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 1 million individuals have already died in the U.S. from the coronavirus. Approximately 500 people continue to die every day from this infection.
When Merck and Pfizer announced that the Food and Drug Administration had granted emergency use authorization for oral COVID drugs, everyone was excited. At last, there were easy-to-take medications that could reduce the likelihood of complications, including death.
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 antivirals 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.”
For greatest benefit, such antiviral medications 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.
Why aren’t people excited about these drugs? And why aren’t they being used more frequently?
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 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.
The FDA’s guidelines about who should be getting the medications also may be confusing. Initially, these antivirals were 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 coronavirus. 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 saying that, “the pharmacy-based clinic component of the test-to-treat plan flaunts patient safety and risks significant negative health outcomes.”
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 variant of omicron, BA.2, is spreading rapidly. It’s time for prescribers to learn how to use all the tools at their disposal.
Navigating the pandemic
