Oral medications that prevent COVID-related hospitalizations, deaths are not widely used
Canada's abundant supply of Paxlovid, a potentially life-saving COVID-19 treatment, has gone largely unused - an oversight that experts say may have led to an unnecessary number of deaths.
Patricia Johnston, 72, from Edmonton recently caught a severe case of COVID-19. He said he sought a prescription for Paxlovid from his doctor to help prevent the worst effects of the disease.
The treatment, which was approved by Health Canada in January, has reduced the incidence of hospitalizations and deaths in clinical trials and real-world settings.
Paxlovid treatment should be started within five days of the onset of symptoms. Johnston said he asked for a prescription on day three.
Johnston said he was turned down, that he was told he didn't meet Alberta's guidelines for oral medication — a pill regimen designed for high-risk patients like seniors and the immunocompromised, among others.
'I'm terrified'
Shortly after he was denied access, he said, his condition changed. What started as a bout of the usual symptoms—sore throat and chest cough—quickly deteriorated into COVID-related digestive issues.
He said his symptoms were so severe - excruciating headaches and constant dehydration - that he needed immediate medical attention.
"I was very, very sick. I had a terrible headache. I had such severe nausea, dizziness and vomiting that I had to go to the emergency room," Johnston told CBC News. "I'm scared."
Johnston said his COVID ordeal continued after he was discharged. He spent almost a month feeling unwell, even after he started testing negative.
He said Paxlovid should have been made available to him, a senior, to help make the whole experience less tiring.
"COVID is a brutal, brutal virus. I want to protect myself," he said.
Johnston says Paxlovid Alberta's guidelines for outpatient use are too strict.
And Alberta's criteria are more stringent than in some other jurisdictions.
Under Alberta rules, patients aged 70 or older like Johnston can access treatment only if they have COVID and at least two other pre-existing health conditions – such as diabetes, obesity, congestive heart failure, chronic kidney disease or chronic obstructive pulmonary disease . (COPD). Younger, unvaccinated, and First Nations people have different criteria.
In comparison, in Ontario, every COVID patient over the age of 60 is eligible for a Paxlovid prescription. Younger people in Ontario can also access treatment if their immune system is weak or at high risk of a severe case of COVID.
"I think the decision whether a patient should get Paxlovid or not should be between the doctor and the patient. The guidelines are definitely in place but the final decision should be up to the doctor. The government should not get involved," said Johnston.
"I believe I don't have to suffer through everything I have Paxlovid. We can reduce the effects of the disease if we use all available tools."
Alberta Health Secretary Jason Copping declined a request for an interview from the CBC.
Dr. Zain Chagla is an infectious disease expert and professor of medicine at McMaster University in Hamilton. Chagla was one of the first doctors to start a COVID treatment clinic in Canada.
Chagla told CBC News that while COVID-19 is less of a problem now than in past years, it is still a deadly virus.
Nearly three years since the start of the pandemic, an average of 40 people are still dying of COVID every day in Canada.
"We're not seeing the same significant health care burden as we did in previous years. But definitely there are still groups who are sick, and sick enough to go to the hospital and ... sick enough to die. We need to use all the tools that we have to navigate this pandemic," Chagla said.
He said Paxlovid is "really a useful tool but it's only useful when it's actually being given to people."
'It's... so easy to pick up'
Data from Israel, the US, and Ontario shows the drug can "significantly reduce hospitalizations and reduce deaths in people at high risk," Chagla said.
"It's also very easy to take. It's only a pill for five days."
"I think raising awareness and education among healthcare professionals is something we can help with," said Tam.
Doctors themselves should also do more to educate the public about the potential benefits of treatment, he said.
"We can do more together in that area, especially those with high-risk conditions or the elderly," said Tam. "This can significantly reduce hospitalizations and deaths in high-risk groups, especially in the elderly."
Federal Health Minister Jean-Yves Duclos said supply should not be a problem for provinces and territories - there is a lot more to be done.
"We will be there to share whatever the provinces and territories need to treat patients," he said.
The federal government has ordered 1.5 million courses of the Paxlovid medication.
According to federal health department figures, Canada has budgeted $2 billion for COVID treatment — not including vaccines — and the majority of that amount has been allocated to Paxlovid.
To date, 745,465 treatment courses have been distributed to provinces and territories, the Canadian Corrections Service, the Department of National Defense and Canada's Indigenous Services. Another 754,535 treatment courses will be administered over the next two weeks.
But given how little has been used to date, there's a risk the Paxlovid kit could go to waste.
Alberta has received 86,000 doses of Paxlovid from the Public Health Agency of Canada. As of December 12, about 10,200 Alberta residents have received the treatment.
In Saskatchewan, the numbers are even lower. Of the 24,050 courses the province has received, only 1,529 have been used as of 11 December. That's about six percent of the total.
To help ease access, Ontario recently joined Quebec, Alberta, Saskatchewan, and Newfoundland and Labrador to allow pharmacists to prescribe Paxlovid.
That means most patients in the province can skip calls to the doctor altogether — something that will make it easier for sick patients to get treatment within five days.
Scott Watson is a pharmacist at Watson's Pharmacy in Ottawa. He said he heard from a number of COVID patients who wanted to get Paxlovid. The calls often come at night or on weekends when access to a family doctor is limited, he said.
Before the Ontario government released pharmacies to prescribe Paxlovid, Watson's hands were tied. Now, a pharmacy can become a one stop shop.
But Watson cautions that Paxlovid isn't for everyone. It is incompatible with some medications.
Health Canada has published a long list of drugs that can interact with Paxlovid.
"We have to do research to make sure there is no interaction, that their body functions are OK - their liver and kidneys," Watson said. This article was written by EDUKASI CAMPUS.