At-risk Ottawa woman with COVID-19 left waiting for antiviral treatment

UPDATE | Amy Ferguson received her Paxlovid treatment Friday afternoon.

An Ottawa woman who is immunocompromised says she's been waiting since Tuesday to fill her prescription for the antiviral COVID-19 drug Paxlovid — a treatment that needs to begin within three to five days of symptom onset to be effective. 

Amy Ferguson has rheumatoid arthritis, an autoimmune disease that puts her in the high-risk category of patients with COVID-19. 

She found out Monday that a friend she'd had contact with had COVID, she said. Ferguson was experiencing mild symptoms, similar to those caused by rheumatoid arthritis, took a rapid test and said it came back as a "faint positive."

The medicine is there, I just don't get the barrier.— Amy Ferguson

She woke up Tuesday morning to worsening symptoms, took another rapid test that also came back positive, and called Ottawa Public Health to get isolation information for her and her family.

Then she called her family doctor's clinic and spoke to a physician, who prescribed her Paxlovid.

Since then, she and that physician have been trying to figure out how to get their hands on the treatment.

"The doctor called me back two separate times to let me know the status of her learning, researching and making those connections," she said.

"The medicine is there, I just don't get the barrier."

Dr. Zain Chagla, an infectious disease specialist and associate professor at McMaster University, said he thinks there are plans to scale up the use of Paxlovid, but it's been slow.

"It's really this that might be the consequence of it, that people just don't know how to navigate the system and the system isn't helping them navigate it," he said.

Timing 'critical'

Ferguson said the doctor at her clinic has been co-ordinating with the public pharmacy and inpatient pharmacy at the Ottawa Hospital's Civic campus.

On Tuesday, it seemed she'd have her prescription by Wednesday at the latest. But when she called the public pharmacy at the hospital, the pharmacist told her they could see her prescription there but couldn't fill it for her.

Currently, Ontario residents can only access antivirals — medication designed to help the body fight off the SARS-CoV-2 virus, reduce symptoms from an infection and shorten the period of illness — at a provincial testing centre after confirmation of a positive molecular test.

Ferguson said when she spoke with the physician at her family doctor's clinic, they didn't think she'd be able to get results from a PCR test fast enough for her window of eligibility for Paxlovid (three to five days after symptom onset).

Clinic staff, who had also been contacting the pharmacy on her behalf, managed to get her a referral to the clinical assessment centre at the hospital.

Thursday was Ferguson's fourth day since symptom onset, though it's difficult to tell exactly when her COVID symptoms started because of their similarity to rheumatoid arthritis symptoms.

Perhaps tonight I can't breathe, I have to go to the ER and then I have to take up a bed and then I have to take up resources.— Amy Ferguson

"We are who this medicine is made for and it's bizarre that I can't access it and my window to do so effectively is closing," she said.

At this point, the best-case scenario for Ferguson is being seen at the clinical assessment centre on Friday — five days since symptoms began.

Chagla said the system needs to be more decentralized, and that there are plans underway to make that happen.

"Get this into test pharmacies outside of hospitals so that community people can prescribe it," he said.

"I saw four very similar patients [Thursday] and prescribed that Paxlovid myself," Chagla said. "These are the ones that need to get to these treatment centres and ... shouldn't be lost in the cracks in all of this."

One of Ferguson's concerns, beyond her short- and long-term health, is becoming a further strain on an already stretched health-care system.

"Perhaps tonight I can't breathe, I have to go to the ER and then I have to take up a bed and then I have to take up resources," she said.

According to a Ministry of Health spokesperson, Ontario received 40,000 courses of treatment for Paxlovid, and has distributed 400 through clinical assessment centres and 755 for patients in hospital.

Ferguson said she doesn't think she is alone in her confusion and frustration at this situation.

"If it's this difficult for me — confirmed sick, has a prescription, can't access this.… They have hundreds of patients, and if this hiccup is happening to me it's certainly happening to others."

'It doesn't help to be angry'

But she also wanted to make clear that she doesn't blame health-care professionals who have been working hard through the pandemic.

"It doesn't help to be angry. Just imagine how our health officials are feeling," she said. "I just feel so intensely for all of our health-care workers."

At about 8 p.m. Thursday, an infectious disease physician who had read Ferguson's blog about the situation contacted her, she said. The doctor works at an assessment clinic like the one she needs to be seen at, and told her they would flag her referral.

Ferguson said the doctor told her someone would call her when the clinic opens Friday morning.