Way back in January of this year, Paxlovid, a successful treatment for COVID-19, was about to be approved in Canada.
In a January 18 interview with CTV, Dr. Isaac Bogoch of Toronto General Hospital Research Institute was asked about the importance of Paxlovid.
“Once this is approved … this would be very, very helpful. I hope we have a lot of it because certainly we could put it to good use,” he said.
The National Post reported that Dr. Theresa Tam, Canada’s Chief Public Health Officer, said she “thought it would be an important tool going forward.”
Our mRNA vaccines are life changing and life saving. Still they, like all vaccines, are not 100 per cent effective at preventing infection, or at preventing severe disease and death. Paxlovid is an antiviral treatment that increases your likelihood of survival.
Paxlovid tested and shown to be effective
A Yale Medicine article last month stated that Pfizer’s Paxlovid “had an 89 per cent reduction in the risk of hospitalization and death.” Data was taken from the clinical trial supporting the Emergency Use Authorization, issued to the company in December 2021. Other treatments to date have much smaller success rates.
Paxlovid medication is for mild to moderate symptoms of COVID-19, not severe sickness. It is supposed to be taken within the first five days of symptoms, after a test confirming you have COVID-19 and with a prescription from a doctor. The five-day series of pills is taken twice a day at home, without the need for hospitalization.
Guidance on eligibility for Paxlovid varies between provinces. Its use is restricted to those who have certain risk factors. Individual medical history and prescription medications may deem Paxlovid unsuitable for a patient, such as their renal status.
A series of restrictions
The government will protect you against COVID-19 the best it can with preventative mRNA vaccines. Regarding treatment to date, restrictions on patient access to Paxlovid exclude a large portion of the population. And for the vulnerable who are eligible for Paxlovid, not everyone can take it due to their medication and drug interactions.
Various health conditions make you potentially eligible for Paxlovid regardless of age. But if you are in general good health, there are two key restrictions.
The first is your age. Only those 70 years or older with any number of mRNA vaccine doses may access Paxlovid.
Some of the reasoning for a high minimum age requirement may be that research has shown the effectiveness of Paxlovid is lower with each cohort under 70. This follows the trend we have seen throughout the pandemic where death rate, hospitalization and severe illness from COVID-19 are lower in young people.
The COVID-19 Epidemiology Update confirms the number of COVID-19 deaths in Canada to date. People 80 and up have the highest proportion of fatalities (60.3 per cent), followed by 70 to 79 (21.5 per cent), followed by 60 to 69 (10.8 per cent). The death rate is more than halved for each subsequent decade – 4.6 per cent for 50 to 59; 1.6 per cent for 40 to 49; and less than one per cent each for the other decades, 30 to 39, 20 to 29, and younger.
The second key restriction to Paxlovid access for people in good health is the number of mRNA doses they have received. Generally, having three or more doses precludes you from eligibility.
Healthy, boosted people in the 60 to 69 year old cohort with age as their only risk factor are not allowed access to Paxlovid when they get COVID-19. Their cohort accounts for 10.8 per cent of COVID-19 deaths in Canada.
The age where one is determined to be at high risk of severe COVID-19 infection is 60 to 65 years of age, not 70.
In Pfizer’s recent New Drug Application for Paxlovid (June 30) that, incidentally, is for either vaccinated or unvaccinated people, they cite the CDC. The U.S. Center for Disease Control and Prevention identifies being aged 65 and up as a risk factor for “progressing to severe COVID-19 illness”.
“People more likely to get very sick with COVID-19 include those aged 65 and older and people with certain underlying conditions or risk factors (such as) cancer, chronic kidney, lung, or liver disease,” the application reads.
The World Health Organization (WHO) goes further, identifying 60 and up as high risk.
“COVID-19 is often more severe in people aged 60 and older, or with health conditions like lung or heart disease, diabetes, or conditions that affect their immune system,” states WHO.
Both the CDC and WHO consider those people in their sixties as being of high risk of severe illness with COVID-19. In neither case do they state people over 60 must have other risk factors as well to be considered at high risk of severe illness with COVID-19.
The economics of COVID treatment
Price could be a factor explaining the tight controls on Paxlovid. In the US as in Israel, a course of treatment costs about $530 American for the blister packs of pills you take for five days. The expense of the drug may be suppressing recommendations for it in Canada.
“In order to protect the commercially sensitive pricing information, we can’t disclose those details,” said Canada’s procurement minister Filomena Tassi in a January National Post article regarding the cost of the drug to the Canadian government.
The Post reported the government “has also refused to disclose on a per dose basis what it paid for COVID-19 vaccines.”
Another reason for restrictions on Paxlovid could be an impression of scarcity. The shortage of Paxlovid is no longer an issue and its production is in full effect.
There is not a lack of Paxlovid in Canada. Correspondence from the Public Health Agency dated July 15, 2022 confirms they have procured “1.5 million treatment courses of Paxlovid for distribution throughout this year (2022).”
They added, “to date, (about) 440,000 treatment courses have been allocated to provinces and territories.” Less than a third of the Paxlovid supply currently in the government’s possession has been distributed to the provinces in the first half of this year.
The Biden administration is increasing the availability of Paxlovid for Americans. An April 26 White House briefing confirmed the US now “has ample supply of these treatments,”stating they are making it easier for “tens of thousands of pharmacies” to now order free oral antiviral treatments directly from the federal government.
President Joe Biden himself has been diagnosed with COVID-19, a second time, on Thursday (July 21). The 78-year-old has had four doses of mRNA vaccine and still caught COVID-19. He started Paxlovid right away and as of this writing is doing well.
A UK Health Security Agency study in January 2022 found three doses of mRNA vaccine offered “robust protection against severe disease”. Specifically, “Researchers found that after a third shot of Pfizer, protection against hospitalization starts out above 95 per cent (two weeks after the shot) and remains around 80 per cent even after four months.”
An Israeli study assessed the protection gained from having a fourth dose of mRNA vaccine, focussing on the 60 and older cohort. The report published in April, 2022 in the New England Journal of Medicine found that protection from severe illness increased, then as with earlier doses waned over time.
Omicron and hospitals
There is hope that an mRNA vaccine will become available not just for past versions of the COVID-19 virus, but also for variants like Omicron and the recent dominant Omicron versions, BA.4 and BA.5. The new vaccine is expected to be available in 2023, possibly by late 2022.
As Omicron becomes increasingly contagious, in our vaccinated population where over 80 per cent of Canadians have received two doses and another 50 per cent have had a third, the disease may seem milder. Still, deaths, hospitalizations and severe illness occur. The pandemic is not over.
Hospitals across Canada are struggling from the burden of COVID-19, at risk of being overwhelmed by large numbers of patients with severe illness. ER waits up to 24 hours in Winnipeg; closed ERs and 800 health-care workers “with long COVID” in Quebec; long wait times in ERs and for ambulances in Nova Scotia – hospitals and their workers are under pressure.
Linda Silas, President of the Canadian Federation of Nurses Unions, said on July 4, 2022 that our health care system, a public one, “teeters on the brink of disaster,” adding, “if governments at all levels don’t act now, we risk system-wide collapse.”
With the mRNA vaccines we are currently using, protection fades and is less effective in people over 60 years of age, even with four doses. Not being tailored to the Omicron variant has reduced mRNA vaccination effectiveness.
As for Omicron BA.4 and BA.5, the impending increase happening at time of writing even has a name. We are on the cusp of an Omicron Tsunami, according to The COVID-19 Immunity Task Force (CITF) out of McGill University’s School of Population and Global Health.
Making Paxlovid at-home treatment available to COVID-sick people 60 years of age regardless of their vaccination status could help them avoid hospitalization.
The Ontario government offers a screener so you can check your eligibility for Paxlovid at any age. It’s a good resource to keep handy, as is the Paxlovid fact sheet.
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