Why officials are pushing Paxlovid to defang the coronavirus

When Martha Smith developed a cough in late April that turned out to be COVID, she thought she might be given Paxlovid, the antiviral pill that is now increasingly available in abundance at many pharmacies, quite soon.

“I thought it would be easy,” says Smith, who lives in Oakland. “We’ve been working on this for two years, we’ve certainly developed some processes around this.”

Instead, Smith spent the next two days on the phone, talking to multiple doctors and CFS sites before tracking down the Pfizer drug at an Oakland pharmacy. All the while, the clock was ticking as she started the process three days after her symptoms and Paxlovid had to be started within the first five days of onset to do its job properly.

“You would think I was the first person to ever ask for this, which seems like a public health mistake but also an organizational mistake,” said Smith, who has been vaccinated and boosted and is eligible for the drug because her weight puts her at higher risk of developing serious illness.

Public health officials are racing to raise awareness and improve access to Paxlovid so people like Smith can stop mild COVID symptoms before they become more severe. Unlike remdesivir and monoclonal antibody infusions — treatments that have been around longer than the pills, but require people to go to a hospital or clinic — antiviral pills have been hailed as an inexpensive, accessible way for anyone to get treatment at home by taking them. get it from a pharmacy.

Combined with widespread vaccination and boosting, the pills offer a promise unimaginable when the pandemic began in 2020: that hardly anyone should die from COVID. Experts from FDA Commissioner Dr. Robert Califf to local health officials in the Bay Area are now daring to talk about “zero COVID deaths” thanks to the combined power of shots and pills.

But the health care system, as on so many other occasions during the pandemic, is struggling to catch up to this vision. Many doctors are not yet comfortable prescribing the new drug, in part because Paxlovid has the potential to interact harmfully with common drugs and therefore requires careful review of the patient’s regimen. Many don’t know which pharmacy to send the prescription to because not all locations have it, despite the federal “Test to Treat” program adding sites every week. Meanwhile, some patients do not know that such treatment is available, whether they qualify or how to get it.

Smith has chronic lung problems and is used to advocating, sometimes stubbornly, for her health. She is lucky to have a regular caregiver who she knows how to reach and that she eventually got her hands on the five-day course of 30 Paxlovid pills. Her symptoms have since faded.

“I’m fine,” she said. “But a lot of people would be sicker than me, and in life situations where they didn’t have the freedom to make six phone calls.”

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In some ways, the US is at a crossroads that would have been unimaginable a year ago — in a good way. Most Americans are now vaccinated, and many are getting a boost, with vaccines that are extremely good at reducing the risk of serious illness and death. And for the first time there is no shortage of two antiviral pills, Paxlovid from Pfizer and the less commonly used molnupiravir from Merck. If anyone was looking for a sign that society can live with the virus, this might be it.

That makes this current wave of cases the first where the promise of antiviral pills — hailed as game-changers when they were first approved in late 2021 — will be put to the test. During the earlier microwave boom that peaked in January, the pills were so new and scarce that only the highest-risk people could get them, and even then they were hard to find for many.

Some progress is being made locally. Contra Costa County has set up a 24/7 phone line to connect residents with doctors who can prescribe Paxlovid if needed. Marin and San Mateo counties are opening new Test to Treat sites where residents can get tested and, if they test positive, get a prescription on the spot. Some Bay Area residents say they’ve been able to get Paxlovid quickly and easily, in some cases on the same day with minimal effort.

“It happened without much fanfare, but it’s an important milestone in our pandemic response,” said Dr. Matt Willis, public health officer for Marin County. “For the first time since the start of the pandemic, we have enough drugs in Marin to effectively treat everyone who needs to be treated with COVID-19.”

“While vaccines are our best line of defense, they are not 100%,” Willis added. “Paxlovid may reduce the risk of death in those at the highest risk by an additional 90%.” When you combine the two, he says, you get a “90% reduction in the risk of dying from being infected, plus an additional 90% reduction in the risk of death if you receive timely and appropriate treatment.”

The result: “For the first time, we can visualize a community without COVID deaths.”

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