Quebec hospitals to start administering new Pfizer drug to high-risk COVID-19 patients

Quebec will begin receiving the sought-after antiviral drug Paxlovid, but not quickly enough to ease the heavy burden that the latest wave of COVID-19 is imposing on hospitals, which are readying more radical ways to prioritize patient care.

About 6,300 treatments of the drug will be delivered to the province this week, with thousands more set to arrive in the coming month.

The medication developed by Pfizer, lauded for its potential to reduce hospitalizations from the virus, was approved for emergency use by Health Canada yesterday. 

The drug's arrival is being welcomed by health officials in Quebec, as hospitals are being overwhelmed by the number of COVID-19 patients infected by the highly contagious Omicron variant. 

At an update on the pandemic situation in the province Tuesday, Health Minister Christian Dubé said the treatments aren't expected to reduce the pressure on hospital beds immediately. 

"We are at the end of the rope," Dubé said. "Our best weapon remains vaccination."

Dubé said it's still too early to relax pandemic restrictions, given the state hospitals are in.

89 deaths reported Tuesday

There are a staggering 3,417 COVID-19 patients in Quebec hospitals on Tuesday. That's unprecedented. But while hospitalizations are still climbing, the rate of increase is beginning to slow, said interim Public Health Director Dr. Luc Boileau. 

"This disease will not disappear anytime soon. It's going to be with us for a while," Boileau said.

There were also 89 deaths reported in the province Tuesday, one of the highest daily death counts since a majority of Quebecers were vaccinated. 

Boileau said doctors have said the numbers don't reflect what they are seeing, and health officials are looking into what's going on. He said statisticians want to understand whether the deaths are of people who died because of the virus or who happened to have COVID-19 when they died.

Quebec records more COVID-19 deaths than other provinces, Boileau said, not because the virus has necessarily killed so many more people here but because the government has found ways to detect more of the people who died.

'How can we do more with what we have?'

The chair of Quebec's COVID-19 ethics committee, Marie-Ève Bouthillier, and other senior health officials outlined their latest contingency plan for managing patient care in a separate media briefing Tuesday afternoon.

The plan rotates around four main axes. The first allows hospitals to find more resources by doing less to restrict the spread of COVID-19 — such as reducing isolation times for asymptomatic staff who test positive, or allowing recovered COVID patients onto wings that have outbreaks.

The second is to find ways to shorten all hospital stays.

The third is to find ways for COVID-19 patients to be treated at home. Opatrny said Montreal's Jewish General Hospital, for example, is already experimenting with providing some COVID-19 outpatients with milder respiratory symptoms with oxygen machines.

The final axis is a guide to reducing the intensity or standard of care. 

"It's about if we can't provide all patients with A+ care, how can we slightly reduce that standard," while still caring for everyone, Opatrny said. "How can we do more with what we have?"

The plan, which was drafted by a team of 30 experts, also recommends relying more on primary caregivers and even, if needed, volunteers, as well as putting more of a burden on emergency departments to free up hospital beds.

One of those experts, Dr Hoang Duong, the president of Quebec's association of internal medicine specialists, said hospitals still aren't at the point of lowering the quality of care. 

"The purpose is to be prepared for any eventuality," Duong said. "Our health-care system is under pressure, but we're not there yet."

He said though the plan may appear alarming, it is the ethical way of preparing for a period of low resources and of recognizing that there is a crisis.

"This is harm reduction," he said.

Paxlovid to immunocompromised, first 

According to health officials, Paxlovid will be used to treat those who have mild to moderate symptoms of COVID-19 but risk developing a severe form of the disease. 

The drug will be given only to patients 18 years and older who are immunocompromised, such as cancer patients or those who have had organ transplants, as well as to those with serious conditions who cannot be vaccinated.

By March, the province says, it's expecting to get about 19,000 treatments. At that point, it could be offered to more patients, not just those who are immunocompromised.

Each cycle of treatment is 30 pills, taken orally: three pills, twice a day, for five days.

Another challenge is supplying the entire province, especially places where there aren't hospitals. To do so, the government will partner with 50 to 60 local pharmacies that will stock the drug.

Health officials say there are challenges to administering it. The drug must be taken within five days of symptoms appearing.

After several months of clinical trials, Pfizer had reported in November that Paxlovid reduced the risk of hospitalization or death by an impressive 89 per cent compared with a placebo in non-hospitalized high-risk adults with COVID-19.