Some Marin coronavirus patients get new treatment


A small number of Marin residents who test positive for COVID-19 are being prescribed a pill that reduces their chances of severe illness and hospitalization by about 89%, regardless of vaccine status.

The medication, Paxlovid, is one of at least six treatments for COVID-19 that have been approved for emergency use in the United States.

“With COVID-19 the realm of treatments is the next horizon for us,” Dr. Matt Willis, Marin County’s public health officer, told county supervisors last month during one of his periodic updates. “COVID-19 is an increasingly treatable disease with pharmaceutical interventions.”

“We have about 25 new COVID-19 cases per day in Marin,” Willis said, “and between one and three people each day are being prescribed Paxlovid.”

No evidence has emerged of a new surge of cases in Marin despite the prevalence of the omicron variant’s more transmissible BA.2 subvariant, Willis said this week.

“I’m increasingly confident we’re not going to experience a major surge in cases due to BA.2,” Willis said. Four people were hospitalized with COVID-19 in Marin on Thursday, and none was in intensive care.

Willis said the subvariant is proving to be less of a threat in communities like Marin with high vaccination and booster rates and, ironically, in communities that had high rates of infection because they resisted precautions. Both types of places have high levels of community immunity.

“In some places,” Willis said, “that immunity was earned the hard way through illnesses and deaths. Another way to earn that level of immunity is through vaccinations.”

Willis said Paxlovid was in short supply during the most recent surge of cases in January and February, but now there is an abundant stock.

The medication, which Marin’s public health division obtains from the state and distributes to local hospitals, is an antiviral drug that inhibits the SARS-CoV-2 protein from replicating.

However, the drug is no panacea for people who would rather wait until they are infected with coronavirus before seeking treatment. It must be prescribed by a doctor, and to be eligible patients must be at high risk of hospitalization or death from COVID-19.

Patients must also be age 12 or older and weigh at least 88 pounds. Paxlovid is not recommended for people with serious kidney or liver disease. Lipitor and other lipid-lowering drugs might interact with Paxlovid, so they can’t be taken simultaneously.

Probably the most daunting obstacle to using Paxlovid is the requirement for it to be taken within five days of the first symptoms of COVID-19. That means patients have to get tested and seen by their doctor in a matter of days.

“It is definitely a challenge,” Willis said. “That’s where my work with the health care system is now in trying to streamline that entire process.”

To that end, Willis said, Marin’s hospitals and federally qualified health centers have agreed to accept a home antigen test as confirmation of infection instead of requiring the more definitive PCR test, which can take much longer to schedule and process.

Willis said the state is also supplying the county with a monthly allocation of 20 doses of Evusheld, a monoclonal antibody treatment that helps protect immunocompromised people from becoming infected with the virus.

Willis said the treatment, which requires two simultaneous injections, “is to help protect people who are at the highest risk of bad outcomes.” That includes people who are receiving treatments for cancer or dialysis due to kidney failure.

Other approved COVID-19 treatments are all less attractive for one reason or another.

Molnupiravir, an alternative antiviral pill, is not recommended for women who are pregnant or breastfeeding. One study has suggested the drug might cause mutations in the human DNA. France and India have decided not to authorize its use.

Willis said alternative monoclonal antibody treatments are challenging to administer, because they involve injections or infusions, and to store, because they must be refrigerated.

In addition, monoclonal antibody treatments must be well-matched to a particular variant to be effective. As a result, they are more vulnerable to mutations in the virus.

Remdesivir, an antiviral treatment, and dexamethasone, a corticosteroid, remain the drugs of choice in seriously treating ill COVID-19 patients after they’ve been hospitalized.

The results of studies at the National Institutes of Health on several more possible therapeutic agents are expected during the first half of this year, and there are hundreds of similar studies in the works internationally.

Willis said the number of treatments available already and their effectiveness “is basically a sign that this virus is amenable to treatment.”

“It’s likely there will be more treatments and more effective treatments,” he said. “That could be a game-changer for us moving forward, especially if a more virulent strain hits.”

On Wednesday, a panel of vaccinators to the Food and Drug Administration spent hours debating key questions for revamping the COVID-19 vaccine and advising future booster campaigns.

“Our goal here is to stay ahead of future variants and outbreaks and ensure we do our best to reduce the toll of disease and death due to COVID-19,” said Dr. Peter Marks, the FDA’s vaccine chief. Marks said frequent boosting could not continue as an approach to future variants.

More meetings of the vaccine panel are expected in coming months.

The Associated Press contributed to this report.



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