To be effective, Paxlovid has to be started within 4-5 days of first real symptoms, so patients may not be in serious condition by that time. The key thing is to be able to ensure there are no serious contra-indications (e.g, satisfactory kidney function, no forbidden heart meds, etc.). I was given the third degree before it was prescribed for me. The idea was to prevent serious issues. If you already had serious issues, it would be too late for Paxlovid to be effective.