Barriers remain to COVID-19 treatment in Niagara, despite expanded access
Although patients usually have a prescription in hand when they stop at a pharmacy to pick up medication, a Niagara pharmacist said it might make more sense for patients to contact their pharmacy first if the drug they need is Paxlovid.
Because time is running out when using the coronavirus drug, said pharmacist Donnie Edwards, a board member of the Ontario Pharmacists Association.
“The sooner you get this drug after symptoms, the better,” he said.
Edwards said the drug only works within five days of the onset of symptoms, and the earlier the drug is taken, the more effective it is. If people wait for their doctor’s appointments, it may be too late to benefit.
He said the Easter long weekend is an example of how access to medicine can be delayed.
“Doctors’ surgeries are closed tomorrow (Good Friday), many pharmacies are closed. And if someone comes in this afternoon needing Paxlovid, it needs to be started within five days of the onset of symptoms and you want that patient to get the drug at the right time,” Edwards said. “It’s important, the right medicine for the right person at the right time.”
Although the drug requires a prescription, Edwards said pharmacists can also facilitate this.
Edwards’ co-owned pharmacy in Ridgeway is one of about 58 pharmacies in Niagara to have received limited quantities of Paxlovid after the province increased eligibility for the treatment this week. Across the region, there are 24 pharmacies in St. Catharines, nine in Niagara Falls and eight in Welland, and five in Fort Erie stocking Paxlovid, as well as a few pharmacies in each of Niagara’s smaller communities.
Edwards said pharmacists first assess whether patients are eligible for Paxlovid, including anyone over 70 who has tested positive for the virus, people 60 and over with fewer than three doses of the vaccine and people 18 and older who are immunocompromised or who have had less than three doses of vaccine and who have at least one risky condition such as pregnancy, obesity, diabetes, heart disease or intellectual disability.
If patients qualify, he said pharmacists would then contact the patient’s doctor or primary healthcare provider and ask the doctor to write a prescription. Pharmacists can also help patients who do not have a family doctor.
Edwards said Paxlovid can interact with at least 100 other drugs, “and we want to make sure people can take it safely.”
“As drug experts, I think we would be able to best advise a doctor or a prescriber,” he said.
Ultimately, if infections continue to rise alongside demand for the drug, Edwards said “it would make sense if pharmacists could just prescribe it and send a note to their (patient’s) doctor saying that I distributed Paxlovid for your patient.”
Despite expanded access to treatment, Niagara’s acting medical officer of health, Dr. Mustafa Hirji, said “major hurdles remain.”
“There are still barriers in people who don’t know the treatment options, don’t know that they need to get treatment as soon as they get sick, even when the symptoms are mild – it’s no longer effective a few days later when you get worse,” he said. .
“The province’s documents are very complex on treatment and therefore those who do not speak English as a first language, who have less education, etc., will find it difficult to access treatment. People without a family doctor will continue to have a huge barrier to getting treatment. For people who don’t have paid sick leave, they will struggle to find the time to make the necessary appointments for treatment and during that time they could be working and spreading the infection.
Hirji said the province needs to better promote treatment, simplify information and processes to make it easier to get care, increase transportation support, ensure workers have paid sick leave in progress and ensure those at high risk have access to primary care options.
Meanwhile, infection cases and hospitalizations continue to rise in Niagara, with Niagara Region Public Health reporting 195 new cases Thursday, along with 1,864 active infections.
On Thursday, Niagara Health reported the death of a patient who was being treated for coronavirus – the fourth this month. The hospital system said the patient, a Niagara resident, died on Wednesday. There are now 64 people in hospital with the virus, including five in intensive care.
Niagara Health’s Medical Director for Infection Prevention and Control, Dr. Karim Ali, said COVID-19 therapies such as Paxlovid are also available to eligible patients at the hospital system’s Clinical Assessment Center located on his Niagara Falls site. However, clinic appointments are only available by referral.
“We’ve come a long way to learn more about the virus and how to provide cutting-edge therapies to manage the patients we care for,” he said in an email.
Ali said patients with mild to moderate symptoms of COVID-19 are being assessed for antiviral treatment options based on advice from the Ministry of Health as well as Ontario’s Scientific Advisory Table on COVID-19. .
Niagara Health is also administering the Remdesivir infusion for patients who qualify based on provincial criteriahe said.
“Expanding patient eligibility by the Ministry of Health and supporting primary care providers to assess and prescribe antivirals will allow more eligible patients to access this treatment,” Ali said.
Staying Safe Easter Weekend
After seeing COVID-19 infections spike after nearly every long weekend for the past two years, Niagara’s Acting Medical Officer of Health Dr. Mustafa Hirji braces for another surge as families and friends gather for Easter celebrations.
“We have seen increases in COVID-19 over the past few years after long weekends for exactly this reason. With the current sixth wave, there is a substantial risk of infection spreading during these events,” Hirji said. “However, we also now have more tools to make it safer to attend.”
- Make sure vaccinations are up to date before attending any Easter event, with three doses for most people.
- Do not attend celebrations if you are not feeling well.
- If it’s a larger event, do a quick test before attending to make sure you don’t infect others.
- Hold celebrations outdoors where the risk of infection is reduced with better ventilation.
- Consider wearing masks at large celebrations.
- Also provide space for physical distancing, including spacing out seats at tables where people will dine “to limit the risk of spreading infection.”