www.covidstates.

org

THE COVID STATES PROJECT:

A 50-STATE COVID-19 SURVEY
REPORT #90: UTILIZATION RATES OF ANTIVIRALS
FOR COVID-19

USA, August 2022

David Lazer, Northeastern University James Druckman, Northwestern University

Ata Uslu, Northeastern University
Hong Qu, Northeastern University
Mauricio Santillana, Harvard Medical School
Roy H. Perlis, Harvard Medical School
Katherine Ognyanova, Rutgers University
Matthew A. Baum, Harvard University
Kristin Lunz Trujillo, Northeastern University
Alauna C. Safarpour, Harvard University
Samantha Cadenasso, Northeastern University
Jon Green, Northeastern University
Alexi Quintana, Northeastern University
Report of August 19, 2022, v.1

The COVID States Project

From: The COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States

A joint project of:

Northeastern University, Harvard University, Rutgers University, and Northwestern University

Authors: David Lazer (Northeastern University); Ata Uslu (Northeastern University);

Hong Qu (Northeastern University); Mauricio Santillana (Harvard Medical School);
Roy H. Perlis (Harvard Medical School); Katherine Ognyanova (Rutgers University);
Matthew A. Baum (Harvard University); James Druckman (Northwestern University);
Kristin Lunz Trujillo (Northeastern University); Alauna C. Safarpour (Harvard University);
Samantha Cadenasso (Northeastern University); Jon Green (Northeastern University);
and Alexi Quintana (Northeastern University)

This report is based on work supported by the National Science Foundation under grants SES-
2029292 and SES-2029297. Any opinions, findings, and conclusions or recommendations
expressed here are those of the authors and do not necessarily reflect the views of the National
Science Foundation.

This research was partly supported by a grant from the Knight Foundation.

We also received generous support from the Russell Sage Foundation.

The project was also supported by the Peter G. Peterson Foundation.

Data collection was supported in part by Amazon.

Our work was made possible through the continued financial and logistic support provided by
Northeastern University, Harvard University, Rutgers University, and Northwestern University.
 COVER MEMO

Summary Memo — August 19, 2022

The COVID States Project

From: The COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States

Partners: Northeastern University, Harvard University/Harvard Medical School,

Rutgers University, and Northwestern University

Authors: David Lazer (Northeastern University); Ata Uslu (Northeastern University);

Hong Qu (Northeastern University); Mauricio Santillana (Harvard Medical School);
Roy H. Perlis (Harvard Medical School); Katherine Ognyanova (Rutgers University);
Matthew A. Baum (Harvard University); James Druckman (Northwestern University);
Kristin Lunz Trujillo (Northeastern University); Alauna C. Safarpour (Harvard University);
Samantha Cadenasso (Northeastern University); Jon Green (Northeastern University);
and Alexi Quintana (Northeastern University)

Note on methods:
Between June 8, 2022 and July 6, 2022, we surveyed 24,414 individuals across all 50 states
plus the District of Columbia. The survey was conducted by PureSpectrum via an online,
nonprobability sample, with state-level representative quotas for race/ethnicity, age, and gender
(for methodological details on the other waves, see covidstates.org). In addition to balancing on
these dimensions, we reweighted our data using demographic characteristics to match the U.S.
population with respect to 2020 vote choice and turnout, race/ethnicity, age, gender,
education, and living in urban, suburban, or rural areas. This was the latest in a series of surveys
we have been conducting since April 2020, examining attitudes and behaviors regarding COVID-
19 in the United States.

Contact information:

For additional information and press requests contact:

 David Lazer at d.lazer@neu.edu

 Mauricio Santillana at msantill@fas.harvard.edu
 Roy H. Perlis at rperlis@mgh.harvard.edu
 Katherine Ognyanova at katya.ognyanova@rutgers.edu
 Matthew A. Baum at matthew_baum@hks.harvard.edu
 James Druckman at druckman@northwestern.edu

Or visit us at www.covidstates.org.

The COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States 3
Utilization rates of antivirals for COVID-19

Antiviral therapies, specifically Paxlovid 1 and Molnupiravir 2, are highly effective in reducing
the risk of hospitalization or death from COVID-19. Clinical trials found that Paxlovid could
reduce the risk of death by as much as 89%. 3 In light of the massive number of COVID-19
deaths - 400,000 deaths last year, which places it third among leading causes of death in
the US, after heart disease and cancer - this suggests the potential benefit of these
interventions could be profound. 4

While Paxlovid has been available since December 22, 2021, 5 there have been challenges
in its clinical application. In order to be effective, it needs to be used within 5 days of
symptoms occurring, i.e., before it is clear how serious the course of illness will be. During
this critical time window, patients must confirm infection, obtain a prescription from their
doctor and locate a pharmacy that has the antiviral in stock. The FDA declared on May 4th,
2022, that "Paxlovid is now widely available at community pharmacies." 6

Despite policy efforts to make them widely prescribed, such as COVID-19 Public
Therapeutic Locator website, 7 the public's awareness and access to antivirals has been
spotty. News reports have emphasized the “Paxlovid rebound” (a return of a positive test
after taking Paxlovid), rather than the high efficacy of the antiviral at preventing death.
Uneven distribution 8 and unclear guidance from the federal government have resulted in
shortages and confusion at the state and local levels among eligible patients and their
healthcare providers. 9

1
Ritonavir-Boosted Nirmatrelvir (Paxlovid)
2
Molnupiravir
3
Pfizer Announces Additional Phase 2/3 Study Results Confirming Robust Efficacy of Novel COVID-19
Oral Antiviral Treatment Candidate in Reducing Risk of Hospitalization or Death
4
COVID-19 was third leading cause of death in the United States in both 2020 and 2021
5
Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19
6
FDA Updates on Paxlovid for Health Care Providers
7
https://healthdata.gov/Health/COVID-19-Public-Therapeutic-Locator/rxn6-qnx8/data
8
Covid-19 antiviral access: uneven supply patterns hinder US rollout
9
Are Pfizer's Covid pills going to highest-risk patients? Inside the U.S. rollout

The COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States 4
In light of these challenges, we sought to understand more about how antivirals are being
used to treat COVID-19 in real-world settings. To evaluate actual usage of antivirals, we
analyze responses from people who indicate that they were infected with COVID-19 since
May to our survey question: Have you been treated for COVID-19 with an antiviral
medicine taken by mouth (Paxlovid or Molnupiravir)?

Specifically, we examined how many people who have been infected with COVID-19 since
January 1st of this year have been prescribed antivirals. In our most recent survey wave
(fielded from June 8 to July 6, 2022), 43% of respondents (10,423 of 24,142) reported
having been infected with COVID-19. Of people infected with COVID-19 between May
and early July, only 11% report having taken antivirals.

When we look at subpopulations, we see that the highest-risk age group, adults over 65,
had a higher, but still low, rate of taking antivirals at 20%. We also see significant gender
(13% of men report taking antivirals versus only 9% of women), and socioeconomic
differences (e.g., 16% of individuals earning $100k or more report receiving antivirals
compared to 7% of those earning $25k or less).

These data suggest a tremendous lost opportunity, where many of the approximately
200,000 deaths from COVID-19 since January 1, 2022 might have been prevented with the
timely use of antivirals. Deaths from COVID-19, while lower than earlier in the pandemic,
are currently running at 400+ per day, and could exceed 200,000 over the next year. Our
results indicate an opportunity to reduce these numbers, perhaps substantially, if the
reasons for the limited use of medication treatment can be better understood.

The COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States 5