High-risk COVID-19 patients now have new treatments they can take at home to stay out of the hospital — if doctors get the pills to them fast enough.

Health systems around the country are rushing out same-day prescription deliveries. Some clinics have started testing and treating patients in one visit, an initiative that President Joe Biden’s administration recently touted.

The goal is to get patients started on either Pfizer’s Paxlovid tablets or Merck’s molnupiravir capsules within five days of symptoms appearing. That can prevent people with big health risks from growing sicker and filling up hospitals if another surge develops.

But the tight deadline has highlighted several challenges. Some patients are delaying testing, thinking they just had a cold. Others have been unwilling or unable to try the new drugs.

With vaccines and treatments available, “we can make this much more manageable in the future, if people are willing to take care of themselves,” said Dr. Bryan Jarabek, who helps lead COVID-19 treatment and vaccination efforts for the Minnesota health system M Health Fairview.

The Food and Drug Administration authorized the drugs last year. Doctors hailed the pills as a huge advance in the fight against COVID-19 partly because of their convenience compared to other treatments that require infusions or injections.

But patients can miss the pills’ short window if they dismiss symptoms like a headache or sniffles and wait to see if they go away before seeking help.

Stanford’s Dr. Thomas Lew said he’s seen high-risk and unvaccinated people who have waited more than a week. Some hospitalized patients on oxygen have told him they thought nothing of their first symptoms.

“They say everyone in the family decided it was a cold or allergy season is coming up, but it was COVID all along,” he said.

People delay seeking help for many health problems, not just COVID-19, Lew noted. But when it comes to the virus, the doctor believes patients may not be aware of the tight deadline.

Even those who get tested quickly, however, sometimes refuse the pills, doctors say.

Jarabek estimates that 30% to half of the patients who qualified for the antiviral pills turned down the treatments in his health system earlier this year.

He said some people didn’t consider themselves high risk or didn’t think they were sick enough to need the pills, which are free to patients. They also worried about side effects or how the drugs would interact with other medications.

Jeff Carlson couldn’t try Paxlovid when COVID-19 hit him in January because it might interfere with his heart medications. The 61-year-old suburban St. Paul, Minnesota, resident has Type 1 diabetes and heart disease.

A doctor asked him to try molnupiravir about three days after he started feeling symptoms. By then, Carlson couldn’t get off his couch. His fever had soared and he was struggling to breathe.

His wife picked up the prescription and a few days later, Carlson felt well enough to shovel snow.

“It turned me around basically in a matter of … pretty much 18 hours after I took the first dose,” he said.

Some health care providers have started free delivery services for Paxlovid or molnupiravir.

New York City has established a hotline patients can call if they test positive for the coronavirus. They can talk to a care provider if they don’t have a doctor and have pills sent to them if they are a good candidate.

The Mass General Brigham health system in Boston started a similar program that ships pills to some patients via FedEx.

Raymond Kelly received a package of Paxlovid about three hours after a doctor cleared him for the prescription last month. The 75-year-old Needham, Massachusetts, resident said he caught the virus despite being vaccinated and receiving a booster shot.

His doctor was on the phone with him minutes after the health system notified him that he had tested positive.

“It was all sort of blur because it was going on so quickly,” Kelly said.

Mass General Brigham aims to treat patients quickly and solve transportation problems with its program. Dr. Scott Dryden-Peterson noted that some COVID-19 patients may not be able to pick up pills, especially since they should be staying off buses and ride-sharing services.

“Transportation is not equally distributed in our society,” he said.

For patients with transportation, the drugstore chain CVS Health has started “test to treat” programs at its nearly 1,200 stores with MinuteClinic locations. Pharmacists cannot test and treat, so that program won’t happen at all stores.

Other retailers like the grocer Kroger also plan to test and treat at some locations. The Biden administration has called for federally qualified community health centers to do the same, but Health Secretary Xavier Becerra recently told The Associated Press that the “test to treat” initiative could be hampered by a funding impasse with Congress.

Chicago’s Cook County Health has run drive-through COVID-19 testing since the beginning of the pandemic. It is planning to pilot a program that adds treatments. Patients will be able to drive to one of the tents, get tested, wait about 15 minutes for the result and then talk to a doctor through telemedicine, said Dr. Greg Huhn.

With options for quick care growing, doctors and public health officials say now is the time for people to stock up on at-home tests.

Testing supplies that ran short during the omicron surge have since rebounded, said Neil J. Sehgal, a University of Maryland health policy expert. But he noted that future supplies also will depend on federal funding.

Doctors say people at high risk of developing health problems from COVID-19 need to remain vigilant for symptoms and seek help quickly, especially if another surge develops.

“It may not be the time to let your guard down,” Huhn said.

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Racial disparities feared in kids’ vaccinations

Nearly one in 10 children, ages 5 through 11, got their first COVID vaccine in the first two weeks after they became eligible, according to White House estimates. But is the newly vaccinated population skewed by race, as has been the case for adults? Few health systems have released numbers to address that question, report Annie Ma and Mike Melia at AP.

“Community leaders fear that Black and Latino kids are falling behind,” the pair write. From data that are available, it’s clear that patterns vary across the United States. White children are more likely to be vaccinated in Michigan, Connecticut and Washington D.C., but Black, Latino and Asian teens have higher vaccination rates in New York City.

These differences impact education because unvaccinated children, if exposed to COVID-19, typically must quarantine away from school. Many schools are adopting a “test-to-stay” policy, but access to the expensive, rapid tests such programs rely on remains a challenge.

Taken together, a race gap in vaccination and testing could put underserved children at further disadvantage during an important and challenging year back in the classroom. Black and Latinx students are among the most likely to be struggling academically, as are those who didn’t attend in-person school last year, writes Jackie Mader of The Hechinger Report.

CDC committee unanimously endorses boosters for all adults

The CDC’s vaccine advisory committee voted 11-0 on Friday to allow all adults to get COVID-19 booster shots six months after completing the initial series of Moderna or Pfizer vaccinations.

The advisors stopped short of saying all adults ought to get boosters, concluding that people age 50 or older should do so, while those between 18 and 50 may consider their “individual benefit and risk.” Adults of any age living in long-term care facilities are also encouraged to get a booster.

All adults who started with Johnson & Johnson’s vaccine were previously advised by the CDC to get a booster two months later.

At least 31 million adults in the U.S. have already received a booster.

The booster authorization means more people face the choice of which booster to get. Mix-and-match boosting was authorized in October for older and high-risk individuals, but CDC’s website offers no specific guidance.

It can be a tricky decision, as Tina Hesman Saey lays out at Science News; a combination of science and availability led her to stay with Pfizer for her booster shot.

A National Institutes of Health study posted online last month suggested that Moderna’s booster yielded the best results, with Pfizer close behind.

Committee members noted their decision wasn’t the final world on the ideal series of COVID vaccinations, with more changes likely as data accumulate.

New analysis: Wuhan market was likely COVID ground zero

The debate over the origins of COVID-19 was renewed last week by an analysis in the journal Science of the earliest cases in Wuhan, China. Evolutionary biologist Michael Worobey of the University of Arizona dug into hospitalization dates for 19 of the earliest cases of “unexplained pneumonia” that arose two years ago, and 10 were linked to the Huanan seafood market.

None of these were likely to be “patient zero,” the very first human case. That person probably didn’t get sick enough for hospital care, and the virus likely spread for weeks before officials noticed.

However, Worobey’s efforts suggest the first known case of COVID-19 was not the previously reported accountant with no link to the market, but rather a seafood vendor on site. She first noticed symptoms on Dec. 10, 2019, as was reported in The Wall Street Journal.

“In this city of 11 million people, half of the early cases are linked to a place that’s the size of a soccer field. It becomes very difficult to explain that pattern if the outbreak didn’t start at the market,” Worobey told The New York Times.

But there’s still no smoking gun, and there may never be. “It’s as reasonable a hypothesis as any,” commented Dr. W. Ian Lipkin, a virologist at Columbia University. “But I don’t think we’re ever going to know.”

Anti-COVID pills could reach high-risk people by year’s end

An FDA advisory committee will convene Nov. 30 to discuss Merck’s application for its antiviral molnupiravir. Specifically, the company seeks authorization to use the pill for mild or moderate COVID-19 in people who are high risk of severe disease.

Pfizer last week also requested authorization for its antiviral pill, Paxlovid, for high-risk patients. The U.S. government has already ordered 10 million courses of Paxlovid, about twice as many as it committed to for molnupiravir, reports Manas Mishra at Reuters.

STAT summarizes what we do and don’t know about the medications:

Data released by both companies, via press release, seem to give Pfizer’s drug the edge against hospitalizations, but the trials weren’t exactly the same. Both medications prevented deaths.

Neither company has completed studies of vaccinated patients, or people who take the antivirals before symptoms appear.

The medications also work differently. Molnupiravir interferes with the copying of the viral genome. Similar drugs can cause birth defects in animals, Mishra notes, though Merck claims there’s no evidence of this in humans.

Paxlovid allows the virus to copy its genes, but then prevents it from completing assembly of new viruses later. It’s part of a class of drugs, called protease inhibitors, with a long history. But it requires a second drug, ritonavir, to stay in the body long enough to work.

These pills would be much more convenient than the only antiviral authorized so far, remdesivir, or antibody infusions, both of which must be delivered intravenously. However, the new pills must be taken early in infection to be effective. 

Evidence is also building that common antidepressants, such as Prozac, may prevent death from COVID-19, writes Kristen Monaco at MedPage Today.

“It’s important to find as many options as possible,” said Dr. Tomiko Oskotsky of UC San Francisco, author of a recent study that linked antidepressant use and lower risk of death. “A particular drug or treatment may not work or be well tolerated by everyone.”

White House to spend billions on vaccines for other nations

Last Wednesday, the Biden administration announced a plan to boost U.S. manufacturing of vaccines. The goal is to produce at least 1 billion doses annually to supply other nations, while also readying the U.S. for future pandemics.

The White House intends to do this by partnering with vaccine-makers such as Pfizer and Moderna, though neither company has agreed to the deal, reports The Washington Post.

Critics said that by focusing manufacturing in the U.S., the move will not do enough to support global needs. “In order to gain the upper hand on this and future pandemics, manufacturing should be spread around the world,” said Robbie Silverman of Oxfam America in a statement.

Overdoses rose during lockdown, but suicides may lag

Drug overdose deaths broke a terrible record last week, with an estimated 100,000 deaths in the span of a year. Experts blamed the synthetic opioid fentanyl as well as pandemic lockdowns, which left people isolated and unable to access treatment or social support, writes Mike Stobbe at AP.

Despite that isolation, suicide rates dropped a bit during the pandemic, particularly among three demographics: women, white, and middle-aged people, reports Theresa Tamkins at BuzzFeed News.

That pattern could change, said Deb Stone, a lead behavioral scientist at the CDC. “Based on prior disasters, suicide rates sometimes dip only to go back up again after the immediate crisis has passed,” she told Tamkins. “We must remain vigilant, and work to address suicide in populations disproportionately impacted.” Among those populations at risk are Native Americans and LGBTQ+ individuals.

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