‘They are making it impossible’ for people to get antivirals: Ottawa doctor

Among other things, doctors have to attest that a patient is likely to live more than a year before they can refer them to be assessed for Paxlovid.

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Amy Ferguson finally held the elusive COVID antiviral Paxlovid in her hands Friday, after days of anxious efforts to get it.

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The Ottawa radio host, who is COVID positive and immune compromised, got the antiviral COVID-19 treatment at the 11th hour after jumping through numerous hoops during the week. It is only effective if taken within five days of symptom onset, which, for Ferguson, was Friday. She took her first dose just after noon.

But barriers continue to prevent most people, including the elderly and those who are highly vulnerable, from getting the drug that reduces the severity of COVID-19 at a time when cases are surging.

One 77-year-old Ottawa woman, who asked that her name not be made public, begged her doctor’s office for a Paxlovid referral this week after testing positive for COVID-19. She was told she “was not immune compromised enough” to qualify.

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She lives alone, is recovering from a stroke and has high blood pressure. Her family says they are worried about her.

Ottawa family physician Dr. Nili Kaplan-Myrth says both the system for getting the antiviral treatment to patients and the criteria around who is eligible are blocking access to it for most people, including those likely to become severely ill with COVID-19.

Among other things, doctors have to attest that a patient is likely to live more than a year before they can refer them to be assessed for Paxlovid. That would rule out many end-stage cancer patients, among the most vulnerable and most likely to suffer severe outcomes from COVID-19.

“We have to tell our patients, ‘You have cancer, you are probably not going to live more than a year, so we are going to let you die from COVID,’” Kaplan-Myrth said.

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“They are making it impossible for people to get it.”

Only a very small percentage of Ontario’s substantial store of Paxlovid has, so far, been used, although Premier Doug Ford and others have touted it as key to managing the current wave of the pandemic. Ontario had 40,000 doses on hand as of March 25 and was expecting regular deliveries. As of that date, just 300 courses of the drug had been dispensed through clinical assessment centers around Ontario, and 755 courses had been sent to hospitals for in-patient use.

People who are not vaccinated are the main group eligible for the drug, in addition to those, like Ferguson, who are immune compromised.

“Almost nobody in Ontario will be eligible except for people who went against medical advice and refused to be vaccinated,” Kaplan-Myrth said.

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People of all ages who are immunocompromised are eligible, as are people who are not vaccinated, depending on their ages and risk factors.

That sends a mixed message, Kaplan-Myrth says.

“They are undermining the message that people should get their third dose (of vaccine). They are saying, ‘You are going to get COVID-19 no matter what and we can treat you if you aren’t vaccinated, but not if you are’.”

While people who are not vaccinated have the most serious outcomes from COVID-19, Kaplan-Myrth noted there is still “real suffering” among people who have been vaccinated.

But, even for those who are eligible, she said, “good luck getting it on time.”

Amy Ferguson got the antiviral COVID-19 treatment at the 11th hour after jumping through numerous hoops during the week.  It is only effective if taken within five days of symptom onset, which, for Ferguson, was Friday.  She took her first dose just after noon.  Supplied photo
Amy Ferguson got the antiviral COVID-19 treatment at the 11th hour after jumping through numerous hoops during the week. It is only effective if taken within five days of symptom onset, which, for Ferguson, was Friday. She took her first dose just after noon. Supplied photo .jpg

Ferguson’s case illustrates that. She had a doctor who was advocating for her and even wrote her a prescription soon after she tested positive on Tuesday and she is a radio personality who told her story to the media. Even then, Ferguson, who has rheumatoid arthritis, got the treatment just in time for it to do any good.

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Others either don’t have doctors, aren’t tuned into the fact that they might qualify or are simply turned down because they don’t meet the restrictive criteria.

In Ottawa, it can only be distributed through the COVID assessment center at The Ottawa Hospital and patients can only get an appointment with a doctor’s referral after being tested. Most people don’t have access to PCR testing in Ontario now. As Ferguson found, jumping through the hoops to get assessed can take valuable time which could mean that, even for those who are eligible, it doesn’t get to them on time.

“I am cautiously optimistic that I will get them,” she said Friday morning on her blog while waiting for the drug. “It happened because I’m privileged to be loud for those in helpful positions to hear.”

During a CBC call-in show Friday, Dr. Peter Juni, scientific adviser to the province’s COVID-19 Science Advisory Table, agreed that the system needed to work better.

“When I hear you, it makes me pause, we need to do something about that,” he said in response to Ferguson’s story.

“There is a real issue with coordination.”

Juni says TeleHealth Ontario (which can be reached at 1-866-797-0000) is working on a process where calls about antivirals can be handled rapidly to help patients navigate the system.

“The process should get better over the next few days.”

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