When COVID-19 antiviral pill treatments received emergency approval at the end of last year, they were touted as a gamechanger in the pandemic.
The convenient take-home pills replaced previous treatments that could only be given intravenously in medical settings.
Two pill brands approved by the U.S. Food and Drug Administration in December were shown effective at keeping infected patients out of the hospital. But they were initially reserved for the sickest patients, hindered by low supply and a long list of potential drug interactions.
Under the “Test-to-Treat” program launched in March, the federal government wanted to increase access to the antiviral pills, Pfizer’s Paxlovid and Merck’s Lagevrio, by allowing people to get prescriptions directly from pharmacies.
Government officials recently announced an effort to vastly expand the program, which could double the the number of drugstores in Georgia that carry the potentially lifesaving medications.
The expansion could come just in time for a predicted rise in cases here. On Friday, President Joe Biden’s administration released new models showing another wave of infections is expected nationally for the fall and winter, driven by omicron’s continually evolving subvariants. But the next outbreak may appear in the South, where a summer wave is projected, similar to those seen in 2020 and 2021.
Doctors and pharmacists said the program’s expansion could save more lives, but more people need to take advantage of the drugs.
“If it had been available nine months ago, my Lord, half of the people who had come in (my pharmacy) probably would’ve been treated with it,” said Bill Posey, pharmacist and owner of the Tifton Drug Company. “But as of right now, we’re just not using a lot of it.”
The take-home antivirals available through Test-to-Treat have the potential to drastically blunt future outbreaks, but doctors have warned of relying on them to end the pandemic. The pills have only been shown to be effective if taken within five days of symptoms, a short window that can pass before some people realize they have something more than allergies or a cold. Test-to-Treat aims to streamline getting diagnosed and obtaining the treatment into one visit to a pharmacy.
COVID cases are slowly increasing in Georgia, but overall infection rates remain among the lowest during the pandemic. Physicians and pharmacists told The Atlanta Journal-Constitution that fewer people are seeking tests, leading to a low number of antiviral prescriptions. That matches statewide data, which shows a lull in testing since the winter.
Dr. Keila Brown, the medical director at The Family Health Centers of Georgia, said she’s optimistic antivirals will play a crucial role going forward.
“Our main prevention would still be our vaccination programs, but in light of these new antivirals, we do have another weapon against the virus,” Brown said. “It would help us be able to prevent deaths as well as prevent overwhelming the healthcare system.”
Trying to make the next Tamiflu
Health experts caution antivirals are not a substitute for vaccination and are only meant to treat sick patients after they’ve been infected. The pills are still primarily prescribed to patients who have preexisting conditions or are at a higher risk of hospitalization or death. And there are limits to who can safety take these antivirals.
While research trials have shown Paxlovid reduces the risk of hospitalization or death among high-risk patients by nearly 90%, it comes with a long list of drug interactions that prevent many patients from taking it. Merck’s Lagevrio, the brand name of molnupiravir, can be taken in tandem with nearly any drug and is only unsafe for pregnant women, but its effectiveness is much lower at roughly 30%.
The FDA recently said some patients who have taken Paxlovid experience a relapse of symptoms a few days after recovering. While they’re studying the cases of viral resurgence, public health officials say the drug is still effective at preventing severe illness. Paxlovid was recently prescribed for Vice President Kamala Harris, who tested negative for the virus less than a week after being diagnosed.
Dr. Jason Hefner, a regional medical director for Piedmont, said it took physicians awhile to educate themselves on the new medications and all of the pros and cons.
“There’s always some hesitancy with new medications to make sure that we know the ins and outs, the risk and benefits and who to prescribe it for,” he said. “Hopefully, we’re getting past that phase into being able to use it in a similar manner to how we use Tamiflu for influenza.”
Tamiflu, the brand name for a similar antiviral that’s been used to combat the flu since 1999, is a benchmark for this type of treatment. More than 5 million doses of Tamiflu and its generic counterparts are prescribed each year to treat flu patients each year in the U.S.
Dr. Thomas Bat, the CEO of North Atlanta Primary Care, said Paxlovid has proven to be a challenge to prescribe given all of its negative drug interactions, especially when the drug’s emergency approval is for high-risk patients.
“(The Test-to-Treat program) is good as long as you’re an uncomplicated patient,” said Bat, whose practice has 16 clinics throughout metro Atlanta. “But if you’re a patient with heart disease or diabetes, you need to really talk to a doctor before you taken an antiviral.”
‘Starting to use it more and more’
During a White House briefing on April 26, COVID-19 Response Coordinator Dr. Ashish Jha said he wants Paxlovid to be available everywhere in the country.
Antivirals are free and currently available in more than 20,000 pharmacies, hospitals and medical centers, and there are more than 2,200 Test-to-Treat sites in the U.S. — 108 of which are in Georgia. Jha announced they’re trying to double both the number of locations that can provide antivirals and the number of Test-to-Treat participants.
Most Test-to-Treat locations are large pharmacy chains, including CVS, Kroger and Walgreens, but there are a few mom-and-pop stores like Bill Posey’s business in Tifton. He said his South Georgia pharmacy has participated in the program for about six weeks, and they’ve only had one patient so far who qualified for an antiviral prescription.
“We really haven’t had the opportunity to actually use the Paxlovid, which is what we have in stock. There’s just not been a serious case for us to have to do that,” Posey said, adding that only about seven or eight people are coming to his shop for COVID tests each week.
Hefner said many physicians in metro Atlanta have been writing antiviral prescriptions, but it took some longer to get on board than others.
“I’ve got some physicians who were very good, very educated and got on board very early and who prescribed probably 150 to 200 prescriptions for those medications at this point,” Hefner said. “And then I have some that really just wanted to understand that they were really prescribing safely, and it took them awhile to dive through the data.”
Cases in Georgia are slowly beginning to increase due to the latest omicron subvariant, BA.2.12.1. When another outbreak does occur, doctors said COVID antivirals will then be able to show their full worth.
“Slowly but steadily as the education that providers get is better, we’re starting to use it more and more,” Hefner said. “... (Widespread availability) will hopefully help brunt some of that surge in volume that we’ll get with the next outbreak.”
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