Why aren’t doctors prescribing anti-COVID drugs?

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When COVID-19 was declared a pandemic in 2020, we were completely unprepared. There were no drugs, no vaccines and little information about how the virus spread from person to person.

Now, however, we have many more tools to combat this life-threatening disease. Vaccines have been developed in record time and new antiviral drugs are now available.

Many people are acting as if the pandemic is over. We wish that were true. About 1 million people have already died in the United States from the coronavirus. About 500 people continue to die from this infection every day.

When Merck and Pfizer announced that the Food and Drug Administration granted emergency use authorization for oral COVID drugs, everyone was excited. Finally, there were easy-to-take medications that could reduce the risk of complications, including death.

At first, Paxlovid (nirmatrelvir plus ritonavir) and Lagevrio (molnupiravir) were rare. Doctors reserved their use for very high-risk patients. There were stories of patients driving for hours trying to find a pharmacy that could fill a prescription.

Now, however, these antivirals can be found on pharmacy shelves. They’re no longer rare, but doctors don’t write many prescriptions anymore. According to Dr. Anthony Fauci, Paxlovid “is underutilized”.

For the greatest benefit, these antiviral drugs should be taken early in an infection. This is also true of oral flu treatments such as Tamiflu (oseltamivir) and Xofluza (baloxavir).

To prevent the virus from replicating and overwhelming the immune system, these drugs should be prescribed as soon as a person tests positive. But this does not always happen.

Why aren’t people excited about these drugs? And why aren’t they used more frequently?

Some doctors may feel like they don’t know enough about the pros and cons of these relatively new COVID drugs. Others may worry about drug interactions. Incompatibility can be a serious issue with Paxlovid, but if doctors and pharmacists do their homework, patients could be protected from COVID complications.

FDA guidelines on who should receive the drugs can also be confusing. Initially, these antivirals were reserved for high-risk patients. However, that could soon change.

Another suggestion that has been made is that pharmacists prescribe and dispense these antiviral drugs to people who test positive for coronavirus. They would be able to check for drug interactions or other contraindications before providing the pills.

Doctors, however, rejected this idea. The American Medical Association issued a statement saying that “the pharmacy-based clinical component of the test-to-treat plan flaunts patient safety and is likely to have significant adverse health effects.”

Another new oral drug, sabizabulin, has performed well in clinical trials. Its manufacturer will seek emergency use authorization, as the trial was terminated prematurely due to positive results.

None of these antiviral drugs will change the course of the pandemic unless people can access them. Covid is not over. The new omicron variant, BA.2, is spreading rapidly. It is time for prescribers to learn to use all the tools at their disposal.

Navigating the Pandemic
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