Paxlovid is key in the fight against COVID, but easy access is important: doctors

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A pill to treat COVID-19 appears to be the country’s best hope, aside from vaccines and strong public health measures, to prevent hospitals from being overrun with cases of the virus now and in the future, doctors say.

But with infections rising across the country, experts say Paxlovid’s distribution system in various parts of Canada may prevent those who need it most from getting it in time.

Paxlovid, an antiviral, has shown a 90 percent reduction in hospitalizations among unvaccinated patients with the Delta variant who received the drug within five days of symptom onset.

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Those who need the drug most would do well to know ahead of time how they might access it, the country’s public health director said this week.

“My message to all Canadians who may be at high risk, like those who are immunocompromised: find out in your community, right now, how you can access that drug in case you need it because it’s a little bit different in different areas of Canada. ”, said Dr. Theresa Tam on Tuesday.

The federal government has distributed some 150,000 Paxlovid courses to provinces and territories, Tam said. Most provinces have a centralized drug distribution system, often through hospitals and testing centers, and eligibility varies across the country.

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“I think we would all like to see Paxlovid mobilized more widely,” Tam said, adding that Health Canada is working with several jurisdictions on the issue.

“We will use these types of drugs more significantly as we have more access to antivirals in the future, which is great news. We just need to know how to get it to people quickly.”

Quebec pharmacists can prescribe Paxlovid, though those most at risk of serious illness are the only ones who can get it.

Ontario had a centralized distribution system, largely through hospitals and testing centers, until the province announced Monday that it would allow select pharmacies to distribute the drug to those with a prescription.

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The move was applauded by infectious disease experts.

“It’s a good move because it makes it a lot easier for people who are eligible and get prescription packs,” said Dr. Gerald Evans, professor of infectious diseases at Queen’s University and medical director of infection prevention and control at the Kingston Health Sciences Center. .

At Evans’ hospital, doctors had only two ways to get the medicine to patients: ask them to drive to the hospital or send it to them by courier, even if they lived an hour’s drive from Kingston, Ontario.

“The drug is inaccessible to many patients,” he said.

He warned that Paxlovid, which must be started within the first five days of symptoms, does not work for everyone and said the best protection remains vaccination against COVID-19.

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Other provinces should follow the lead of Quebec and Ontario, said Dr. Zain Chagla, an associate professor of infectious diseases at McMaster University in Hamilton.

“Drugs need to be decentralized,” Chagla said.

This week, Ontario also expanded the eligibility parameters for Paxlovid to anyone over the age of 70, people over the age of 60 with fewer than three doses of a COVID-19 vaccine, and people over the age of 18 with fewer than three doses of vaccine, and at least one risk factor such as a chronic medical condition.

“We have a drug that can significantly mitigate hospitalization,” Chagla said. “We need the community now to start being prescribers and providers to make sure their patients are not hospitalized.”

In Ontario, hospitalizations and intensive care unit capacities have been the key drivers for the imposition and lifting of public health measures in past waves of COVID-19. The provincial government lifted almost all public health measures, including the wearing of masks in most public spaces, in mid-March.

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Ontario is now in its sixth wave, spurred by lifting those public health measures, according to Public Health Ontario, and hospitalizations are on the rise.

Chagla said he has prescribed Paxlovid to about 150 people over the past month and warned that it interacts with many medications, including blood thinners, cholesterol medications, birth control and seizure medications.

“About 95 percent of these potential interactions can be resolved in just a few minutes of my time,” he said. “It’s not insurmountable by any means. The vast majority of people can stop their medications or deal with medication changes for a week to stick with this.”

In Quebec, those who are considered “high risk” for complications from COVID-19 and meet certain criteria are eligible for Paxlovid, although some doctors believe the criteria are too strict.

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“It really comes down to how you define high risk,” said Dr. Emily McDonald, an associate professor of medicine at the McGill University Health Center. “I or someone else could define high risk differently than the government has defined it.”

But McDonald said it’s a tradeoff to be able to give pharmacists the ability to prescribe Paxlovid.

Each province has different eligibility criteria and that, coupled with a paucity of communications about the drug, leaves the public in the dark, McDonald said.

“It’s an issue of access and communication and we have to address both,” he said. “A simpler message is more likely to be successful.”

-With files from Laura Osman in Ottawa.

This report from The Canadian Press was first published on April 13, 2022.