The CDC lists the conditions that make a person "more likely to get very sick from COVID-19." Currently, Paxlovid supply is abundant, but available only to people with at least one of these risk factors.

Paxlovid access may be crucial long-term, as the rate at which vaccines can be updated using conventional clinical trials seems to be too slow to keep up with the rate at which viral variants evolve.

I am also drawing from Interim DOH Guidance for Use of Paxlovid, from May 2022, which is more recently updated than the CDC's list but less prominently featured on government websites for healthcare providers.

On the FDA's website (4 May 2022):

Patients do not have to have more than one risk factor to be considered “high risk”.

My guess is that many people who have one or more of these risk factors don't realize it, and neither do their medical providers. This may be because they're not informed about what the risk factors are, because they don't think to check, because that "risk factor" has never before manifested as a clinical problem, or because it's not the sort of thing that intuitively seems like a "risk factor" for a respiratory infection.

I currently have a friend who is very sick with COVID-19, has several of the below risk factors, and was not prescribed any medication by her doctor. She is poor, alone in her house, suffering, when a widely available treatment is available that could have helped her. I hope this list helps others avoid this outcome.

I'm going to go through the list of risk factors they publish and highlight the ones I suspect get forgotten relatively often. Remember that there are many more obvious risk factors on the above CDC list (things like being over 65, having cancer, asthma, heart disease, and many others). 

  • Being from a racial or ethnic minority group: American Indian/Alaska Native (non-hispanic), Asian (non-hispanic), Black (non-hispanic), Hispanic/Latino, Multiracial (non-hispanic), Native Hawaiian or other Pacific Islander
  • Mobility, sensory, or intellectual disabilities.
    • One reason given for considering disabilities a risk factor for COVID-19 is that many people with disabilities live in shared or congregate housing. It is not clear to me whether living in shared/group housing for other reasons can also be considered a risk factor worthy of a Paxlovid prescription, but it may be worth checking if no other risk factor applies to you.
  • ADHD and learning disabilities. Some other learning disabilities include dyslexia, dysgraphia, dyscalculia, auditory processing disorder, language processing disorder, nonverbal learning disabilities, and visual perceptual/visual motor deficit.
  • High blood pressure (hypertension)
  • Mood disorders, including depression, bipolar, seasonal affective disorder, self-harm, and schizophrenia spectrum disorders
  • Mental health conditions (from Interim DOH Guidance)
  • Being overweight or heavier (BMI of at least 25)
    • BMI is calculated as your weight in kilograms divided by the square of your height in meters: (kg)/(m^2)
    • Pound to kg conversion calculator
    • Height in feet and inches to height in meters conversion calculator
    • You can also just google something like '5'10" to m' and '160 lb to kg' and it will tell you the conversion. 
    • For example, a 5'10" person weighing 160 pounds is 1.8 meters tall and weighs 73 kg. Their BMI is 73/1.8^2 = 23.
    • A 5'10" person weighing 180 pounds is 1.8 meters tall and weighs 82 kg. Their BMI is 82/1.8^2 = 25 and they can get Paxlovid.
  • Having little-no physical activity
  • Pregnancy
  • Smoking
  • Substance use disorders
  • Not being fully vaccinated or boosted
  • This isn't on the CDC's list, but being gay, lesbian, bisexual, or gender nonconforming people have been described as a risk factor for more severe COVID-19 and may possibly qualify you for Paxlovid.
  • Limited access to care or members of communities disproportionately impacted by COVID-19 (from Interim DOH Guidance)

In case you're unsure if conditions like these really qualify for Paxlovid, despite being listed by the CDC as qualifying risk factors, NPR makes the point as well:

Now, health conditions such as high cholesterol, depression, smoking-related lung disease, obesity, not being fully vaccinated or boosted – all factors that increase a person's risk for severe COVID outcomes – might qualify a recently infected COVID patient for a course of Paxlovid. "If someone wants it, and is eligible for it, they should be able to access it," Tien says.

Some people may have one or more of these neglected risk factors, yet be undiagnosed. This may be due to lack of access to or aversion to healthcare, managing to cope with with the symptoms, a tendency to downplay symptoms, or for other reasons. If you want Paxlovid and are worried you won't be prescribed it, you may want to consider which of these risk factors might apply to you and consider emphasizing them in your conversations with your doctor.

This is deeply perverse, but three "risk factors" over which you may have direct, immediate control are smoking (possibly of marijuana as well as tobacco) your level of vaccination, and your amount of physical activity. It is not medical advice to take up smoking, avoid vaccination/booster shots, or sit around all day, in order to qualify for Paxlovid should you get sick. But I do worry that some people might go to such lengths due to this policy.

It may possibly be worth printing out the CDC and DOH guidance, along with a description of what risk factors you have, in case you come down with COVID-19. This may help structure your conversation with your doctor and allow you to get access to Paxlovid more quickly.

Note also that some clinics have extremely restrictive internal policies that differ from the CDC's guidelines on who should receive Paxlovid. All providers may use their "professional opinions" to form their own idiosyncratic lists of criteria using a subset of the CDC's guidance, and they will not reveal that "professional opinion" outside the context of a visit with a particular patient. It can therefore be hard to find a provider who you can feel confident respects the CDC's guidelines without actually going in for a visit.

However, I can confirm that the telehealth office of Dr. Daniel Griffin, recommended in Nanda Ale's Youtube link in the comments, was very accommodating about this issue.  Dr. Griffin stated on the interview that patients having trouble accessing Evusheld or Paxlovid should contact him. His office's phone number is (516) 656-6500. They have near-term appointment availability. Despite the fact that Dr. Griffin's office is located in New York, his office assistant told me that they can do telehealth appointments in my state of Washington.

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Some doctors are frustrated by other doctors reluctance too.  The doctor that does the This Week In Virology weekly medical updates straight up said, "If you can't get Evushield or Paxlovid, call my office. We will make sure it happens. Really."

YouTube Link (41 minutes in)

Early IV Remdesivir looks to be nearly as effective as Pax (when given early), with less drug interactions than Pax and less potential kidney issues, and is heavily underutilized. 3 days, 30 minutes per infusion, not a big deal.

I just shared this info with an immune-compromised relative, thanks so much for this.

This sounds absurd. This list of "risk factors" is basically "being anyone mildly unusual".

It adds up to "you'd be unusual NOT to qualify".  From what I can tell, it's purely a test of how clueful your healthcare provider is, and how willing/able you are to advocate for yourself.  I know of nobody who's been denied it when they want it, and only a few who haven't gotten it because their provider didn't bring it up and they didn't ask.  

My sample set skews rich and intellectual, so that likely explains a lot.  I'm certain that many of these categories are listed BECAUSE they get lower-quality care and are less able to push for the medication that would help them.  I don't know how expense for the un/underinsured plays into it either.

Do you still need a positive test result? The main ones commercially available are notorious for false negatives.

I don't know the answer to that question, but I think it's an important one.

This is deeply perverse, but three "risk factors" over which you may have direct, immediate control are smoking (possibly of marijuana as well as tobacco) your level of vaccination, and your amount of physical activity. It is not medical advice to take up smoking, avoid vaccination/booster shots, or sit around all day, in order to qualify for Paxlovid should you get sick. But I do worry that some people might go to such lengths due to this policy.

I can't imagine why anybody would take up smoking or stop exercising in order to get Paxlovid instead of just falsely telling their doctor that they smoke/don't exercise. Your doctor is not going to check. You can also easily claim to be gay or bisexual.

You may be right, but some people are very averse to lying.