Paxlovid sits on shelves as COVID-19 transmission grows in Alberta

With supplies of Paxlovid stockpiled in Alberta, and COVID-19 numbers ticking back up, some doctors hope the province will move quickly to improve access to the at-home antiviral treatment.

Alberta has 16,000 courses of the treatment in stock, and 670 prescriptions have been filled since the drug became available in the province at the end of January.

Paxlovid is designed for people with mild to moderate symptoms who are at high risk of getting very sick and needing hospitalization. A positive PCR test is required in Alberta, and the treatment must be given within five days of symptoms onset.

Ontario announced Monday it is making the pills available to more high-risk groups.

"Right now, the criteria in Alberta is fairly restrictive," said Dr. Stephanie Smith, an infectious disease physician with the University of Alberta Hospital.

With the highly transmissible Omicron subvariant, BA.2, pushing up community transmission and hospitalizations, she'd rather not see the pills sitting on shelves.

"In other provinces, they have expanded, and I do think that we're in a position, if we have enough stock, that we should be expanding the criteria."

Alberta currenty offers Paxlovid to very specific groups of people who are unvaccinated or have just one dose, including all Albertans 55 and over, all First Nations, Inuit and Métis people 45 and over and people 18 and up who have underlying conditions such as diabetes and heart failure.

It's also available to immunocompromised Albertans, including transplant recipients and those undergoing cancer treatment, and residents of continuing care facilities regardless of their immunization status. 

Smith believes other high-risk individuals could benefit, too, pointing to Ontario, which now includes groups such as people over 60 who don't have third doses.

"If we have enough stock of Paxlovid, we should be using it. And we should be using it in the patients that were tested in the clinical trials, which are those high-risk patients — so those who have comorbidities, the elderly — especially those who have only had two doses of vaccine," she said.

"Ontario is going in the direction of [offering Paxlovid to some people with] two doses of the vaccine, which makes sense. With the Omicron variant, we know that there is not as good protection with just two doses."

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Alberta announced last week it was expanding eligibility to include care home residents (regardless of their vaccination status) and First Nations, Métis and Inuit people 45 and over who are unvaccinated or have just one dose.

In a statement emailed to CBC News, a spokesperson for Alberta Health did not rule out a further expansion.

"We continue to monitor evidence around Paxlovid … and will make adjustments to eligibility as appropriate," spokesperson Lisa Glover said. 

More awareness needed

Dr. Jia Hu, a Calgary-based public health physician and chair of 19toZero, said he's pleased Alberta expanded its list of who is eligible.

His big concern is uptake. 

"We are sitting on a very large number of doses that aren't getting used," he said.

"Yes, you can make testing more easy. Yes, you can expand the eligibility. But the core problem remains the fact that the awareness of this treatment and the need to get some sort of PCR test for it is still too low."

To qualify for Paxlovid, Albertans must have a positive PCR test and be able to be treated within five days of symptom onset. And Hu doesn't think most people understand PCR testing is available for Albertans who qualify.

Hu said Alberta's central intake line is one of the more streamlined the country. There is a dedicated phone line (1-844-343-0971) people can call to find out if they qualify for treatment.

"People just don't know about it. They don't seek it out," Hu said.

"I think the problem is people aren't calling that number because they don't know about Paxlovid or think they don't need to get a test and they sort of fall out of the eligibility window."

Canada's Chief Public Health Officer, Dr. Theresa Tam, acknowledged the problem at a news conference on Tuesday and urged high-risk Canadians to monitor themselves closely for any possible symptoms.

"You've gotta get that medication pretty fast. So that is a challenge," Tam said.

"Sometimes, people don't even know they're sick. They think they have allergies because it's spring. But if you're at high risk, be hyper-vigilant that any symptoms could be COVID."

Tam also suggested at-risk people find out how they can access Paxlovid ahead of time, so they can act quickly if they do get sick.

Meanwhile, Smith said allowing rapid tests — rather than requiring a PCR confirmation — could help in Alberta.

And she said while Paxlovid is an important tool as the province faces yet another potential pandemic surge, the best protection is full vaccination including booster doses.

"Therapeutics do have a place in our toolbox in … trying to reduce the risk of people coming into hospital … [but] vaccination still has the best bang for our buck."