Why officials are pushing Paxlovid to defang the coronavirus

When Martha Smith came down with a cough that turned out to be COVID in late April, she figured she’d be able to get Paxlovid, the antiviral pill that’s now in an increasingly ample supply at many pharmacies, pretty quickly.

“I thought it was going to be easy,” said Smith, who lives in Oakland. “We’ve been at this for two years, surely we’ve developed some processes around this.”

Instead, Smith spent the next two days on the phone, speaking to multiple doctors and CVS locations before tracking down the Pfizer drug at a pharmacy in Oakland. All the while, the clock was ticking because she began the process three days into her symptoms and Paxlovid must be started within the first five days of onset to properly do its job.

“You would’ve thought I was the first person to have ever asked for this, which seems like a public health education flaw, but also an organizational flaw,” said Smith, who is vaccinated and boosted and qualifies for the drug because her weight puts her at higher risk for progressing to severe disease.

Public health officials are racing to raise awareness and improve access to Paxlovid so people like Smith can halt mild COVID symptoms before they get more serious. Unlike remdesivir and monoclonal antibody infusions — treatments that have been around longer than the pills, but require people to go to a hospital or clinic — antiviral pills have been lauded as a cheap, accessible way anyone could get treatment at home by picking them up at a pharmacy.

Combined with widespread vaccination and boosting, the pills offer a promise unthinkable when the pandemic started in 2020: that almost nobody should die from COVID anymore. Experts from FDA Commissioner Dr. Robert Califf to local Bay Area health officers are now daring to talk about “zero COVID deaths,” thanks to the combined power of shots and pills.

But the health care system, as on so many other occasions during the pandemic, is struggling to catch up to this vision. Many doctors aren’t comfortable yet prescribing the new drug, in part because Paxlovid has the potential to interact harmfully with common medications and thus requires a careful review of the patient’s regimen. Many don’t know which pharmacy to send the prescription to since not all locations have it, despite the federal “Test to Treat” program adding sites each week. Meanwhile, some patients are uncertain such a treatment is available, whether they qualify, or how to get it.

Smith has chronic lung issues and is used to advocating, sometimes stubbornly, for her health. She feels lucky to have a regular health care provider that she knows how to reach and that she eventually got her hands on the five-day course of 30 Paxlovid pills. Her symptoms have since faded.

“I’m fine,” she said. “But a lot of people would be sicker than me, and in life situations where they didn’t have the freedom to make six phone calls.”

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In some ways, the US is at a juncture that would’ve been unimaginable a year ago — in a good way. Most Americans are now vaccinated, and many are boosted, with vaccines that are extraordinarily good at reducing the risk of severe disease and death. And two antiviral pills, Pfizer’s Paxlovid and the less commonly used molnupiravir from Merck, are for the first time no longer in short supply. If anyone was looking for a sign that society can live with the virusthis is arguably it.

That makes this current swell of cases the first where the promise of antiviral pills — hailed as game-changers when they were first authorized in late 2021 — will be put to the test. During the earlier omicron surge that peaked in January, the pills were so new and scarce that only the very highest-risk people could get them and even then they were hard to find for many.

Some progress is being made locally. Contra Costa County has set up a 24/7 phone line to help connect residents with doctors who can prescribe Paxlovid, if appropriate. Marin and San Mateo counties are opening new Test to Treat sites where residents can get tested and, if they’re positive, get a prescription on the spot. Some Bay Area residents say they’ve been able to get Paxlovid quickly and easily, in some cases on the same day with minimal effort.

“It happened without a lot of fanfare but is a key milestone in our pandemic response,” said Dr. Matt Willis, public health officer for Marin County. “For the first time since the beginning of the pandemic, we have enough medication in Marin to effectively treat everyone who should be treated with COVID-19.”

“While vaccines are our best line of defense, they aren’t 100%,” Willis added. “Paxlovid can reduce the risk of death in people at highest risk by another 90%.” When you combine the two, he says, you get “a 90% reduction in risk of dying by being infected, and on top of that, an additional 90% reduction in risk of death if you receive timely and appropriate treatment.”

The result: “For the first time, we can visualize a community with zero COVID deaths.”

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