Four days after recovering from a COVID-19 infection, President Joe Biden has tested positive again. When he first got sick, Biden—like more than one-third of the Americans who have tested positive for COVID-19 this summer, according to the U.S. government’s public records—was prescribed Paxlovid, an antiviral pill treatment made by Pfizer. Like many Paxlovid takers, he soon tested negative and resumed his normal activities. And then, like many Paxlovid takers, his infection came right back. (Biden does not currently have symptoms, according to his physician.)

With more than 40,000 prescriptions being handed out a day, we’re taking Paxlovid at about the same rate that we’re taking oxycodone. When Biden got sick last week, he started taking the pills before the day was out. When Anthony Fauci had COVID in June, he took two courses. That enthusiasm is in line with the government’s messaging around the drug.

But some providers are prescribing the drug with a bit less enthusiasm, particularly when it comes to vaccinated patients (such as Biden and Fauci). Reshma Ramachandran, a family-medicine doctor and researcher at Yale, told me that she’s feeling a sense of “resignation” about Paxlovid. Though it’s one of the few COVID treatments she can offer, she can’t say with confidence that the pills will help someone who’s been immunized. Bob Wachter, the chair of medicine at UC San Francisco, called assessing the value of Paxlovid for these patients a “massively complicated three-dimensional chess game.” Anyone who might want to take the drug should discuss with their doctor whether and when they’ve been infected before, how many vaccine doses they’ve had (and when they had them), their age, and other risk factors—all in light of the limited clinical data that are now available. Patients will surely struggle to make sense of all these variables. Their doctors might, too. “I can barely decide whether I want it, and I do this for a living,” Wachter said.


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