Tens of thousands of people are still catching COVID-19 every day in the US. The seven-day average on Sunday, April 24, 2022, was over 47,000. That’s up 30%. Because most people are now testing at home, the actual increase could be far higher. Hospitalizations are also climbing in over 30 states. Deaths are up in 16 states. Hundreds of people die from COVID each day. Why aren’t doctors prescribing pills to treat COVID?
Masks Are a Thing of the Past:
We just returned home after a long trip to visit a dear older relative. We flew across the country and saw up close and personal that most travelers have stopped wearing masks. People were jammed together on planes, in the trams and on the rental car buses. Restaurants, bars and airport shops were shoulder to shoulder with maskless people.
It seems as if almost everyone has decided that COVID-19 is a problem of the past. We completely get that. We all want to return to “normal.” The trouble is that COVID has not disappeared. It is as infectious as ever, if not more so. And we are hearing about people who were vaccinated and boosted and who still became sick with the latest variant of the coronavirus.
What Have We Learned?
When COVID-19 was declared a pandemic in 2020, we were totally unprepared. There were no drugs, no vaccines and not much information on how the virus spread from one person to another.
Now, though, we have a lot more tools to combat this potentially deadly disease. Vaccines were developed in record time and new antiviral medications are now available.
Many people are acting as if the pandemic is over. We wish that were true. Around a million individuals have already died in the US from the coronavirus. COVID-19 was the third leading cause of death in the US last year. Only cancer and heart disease killed more people.
Pills to Treat COVID:
The virus continues to mutate, and the new variants are capable of bypassing the vaccines. That is not surprising. Viruses are quite capable of evolving. Influenza viruses are a case in point. That is why vaccine makers have to try and predict what is coming many months in advance. This past year they guessed wrong…again. The flu shots weren’t very effective (MMWR, March 11, 2022).
While most COVID-vaccinated people are protected from severe illness, hospitalization and death, some get pretty sick. Why aren’t more doctors prescribing pills to treat COVID?
When Merck and Pfizer announced that the FDA had granted emergency use authorization (EUA) for oral COVID drugs, everyone was excited. At last there were easy-to-take medications that could reduce the likelihood of complications, including death. Here is a patient-oriented summary about these medicines from the medical journal JAMA (April 25, 2022).
At first, Paxlovid (nirmatrelvir plus ritonavir) and Lagevrio (molnupiravir) were scarce. Doctors reserved their use for extremely high-risk patients. There were stories of patients driving hours to try to find a pharmacy that could fill a prescription.
Now, though, these pills to treat COVID are sitting on pharmacy shelves. They are no longer in short supply, but doctors are not writing many prescriptions. According to Dr. Anthony Fauci, Paxlovid “is being underutilized.”
Timing Is Everything for Pills to Treat COVID!
For greatest benefit, such pills to treat COVID need to be taken early in the course of an infection. That’s also true of oral influenza treatments such as Tamiflu (oseltamivir) and Xofluza (baloxavir).
To keep the virus from replicating and overwhelming the immune system, these drugs should be prescribed as soon as someone tests positive. But that’s not happening consistently.
Where’s the Enthusiasm for Pills to Treat COVID?
Why aren’t people excited about pills to treat COVID? And why aren’t they being used more frequently?
According to NBC News (April 14, 2022):
“Antivirals are ‘very valuable tools,’ said Dr. Natasha Bagdasarian, Michigan’s chief medical executive. But on pharmacy shelves in her state, she said, thousands of doses of Paxlovid and another antiviral, from Merck, sit unused.
“Bagdasarian said some doctors may hesitate to prescribe Paxlovid because it’s a relatively new medication and they may not feel comfortable offering it to patients.
“Other doctors may want to prescribe it but can’t because of the FDA’s limitations for using the drugs, said Dr. Ryan Maves, an infectious diseases and critical care physician at the Wake Forest School of Medicine in North Carolina.”
Who Is Eligible?
According to the FDA, one of the most effective pills to treat COVID is Paxlovid.
Here are the criteria for prescriptions:
“Paxlovid is authorized for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS- CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death.”
MD Reluctance:
Some doctors may feel that they don’t know enough about the pros and cons of these relatively new COVID drugs. Others may worry about drug-drug interactions. Incompatibility can be a serious problem with Paxlovid, but if physicians and pharmacists do their homework, patients could be protected from complications of COVID-19.
The FDA’s guidelines about who should be getting the medications may also be confusing for some physicians. As noted, these antivirals were initially restricted to high-risk patients. That could soon change, however.
Another suggestion that has been floated is for pharmacists to prescribe and dispense these antiviral medicines to people who test positive for COVID-19. They would be in a position to check for drug interactions or other contraindications before providing the pills.
Doctors have rejected that idea, though.
The American Medical Association issued a statement that:
“the pharmacy-based clinic component of the test-to-treat plan flaunts patient safety and risks significant negative health outcomes.”
We hate it when turf wars affect patients. If doctors do not want to prescribe pills to treat COVID, then pharmacists should be given guidelines that would be acceptable for such dispensing.
The “Test to Treat” Plan:
According to Zeynap Tufekci, writing in the New York Times (April 22, 2022):
“In his State of the Union address, Biden announced a ‘test to treat’ initiative to provide such pills on the spot in pharmacies when someone tests positive.
“Reality is much less rosy.
“The national map of participating pharmacies in test to treat shows large parts of the country with none. Even in areas where treatment is supposed to be available, it can be hard to get. A Kaiser Health News reporter spent three hours driving around Washington, D.C., before finding a pharmacy where testing was available and the drug was in stock — something we should not expect sick people to do.”
You can learn more about pills to treat COVID at this link. Keep in mind, too, that some social media posts offer the disturbing possibility that COVID may return even after a full course of treatment with Paxlovid. Researchers still have more to learn about the behavior of pills to treat COVID.
Other Options:
Another new oral medicine, sabizabulin, performed well in clinical trials. Its manufacturer will be seeking emergency use authorization because the trial was stopped early due to positive results.
None of these antiviral medications will change the course of the pandemic unless people can access them. COVID is not finished. The new variants of Omicron are spreading rapidly. It’s time for prescribers to learn how to use all the tools at their disposal. And patients need to request pills to treat COVID if they are at high risk!
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