Last week Australia’s deputy chief medical officer told GPs to be more proactive in raising awareness about new COVID-19 antiviral treatments with their patients at risk.
These drugs – nirmatrelvir–ritonavir (Paxlovid) and molnupiravir (Lagevrio) – are effective in preventing people from going to hospital and are believed to lower the death rate, which stands at more than 1,000 people per month.
Deployment was problematic and, as widely reported, many if not most people who were eligible for treatment missed.
The “missive” by Deputy CMO Professor Michael Kidd is the latest attempt to raise awareness of drugs – and the time constraints of obtaining them – among doctors and their patients.
Speaking to GPs, Prof Kidd said: ‘I recommend you start a conversation with your at-risk patients if you haven’t already.
One of the issues affecting the rollout is that patients must start taking the drug within five days of the first symptoms of COVID appearing.
Prof Kidd said: “As you know, it is essential that people start treatment as soon as they develop symptoms, so those at risk need to be tested quickly and antivirals started quickly.”
But for patients, it is not so simple. Between falling ill and accessing medicine, there are several obstacles to overcome.
How to access these drugs
Dr Chris Moy, an Adelaide GP and vice-president of the Australian Medical Association, has worked to identify and address deployment issues.
In a conversation with The new dailyDr. Moy listed the steps the patient should follow and what “should” happen:
- Patient develops symptoms of COVID
- They need to get tested as soon as possible
- If they have taken a PCR test, they will be notified by text that they are positive. But if they took a RAT at home, they must report the result to the state health department.
- What is “supposed” to happen then is that the patient is supposed to be referred to the national coronavirus hotline where their symptoms are checked over the phone. They will be asked their age, when symptoms started, do they have any pre-existing conditions, are they fully vaccinated, do they have compromised immunity
- At the end of the phone call, the patient is informed of their level of risk of developing a severe case and they may be eligible for antiviral treatment listed in the PBS.
- The patient is advised to contact their general practitioner as soon as possible
- The GP is contacted by the helpline
- The GP checks the patient’s medical history and medications and will determine which antiviral is the best and safest option.
- An e-prescription is sent to the pharmacy which will dispense the drugs.
“That’s what’s supposed to happen,” Dr. Moy said.
“But some people don’t have a GP. Or they can’t contact their GP because it’s the weekend. And that’s two days wasted.
He said each state has different contingencies to deal with this problem. “There are different back-up plans,” he said.
The patient may be referred to a respiratory clinic or a telehealth service.
Throughout all of this there is a sick person, who is probably getting sicker and sicker, trying to make this happen.
“Otherwise, how are they going to get there? said Dr. Moy.
“They can try to contact their GP if they’ve had a positive test, and that’s fine,” he said.
“But part of the problem is awareness. A lot of people don’t know they can do that.
Dr Moy said it remains a complex issue, partly because these drugs can be dangerous if taken with certain other drugs. Hence the need for a doctor who knows your history.
Who is eligible?
Patients must also meet the following eligibility criteria:
- Be 75 or older with an additional risk factor for developing a serious illness
- Be 65 years of age or older and have two other high risk factors for developing a serious illness
- Identify as Aboriginal and Torres Strait Islander and be 50 years of age or older with two additional high risk factors for developing severe disease
- Being moderately to severely immunocompromised.
Risk factors include not having at least two doses of a COVID-19 vaccine, being in an aged or disabled care facility, and having conditions such as insufficient heart disease, chronic obstructive pulmonary disease (COPD), neurological disorders, obesity, diabetes or cirrhosis.
Dr. Moy said a five-day course of either drug would cost upwards of $1,000. On PBS, they’re about $6.
The costs, the complexity of matching the right drug to a particular patient’s history, and knowing precisely when to take the drug (after a positive test) mean that drugs cannot be provided to at-risk patients as a ” just in case”. measure.
Dr Moy said that over time these antivirals could become standard treatment, similar to antivirals prescribed for HIV.
Meanwhile, it is hoped they will prevent more people from being hospitalized, especially with the aggressive flu season underway.
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