U.S. COVID-19 cases appear significantly lower this winter compared to previous years, which may affect demand for treatments such as Paxlovid.

Pfizer has seen a sharp decline in COVID-related sales from a peak of nearly $60 billion, with an increasing focus on its other drug portfolios. Despite lower COVID-19 case volumes, Paxlovid remains a widely used antiviral, with projected 2024 sales of $5.3 billion, though demand is expected to decline by 25% in 2025.

U.S. emergency department data through Jan. 21 indicate a significant decline in COVID-19 cases over the first three weeks of the year. Cases peaked around Jan. 1, when approximately 1.4% of emergency department visits resulted in a COVID-19 diagnosis—substantially lower than the 3.4% rate seen at the same time last year.

The CDC has not recently updated its COVID data, but wastewater surveillance suggests a decline in viral circulation since early January. Paxlovid prescriptions also peaked at the beginning of the year at less than a third of last year’s volume and have steadily declined for three consecutive weeks, according to IQVIA data.

Jeremy Kamil, PhD, a microbiologist at the University of Pittsburgh, attributes the smaller COVID-19 wave to widespread immunity from prior infections and vaccinations. “That makes it harder for this new pathogen to cause new enormous waves. It just bounces into one person, maybe infects a couple others, but then they don’t spread it efficiently,” he said.

Johns Hopkins microbiologist Andy Pekosz, PhD, noted that while it is too early to predict this summer’s potential case trends, current data do not indicate an imminent surge. Marc Johnson, PhD, a microbiologist at the University of Missouri, suggested that the similarity between circulating variants may explain why cases remain lower than in previous winter surges, which were driven by new viral mutations.

“I'm sort of waiting for another variant to come out of left field,” Johnson said. “But it hasn’t happened yet.”