Chris Lindsey has been very careful to not catch COVID-19 for the past two years.
In late 2021, he was diagnosed with an autoimmune disorder requiring immune-suppressing prescription drugs.
In mid-2020, he had his gallbladder removed for a mass that turned out to be not cancerous.
That surgery came less than a year after he started treatment for thyroid cancer.
And in May 2018, he was diagnosed with stage 3 lymphoma.
Fear of catching COVID-19 was very real for Lindsey and his family.
“My family obviously has been on pins and needles because they don’t want to bring something home – they don’t want to get me sick,” the Cochrane, Alta., father said.
“They don’t want to bring that into the house cause they’re like, they’ll be fine, but they don’t want me to go through any more sickness.”
Reanne Booker, president of Canadian Association of Nurses in Oncology and Calgary oncology and a palliative care nurse practitioner, said COVID-19 presents a significant threat for cancer patients.
“The case fatality rate in the general population is in the neighbourhood of 1 to 2 per cent. But the fatality rate for somebody with cancer, if they were to get COVID 19, is in the neighbourhood of 25 per cent-plus,” she said.
“So we’re seeing significantly worse outcomes potentially in patients with cancer.”
Even though Lindsey has had a full course of vaccination and a booster shot, the chances he would end up in hospital from a COVID-19 infection were very real for the immunocompromised Albertan.
“It’s been a rollercoaster, emotionally,” he said.
And then 10 days before Lindsey was due to receive a fourth dose of vaccination, he caught COVID-19.
He started having symptoms on a Monday and tested positive on a rapid antigen test on a Thursday.
“The cough was definitely different; it was very coarse and hard to clear. But it wasn’t as bad as what I’ve heard from other people that have had it,” he told Global News.
“So I believe that the vaccination helped to minimize that risk to me.”
“Patients with cancer and those receiving immunosuppressive medications don’t always mount effective immune responses to the COVID-19 vaccines,” Booker said. “So, again, they’re particularly vulnerable to the adverse effects of COVID-19 infection.”
Enter antiviral treatments.
Gilead Sciences’ Remdesivir, an intravenous antiviral treatment, and Pfizer’s oral prescription Paxlovid are available to Albertans who fit very specific criteria: long-term care and supportive living residents, immunocompromised Albertans, and some un- or under-vaccinated people.
It’s supposed to be taken within five days of the start of symptoms to prevent severe disease, hospitalization and death.
“It inhibits the replication of the virus in someone’s body,” Booker said. “We know if there’s huge amounts of virus in someone’s body that that can be associated with more severe disease.”
At the beginning of April, pharmacists were able to directly dispense Paxlovid with a prescription from an AHS doctor. That prescription requires a lab-confirmed test, a PCR test that the province restricted from the general population in January.
Molecular testing is only available to those who have “clinical risk factors for severe outcomes” and work and live in “high-risk settings,” according to the province.
On Thursday night, after his rapid test showed he had COVID-19, Lindsey booked a PCR test online. On Friday, he was swabbed at the Richmond Diagnostic Centre, and within a couple hours he received his result.
After a sequence of phone calls, which included screening for antiviral eligibility and a phone consultation with a doctor, Lindsey had a prescription for Paxlovid.
“As the phone calls started coming up, I definitely was starting to relax a little bit more because it was happening exactly how they said it would happen,” Lindsey said.
A friend was able to pick up the prescription from a nearby pharmacy, and on the fifth day of his symptoms, Lindsey started his treatment with Paxlovid, one of about 1,300 that have been issued province-wide.
Provincial warehouses contain about 25,000 more, according to Alberta Health officials.
The combination of available supply, lab test restrictions, confusing eligibility and an opaque process has medical professionals like Booker calling for a widening who can get access to the prescription antiviral.
“It’s frustrating to know that we’ve got those options and they’re not being used fully. And part of that simply might just be better education, informing the public about the eligibility criteria and how to access it,” she said.
“As we’re learning more and more about the benefits of Paxlovid, I’d like to see access expanded.”
On Wednesday, Health Minister Jason Copping announced work was underway to allow doctors outside of the province’s COVID-19 outpatient treatment program to prescribe Paxlovid.
“Family physicians are getting tools and education to ensure they’re comfortable prescribing this medication, and I hope to announce very soon that prescribing will be fully transferred to them,” he said, recognizing the wider demand for it.
That can be a challenge for some Albertans, Booker pointed out.
“Not everyone has a family doctor in Alberta. And so I worry about, as we have throughout the pandemic, that equity in access to treatments and testing,” she said.
“I worry about people that don’t have a family doctor or who perhaps are too unwell from their underlying medical conditions to be able to kind of navigate these processes.”
Booker also flagged potential problems if a patient were to try to get an appointment with their family doctor within that five-day window, but was unsuccessful.
Chief medical officer of health Dr. Deena Hinshaw said the current eligibility criteria balances benefits with risks of taking Paxlovid.
“It is important to remember that determining who can benefit most from this medication depends on who is most at risk of severe outcomes right now,” Hinshaw said on Wednesday.
“With any medication, including Paxlovid, it is important to consider what benefit a medication can provide and also what the potential side effects are.
“Paxlovid is an extra line of defense that can help some people with their COVID-19 infection.”
Lindsey counts himself fortunate for being able to start the five-day course of Paxlovid treatment on the last day it would have been most effective.
“I didn’t end up in the hospital. The way I look at it is if it did its job in preventing the progression of it getting worse, because I didn’t get worse from the day I started it,” he said, adding the AHS process was “seamless.”
And he had some simple advice for those eligible for antivirals.
“Don’t wait. Just contact them.”
— with files from Lauren Pullen, Global News