The COVID-19 medication Paxlovid is still too difficult to access in New Brunswick, despite recent improvements, according to some pharmacists.
Earlier this month, the province announced it expanded eligibility for the antiviral drug treatment, which is designed to reduce the risk of hospitalization or death for vulnerable adults with mild to moderate symptoms in the early stages of infection.
The Pfizer pills can also now be prescribed by primary care providers, such as doctors and nurse practitioners, without the need for a team assessment, and are available at all pharmacies at no cost.
But unless people work in a nursing home or live in an Indigenous community, a positive PCR (polymerase chain reaction) lab test is still required to be prescribed Paxlovid.
This restricts access for many patients, said Daniel Landry, the infectious disease pharmacist at the Dr. Georges-L.-Dumont University Hospital Centre in Moncton, because to be effective, Paxlovid must be taken within five days of the onset of symptoms.
"In my experience with the clinic, people would wait a day or two after they had symptoms [before saying to themselves], 'Oh, OK, I'll go get tested.' There, a day or two later, they have the results, and we are on day four or five of their illness," he said.
"So if you wait too long to get tested, sometimes you can really lose the window of opportunity to treat it."
Véronique Soucy, pharmacist-owner of the Jean Coutu pharmacy in Edmundston, agreed the limited time for the drug to be prescribed complicates matters.
"The best advice I have is if you are 50-plus and not fully vaccinated, apply for a PCR test," she said. "There are some people sometimes who have co-morbidities, and then we don't know what COVID has in store for us."
New Brunswick is the only Atlantic province that does not accept rapid tests for the prescription of Paxlovid.
The Department of Health said in an emailed statement it understands "that the deadline may be difficult to meet; however, both the drug and the process are new."
A total of 606 people have now been prescribed the drug, said department spokesperson Bruce Macfarlane. That's up from 323 on April 7.
Drug interactions complicate matters
He previously suggested several factors could account for the low numbers, including drug interactions with commonly prescribed drugs, contraindications with certain medical conditions, and limited availability.
Landry acknowledged Paxlovid it is not suitable for everyone because of its many possible interactions with other drugs.
"It's like playing a bit of Sudoku, but with medication to allow people to receive Paxlovid," he said.
The Jean Coutu in Dieppe dealt with a "rather complex" file last week, said pharmacist-owner Dennis Abud.
"It took my pharmacist about two-and-a-half hours to decipher everything there was to decipher," he said. "The patient had a lot of drugs."
Better communication needed
Landry believes communication surrounding Paxlovid has not been handled clearly enough in New Brunswick.
"I know it was all sped up a bit so that we could deal with the people of the province, but yes, I think that communication could have certainly been improved."
Soucy agrees, noting Paxlovid was only approved for use in Canada in January.
"I believe that perhaps the population is perhaps not yet aware that this treatment exists, then of how to obtain it."
In November, Pfizer reported that Paxlovid reduced the risk of hospitalization or death by 89 per cent compared to a placebo in non-hospitalized high-risk adults with COVID-19.
Eligibility for the drug has expanded in New Brunswick to include:
People aged 50 to 59 who are partially or "under vaccinated," meaning they don't have all the vaccine doses they are eligible for.
People aged 50 to 59 who either live in a long-term care home or receive home care, or are from or live in a First Nations community.
Before April 11, people from these groups had to be aged 60 to 79 to receive Paxlovid.
Other groups who are currently eligible include:
People 80 or older
People 18 or older who are immunocompromised by active or recent cancer treatment within the past months, a solid organ transplant, a stem cell transplant within the past years, moderate to severe primary immunodeficiency or advanced or untreated HIV infection, or moderate to severe immunosuppressive treatment, such as biologic medications or high-dose systemic corticosteroids
A full course of treatment requires a patient to take 30 pills — two nirmatrelvir and one ritonavir taken together twice a day for five days.
Nirmatrelvir interferes with the proteins the coronavirus needs to multiply and stops it from infecting more cells. Ritonavir slows the breakdown of nirmatrelvir so it stays in the body long enough to do its job.
The province has received a total of 3,550 treatment courses so far. It's unclear when the province is going to get another shipment.
Vaccination remains the most effective method to protect people against the virus, said Landry.