High-risk COVID-19 patients now have new treatments they can take at home to stay out of the hospital – if doctors get the pills for them quickly enough.
Health systems around the country are rushing out with prescription deliveries the same day. Some clinics have begun testing and treating patients in one visit, an initiative recently announced by President Joe Biden’s administration.
The goal is to get patients started on either Pfizer’s Paxlovid tablets or Merck’s molnupiravir capsules within five days of the onset of symptoms. It can prevent people with high health risks from getting sicker and filling up hospitals if a new increase occurs.
But the tight deadline has highlighted several challenges. Some patients delay testing because they think they have just had a cold. Others have been reluctant or unable to try the new drugs.
With vaccines and treatments available, “we can make this much more manageable in the future if people are willing to take care of themselves,” said Dr. Bryan Jarabek, who helps lead COVID-19 treatment and vaccination efforts for the Minnesota M Health Fairview health system.
The Food and Drug Administration approved the drugs last year. Doctors hailed the pills as a huge step forward in the fight against COVID-19, in part because of their convenience compared to other treatments that require infusions or injections.
However, patients may miss the short window of the pills if they reject symptoms such as headaches or snuff and wait to see if they go away before seeking help.
Stanfords Dr. Thomas Lew said he has seen high-risk and unvaccinated people who have been waiting more than a week. Some inpatients on oxygen have told him they did not think about their first symptoms.
“They say everyone in the family decided it was a cold season, or the allergy season was approaching, but it was COVID all the time,” he said.
People are delaying seeking help for many health issues, not just COVID-19, Lew noted. But when it comes to the virus, the doctor thinks patients may not be aware of the tight deadline.
However, even those who are tested quickly sometimes refuse the pills, doctors say.
Jarabek estimates that 30% to half of the patients who qualified for the antiviral pills rejected the treatments in his health system earlier this year.
He said some people did not consider themselves high risk or did not think they were sick enough to need the pills, which are free for patients. They also worried about side effects or how the drugs would interact with other drugs.
Jeff Carlson could not try Paxlovid when COVID-19 hit him in January because it could interfere with his heart medication. The 61-year-old resident of the suburb of St. Paul, Minnesota, has type 1 diabetes and heart disease.
A doctor asked him to try molnupiravir about three days after he began to feel symptoms. At the time, Carlson could not get up off the couch. His fever had risen and he was having difficulty breathing.
His wife picked up the prescription, and a few days later Carlson felt good enough to shovel snow.
“It basically turned me around during … pretty much 18 hours after I took the first dose,” he said.
Some healthcare providers have started free delivery services for Paxlovid or molnupiravir.
New York City has established a hotline that patients can call if they test positive for coronavirus. They can talk to a caregiver if they do not have a doctor and get pills sent if they are a good candidate.
The Mass General Brigham healthcare system in Boston started a similar program that sends pills to some patients via FedEx.
Raymond Kelly received a packet of Paxlovid about three hours after a doctor approved him for the prescription last month. The 75-year-old resident of Needham, Massachusetts, said he got the virus despite being vaccinated and receiving a booster shot.
His doctor spoke to him on the phone minutes after the health system informed him that he had tested positive.
“It was all blurry because it was going on so fast,” Kelly said.
Mass General Brigham aims to treat patients quickly and solve transportation problems with its program. Dr. Scott Dryden-Peterson noted that some COVID-19 patients may not be able to pick up pills, especially since they should stay away from buses and carpooling services.
“Transportation is not evenly distributed in our society,” he said.
For patients with transportation, the pharmacy chain CVS Health has launched “test to treat” programs in its nearly 1,200 stores with MinuteClinic locations. Pharmacists can not test and treat, so that program will not occur in all stores.
Other retailers like the grocer Kroger also plan to test and process in some places. The Biden administration has called on federally qualified health centers to do the same, but Health Minister Xavier Becerra recently told The Associated Press that the “test to treat” initiative could be hampered by a funding blindness with Congress.
Chicago’s Cook County Health has been running drive-through COVID-19 testing since the beginning of the pandemic. It plans to pilot a program that adds treatments. Patients will be able to drive to one of the tents, be tested, wait about 15 minutes for the result and then talk to a doctor through telemedicine, said Dr. Greg Huhn.
With opportunities for rapid care growing, doctors and public health officials say now is the time for people to fill up on home tests.
Test supplies that ran short during the omicron rise have since returned, said Neil J. Sehgal, a health policy expert from the University of Maryland. But he noted that future supplies will also depend on federal funding.
Doctors say people at high risk of developing COVID-19 health problems should stay alert to symptoms and seek help quickly, especially if another increase occurs.
“It may not be time to let your guard down,” Huhn said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Department of Science Education. AP is solely responsible for all content.
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