Coronavirus Files: Pharmacists can prescribe Paxlovid, but need detailed health info

coronavirus
July 11, 2022

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POC less likely than whites to think things are back to normal

Black and Hispanic people have been at greater risk for infection, hospitalization and death than whites throughout the pandemic, and they are now more hesitant about getting back into public life.

That finding comes from a new poll from The Associated Press-NORC Center for Public Affairs Research that notes disparities in how ready people are to return to pre-pandemic habits.

Hispanic adults were more concerned about the virus than white people, according to the poll, and less likely to get back to socializing with friends in person (77% of Hispanic people versus 92% of white people were willing to do so) or going out to eat (63% versus 86%).

Black and Hispanic adults were also more likely to implement protective measures when they did go out. Only 44% of white respondents thought it important to mask up in public settings, compared to 78% of Black respondents and 62% of Hispanic people. Black and Hispanic participants were also more supportive of regular COVID-19 testing.

The poll results also imply inequities in access to safer activities during the pandemic: White adults were more likely than Black people to have used more telehealth, shopped online, and used curbside pickup options.

Despite the rise of the highly contagious BA.5 variant, 66% of poll respondents said their lives were somewhat or wholly the same as before the pandemic.

FDA opens up Paxlovid to pharmacist prescriptions

Last Wednesday, the FDA updated its emergency authorization for the antiviral drug Paxlovid to allow pharmacists to prescribe the medication.

Previously, the prescriptions were only available from physicians, nurses and physician assistants, and the medicine has been underused in poor communities.

In theory, the move should remove an important barrier to drug access, which is important because the medication is only effective if taken within five days of symptom onset.

However, the FDA made additional requirements for pharmacist prescriptions that could complicate access, particularly for people who lack regular health care. Those seeking the drug must come to the pharmacy with their medical records, including a list of other medications they take, plus blood tests results from within the last 12 months. This would allow pharmacists to check for kidney or liver problems that could indicate a person shouldn’t take the medication.

The American Pharmacists Association supported the move. “Removing barriers to pharmacist prescribing of oral antivirals has the potential to be a game-changer for addressing health equity and providing timely access to these life-saving treatments in pockets of the country where pharmacists may be the only health care provider for miles,” said APA’s Ilisa Bernstein in a press release.

The American Medical Association disagreed. “While the majority of COVID-19 positive patients will benefit from Paxlovid, it is not for everyone and prescribing it requires knowledge of a patient’s medical history, as well as clinical monitoring for side effects and follow-up care to determine whether a patient is improving — requirements far beyond a pharmacist’s scope and training,” said AMA president Jack Resneck in a press statement.

Bernstein noted that reimbursements could create another hurdle to pharmacist prescriptions: “This effort will only be successful and sustainable if [the Centers for Medicare & Medicaid Services] and other payers take immediate action to provide adequate and appropriate payment for pharmacist consultations and services.”

And while Paxlovid is the COVID treatment du jour, its dominance may be temporary. Even physicians are struggling with questions of when to prescribe Paxlovid and which patients should get it, reports Edward Chen at STAT.

Doctors are also unsure if they should prescribe a second course of Paxlovid if symptoms return after the first course, as happens in some patients — including, recently, the NIH’s Dr. Anthony Fauci. (Fauci did take a second round.)

Some pharmacists have refused to fill a second prescription, said Dr. Myron Cohen of the University of North Carolina at Chapel Hill.

It’s also possible the coronavirus will evolve so that Paxlovid is no longer effective. Lab studies indicate this is possible, and some variants circulating at low levels already have mutations that confer resistance, Robert F. Service reported recently in Science.

These studies are “raising fresh concerns that physicians could soon lose one of their best therapies for fighting COVID-19,” Service wrote.

Other potential medications are under study. A Miami-based company called Veru recently reported that its medication sabizabulin more than halved death rates in people with severe COVID-19, reports Ian Ingram at MedPage Today.

The medication, which can be taken orally, doesn’t work against the virus directly but disrupts cellular trackways the coronavirus needs to enter, move about, and exit cells.

The company has applied to the FDA for emergency authorization.

Republican states aim to turn COVID relief dollars into tax cuts

The federal government has sent states $1.9 trillion dollars to fight the pandemic as part of 2021’s American Rescue Plan. Now, several Republican states are converting those funds into tax cuts, reports Tony Romm at The Washington Post.

Congress explicitly prohibited the use of the funds to subsidize state tax cuts, but when Republican state leaders have challenged that rule in court, they have generally won.

Nearly two dozen states have cut tax rates in the past two fiscal years, though some of those efforts were underway before the pandemic.

“The controversy around the state and local aid program reflects a broader challenge facing Washington as it looks to keep watch over more than $5 trillion in emergency spending approved since the start of the pandemic,” writes Romm. “The loans, grants, direct checks and other assistance exceeded the size of the entire federal budget in fiscal 2019, creating a unique and lasting strain on policymakers to ensure the funds have been put to proper use.”

The diversion of such funds from COVID relief could not only impact measures to fight the pandemic, but also leave states high and dry in the case of a future recession.

Caltech makes progress towards all-coronavirus vaccine

The world has seen the emergence of multiple coronaviruses — causing SARS and MERS as well as COVID-19 — since the turn of the century. Future instances of coronavirus leaps from animals to people seem all but inevitable. Meanwhile, new coronavirus variants are spreading faster than vaccines can be updated.

If only there were a vaccine to target potential future, unknown variants and viruses.

That’s what a team at Caltech is working on, and they recently reported a successful step forward in Science. SARS and MERS are all from a family known as betacoronaviruses, so the researchers glued bits of the spike protein from eight different betacoronaviruses to nanoscale particles, creating a “mosaic” vaccine. They then injected it into mice and monkeys. They intentionally didn’t include any spike from the original SARS virus — but the vaccine protected the animals from it anyway.

“If the mosaic vaccine works as well in humans as it did in animals, it could offer protection against the betacoronaviruses we know about, as well as related ones that have yet to make the leap to humans,” write Corinne Purtill and Melissa Healy at the Los Angeles Times. “That prospect is promising but far from certain.”

The researchers must next trial the vaccine in people, and they plan to do so over the next year or so at Oxford University.

Nonetheless, the NIH’s Dr. Anthony Fauci called the research “a major conceptual step toward a pan-coronavirus vaccine.”

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What we’re reading 

  • “Now that BA.5 is dominant, stopping it will be difficult,” by Kyla Mandel, Time
  • “Did COVID vaccine mandates work? What the data say,” by Liam Drew, Nature
  • “Army Reserve, Guard face growing vaccine criticism as deadline passes,” by Paul D. Shinkman, US News & World Report
  • “Health care in jails and prisons is terrible. The pandemic made it even worse.” By Victoria Law, Vox
  • “For some workers, office mandates aren’t just a pain. They’re harmful.” By Danielle Abril, The Washington Post
  • “The FDA owes parents an explanation about why it delayed authorizing Moderna’s COVID-19 vaccine for young kids,” by Jorge A. Caballero, STAT

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