The White House just announced a “test to treat” program that’s a great, but not perfect, way to deal with future COVID infections. The program focuses on rapid access to Pfizer’s antiviral drug Paxlovid, something I’ve written about many times, most recently here, here, and here.
As Professor Katherine Seley-Radtke and I wrote in the Baltimore Sun in June 2020, “Vaccines may not be the only way to treat COVID-19.” Indeed, it turned out to be the case. While vaccines have helped keep COVID under control and have dramatically reduced both hospitalizations and deaths, the emergence of more deadly and highly contagious variants, Delta and Omicron, respectively, has changed the infection landscape. from 2020 to 2021. The original vaccines were never designed. to handle these variations. It’s no one’s fault; no one could have predicted Delta and Omicron. But these variants and (presumably) those that may emerge in the future can very well be handled by Paxlovid, which remains effective regardless of the variant in question.
But like any other antiviral drug, the earlier it is given, the better. Paxlovid is 90-100% effective in reducing deaths and hospitalizations when taken within five days of onset of symptoms. This raises a problem, which Dr. Jeffrey Singer of the Cato Institute (and an ACSH adviser) and I discussed in a recent editorial in the New York Daily News: the lack of an effective system to deliver the drug to sick patients in a rational and timely manner. The “test to treat” plan does just that.
How it works
- Drug availability is no longer a critical issue as it was months ago. And more than a million doses will be available this month and twice as many as in April.
- The administration will work with Pfizer to facilitate delivery of the drug.
- “One-stop-shop” centres, where people can be tested, presumably with more accurate tests, and the pills given to anyone who tests positive.
- These centers will be located in pharmacies, supermarkets and long-term care facilities.
- It should be possible for infected people to start treatment within a day of diagnosis without jumping through hoops.
But it’s not perfect
For people who aren’t on prescription drugs, the plan is simple, but, as I wrote about last month, Paxlovid consists of two different drugs: nirmatrelvir, the antiviral drug, and ritonavir, a ” booster,” which dramatically decreases the metabolism of nirmatrelvir, allowing it to stay in the blood at higher levels for longer. (See The drug that makes Paxlovid so effective may also make it dangerous.) Ritonavir can cause serious problems for people taking certain prescription drugs such as statins (for high cholesterol), antiarrhythmics, blood thinners, sedatives and at least two asthma medications.
This is where the program might run into difficulties. To prevent dangerous drug interactions, the dispensing pharmacist should have an accurate list of other medications (and herbal supplements) taken by each patient.
At the end of the line
As variants have undermined the effectiveness of vaccines, we are fortunate to have a treatment to add to the arsenal. The administration’s plan to facilitate access to this treatment is very solid. We will all benefit from quick and easy access to Paxlovid.