While COVID-19 has entered an endemic phase and become a resident disease in daily life, it remains a significant threat to high-risk groups like the elderly.

In fact, the outbreak of COVID-19, which had slowed down for a while, has been showing an upward trend again. According to the Korea Disease Control and Prevention Agency's Infectious Disease Portal, signs of sporadic resurgence have emerged, such as the number of patients hospitalized for COVID-19 increasing from 139 to 220 within a week in early August.

Hyun Jong Lee, Vice President of Academic Affairs, Korean Society of Otorhinolaryngology-Head and Neck Surgery (Director of Lee & Hong ENT Clinic), emphasized the importance of rapid diagnosis and treatment, stating, “Although public awareness has significantly declined since COVID-19 became endemic, the fatality rate remains high for high-risk patients if they become infected.”

COVID-19 response remains critical for the elderly… proactive measures needed

COVID-19 has shown a recurring pattern of outbreaks during the summer and winter seasons since entering the endemic phase. In clinical practice, the actual number of patients is reported to be higher than the official statistics.

Lee explained, “Many hidden cases go undetected because COVID-19 is often mistaken for a common cold or air-conditioner-related illness. For those not considered high-risk, testing is not covered by insurance, so patients often don’t feel the need to get tested. In addition, many people who have had a previous infection assume, on their own, that ‘this time it can’t be COVID-19,’ which is not uncommon.”

As a result, testing is carried out more actively only among patients aged 65 and older, those in poor general health, or when high-risk family members are living in the same household.

Lee stated, “When recommending testing to suspected patients, only about 20-30% of those under 65 get tested, while about 50-70% of those aged 65 and older do.” He interpreted this as “likely because insurance covers diagnosis and treatment for those over 65, and they have greater health concerns.”

Indeed, for those aged 60 and above, COVID-19 treatments are covered through reimbursement, allowing prescriptions to be issued upon a positive test result, which is why medical professionals actively recommend testing. However, for those under 60, both testing and treatment are out-of-pocket expenses unless specific risk factors exist, making it difficult for doctors to recommend them readily.

Nevertheless, doctors unanimously agree that proactive measures are necessary for the elderly and those with underlying conditions who face a high risk of severe illness.

According to Statistics Korea data, individuals aged 65 and older accounted for 91.9% of domestic COVID-19 deaths in 2022, and the fatality rate for those aged 65 and older was approximately 40 times higher than for those under 65.

Lee emphasized, “For patients aged 65 and older, those with weakened immunity due to cancer, or those with serious underlying conditions, a COVID-19 infection still carries a very high risk of progressing to severe illness or death. When endoscopic examinations show clear signs that the condition may progress to bronchitis or pneumonia, physicians strongly recommend testing.”

Paxlovid transforms COVID-19 response..."Contributing to Reduced Early Mortality"

Currently, the mainstay of antiviral treatment for mild-to-moderate COVID-19 cases in Korea is Paxlovid (nirmatrelvir/ritonavir). Developed by Pfizer, this oral therapy has been proven effective when administered early in patients at high risk of severe disease progression.

Lee evaluated, “Paxlovid is a very good drug that works by suppressing viral replication. It has demonstrated excellent effects when given in the early stages. Between 2023 and 2024, with stable supply and growing clinical experience, its use has expanded significantly, and we confirmed that it contributed to reducing early mortality.”

The outstanding therapeutic effect of Paxlovid is also evident in patient experiences. According to Lee, “Elderly patients who had struggled greatly during previous COVID-19 infections now report a dramatic improvement after taking Paxlovid, saying they ‘feel much better.”

Unlike when taking common cold medicine, patients reported feeling the effects directly after taking antiviral drugs, such as fever and pain subsiding much faster.

These clinical observations are supported by research data. In the global EPIC-HR clinical trial, early administration of Paxlovid reduced the risk of hospitalization and death among COVID-19 patients by up to 86%. Similarly, a domestic study analyzing about 1.94 million patients reported that confirmed cases aged 60 or older who took Paxlovid within five days of symptom onset had a significantly lower risk of severe progression and death compared with those who did not.

The prescription environment for oral COVID-19 treatments recently reached a major turning point. The government provided Paxlovid free of charge until last year, but starting this year, it transitioned to being reimbursed by national health insurance, meaning patients now bear part of the cost.

Regarding this, Lee explained, “During the period when it was provided free of charge, some patients did not take the medication even after receiving a prescription because they didn't realize its value since they weren't paying for it. However, the shift from free to paid supply, introducing patient coinsurance, has brought one positive change: increased medication adherence.”

“Reimbursement limited for the elderly and high-risk groups...Reimbursement criteria must be expanded”

Nevertheless, this hasn't resolved all concerns on the site. Criticism persists that Paxlovid's current insurance reimbursement criteria are overly restrictive, potentially causing some high-risk patients to miss treatment opportunities.

Lee emphasized, “Paxlovid currently faces many reimbursement restrictions. An infection that young family members might brush off lightly can be difficult for those in their 70s and 80s to recover from, potentially leading to death. Reimbursement should be lowered to include those aged 50 and above, and if safety is not an issue, it should also be expanded to include pediatric patients with underlying conditions.”

In other words, experts believe that the current prescription system, centered on those aged 60 and above, should be expanded to include those in their 50s. They also advocate allowing healthcare providers to apply antiviral drugs at their discretion to middle-aged and older adults with underlying conditions.

Finally, Lee urged high-risk COVID-19 patients and their families to adhere to two principles: prevention and prompt treatment.

He advised, “As The Art of War states, ‘The best victory is one won without fighting,’ avoiding infection is paramount in COVID-19 management. Alongside hygiene protocols, establishing a primary defense line through vaccination in consideration of one's immune status is necessary.”

Lee further added, “For those who cannot get vaccinated or fail to develop antibodies after vaccination, there is now Paxlovid. Since rapid diagnosis and treatment are crucial for its use, early testing and prompt treatment are a must for high-risk groups.”