Writing for the New York Times, Aaron Carroll, the chief health officer of Indiana University, explains how the benefits of Covid-19 treatments have been hampered by lack of access—and what can be done to improve this problem.
Covid-19 antivirals are here: Here's how to make them 'game changers'
The difficult path to getting Covid-19 treatments
Covid-19 vaccines are essential for developing widespread immunity against the coronavirus, but other treatments, such as monoclonal antibodies and antiviral drugs, are also critical to combatting the pandemic, Carroll writes.
However, while the available Covid-19 treatments can effectively reduce the risk of hospitalization and death, particularly for those who are immunocompromised or unvaccinated, gaining access to them can be difficult for many people.
For example, Pfizer's antiviral drug Paxlovid can reduce people's risk of hospitalization and death from Covid-19 by more than 85%, but people need to take the drug within five days after being infected—something that may be hampered by "the deficiencies of our testing system," Carroll writes.
Finding a Covid-19 test and getting results back in a timely manner can be difficult. PCR tests are typically the most reliable, but it can take a day or more for patients to receive results. In comparison, at-home tests return faster results, but they largely remain in limited supply and may be too costly for some people, such as the uninsured.
After testing positive, people often face another obstacle to accessing necessary treatments: a prescription. Many people don't have a primary care provider, Carroll writes, and for those who do, getting an appointment quickly is often difficult. Even before the pandemic, fewer than half of Americans could get a same-day or next-day appointment with their doctor when they were sick.
And then, even with a prescription, people are not guaranteed the antiviral pills they need since "it's hit or miss whether [pharmacies] will have pills in stock," Carroll writes, meaning people may lose "precious days" just waiting for the medication to be available.
Overall, Carroll writes that "the U.S. health care system is set up to make it harder for people to get care," and poorer people often shoulder the most burden. In fact, a recent study published in JAMA found that Medicare beneficiaries at the highest risk for Covid-19 were the least likely to be treated with monoclonal antibodies, largely because of difficulties accessing the treatment in a timely manner after being infected.
How the health system could improve access to Covid-19 treatments
According to Carroll, there are several ways to improve the country's health care system to ensure people can access Covid-19 tests and treatments.
Currently, the federal government is sending four free at-home antigen tests to all households in the United States, and Carroll says this practice should continue to increase the accessibility and affordability of these tests for many Americans.
Carroll also recommends physicians prescribe Covid-19 antiviral pills to high-risk individuals ahead of time, similarly to how EpiPens are prescribed, so they can start the medication immediately if they are infected.
Pharmacists could also help provide care to patients, Carroll writes. Instead of waiting for a doctor's prescription, pharmacists could talk to patients about whether certain Covid-19 treatments are safe for them and distribute medication without a prescription if patients qualify.
Finally, Carroll writes that insurance companies could change their cost-sharing requirements to incentivize people to get care for serious illnesses instead of avoiding it.
However, "[m]aking changes like these will not be easy," Carroll notes, particularly because the country's "fragmented multipayer system is ill equipped to think and act collectively."
Ultimately, Carroll writes that the pandemic may not improve in the United States, "not because [Covid-19] medications don't work well ... [but] because our health system doesn't." (Carroll, New York Times, 2/13)