Two new antiviral pills considered powerful tools to fight COVID-19 are trickling into Georgia, and doctors are eagerly reaching for them to lessen the odds of hospitalization at a time when the number of new infections remains high.
But how quickly patients can get the required prescription and then locate a pharmacy with the pills has proven to be a hurdle. Initial supplies in Georgia and elsewhere have been low as manufacturers have raced to ramp up production.
And, from a medical point of view, the scarcity of the new antivirals is only one of the challenges for doctors. Both drugs, Paxlovid, manufactured by Pfizer, and molnupiravir, made by Merck, come with a list of interactions and possible side effects that limit who can take them.
“With the amount of illness we have seen in Georgia as a whole, we are certainly excited to have another tool in our tool belt to help those patients who could potentially suffer from COVID,” said Dr. Derek Heard, Medical Director for Primary Care for Putney Health System in Albany and surrounding areas. “With the addition of these two antivirals, we do have the ability to give patients some hope that we can prevent serious illness and keep them from going into the hospital.”
Credit: Steve Schaefer
Credit: Steve Schaefer
The pills — both billed as game-changers when they were approved for emergency use by the Food and Drug Administration for high-risk people in December — are the first take-home pills for COVID. They were designed to be an early treatment to keep people out of the hospital.
Doctors are clamoring to prescribe the pills now, not just because omicron is causing a geyser of cases but because some earlier treatments don’t work as well against the variant and are no longer being used.
Pfizer’s version appears to be the more effective treatment, with a research trial showing it reduced the risk of hospitalization or death among high-risk patients by about 85%. Merck’s version reduced risk of hospitalization and death in high-risk patients by 30%.
Both drugs should be taken as soon as possible after a COVID-19 diagnosis and within five days of first symptoms. And there’s yet another layer of complication given Paxlovid’s interactions with many other drugs used for chronic medical conditions, and molnupiravir’s risks to women of childbearing age.
The pills aren’t for everyone. And doctors will need to consider which patients can safely take them.
“No medication is without any risk when you prescribe it. So you are always weighing risks and benefits,” said Heard.
He said, for example, if he were considering Paxlovid for someone who was at high risk of getting seriously sick from COVID-19 and who was taking colchicine, a medication for gout, or statins for high cholesterol, he might suggest the patient pause those medications for a few days while taking the antiviral.
“Not ideal, but not as much risk as COVID,” he said about a patient taking a few days off a medication to take Paxlovid.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
With such a tight supply, Heard said doctors are having to limit prescriptions to only patients at the highest risk of severe illness. For example, an unvaccinated person with multiple chronic conditions such as obesity, diabetes or chronic kidney disease. Even then, Heard said there is not enough to go around.
The first shipments of Paxlovid and molnupiravir arrived in Georgia in early January and totaled just over 9,000 doses, which were distributed to about 50 pharmacies across the state. Each dose is enough for a full course of treatment.
In shipments that arrive every two weeks, the state’s total allotment has increased to 34,080 doses for both antivirals: 27,480 for molnupiravir and 6,600 for Paxlovid. Pharmacies that have received allocations of the pills can be found on the HSS therapeutics locator map. The website also updates how many doses are currently available at each of the locations.
Only about 70 pharmacies including those located at some hospitals across the state received shipments of the drugs. Some pharmacies are nearly or completely out, others awash in supplies. As of late last week, Derek Chapman, pharmacist and owner of Chapman Drug pharmacy in Hapeville, said he had only dispensed two prescriptions for the antivirals and had hundreds of doses still on the shelves.
Meanwhile, Ashley Smith, a pharmacist at AllCare Pharmacy in Lyons in southeast Georgia was down to her last four bottles of molnupiravir. Her supply of Paxlovid was long gone.
“I’m dreading it,” Smith said about running out of the drug. “The demand is huge and this really seems to be helping people.”
Smith, who has dispensed the antivirals for a wide range of ages, said she made follow-up calls to some customers who filled their prescriptions there to see how they were responding to the medication.
“A lot of people said after taking it, ‘I don’t know if I was starting to feel better anyway, but I feel way better,” said Smith. “It seems real.”
Dr. Thomas Bat — CEO of North Atlanta Primary Care, a large practice with 16 clinics throughout metro Atlanta, said they have generally been able to find the medication at pharmacies although they might be located several miles away from where patients live.
”But we also don’t give this to everyone and we look for risk factors, someone who has decided not to be vaccinated with high-risk factors, so I tend to think, we physicians know there is a limited supply and we are prescribing it for people who we think it’s most important,” he said.
The number of treatment options for COVID-19 remains limited and the number of treatments options have narrowed recently. The FDA has restricted the use of two monoclonal antibody treatments that were less able to target omicron due to its mutations and lost their effectiveness against this now-dominant variant.
That leaves one monoclonal antibody treatment by GlaxoSmithKline and Vir Biotechnology which has remained effective against omicron, though doctors say it too is in extremely short supply.
Another widely used and once-promising COVID-19 treatment is also no longer recommended or used at hospitals. Convalescent plasma therapy uses blood from people who’ve recovered from COVID-19 to help others recover.
And while antivirals may help treat COVID-19 infections, DPH, doctors and public health experts emphasized vaccination is the best prevention. Georgians ages 5 and older are eligible for vaccination.
