Should Paxlovid be prescribed for patients with severe COVID-19 in the late course of infection? A case report

The infection of the coronavirus disease 2019 (COVID-19) is often accompanied by pneumonia with both high incidence and mortality. Paxlovid is commonly prescribed in patients with mild and normal pneumonia within 5 days from the symptom onset. Herein, we report a practically effective use of Paxlovid compensatively in patients with COVID-19 and severe pneumonia after 5 days of infection in a typical case in China. In this case, a 75-year-old man was diagnosed with severe COVID-19 complicated with a pulmonary bacterial infection. After treatment with oxygen inhalation, Cefoperazone-sulbactam and ambroxol, fever and upper respiratory symptoms were alleviated, except for the Oxygenation index (OI) remaining worse, Coronavirus was detected as positive, and levels of interleukin-6 remained high. Paxlovid was prescribed for 5 days subsequently though it was 14 days since symptom onset. Thereafter, the nucleic acid of the patient turned negative in 7 days and the symptoms resolved. This case showed that Paxlovid can be considered in patients with COVID-19 and severe pneumonia even in the later course of infection in clinical practice in China.