N.B. use of COVID-19 treatment still low, as hospitals struggle with respiratory illnesses

As New Brunswick hospitals struggle with a surge of respiratory illnesses, only about a third of the province's supply of a COVID-19 treatment has been prescribed, while only a fraction of a COVID-19 preventive treatment has been administered.

Paxlovid has been shown to significantly reduce hospitalizations and deaths among people at high risk of progressing to serious illness from COVID-19, such as seniors and people with compromised immune systems.

But only 5,056 of the 15,200 treatment courses New Brunswick has received from the federal government have been dispensed as of Dec. 6, according to the Department of Health.

This, despite the fact that the province expanded eligibility and access to the combination of pills that can be taken at home to treat COVID-19, three months ago.

"The numbers … make me wonder if people know" about Paxlovid, said Kevin Duplisea, a pharmacist at Shoppers Drug Mart in Quispamsis and a board member of the New Brunswick Pharmacists' Association.

He encourages people who test positive and aren't sure whether they're eligible to call a pharmacist.

A drug that could prevent vulnerable people from getting COVID-19 isn't being used much in New Brunswick either, figures from the Department of Health show.

Of the 1,025 boxes of Evusheld the province has received, only 47 have been dispensed, as of Dec. 6.

That means as few as 23 people may have been prescribed the drug, since a dose may be one box or two, depending on the patient's needs.

Duplisea suspects part of the reason for the low numbers is that emerging evidence suggests Evusheld may not be effective against Omicron, particularly the subvariants that are currently prevalent. "So for many people, there would be no benefit to giving it," he said.

Who is eligible for Paxlovid?

In New Brunswick, people may be eligible for Paxlovid if they're over 18 and have tested positive for COVID-19 on a PCR (polymerase chain reaction) lab test or rapid test, have mild to moderate symptoms of COVID-19 that started within the last five days, and are at higher risk of severe outcomes.

People may be considered at higher risk of severe outcomes if they:

• Are not fully vaccinated.
• Are an older adult.
• Have one or more chronic medical conditions.
• Are moderately to severely immunocompromised due to a medical condition or treatment.

"The hope is that [Paxlovid] could decrease the overall severity of their illness such that they didn't require to go to the hospital," said Duplisea.

Triple threat rising

New Brunswick recorded seven more COVID-19 deaths in last Tuesday's COVIDWatch report. The pandemic death toll has now reached 714.

There were 40 people hospitalized because of the virus, according to the province's report, and 29 people were newly admitted to hospital, including a child under 10.

Meanwhile, the two regional health authorities, which count people admitted to hospital because of COVID-19, as well as those initially admitted for another reason who later test positive for the coronavirus, reported 130 people hospitalized, including six in intensive care.

New Brunswick has also seen an all-time high of people hospitalized by the flu, at 115 as of Dec. 3, nearly double the previous record.

In addition, lab-confirmed cases of respiratory syncytial virus, or RSV, have jumped by nearly 150 in a week, the latest national figures show, with 463 cases reported as of Dec. 10. RSV, which infects the lungs and respiratory tract, can result in severe infection in some people, including infants, older adults, adults with heart or lung disease, or with a weakened immune system.

Pharmacists prescribing 'steady'

Pharmacists are doing their part to help ease the strain, said Duplisea, and prescribing for a "steady" number of COVID-positive people who are eligible for Paxlovid.

Accessibility has improved since Sept. 22, when pharmacists became authorized to assess patients and prescribe the drug, according to the Department of Health.

At that time, only 2,465 treatment courses had been prescribed, compared to 5,056 as of Dec. 6 — a nearly 106 per cent increase.

Prior to the change, New Brunswickers had to get an appointment to see a physician or nurse practitioner within five days of the onset of symptoms to find out if they were eligible for the treatment.

Eligibility for Paxlovid was also far more limited prior to September.

Health Department not worried about spoilage

"Public Health is pleased to have pharmacists helping to make this medication more available, and thanks them for their dedication to their communities, and their patients," Department of Health spokesperson Adam Bowie said in an emailed statement.

"Throughout the pandemic, pharmacists have stepped up to assist with vaccinations and other services, and we know that they've contributed to keeping New Brunswickers healthier through these challenges."

A list of pharmacies offering the pharmacist assessment for Paxlovid is available online.

Asked when the province's stock is set to expire, Bowie did not respond directly.

"All of the province's supply is available, and has yet to expire, and the department isn't concerned with spoilage at this time," he said.

"New Brunswick is expecting an additional allocation of Paxlovid in the near future, but the department isn't worried about its supply at this time," he added.

'Not a magic bullet'

According to Duplisea, pharmacies are getting "many calls every day" from people who could be eligible for the Paxlovid.

The antiviral treatment can significant interactions with other prescription medications, however.

"So it's really, in many cases, weighing the risks and benefits. It's not just a matter of, do they know about it? The real question is, will it work and is it safe?"

And while Paxlovid works well for some people, it's "not a magic bullet," Duplisea cautioned.

"So if you're having trouble breathing, if you're having chest tightness, if you're getting worse on Paxlovid, you certainly need to be assessed by a medical professional."

The New Brunswick Medical Society did not respond to a request for an interview.

Paxlovid does not stop people from getting COVID-19 and is not a substitute for vaccination, the province's COVID-19 website advises.

A full course of treatment consists of 30 pills over five days.

Paxlovid reduced the risk of hospitalization or death by 89 per cent in non-hospitalized high-risk adults with COVID-19, compared to a placebo during its clinical trial, according to Pfizer.

No plans to seek more Evusheld

In New Brunswick, Evusheld is a preventive treatment designed for people at high risk for complications if they were to contract COVID-19.

While vaccines rely on a person's natural immune system to develop targeted antibodies and infection-fighting cells, Evusheld contains the lab-made antibodies tixagevimab and cilgavimab, which are designed to linger in the body for months to contain the virus in case of an infection.

A health-care professional administers each antibody through an injection, usually in the buttocks.

In October, Health Canada expanded its authorization for Evusheld to also be used as a treatment by those age 12 and older who are immunocompromised, such as organ transplant recipients or people with certain blood cancers, and are unlikely to have enough of an immune response to COVID-19 vaccination alone.

Asked whether New Brunswick plans to offer Evusheld as a treatment and if not, why not, the Department of Health spokesperson did not answer directly, saying only that it's currently offered as a preventive treatment in the province.

"Given the demand to date for this product, the Department of Health isn't currently seeking any additional supply, and it will continue to monitor its inventory," Bowie said.

He did not provide expiry dates, saying only that the department "isn't concerned with spoilage at this time."

The drug maker AstraZeneca's clinical trial of Evusheld as a treatment showed about a five per cent benefit from the drug compared with the placebo among those at high risk.

The clinical trial to approve the drug was done in about 900 individuals. Health Canada previously said it's not known if the drug can be taken in pregnancy or while breastfeeding.