Lack of awareness over COVID-19 antiviral pill causing barrier to access: experts

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Ontario government urged to increase speed and accessibility of COVID-19 antiviral treatments
WATCH: Ontario government urged to increase speed and accessibility of COVID-19 antiviral treatments – Apr 6, 2022

Health Canada approved Pfizer’s Paxlovid COVID-19 antiviral pill for use against COVID-19 in January this year, but with a large supply of these pills available, experts say there is a lack of awareness among the public for who qualifies and how to access them.

According to Health Canada, Paxlovid can be given to adults 18 and older who are positive for COVID-19 and experiencing mild to moderate illness and at high risk of becoming seriously ill.

The agency currently recommends prioritizing severely immuno-compromised patients, people over 80 who haven’t had all their vaccine shots, and people over 60 living in remote and rural locations, long-term care homes and First Nations.

How does this treatment work?

The treatment, which has to be prescribed, involves taking three pills of two different drugs — nirmatrelvir and ritonavir — twice a day, for five days. It should be started after a positive COVID-19 test and within five days from the onset of symptoms, according to Dr. Sohal Goyal, lead physician at the Mississauga Medical Arts — COVID, Cold and Flu Care Clinic.

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“There’re enough pills now, but the issue is when you’re sick, you have a five-day window, so the patient needs to identify they have COVID-19. But lots of people, to this day, think they have a cold,” Goyal said.

This is why people who are at higher risk should test or contact their primary healthcare provider as soon as they experience cold or flu-like symptoms no matter how mild because they might qualify for Paxlovid, Goyal added.

Goyal, who is also chair of the Mississauga Halton primary care network, says lot of people don’t think they can get tested but if someone is at higher risk they do qualify to get a PCR test, such as pregnant women or a high-risk patient.

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“If we target the right patients, we only need to treat 25 patients to prevent one hospitalization,” said Goyal.

He explained that treating that many patients is not a lot, if it can prevent one hospitalization and possibly admission to an ICU, which could cost the healthcare system a lot more money and resources.

“Not only can we prevent hospitalizations, but we can actually save money for the system as well,” said Goyal.

“I want to give this drug to as many patients as possible, who are at high risk, and so I definitely think increasing awareness among our patients as well as healthcare providers (would be) helpful.”

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Who can prescribe Paxlovid?

Goyal’s clinic in Mississauga dispenses Paxlovid on site to those who need them. It was the first clinic in Ontario aimed at serving patients who have any type of cold, flu or COVID-19 symptoms.

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“If (people) can’t access their primary care provider, they can access (such) centers where we can examine them,” said Goyal.

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Infectious diseases specialist Dr. Sumontra Chakrabarti says he’s been prescribing the Paxlovid COVID-19 antiviral pill for about a month and is working along with Goyal and other physicians to make the treatment better known among patients and other healthcare providers.

“The next step is not only to raise awareness about the pill…but to get the pill out into the community,” said Chakrabarti.

He said currently only a hospital can prescribe Paxlovid and a few clinics, like Goyal’s, and hopes that family doctors in Ontario would at some point be able to prescribe the pills without having to refer their patients to a hospital or clinic.

“We have this available. (Paxlovid) has a very strong effect on preventing death and hospitalization. It’s a great tool for us to use for high risk individuals,” said Chakrabarti.

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How to know if you're eligible for Paxlovid

Chakrabarti said people who are high risk can get tested for COVID-19 at clinical assessment centres where Paxlovid can also be found.

These centres include the Health Sciences North COVID-19 Clinical Assessment Centre in Sudbury and St. Joseph’s Healthcare Hamilton.

“The testing right now is actually made specifically for this high risk population,” Chakrabarti said. “Go there (to the centres), get tested very quickly and get the results quickly.”

READ MORE: Paxlovid, Pfizer’s oral COVID-19 pill, approved in Canada

He says if the clinic doesn’t dispense Paxlovid, then the patient would be referred to the nearest hospital.

Goyal says he expects that family physicians will be able to prescribe Paxlovid in the near future, but adds, “there are some nuances with prescribing.”

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First of all, Goyal says, physicians must make sure the patient gets a COVID-19 test. The doctor needs to run a kidney function test for the patient and a pharmacist or the family doctor must go through the patient’s drug list to make sure Paxlovid won’t interact with anything the patient is taking.

To know if a person is eligible for the drug, Goyal also created a google document to help people find out whether they are eligible, which can be accessed here. 

How are rising cases impacting Paxlovid availability?

The latest modelling by the Public Health Agency of Canada (PHAC) released on April 1, showed a 34 per cent increase in daily average case counts as of March 30, indicating a COVID resurgence is underway.

READ MORE: New Pfizer COVID-19 pill reduces hospital, death risk by 90%, company says

The latest surge is being partially driven by the highly transmissible BA.2 subvariant of Omicron, which is now the dominant version of the virus in several provinces, as well as the lifting of COVID-19 restrictions in most settings, federal health officials say.

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“We are getting concerned…this wave is pretty hard,” said Goyal. “So what would help is having more patients become vaccinated, especially fully vaccinated and triple vaccinated, to lessen the burden on the healthcare system.”

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Meanwhile, Goyal said his clinic has seen a “dramatic increase” in the past couple of weeks of people coming to the clinic to get assessed, with some ending up needing Paxlovid. However, even with demand being high, there are enough pills available for high-risk patients.

“COVID in the last two weeks has substantially increased, so we’re seeing a lot more people coming out of the woodwork to our clinic,” Goyal said.

Goyal said healthcare professionals still need to emphasize prevention, like getting vaccinated and wearing masks.

“We really want to protect the most vulnerable,” he said.

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— With files from The Canadian Press

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