Biden's Paxlovid use and the problem of overtreatment

In the Israel study of 180,000 high-risk Covid patients (only about 5000 patients actually received Paxlovid), the rate of hospitalization was only 0.5%. That figure was under 1% in the Massachusetts study. In the pre-Omicron Pfizer EPIC-SR study that included high-risk vaccinated patients, 1.8% of placebo patients experienced a severe outcome. I observe that these figures, while obtained from studies with median ages in the 50s and 60s, are based entirely on formally diagnosed cases. Were Joe Biden a Joe Smith, would his cold symptoms have led to a laboratory diagnosed, reported case of Covid? Probably not.

I suspect the ballpark of 1% hospitalization risk for a 79-year-old man in good overall health is probably not far from the mark. It’s important to note that, even if our best case scenario is true — that the Israel, Massachusetts and EPIC-SR data can be extrapolated to estimate, say, a 40% reduction in risk — the absolute risk reduction, from around 1% dropped to 0.6%, is tiny. Among 250 parallel universe “to treat or not to treat” scenarios, the Paxlovid course would save a single hospitalization. The question, always, is whether that small gain is worth it.

On a societal level, it gets expensive to push out 250 definite $600 treatments to save one possible hospitalization. On a personal level, the concern is harm.