Antiviral COVID treatments are hailed as a pandemic game-changer, but they're currently in very short supply — and that's only one of several barriers to access for high-risk patients.
The big picture: Even when supply ramps up, it will still be tricky to connect some of the most vulnerable patients to the pills without changes to the process.
Why it matters: Recently approved antivirals reduce the risk of hospitalization and death by up to 89%.
- But patients have a relatively short window of time to begin the treatment regimen once they're diagnosed, meaning that access to timely testing, a provider who can write a prescription, and the pills themselves are all critical.
Between the lines: These three distinct steps each come with their own difficulties, making the path from diagnosis to treatment a convoluted race against the clock.
- Both Merck and Pfizer's antivirals were recently authorized by the FDA to treat mild to moderate COVID following a positive test in high-risk patients (Pfizer's performed significantly better in clinical trials). Treatment should begin within a few days of symptom onset, and can't be initiated after a patient is hospitalized.
- "Early treatment depends on early testing, which means that people need to have access to reliable testing right after they start developing symptoms," said Leana Wen, an emergency physician and a professor at George Washington University.
- "The test has to come back ideally the same day, and there needs to be clear guidelines about what tests are acceptable.”
Once someone tests positive, they need to get a prescription for an antiviral from a provider.
- Some providers aren't yet writing prescriptions for the antivirals, Wen said, and many patients don't know where to go to get a prescription.
- And finally, once a patient has a prescription, they have to find the pills themselves, which are in short supply around the country. GoodRx recently launched a website that tracks antiviral availability.
What we're watching: In the short-term, the most at-risk patients should make a plan for how they'll access antivirals should they test positive for COVID, Wen said.
- Many of these people, such as cancer patients or organ transplant recipients, already interact heavily with the health care system. It would make sense to target supplies to the doctors' offices and facilities that treat these patients.
- But in the longer term, when more pills are available to a larger pool of high-risk people, one way to ensure the right people get access to them is to package all of the steps together.
- "Ideally, this could all be streamlined into one visit," Wen said, describing a COVID care center where a patient could receive a test, consult a physician, get a prescription and pick up the pills.
The bottom line: "Standing up a robust test-and-treat capability to provide access to oral antivirals will be a massive challenge globally," said Krishna Udayakumar, director of the Duke Global Health Innovation Center.
Editor's note: This story was first published on Jan. 26.
