness of 67% against hospitalization and 81% against death, 2.7% fewer hospitalizations and 3.2% fewer deaths may have occurred.

In sensitivity analyses, estimated COVID-19 hospitalizations declined 0.5% to 7.5%, and deaths fell 0.6% to 7.5%. In nursing homes, higher Paxlovid uptake may have lowered hospitalizations and deaths 7.7% and 9.3%, respectively (model 4).

If Paxlovid uptake were 40% (model 7), hospitalizations and deaths may have fallen 21% and 25%, respectively. If uptake were 80% (model 8), hospitalizations and deaths may have declined 42% and 51%, respectively.

If Paxlovid uptake were 40%, hospitalizations and deaths may have fallen 21% and 25%, respectively.

At 5% Paxlovid uptake (model 1), 4.8 million symptomatic tests and 2.5 million Paxlovid courses would have been needed to avert 2.7% of hospitalizations and 3.2% of deaths. At 80% uptake (model 8), 75.3 million tests and 39.8 million Paxlovid courses would have been needed to avert 41.8% of hospitalizations and 50.5% of deaths.

“We estimated that had current Paxlovid uptake been achieved in January 2022, 4.8 thousand deaths would have been averted,” the authors wrote. “We provide a simple, flexible framework for understanding the resource requirements and benefits associated with future expansions of the test-to-treat initiative.”