Last week, Australia’s deputy chief physician told GPs to proactively raise awareness about new antiviral treatments for COVID-19 among their at-risk patients.
These drugs — nirmatrelvir-ritonavir (Paxlovid) and molnupiravir (Lagevrio) — are effective at keeping people out of the hospital and are designed to lower the death rate, which stands at more than 1,000 people a month.
The rollout has been problematic, and, as widely reported, many, if not most, people eligible for treatment missed it.
The “mission” of the Deputy CMO, Professor Michael Kidd, is the latest effort to raise awareness about the drugs — and the time constraints involved in getting them — among doctors and their patients.
Professor Michael Kidd.
Professor Kidd addressed GPs, saying, “I recommend you start a conversation with your at-risk patients if you haven’t already.”
One of the issues affecting the rollout is that patients must begin the medication within five days of the initial development of COVID symptoms.
Professor Kidd said: “As you know, it is essential that people start treatment as soon as they develop symptoms, so people at risk should be tested quickly, and antivirals should be started quickly.”
But for patients, it is not so simple. There are several hoops to jump through between getting sick and getting access to drugs.
How to access these drugs?
Dr. Chris Moy, a GP in Adelaide and Vice President of the Australian Medical Association, have been working to identify and resolve the rollout issues.
Speaking to news gear, Dr. Moy lists the steps the patient should take and what “should” be done:
The patient develops COVID symptoms. They should be tested as soon as possible. If they have taken a PCR test, they will be notified by text message that they are positive. But if they have taken a RAT at home, they must report the result to the state health department. What should then happen is for the patient to be referred to the National Coronavirus Helpline, where they have their symptoms checked over the phone. They will be asked about their age, when symptoms started if they have pre-existing conditions if they have been fully vaccinated and if they have reduced immunity. At the end of the phone call, the patient is told the risk of developing a severe case and may be eligible for PBS-listed antiviral treatment. The patient is requested to contact the general practitioner as soon as possible. The GP is approached by the helpline. Which antiviral is the best and safest option? An e-prescription is sent to the pharmacy, which will deliver the medication?
“That’s what should happen,” Dr. Moy said.
“But some people don’t have a doctor. Or they can’t reach their GP because it’s the weekend. And that’s two lost days.”
He said that each state has different contingencies to solve this problem. “There are several backup plans,” he said.
AMA Vice President Dr Chris Moy.
The patient may be referred to a respiratory clinic or telehealth service.
Through it all, a sick person is probably getting sicker, trying to make this happen.
“How else are they supposed to get there?” said Dr. Moy.
“They can try to contact their GP if they’ve had a positive test, and that’s fine,” he said.
“But part of the problem is awareness. A lot of people don’t know they can do that.”
Dr. Moy said it remained a complex issue, partly because these drugs can be dangerous when taken with certain other medicines. Hence the need for a doctor who knows your history.
Who is eligible?
Patients must also meet the following eligibility criteria:
Identify as Aboriginal and Torres Strait Islander and be 50 years or older with two additional risk factors for serious disease develop severe disease Moderately to severely immunocompromised. Be 75 years or older with one additional risk factor for developing a serious disease. Be 65 or older with two other risk factors for developing a serious illness.
Risk factors include not having at least two doses of a COVID-19 vaccine, being in a residential aged care or residential disability care facility, and having conditions such as heart failure, chronic obstructive pulmonary disease (COPD), neurological disorders, obesity, diabetes, or cirrhosis.
Costs
dr. Moy said a five-day course of both drugs would cost over $1,000. On PBS, they cost about $6.
The price, the complexity of matching the right medication to a particular patient’s history, and knowing exactly when to take the medication (after a positive test) means that the drugs cannot be supplied to at-risk patients as a “premature just in case” unit of measure.
Dr. Moy said these antivirals could become the standard of care over time, similar to those prescribed for HIV.
In the meantime, they hope to keep more people out of the hospital, especially now that the aggressive flu season is in play.
