Just over 3,500 patients at risk of developing a severe form of COVID have to date benefited from Paxlovid in Quebec. A small number, given the thousands of treatments available which have still not found takers in pharmacies.
“Since we have been able to prescribe it, there have been many calls for it, but very few elected officials,” notes the president of the Association québécoise des pharmacists proprietors (AQPP), Benoît Morin, who fears that eligibility criteria for this drug are still too restrictive.
It is not access to this new antiviral that poses a problem, because since the 1er April, it can be obtained through any pharmacy in Quebec, without prior prescription from a doctor. Some 8,000 treatments are currently available behind the counter of pharmacies, explains the president of the AQPP, but very few have passed. In January, Quebec expected to receive more than 21,000 in three months.
Despite the enthusiasm generated by the arrival in pharmacies of this antiviral capable of reducing the risk of hospitalization and death by 89%, very few patients qualify for the criteria to obtain it.
According to figures obtained from the Régie de l’assurance maladie du Québec (RAMQ) by The duty, some 513 Paxlovid prescriptions were filled (487 by physicians) between March 17 and March 31. Since Quebec extended to community pharmacists the right to prescribe this treatment directly to their patients, some 3,006 prescriptions for Paxlovid have been filled between 1er and April 18, including 2042 by pharmacists.
“A lot of vaccinated and elderly people call us, but they don’t fit the program criteria. You must have moderate or severe immunosuppression. Even unvaccinated people under 60 must have serious risk factors like obesity, hypertension, diabetes, etc. insists Benoît Morin.
Escape the virus
Five days ago, unvaccinated Tania, 42, managed to get her hands on this preventive treatment, which she says saved her from landing in the emergency room.
Suffering from arthritis since the age of 27 and immunocompromised, Tania had decided in 2021 not to be vaccinated due to previous adverse reactions. The young woman, who also suffers from significant lung problems, has lived practically isolated from the rest of the world since 2020, with her spouse.
“I hardly see anyone, no friends, no family. At work, I am surrounded by plexiglass. She lives with fear in her stomach. With a suitcase always ready to go to the hospital, just in case.
A few days ago, after returning from a visit to her sister, her husband learned that she had just contracted the virus. What Tania had feared for months finally happened.
“From this call, we wore our masks in the house. But my spouse still received a positive test a few days later. Despite his isolation, I also got a positive result two days later. I woke up with a sore throat. »
Fortunately, Tania had already contacted her pharmacist to be evaluated and to obtain, in advance, access to Paxlovid if necessary. At the end of the afternoon, his condition had already changed considerably. “I had trouble breathing, I felt oppressed. The treatment was delivered the same day, around 5:30 p.m. “By midnight, my symptoms had diminished. I am on my last day of treatment and I have almost nothing left. We’ll see if it lasts,” she said.
Restricted
For Benoît Morin, information on Paxlovid does not reach all those for whom this treatment is intended. Many people at risk, especially unvaccinated, are unaware even of the existence of this treatment, or the fact that it must be started no more than five days after the onset of symptoms and after obtaining a positive test result (rapid or PCR).
“I don’t think we’re reaching 100% of the people it’s intended for. It might also be advantageous to broaden the access criteria a little, especially for vaccinated people who have fragile health conditions,” he says.
The majority of Paxlovid treatments prescribed in recent weeks have been for unvaccinated people, says Benoît Morin. The studies of the manufacturer Pfizer which demonstrated the effectiveness of this antiviral mainly concerned unvaccinated subjects. More data will be needed to know if this treatment can also benefit more vaccinated but vulnerable people, says Benoît Morin.
According to the latter, immunocompromised or unvaccinated people have every interest in already having rapid tests on hand in the event of infection. “These people also have access to PCR tests. I suggest that they go for a PCR test as soon as they know they have been in contact with an infected person. »
Paxlovid’s many drug interactions also limit access. “It was never a miracle solution. Nor should it be extended to patients, just to lessen their symptoms. Because the primary goal is to avoid hospitalizations, ”says the Dr Donald Vinh, infectious disease specialist at the McGill University Health Center (MUHC).
A very slow start
A survey of Globe and Mail revealed in early April that 90% of Paxlovid stocks available in Canada were, at that time, unused. In several provinces, as little as 3, 4 or 5% of available treatments had been prescribed.
The distribution of Paxlovid is also experiencing failures in several countries, particularly in the United States, where the obligation to obtain a medical prescription and the costs for obtaining a screening test limit accessibility.