Two newly authorized COVID antiviral pills began arriving at a small number of Bay Area medical centers and pharmacies this week. But the supply is so meager that drugs are unlikely to have a major impact in the current wave of omicron.

The number of pills allocated to each county is far exceeded by the amount of new infections reported each day. And supply is expected to be tight over the next few weeks, if not months, health officials have signaled, so that by the time the pills become more widely available, the worst of the omicron wave – which , according to modelers, will peak around mid-late January – will likely have declined.

The pills were only licensed in the United States about two weeks ago, and although drug makers started manufacturing them before that, it will take months to speed up complex production processes.

The limited availability of the pills, Pfizer’s Paxlovid and Merck’s Molnupiravir – along with national shortages of sotrovimab, the only monoclonal antibody infusion therapy that works against omicron – means that only a tiny proportion of people who could benefit from the drugs. treatments will be able to get them in the short term.

Pills and infusions prevent serious illness and hospitalization by treating COVID patients early during infection. The pills block the ability of the virus to replicate, while the infusions prevent the virus from infecting human cells. The pills have been hailed as the real game changers because they will make treatment more accessible – cheaper than infusions and can be taken at home.

“We have used up our entire supply of Paxlovid at this point, although we are quite restrictive about who can get the drug,” said Dr Sarah Doernberg, who is overseeing the rollout of COVID antiviral treatments at UCSF, who received 40 courses of the drug in the last week of December and ran out within a week. “On a public health level … we don’t have enough nationwide supply to really prevent hospitalizations and the spread of infections and other purposes of giving some of these very rarely available treatments.”

Most people who contract COVID are unlikely to need treatment, especially if they are vaccinated and have no underlying health issues. Additionally, omicron appears to cause less severe symptoms than previous variants. Yet for the millions of Americans who are unvaccinated, have weakened immune systems, or are vaccinated but at high risk due to age or co-morbidities, the drugs could save lives.

Due to supply restrictions and increasing demand, providers limit Paxlovid and sotrovimab to people at the higher end of the risk spectrum – those who are severely immunosuppressed and unlikely react to vaccination, or those that are unvaccinated and at high risk. risk of serious illness due to underlying conditions.

This is a change from just a few months ago, when patients could access monoclonal antibodies if they were only at a moderately high risk, like those who were vaccinated and have diabetes. or heart problems. But since then, two monoclonal antibody treatments have been stopped because they are less effective against omicron. This has narrowed the antibody options to one, sotrovimab, for the growing number of people who need them now. Many suppliers have run out of sotrovimab or have run out of sotrovimab, manufactured by GlaxoSmithKline and Vir Biotechnology.

Pills and monoclonal antibody treatments are allocated by the federal government to states, then state to local health departments, based on new case rates and a measure of equity.

Neither Pfizer nor Merck immediately responded to questions about why the pill supply is so limited. But the federal government announced this week that it is doubling its order of Paxlovid from 10 million to 20 million courses, although most will not be available right away due to the manufacturing delay. Only around 450,000 courses are expected to be available over the next two months nationwide.

In addition to supply constraints, the lack of predictability makes prescribing drugs difficult. Some providers did not receive their scheduled delivery of pills, or received them later than expected. Without knowing how much they will receive in the near future, providers struggle to tell patients when or if they can receive treatment.

And then there is the question of timing. The pills should be taken within the first five days of symptoms, but given the difficulty of getting tested immediately, it can be difficult, Doernberg said. For this reason, she recommends that people who know they are severely immunocompromised contact their provider immediately at the first symptoms of COVID so they can get tested quickly.

Of the two approved pills, Paxlovid is more effective, reducing hospitalizations by 88%, compared to 30% for Molnupiravir. The supply of Molnupiravir is slightly better, the providers say, but some consider it a less desirable option due to concerns that it could lead to a mutation of the virus in an immunocompromised patient.

California Health Secretary Dr Mark Ghaly said this week that the state is unlikely to see a huge increase in supply this month and looks forward to more in February and March.

Contra Costa County, for example, has so far only received 120 courses of Paxlovid and Molnupiravir, while 1,300 new cases are reported every day. Likewise, Sonoma County has also secured 120 courses, which will be distributed through three pharmacies. San Francisco has received 100 courses of Paxlovid and 500 of Molnupiravir, but at least 160 courses of the latter have been delayed and will not arrive until the end of this week.

“At this point there just isn’t enough to make a game-changer,” said Will Harper, spokesperson for Contra Costa Health Services. “120 courses is a drop in the ocean as we see over 1,300 new cases of COVID every day. “

The pills will be distributed to more than 5,000 pharmacies and providers across the country, including nearly 400 in California, according to federal and government officials. But not all of them have received the pills yet. And those numbers represent a very small percentage of providers and pharmacies overall. Each county in the Bay Area, for example, has nine or fewer locations receiving the pills, depending on the state.

“It’s difficult to fight this current wave with such a small number of treatment options,” said Deepak Sisodiya, pharmacy director at Stanford Health Care, who plans to receive and start prescribing antiviral pills next week. . “A half-full glass approach in the future, there will always be affected patients because this peak potentially subsides, there will always be a need because COVID will always be with us. “

Catherine Ho is a writer for the San Francisco Chronicle. Email: Twitter: @Cat_Ho

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