Sarah Moser finds it infuriating that three weeks after her 75-year-old father tested positive for COVID-19, he continues to suffer because he was denied an antiviral drug that could have eased his symptoms.
Paxlovid is intended for adults with mild to moderate COVID-19 at high risk of hospitalization or death. The five-day course is supposed to stop the virus from multiplying, allowing patients to recover faster.
“Oddly, being 75 and having a lung condition does not qualify my dad for Paxlovid,” said Moser, 49, a geography professor at McGill University in Montreal.
Her father, who lives in Victoria, has had several bouts of pneumonia and bronchitis, she said.
In B.C., a person with a mild to moderate case of COVID-19 who is within a five-day window of symptoms is eligible for Paxlovid if they are immuno-compromised or deemed clinically extremely vulnerable, or 70 and older with three or more other pre-existing serious diseases.
Eligibility criteria also extend to some Indigenous people and others 50 and older, depending on their chronic conditions and vaccination status.
By contrast, in Ontario, the drug is available to anyone 60 and older, and those 18 and older who are immuno-compromised or at high risk of severe illness due to having at least one other serious disease, such as liver, lung or kidney disease.
Moser said she and her husband, a neuroscientist, have read scientific literature on the drug and can’t understand why the antiviral is more available almost anywhere other than B.C.
Moser said her father was told by medical staff over the phone that he is “too healthy” and would need to have “three pre-existing conditions” to qualify, or he could be as young as 50 and unvaccinated, said Moser.
“So those who deny science and refuse vaccinations have the right to life-saving medication in B.C., and not vaccinated seniors with lung problems?” asked Moser. “There is no Paxlovid shortage, so there is no need to ration this drug for seniors.”
This month, provincial health officer Dr. Bonnie Henry said Paxlovid protects people at highest risk but is “not a panacea.”
It also has many interactions with other common medications that people at higher risk of having severe illness are prescribed, she said.
For example, it can react with drugs prescribed for at least 20 conditions, from high blood pressure to high cholesterol, liver problems, some cancers, kidney problems, gout, anxiety, and chronic obstructive pulmonary disease. It can also result in severe allergic reactions.
People who are pregnant or have HIV are advised not to take the antiviral. Health Canada says it’s not for patients hospitalized with severe symptoms or intended to be used longer than five consecutive days or in people younger than 18.
“So it is such a discussion between a clinician and an individual who’s at risk about receiving Paxlovid,” said Henry.
Henry said the COVID-19 Therapeutics Committee has been asked to re-examine the drug as more evidence on Paxlovid becomes available. “I’m hopeful that they will be making it more available.”
Nanaimo infectious disease specialist Dr. David Forrest said restricting the drug to those at highest risk who will benefit from it most “makes sense.”
The difficulty, said Forrest, is that figuring out who qualifies “is confusing and difficult and requires some navigating.”
“Because it’s been restricted, more often than not, I find that the patients that really would have benefited from this don’t access it because they don’t know enough about it,” said Forrest. His experience of late is that fully immunized people are not getting seriously ill from COVID-19, “which is quite astonishing.” Forrest recalls one COVID death in Nanaimo Regional General Hospital ICU in the last year.
He said Paxlovid is a highly effective antiviral that is more liberally prescribed in hospital settings, including for patients who contract the disease while in hospital. But he doesn’t think wider prescribing would make a substantial difference. For those who do take it, he believes concern around drug interactions have been “overblown” and said it’s not clear to him that there are serious consequences with a short course of therapy.
Last month, the UBC Therapeutics Initiative, which provides evidence about drug therapy to prescribers and pharmacists, released a report on the effectiveness of the treatment for people with new COVID-19 infections.
Lead author Dr. Colin Dormuth, associate professor in the department of anaesthesiology, pharmacology and therapeutics at UBC, said “there is no reason for lower-risk people, including elderly people, to rush to obtain Paxlovid if they have COVID-19.”
“On the other hand, we have found some evidence that Paxlovid may still help some people at high risk to avoid hospitalization or death, even after immunization and with the Omicron variants,” said Dormuth.
The report said Health Canada licensed the drug in January 2022, after Pfizer released results of a trial July through December 2021 in 20 countries showing “a statistically significant reduction of hospitalization and death” in high-risk patients treated within five days of symptom onset.
Patients in the trial, however, were not vaccinated and they were infected by the Delta variant circulating during 2021. (The Omicron variant is now the variant of concern and several rounds of boosters have been offered).
A second study of lower-risk participants from 20 countries run by Pfizer, the maker of Paxlovid, was stopped in June 2022 after finding no statistically significant reduction in hospitalization or death and no reduction in COVID-19 symptoms. Dormuth said Therapeutics Initiative tried to replicate Pfizer’s trial using the four groups allowed under B.C. rules to have the drug treatment last year.
The study found “significant protective effect” in two of the highest-risk groups, and a modest reduction in hospitalization or death in the third group, “but we have yet to see any reduction in hospitalization or death in the expanded eligibility group, which would be more like a standard-risk population,” he said.
About three-quarters of the people in the expanded eligibility group were over age 70, said Dormuth, “and we don’t see a reduction in deaths or COVID-19 related hospitalization in that group.
“So I think what the province has done is very reasonable and that the criteria they’re using seems to correlate with focusing the drug on the people who might benefit,” said Dormuth.
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