Why the main antiviral medicine for COVID may be underused
Palm Beach Post (FL)
As new mutations of the coronavirus omicron variant spread across Florida, publicly available data can show where to find medication that reduces severe illness, but medical professionals say that too few people are using the treatments.
Medications such as Paxlovid, a federally approved Pfizer-made antiviral pill, can fight severe infections caused by some omicron subvariants. But doctors may be missing chances to prescribe the drug to patients it could help the most: elderly, immunocompromised or unvaccinated people.
And a lack of information from the government makes it unclear how many doses have reached them.
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"I think there's plenty of Paxlovid available," said Dr. Carlos Del Rio, president of the Infectious Diseases Society of America. "The problem is not enough (doses) are being prescribed."
"Much like the vaccine rollout, there has been hesitancy for both the community and the prescribers," Boynton Beach epidemiologist Dr. Kitonga Kiminyo said. "People need information. People need to know it's safe and effective."
About 2.1 million courses of the antiviral drug nationwide, including about 156,000 in Florida, remain unused as of Sunday, data from the U.S. Health and Human Services Department show.
HHS reports online how many courses of Paxlovid it estimates are available in each pharmacy nationwide. But elderly people, who are among the most at risk for severe illness from COVID-19, may lack computer knowledge to find that information, Johns Hopkins University epidemiologist Dr. Caleb Alexander said.
"My sense is Paxlovid is still underused relative to its value," Alexander said. "We are still missing lots of opportunities to use this product."
Supply of Paxlovid is plentiful
A lack of supply of the drug is not causing this issue, Palm Beach County's top health official says.
"There is no reason to think that we have any shortages," the director of the state-run county Health Department, Dr. Alina Alonso, said. "I am mainly getting questions about where folks can get the prophylactic medication" such as Paxlovid.
The pill is far more effective at preventing hospitalization and death than the only other one approved by the federal Food and Drug Administration, Merck's Lagevrio, HHS has said.
Although Paxlovid was developed before the rise of omicron, it can fight illness caused by the BA.2 subvariant, laboratory tests conducted this past spring by Japanese scientists show. That strain, along with BA.4 and BA.5, comprise most infections across Florida and the United States.
Other medications that react with Paxlovid might be a problem
And yet, Del Rio and others say, doctors remain hesitant to prescribe the pill.
"It's something new and takes awhile to learn how to do something new," he said. Physicians also may be wary of prescribing the drug if it reacts unexpectedly with other medications their patients use, he added.
That's why Del Rio's organization put together a Paxlovid guide for physicians that White House coronavirus coordinator Dr. Ashish Jha endorsed and made available for doctors nationwide.
The National Institutes of Health has a guide showing which drugs are risky to take while on Paxlovid, or should not be taken. This includes some medication for blood thinners, erectile dysfunction and migraines.
"Usually we have to make sure that the pharmacist clarifies (that the patient's) medication, specifically cardiac medication, may cause a potential interaction," Kiminyo said. Besides that, patients taking kidney medication may have to take a lower dose of Paxlovid than what is standard, he said.
Paxlovid is recommended for older people, the immunocompromised and the unvaccinated rather than healthier, younger or inoculated people, whose infections would be milder.
Those who test positive for COVID and are prescribed the drug should start taking it within five days of experiencing symptoms.
But Paxlovid might be ineffective for vaccinated people who catch COVID. Former Palm Beach County Medical Society President Dr. Larry Bush, an infectious disease specialist, said that inoculated acquaintances of his who had taken Paxlovid after testing positive for COVID-19 felt better then worse after the drug wore off.
The nation's leading infectious disease expert Dr. Anthony Fauci is experiencing a rebound of COVID symptoms, he said Wednesday, after he stopped taking Paxlovid. Fauci first tested positive June 15. He has gotten four shots of the vaccine, which wards off serious illness even if the recipient catches the virus.
For those seeking Paxlovid treatment in Palm Beach County and elsewhere, or information about availability and distribution from pharmacies, several options are available.
The federal government's Test-to-Treat Locator shows which pharmacies and clinics nationwide have doctors who can prescribe Paxlovid and a pharmacist who can fill the script at the same location. Palm Beach County has more than a dozen. All are in the county's urbanized areas. None is in the Glades.
The government's Therapeutics Locator shows an estimate of how many courses of the drug each pharmacy has in stock.
Another website showing such information is called "covid-safe." It can display Paxlovid availability estimates for every pharmacy in a county or state on a single, easy-to-read web page. The federal government's usually loads slower.
Covid-safe, developed by computer programmer Rob Relyea, also uses HHS data to estimate how many doses have been delivered to each pharmacy each week, letting viewers see supply trends in their local facilities.
Dr. Philip Bretsky, an internist in Santa Monica, Calif., uses Relyea's website to quickly find pharmacies carrying treatments for his patients. "It took what was basically a half an hour process and made it two minutes," he said.