Even before the US president tested positive for Covid-19, Dr David Smith, an infectious disease consultant at the University of California, San Diego, said he was asking other doctors every day for advice on whether to prescribe Paxlovide, the antiviral drug. to patients with coronavirus.
Smith said the calls “are coming from doctors who haven’t been trained how to use the medication, so they’re a little hesitant about it.” “If I had a magic wand … one of the things I’d like to do is make more people comfortable with medication.”
Scrutiny over the potential benefits and drawbacks of paxlovide intensified last month after Joe Biden and his chief medical adviser, Dr. Anthony Fauci, received the drug to treat cases of Covid-19.
Infectious disease experts say a lack of knowledge about the drug — some of it is just new — and misconceptions about its benefits have limited the ability to protect patients from getting sicker from the virus.
“I think some clinicians, unfortunately, based on the misconception that Paxlovid doesn’t work or that it doesn’t work well, that it’s not a good option for patients who could benefit the most,” said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University’s School of Public Health. “I’m worried we’re robbing people of an important weapon.”
Paxlovid, developed by Pfizer and approved by the Food and Drug Administration late last year, is a combination of two antiviral drugs that “blocks the virus from multiplying,” said William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine.
This prevents the virus from causing more damage, Schaffner explained. According to the FDA, the drug reduced the need for clinical hospitalization by 88% for people with Covid-1 compared to patients who were given a placebo during the trial.
Paxlovid is intended for patients at risk of serious illness from the virus, such as older adults with underlying viruses, people with diabetes, heart and lung disease, and people with weakened immune systems, Schaffner said.
“The risk factors for being eligible for this drug are very broad: being overweight, being older,” Smith said. “Several co-morbidities like high blood pressure, diabetes really put someone at high risk and qualify for this drug.”
Despite its potential benefits, the drug is underused and likely to expire on the shelves, according to government data and reports from doctors in the US and elsewhere.
Infectious disease experts say this is because of the limited time the drug will be useful.
To be effective, the drug must be taken within five days of the onset of symptoms. But people don’t get tested right away when they have a sore throat or take a home test that initially comes back negative, until they take a second test a day later that shows they’re positive, explained Andrew Pecos, a Johns Hopkins virologist.
Many people don’t have an easy way to get to their primary care doctor or an urgent care center to get a prescription, Nuzzo said.
“The clock starts ticking, so you miss the opportunity to start treatment,” Nuzzo said.
To make it easier for patients to get the drug, this month the FDA allowed pharmacists to prescribe it to Covid patients.
But another big concern for providers and patients is the resurgence of Covid-19 symptoms after Paxlovide treatment. That’s what happened to Fauci, who was the president’s chief medical adviser during the pandemic. He told news organizations that his recovery symptoms were worse than before treatment, but improved after a second course of Paxlovide.
“The biggest question on people’s minds is whether they will experience re-infection,” Nuzzo said. “The calculation is very understandable for people who are at risk of serious illness, because it seems like a small inconvenience compared to the possibility of going to the hospital. But for people who aren’t at high risk, I think it’s questionable whether they’re really going to benefit. [Paxlovid]we don’t know how well it works in people who have been vaccinated and are not at high risk.
Paxlovid, like other drugs, has possible side effects – patients reported metallic taste and diarrhea. Doctors should also consider its interactions with other medications.
“It’s not the easiest medicine,” Pekosh said. “There are many conditions where paxlovide can be difficult to prescribe because of its side effects.”
To help get the most out of this new tool, infectious disease experts are recommending that people contact their doctor immediately if they contract Covid.
They also called for improving the education of doctors. Smith recommended that doctors review the National Institutes of Health’s treatment guidelines and attend regular medical education forums about the drug.
Another question on the public’s mind regarding Paxlovid is the effects on Biden’s health.
Paxlovide research “actually reduced the risk of hospitalization and death,” Smith said. “So I think he’s very aware of what’s going on and how he’s being treated, so hopefully it’s just a bump in the road.”