Due to multiple medical problems, his 70-year-old father was in danger, and McGovern knew that the Paxlovid antiviral pill – which must be taken within five days of the first symptoms – could keep him out of the hospital. “Every hour that passes, you get closer to that limit,” McGivern said by telephone from Wallaceburg, OD, near Chatham. “And this is extremely frustrating – because no one knew how to get what he needed.” With coronavirus outbreaks soaring in Ontario – reaching about 100,000 new infections a day, according to sewage readings – Paxlovid is touted by medical experts as the game-changing factor in tackling the province’s pandemic, a key tool to protect those most at risk. But in recent weeks, doctors and vulnerable patients have been struggling to access the drug and are urging the province to step up training and promotion efforts and make Paxlovid more widely available. “What strikes me is how many people do not realize that they would qualify for these drugs if they had COVID. “And even if they realized they were eligible, it’s not clear what to do and where to go. And it varies by region,” said Dr. Tara Kieran, a family doctor at St. John’s Hospital. Michael’s of Toronto. “It’s a big problem. We need a public education campaign. “ By March 31, approximately 400 Paxlovid courses had been delivered to Ontario and 755 had been distributed to hospitals. The county, which had previously said it had about 40,000 courses from the federal government, will not provide Star with updates on Friday. Currently, patients who believe they can benefit from Paxlovid can visit their GP or one of more than 80 provincial clinical evaluation centers for PCR or rapid screening. If the center has Paxlovid on site, it can be given immediately to suitable high-risk patients. Or, one of the province’s approximately two dozen distribution nodes can deliver the treatment to the patient’s home. The drug, which a recent trial suggests reduces the risk of serious disease by about 89 percent in unvaccinated patients, may interact with other drugs, requiring individual patient evaluation. However, experts – and patients and their families – who spoke to Star say the province needs to do more to bring Paxlovid to patients who need it most. Taking the pills led the McGivern family to a desperate fight in southwestern Ontario, with Derek’s sister transporting their father John from his Wallaceburg nursing home to the Chatham Assessment Center. She even crossed the border in Port Huron, Mich., Where Paxlovid is available in pharmacies, in a desperate attempt to give her vulnerable dad, who had already developed a “whistle”, the best chance to fight the virus. But they were confused at every step. “Everyone is very polite, but I think the bureaucratic monster here is just bigger in this case,” McGivern said. “The process is extremely opaque.” Health Minister Christine Eliot told reporters Tuesday that the province initially received small shipments of the drug. But with more supply, they are trying to expand access, “potentially through pharmacies”. The ministry did not confirm whether this was the plan. In eastern Ontario, attorney Michele Allinotte also faced a difficult battle to get the drug. Although she has been triple-vaccinated, Allinotte has underlying conditions that could put her at risk for serious illness. He did not know that Paxlovid was a choice until he began to see headlines about the drug. “I did not know it existed,” he said. “Many people know I have COVID, but no one said, ‘Hi, this medicine is available.’ For several days, Allinotte suffered from various symptoms, such as headaches, congestion, cough and fog in the brain, before she could call the clinical evaluation center in her area. It took another day to reach a health worker who said he did not qualify for Paxlovid. “They are just a lot of hoops to jump on, even if they are available and you are eligible, especially when you feel sick,” he said. Unlike Quebec and the United States, Ontario has not expanded its distribution of Paxlovid to pharmacies, a situation that the Ontario Pharmacists Association (OPA) is trying to change. “Having more local access to a center where you could be evaluated, tested and prescribed the drug, as well as its administration could be very helpful for people, especially in more rural and remote areas,” he said. Jen Belcher, Vice President of OPA. strategic initiatives and relations with members. “The sooner you allow this community pharmacy footprint to participate in it, the sooner you make treatment available,” he said. Last week, Kiran made an appointment at a clinical evaluation center for some patients who thought they were suitable for Paxlovid based on age and underlying health conditions. But they were told they were not eligible and Kiran is not sure why. He is concerned that the eligibility criteria are being interpreted differently across the province and would like to see more guidance and training on the new drug. As Vice President for Quality and Innovation at the University of Toronto Department of Family and Community Medicine, Kiran is working with colleagues to create COVID training materials, from testing to treatment. He said general public health guidance on COVID treatments was lacking for the general public. Family doctors can play a role in prescribing Paxlovid directly to patients, he said, if they are given additional support, such as a consultation with a pharmacist or infectious disease specialist. Dr Kate Miller, a family doctor at Guelph General Hospital and Listowel Memorial Hospital, said the diagnostic and prescribing system could work well, but only if “all the stars are aligned”. He described a recent visit to a patient during regular business hours, who showed up quite early in the course of the disease, was eager for treatment and was not at risk of harmful drug interactions. In addition, Miller specializes in eligibility for treatment, as she helped develop Ontario eligibility criteria for Paxlovid. He noted that public health messages from the county – do not worry about a PCR test, stay home if you feel sick and wait until you recover – have contributed to a lack of public awareness about the drug. “While many people think they can not do a test, anyone who qualifies for treatment also qualifies for a PCR test. Thus, people believe that they can not take medication because they believe that they do not qualify for an examination. “It’s absolutely a confusing system,” Miller said. Another development problem, said Akwatu Khenti, chair of the Black Scientists Working Group on Vaccine Equality and a scientist at the CAMH Institute for Mental Health Policy Research, is that there was no apparent assessment of equality in the drug’s dissemination plan. He added that community health centers in neighborhoods hardest hit by COVID should have special access to the drug. In addition, community ambassadors who have helped build trust to increase vaccine absorption in these neighborhoods should also be involved in disseminating awareness about Paxlovid, he said. “If it’s mild COVID, do not worry. “But if you have diabetes, asthma, heart disease and STIs get COVID, get your Paxlovid right away so you can really reduce your risk of having severe COVID… This should be a message across the country,” Khenti said. . . McGovern said they tried to call the local health unit first and then his family doctor and no one knew where to send him. He then found a clinical evaluation center in Chatham, where a doctor was prescribing Paxlovid for his dad. But when they got the prescription at a local pharmacy, no one there really knew how to get the medicine. Eventually, after some Twitter defense, and with Chatham-Kent Public Health and the local Chatham-Kent Health Alliance hospital on the case, it was decided that the necessary blood donation would take place at Wallaceburg Hospital and a Paxlovid center in Windsor would send the drugs. . Chatham-Kent Health Alliance spokeswoman Fannie Vavoulis said in an email that they responded as soon as they realized there was a problem with the center’s initial response and identified “a number of improvements” to ensure residents have timely access to Paxlovid. “We regret that this has led to unnecessary and additional steps for the patient and the family,” he added. The possible life-saving pills were finally sent to Derek’s father on Thursday night. The family is relieved to now have the drug in their hands, but McGivern worries about people being less connected and stubborn. His daughter has a disability, he said, so he is used to being a tough supporter in the healthcare system. “What I’m worried about are people who do not have this,” he said, “people who go through one, or two, or three or four levels of rejection and just give up.” May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @ maywarren11 Megan Ogilvy is a health reporter for the Toronto-based Star. Follow her on Twitter: @megan_ogilvie Kenyon Wallace is a Toronto-based investigative investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or contact him via email: [email protected]
