One in demand across the country is an oral antiviral, paxlovid, which is intended to be given to people at high risk of developing severe COVID-19 soon after symptoms start.
In clinical trials, it was around 90% effective at keeping high risk COVID-19 patients out of the hospital and alive.
“It is extremely promising, but extremely limited,” said Dr. Joe Morman, a family physician and Springfield Regional Medical Center associate chief clinical officer.
In the Springfield area, Morman said he thinks they have only gotten to treat around 20 people and right now have no doses available.
“We get updated every day or two about the supply, and that has sat at zero for a long time,” he said.
Paxlovid also can have negative interactions with some common medications, like birth control pills and blood thinners.
Another antiviral, molnupiravir, has less medications that it negatively interacts with, though shouldn’t be given to pregnant patients. It is also less effective than paxlovid -- in trials it lowered the risk of COVID-19 hospitalization or death by around 30% for those at high risk.
Stepping up production of these drugs is a complex process; Associated Press previously reported paxlovid takes six to eight months to manufacture. Pfizer expects to increase production over the year.
Meanwhile cases and demand are both high.
“The whole world is going to want paxlovid,” Morman said.
There’s extra pressure to increase supplies of these drugs because two monoclonal antibodies have not held up against the fast-spreading omicron variant, which now accounts for almost all U.S. cases. The FDA advises to no longer use these, and the drug manufacturers Regeneron and Eli Lilly agreed with the call.
“In Springfield, we are not providing that anymore, just because omicron is the predominant variant,” Morman said.
Another monoclonal antibody has been shown to be effective, sotrovimab, and Morman said when it becomes available in Springfield, they will be giving it out.
“The good news? There is stuff, but the bad news is there’s not enough of it and it’s not in our area right now,” he said.
Remdesivir, an antiviral drug given by infusion, was first given for hospitalized patients and more recently has been used to treat outpatients.
“It does require coming into the infusion center, or some people have gotten like a first dose at the emergency room and then second and third doses at our infusion center as an outpatient,” said Dr. Jeffrey Weinstein, Patient Safety Officer for Kettering Health, which operates a network of southwest Ohio hospitals.
While supplies of these new medications is overall low, availability ranges from community to community. The new drugs are now limited, generally, to those at highest risk of severe disease or competition.
“To give you an example, when we first got the oral medication paxlovid, which is the drug that’s made by Pfizer, we only got 20 treatment courses. Two. Zero. And obviously that’s not going to go very far when we have thousands of patients in the region,” Weinstein said.
“Unfortunately, while we do have some of these newer therapeutics, because of the very limited numbers, it’s a very restricted number of individuals that are going to be able to get them and are usually going to be those that are at highest risk of severe disease or complication,” Dr. Roberto Colón, Miami Valley Hospital chief medical officer, said.
One drug, Evusheld, is the only non-vaccine authorized to prevent infection from COVID-19, to be given before someone is exposed to the virus, according to the CDC.
Given as an intramuscular injection, the monoclonal antibodies can help immunocompromised patients who can’t get a strong protective response from a COVID-19 vaccine. For example, transplant patients might be good candidates, or people with severe allergies to vaccine ingredients, according to the FDA.
The FDA states Evusheld was authorized for emergency use the first week of January. In a clinical trial of about 5,000 participants, Evusheld recipients saw a 77% reduced risk of developing COVID-19 compared to those who received a placebo. Manufacturer AstraZeneca said later in December that a lab study found the drug still held up against omicron.
The medication is in very limited supply. Like the other new drugs, in Ohio, health networks are generally the ones distributing and triaging the medication.
“We only have two doses in all of Springfield,” Morman said.
Along with the new medications, he said they continue to use other treatments. Some patients can be helped with inhalers. Some are good candidates for steroids.
And physicians continue to emphasize that vaccines are the gold standard for preventing COVID-19 and severe disease.
“Prevention is always better than treatment,” Weinstein said.
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