Study Reveals Why High-Risk Patients Are Not Receiving COVID-19 Antiviral Drugs
The COVID-19 pandemic has taken a toll on the world, and health officials have been searching for ways to reduce the risk of severe illness or death. Antiviral medications like Paxlovid have been hailed as a potential solution, but studies have found that these drugs are not being used to their full potential. A group of researchers in Boston set out to understand why this is happening and what can be done about it. Their findings, published in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, shed light on the issue and suggest that more education is needed for doctors to ensure that high-risk patients receive the necessary treatment.
The researchers, from the VA Boston Cooperative Studies Program, analyzed records from the Veterans Health Administration to investigate what happened to high-risk patients who did not receive Paxlovid, remdesivir, or molnupiravir. They focused on 110 patients who had received organ transplants or had other medical conditions that left them immunocompromised and at a higher risk of severe illness from COVID-19 despite being vaccinated. The analysis revealed that 20% of these patients declined the drugs when offered, but a staggering 80% were never even offered the treatment in the first place.
There were various reasons why medical providers decided not to administer the COVID-19 drugs. Some were concerned about potential interactions with other medications that patients were already taking, such as cholesterol-lowering statins or drugs used to prevent organ rejection after transplantation. In other cases, doctors hesitated because their patients had experienced COVID-19 symptoms for more than five days, which is beyond the recommended window for receiving Paxlovid.
Surprisingly, none of the medical records mentioned concerns about “Paxlovid rebound,” a phenomenon where symptoms recur after treatment. However, in almost half of the cases where patients were not offered the medication, no reason was given other than the patients having mild symptoms. This is particularly concerning because patients with mild symptoms early in their illness are the exact target group for receiving the treatment.
The drugs are recommended for individuals with mild-to-moderate COVID-19 who are at high risk of severe illness due to their age or medical conditions. These are the same patients that the Boston researchers were studying. The CDC advises doctors to treat high-risk patients within five days of symptom onset rather than waiting for symptoms to worsen. Dr. Davey Smith, an infectious disease specialist at UC San Diego, emphasizes the importance of early treatment, as it is unpredictable whether symptoms will become more severe. Waiting until the fifth or sixth day may be too late to administer these medications.
Dr. Paul Monach, the lead author of the study and head of the rheumatology section at the Veterans Affairs Boston Healthcare System, suggests that physicians need more education on when to consider using these drugs. Additionally, patients should be encouraged to reach out to medical providers as soon as they start experiencing symptoms. The study also revealed that some patients had gone home before receiving their coronavirus test results, and medical staff did not mention the possibility of antiviral medication during follow-up calls.
The underuse of antiviral medications like Paxlovid has been a concern since they became available. A national survey conducted by the COVID States Project found that only 11% of people infected with COVID-19 between May and early July 2022 reported taking antivirals. Among individuals over the age of 65, a higher-risk group, the rate was slightly higher at 20%. Another study focusing on patients in the Veterans Affairs health system discovered that less than a quarter of outpatients who tested positive for COVID-19 were receiving any form of anti-COVID medication.
Furthermore, there are alarming disparities in access to Paxlovid, with Black and Latino patients receiving treatment at significantly lower rates than white and non-Latino patients, even among immunocompromised individuals. Dr. Smith expresses frustration with his colleagues for not utilizing these medications, especially for patients with weakened immune systems who are still being hospitalized and dying from COVID-19.
Dr. Richard Dang, an assistant professor of clinical pharmacy at USC, believes that it is worth discussing the option of taking Paxlovid or another antiviral medication when someone tests positive for COVID-19. These medications are most effective for high-risk individuals, a broader group than many people realize. This includes individuals who are overweight, have asthma or heart conditions, and even those from racial and ethnic groups that have experienced worse outcomes from COVID-19. Dr. Dang emphasizes that the risks of taking these medications are minimal compared to the benefits of preventing serious illness and hospitalization.
The underuse of antiviral drugs like Paxlovid is a concerning issue that needs to be addressed. Physicians need more education on when to consider using these medications, and patients should be encouraged to seek
