Antiviral pills help usher in new phase of COVID-19 pandemic

When Brian Robbins of Lewiston contracted COVID-19 in early March, he was offered something relatively new for patients falling ill with the virus: a five-day course of the antiviral medication Paxlovid.

“My doctor called me and asked me if I’m willing to try the drug. I agreed because I thought it couldn’t hurt anything,” Robbins said. “I took it, and it seemed to work. My symptoms stopped getting worse, and then I started to get better.”

Paxlovid, which is taken in pill form, is helping usher in a new phase of COVID-19 as the disease shifts from a pandemic marked by surges of infections and hospitalizations to an endemic, in which the virus is present but can be kept under control through better medical tools. Along with vaccinations to protect individuals from disease and limit the spread of the virus, accessible and convenient treatments such as Paxlovid are expected to reduce severe disease and reduce hospitalizations and deaths.

The Biden administration has ramped up supplies of Paxlovid, with deliveries going from about 100,000 every other week in February to 175,000 courses of treatment per week in early March. The pill first became available on a very limited basis in December. Previously, treatments for COVID-19 were limited to expensive infusions that had to be given in a hospital or outpatient setting.

When Brian Robbins came down with COVID-19, he took the new Paxlovid pills, which he believes helped. He is vaccinated and boosted but was at higher risk for COVID because he had just finished radiation treatment that had suppressed his immune system. Ben McCanna/Staff Photographer

Robbins, 64, said even though he was vaccinated and boosted, his immune system was in a weakened state because he had just finished a round of radiation treatment for prostate cancer. He said he can’t prove the Paxlovid pills helped resolve his symptoms – which included a scratchy throat, chest and nasal congestion and chills – but he feels like it probably helped.

ELIGIBILITY LIMITED TO THOSE AT RISK

The pills are shown to be nearly 90 percent effective at preventing hospitalization, according to the U.S. CDC. Because supplies are limited, not everyone who tests positive is eligible to receive Paxlovid.

Packages of Paxlovid Shawn Patrick Ouellette/Staff Photographer

Currently, it is recommended for people age 12 and older who have a high risk for hospitalization, such as obesity, cancer, diabetes, immune conditions, age and a number of other risk factors. Vaccination status is not a factor in eligibility for Paxlovid.

As a cancer patient who recently underwent radiation, Robbins qualified, and he said he feels much better and is now back at work as a contractor in the solar power industry.

Karen Jimenez, 56, of South Thomaston, said she contracted COVID-19 in late January. She’s vaccinated and boosted but qualified for Paxlovid because she has rheumatoid arthritis, which suppresses her immune system. Jimenez said she’s not sure if the pills helped, but “if they helped me to recover and not get anybody else sick, that was a huge benefit,” she said.

Jimenez, 56, said she had body aches, severe headaches, swollen glands, hoarseness and fatigue, and it took her about three weeks to feel significantly better. She is still dealing with some hoarseness and fatigue, but has been able to return to work as an in-home physical therapist.

TREATMENT FREE

Paxlovid consists of two drugs, nirmatrelvir and ritonavir. Nirmatrelvir inhibits the coronavirus protein, which stops the virus from replicating, according to the Food and Drug Administration. Ritonavir is an agent that helps nirmatrelvir “remain in the body for a longer period at higher concentrations,” which makes the drug more effective at fighting COVID-19, the FDA said.

Paxlovid costs $530 for a five-day course of treatment, but the Biden administration is making it free for patients.

Before the arrival of Paxlovid, monoclonal antibodies were the most common treatments for COVID-19. Monoclonal antibody treatments, which are given as an infusion, work by blocking the coronavirus from attaching to cells, making it harder for the virus to replicate.

But while two of three monoclonal antibody treatments were discontinued because they were shown to be ineffective against omicron, Paxlovid is holding up against the omicron variant, at least three studies have shown.

Dr. Kendra Emery, the medical director for COVID-19 treatment facilities tied to Pen Bay Medical Center in Rockport and Waldo County General Hospital in Belfast, said Paxlovid is “really impressive” at preventing hospitalizations and making the disease less severe for patients.

“It’s really an effective treatment option, and much more convenient,” Emery said. “It’s moved to the front of the line with what we are offering our patients.”

PROMPT ACTION IS KEY

The medication is most effective when given shortly after contracting COVID-19, which is one limitation, said Dr. Laura Blaisdell, a South Portland pediatrician and infectious disease expert.

“Once you get sick, you have to test right when you start having symptoms, and you have to start taking the medications early on,” Blaisdell said. “There’s no, ‘Oh, I thought it was just allergies’ and wait.”

Patients who test positive and might be eligible for the medication need to contact their doctors for a prescription. The Biden administration plans to roll out a program this year that will allow a patient to get tested at a pharmacy and, if positive, receive the receive free pills on the spot with a pharmacist’s prescription.

Blaisdell said Paxlovid – when taken shortly after falling ill – does a great job of reducing the burden on hospitals and the health care system. Even if cases begin to surge again, Paxlovid will be a key tool to prevent patients from overwhelming hospitals.

Emery said there’s enough supply of Paxlovid to meet demand under current eligibility standards, and it’s possible restrictions on which patients can access the drug could be loosened. But Congress is currently debating funding to continue the fight against COVID-19, including funding for vaccines and treatments, and White House officials have warned that if the relief package is insufficient it could hamper the response if there’s another major spike similar to the omicron surge this winter.

Emery said Paxlovid is helping society move to another phase of the pandemic, when the health care system has not only vaccines, but also effective treatments that can make the disease less severe.

“You can see the transition that we’ve made since the pandemic began, from pre-vaccine time, to having vaccines, to a pre-treatment era of the pandemic to now. It (Paxlovid) makes a huge difference. For patients, the progression of the disease is much more mild.”