Doctors finding hurdles to using pills to treat COVID-19

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.