Pills to fight COVID-19 coming to a drugstore near you

Sore throat? Cough? Sniffles? Finally, effective treatments for COVID-19 are available.

But temper your expectations.

The president launched a nationwide “Test to Treat” Initiative on March 8 that seeks to make treating COVID-19 simple: You get tested at a pharmacy-based clinic. If you’re positive and at high risk, you can get antiviral pills on the spot, which can cut the chance of developing severe disease by some 85%.

“It’s a very exciting time,” said Dr. Annie Luetkemeyer, professor of medicine at UC San Francisco, in a recent USC webinar.

But, of course, things are never simple.

“The health care system is already set up to make things as difficult as possible,” said Dr. Aaron E. Carroll, distinguished professor at Indiana University, at the webinar.

One-stop shops are more likely to be in wealthy communities than in poorer ones, where the drugs are more likely to be needed, he said. So sick people without pharmacy-based clinics nearby must find a testing site — getting more difficult as states scale down those efforts — and test results can take a day or two to come back. Then folks must find a doctor to write a prescription for the new drugs, and then find a pharmacy that has them in stock.

And all this must happen very quickly — within about five days of infection, for some of the oral drugs to work their magic.

“Most people who get it are people of means,” Carroll said. “In many ways, COVID exposed and exacerbated health care inequities.”

Seeking equity

The federal government controls the distribution of these drugs, which are free, and sends them directly to the states.

In California, health officials then send them to counties, and then they make their way to local pharmacies, hospitals and medical groups, based on formulas that factor equity into the distribution equation, officials said. The therapies aren’t distributed based on population: Orange County, for example, had 11,869 treatment courses available as of Friday, while smaller Riverside County had much more — 16,528 courses, according to data from the U.S. Department of Health and Human Services.

Instead, the drugs are sent where they’re most needed, based on measures such as current infection rates, hospitalization rates and “Healthy Places Index” scores, according to the California Department of Public Health. The Healthy Places Index combines data to reflect an area’s poverty level, employment, median income, educational attainment, health care access and other measures.

Many neighborhoods in Riverside County have much lower Healthy Places scores than do those in Orange County, reflected in the treatment allocations.

Harder-hit communities have received much more inventory thus far than their more well-off neighbors. Santa Ana, for example, had 1,211 treatment courses available Friday, while Irvine had 583. Inglewood had 1,003 courses available, while similarly sized Burbank had 108.

All told, more than 2,300 pharmacies, hospitals and medical providers are distributing the drugs in California. CVS, Walgreens and Rite Aid stores represent more than half of the stocked sites, with Kaiser Permanente, medical groups, hospitals, grocery chains and smaller pharmacies comprising much of the rest.

To find a pharmacy near you with the drugs, see https://bit.ly/3wjWZBh. Click on the magnifying glass and enter your city or ZIP code.

“The therapeutics are very different now than they were a year ago,” said Dr. George Rutherford, professor of epidemiology and biostatistics at UC San Francisco. They can be game-changers for people who can’t get vaccinated or who haven’t had a robust immune response after vaccination.

Test and treat can be helpful if it can be implemented well, said Dr. Elizabeth Hudson, regional chief of infectious diseases at Kaiser Permanente Southern California, which has 4.8 million members in Southern California.

“There are several challenges with it, however,” she said by email. “First, people have to come in earlier enough in their illness to qualify for this treatment. As we know, many try to manage their symptoms at home for a few days before going to seek care, and this may be a stumbling block. If we can get everyone accustomed to going in early for testing, this could work, yes.

“There is also a question around overall supplies of both COVID tests and Paxlovid. It does appear that by the summer, we should have an adequate supply of both tests and Paxlovid, so, hopefully, all of these will work together to allow for this program to be a success.”

What are these drugs?

Antivirals prevent viruses from making copies of themselves, while monoclonal antibodies bind to virus and help the body get rid of it. Here’s a few of the treatment options:

• Pfizer’s Paxlovid is the new star in the antiviral treatment arsenal. It’s a series of pills, taken orally. They contain nirmatrelvir, which stops the virus from replicating, and ritonavir, which helps the main drug stay in the body longer, at higher concentrations. It’s three tablets taken together, twice daily, for five days, for a total of 30 tablets. Paxlovid significantly reduced the proportion of people with COVID-19-related hospitalization or death from any cause by 88% compared to placebo, the U.S. Food and Drug Administration said when it issued an emergency use authorization in December.
• Also new is Merck’s molnupiravir, an antiviral that received emergency use authorization in December as well. It works by introducing errors into the virus’ genetic code, which prevents the virus from replicating. It’s only for patients 18 and older, as molnupiravir can affect bone and cartilage growth, the FDA said. It’s a course of four capsules taken orally every 12 hours for five days, for a total of 40 capsules.
• Veklury, the antiviral remdesivir, has been available since 2020 and isn’t part of the federal/state effort; clinics can order it directly. The drug must be delivered intravenously.
• Monoclonal antibodies must be given intravenously or through injection as well, within about 10 days after symptoms. Sotrovimab is effective against omicron and part of the federal effort; Evusheld is for those who can’t get COVID-19 vaccines for medical reasons, or who didn’t have robust immune responses to vaccination.

Candidates for these treatments are those at high risk for developing serious disease, including folks who are older, overweight, pregnant, diabetic or have heart issues and other underlying health problems.

Rollout

As transmission of COVID-19 continues to drop and access to effective therapeutics improves, equitable distribution of COVID-19 treatments is a critical issue, said the Los Angeles County Department of Public Health in an update on March 17.

“As supply of these medicines increases, we need to be sure that information and access about therapeutics is available across the county, particularly in those communities with residents at elevated risk of poor outcomes should they become infected with COVID,” it said, stressing that treatment is available for those at increased risk even if they have mild symptoms, such as a runny nose or cough.

People should act as quickly as possible, contacting their doctors or finding a Test to Treat site at a local CVS or Walgreens, officials said.

“Although supplies remain limited, more residents are receiving these treatments through pharmacies, partners, and providers,” L.A. County’s COVID-19 update said. “To date, Public Health has distributed 20,960 doses of Paxlovid, 39,764 doses of Molnupiravir, and 13,584 doses of Evusheld, with 73% of Paxlovid doses, 82% of Molnupiravir doses and 66% of Evusheld allocated to residents in the most under-resourced communities.”

In San Bernardino County, providers who are registered in the state’s health partner ordering portal system can request therapeutics and the county will direct ship them, spokeswoman Felisa Cardona said. It hopes to serve even more.

“The county has an adequate supply of COVID-19 treatments and therapeutics available and we highly recommend interested providers and pharmacies reach out to the county’s therapeutics team at sbcovid19therapeutics@dph.sbcounty.gov and we will help them with the process,” she said.

While therapeutics are a powerful tool, they’re not a substitute for vaccinations, officials said. Being fully vaccinated and boosted offers the strongest layer of protection.

Source: Orange County Register