Some Marin COVID patients receive new treatment

A small number of Marin residents who test positive for COVID-19 are being prescribed a pill that reduces their chances of serious illness and hospitalization by about 89%, regardless of vaccine status .

The drug, Paxlovid, is one of at least six treatments for COVID-19 that have been approved for emergency use in the United States.

“The scope of treatment with COVID-19 is the next horizon for us,” Marin County Public Health Officer Dr. Matt Willis told county supervisors during one of his periodic updates last month. “Covid-19 is an increasingly treatable disease with pharmaceutical interventions.”

“We have about 25 new COVID-19 cases per day in Marin,” Willis said, “and between one and three people are being prescribed Paxlovid each day.”

Willis said this week that despite the prevalence of the more transmissible BA.2 subtype of the Omicron type, there has been no evidence of a new increase in cases in Marin.

“I’m pretty confident that we’re not going to experience a huge increase in cases because of BA.2,” Willis said. Four people were hospitalized with COVID-19 in Marin on Thursday, and none were in intensive care.

Willis said the subvariant is proving to be less threatening in communities like Marin with higher vaccination and booster rates, and ironically, those communities had higher rates of infection because they resisted the precautions. Both types of locations have high levels of community immunity.

“In some places,” Willis said, “that immunity was earned the hard way through diseases and deaths. Another way to earn that level of immunity is through vaccination.”

Willis said PaxLovid was in short supply during the most recent surges in January and February, but stocks are now abundant.

The drug, which Marin’s Department of Public Health receives from the state and distributes to local hospitals, is an antiviral drug that blocks the SARS-CoV-2 protein from replicating.

However, this medicine is not a panacea for those who prefer to wait until they become infected with the corona virus before getting treatment. It must be prescribed by a doctor, and patients must be at high risk of hospitalization or death from COVID-19 to be eligible.

Patients must also be 12 or older and weigh at least 88 pounds. Paxlovid is not recommended for people with severe kidney or liver disease. Lipitor and other lipid-lowering drugs can interact with Paxlovid, so they cannot be taken together.

Perhaps the most difficult obstacle to using Paxlovid is the need to take it within five days of the first symptoms of COVID-19. This means that patients will have to get tested by their doctor within a few days.

“It’s definitely a challenge,” Willis said. “That’s where my work with the health care system is now trying to streamline that whole process.”

To that end, Willis said, Marin’s hospitals and federally qualified health centers have agreed to accept an at-home antigen test as a confirmation of infection rather than requiring a more definitive PCR test, which needs more time in the schedule and process. It may take time.

Willis said the state is also supplying the county with a monthly allotment of 20 doses of EvuShield, a monoclonal antibody treatment that helps protect immunocompromised people from becoming infected with the virus.

Willis said the treatment, which requires two simultaneous injections, “is to help protect those who are at highest risk of poor outcomes.” This includes people who are receiving treatment for cancer or dialysis due to kidney failure.

Other approved COVID-19 treatments are less attractive for one reason or another.

Molnupiravir, an alternative antiviral pill, is not recommended for pregnant or breastfeeding women. One study has suggested that the drug can cause mutations in human DNA. France and India have decided not to authorize its use.

Willis said alternative monoclonal antibody treatments are challenging to administer, because they involve injections or infusions, and to store, because they must be refrigerated.

In addition, monoclonal antibodies must be well matched to a particular variant for treatment to be effective. As a result, they are more vulnerable to mutations in the virus.

Remdesivir, an antiviral treatment, and dexamethasone, a corticosteroid, remain the drugs of choice in the treatment of critically ill COVID-19 patients after their hospitalizations.

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