Easy-to-take antiviral pills, authorized just before Christmas, were hailed as a potential turning point in the fight against the coronavirus because of the medicines’ ability to keep high-risk people out of the hospital.
But doctors say the limited initial supply of the pills, especially Pfizer’s Paxlovid, means they are unlikely to alleviate the strain on many hospitals confronting climbing admissions and staffing shortages made worse by omicron infections. In communities with soaring case numbers, physicians are especially eager to offer the pills, which people can take at home to avoid serious illness.
“I don’t think they’ll end up being the game changers we want them to be,” because of scant supply, said Shelley Schmidt, a critical care physician and pulmonologist in Grand Rapids, Mich., who doesn’t expect to have access to the antiviral pills until mid-January.
President Joe Biden acknowledged the drugs’ scarcity in his remarks on the pandemic Tuesday, but said the government is doubling its order of Pfizer’s antiviral to 20 million treatment courses this year, which he said would be distributed as the drug is manufactured.
“They are already saving lives,” Biden said of the medication. “But due to the complex chemistry of the pills, to make the pill, it takes months literally to make a pill.”
The president emphasized the drug’s potential to alter the pandemic’s impact on Americans. “These pills are going to dramatically decrease hospitalizations and deaths from covid-19,” he said. “They’re a game changer.”
That impact hasn’t been felt yet in Grand Rapids. Schmidt said hospital admissions for covid-19 are mounting in Spectrum Health’s Blodgett and Butterworth hospitals, where she treats patients – with the unvaccinated accounting for most of the severe infections. She worries that the pills’ efficacy may also be limited by the narrow window for their use. Many people don’t seek treatment until they are experiencing severe symptoms, she said, and by that time it is often too late to prescribe the antivirals, which must be taken within a few days of the first symptoms.
“We’re seeing our patients really gasping their last breaths of life,” Schmidt said. “These are healthy people in their 30s, 40s and 50s. We are in the room when they are on their FaceTime phone call with their spouse, telling them that they’re the love of their life and apologizing.”
She added that physicians are “always happy for any help we can get, but it’s very hard to get these early therapies into the regular population.”
In late December, the Food and Drug Administration granted emergency use authorization for the two antiviral drugs – Pfizer’s Paxlovid and Merck and Ridgeback Biotherapeutics’s molnupiravir – as omicron began to overtake delta as the most prominent variant of the novel coronavirus in many parts of the country. The antiviral pills, alongside the monoclonal antibody sotrovimab, are among the few outpatient treatments shown to be effective against the omicron variant.
Although the government has already purchased 10 million courses of Paxlovid and 3 million of molnupiravir – and has distributed 365,000 so far – the national supply of the antiviral pills will be low for several weeks as the drug companies ramp up production.
About 65,000 courses of Paxlovid, which reduced hospitalizations and death for high-risk people with covid-19 by nearly 90% in clinical trials, have been distributed to states on the basis of a population formula.
Populous states such as California, Texas and Florida received thousands of courses, and many less-populous states, such as Wyoming and Vermont, received proportionally fewer, in some cases fewer than 150 units. Each treatment course contains 30 tablets to be taken over five days.