Prescription and Testing for Paxlovid: Why many people can’t get a prescription and why: a case study in South Korea and Europe
First, a programming note: This is my last newsletter before starting a book leave. I’ll be back in late January. Other Times journalists will be writing The Morning until that time, and I look forward to reading their work.
Unfortunately, at least 60% of people who may qualify for Paxlovid don’t get a prescription, and – as with testing – stubborn disparities remain in who gets access to these time-sensitive treatments. Blacks, Hispanics, Native Americans and other people living in high social vulnerability areas are more likely to get a prescription for Paxlovid than other people. Many people can’t get a prescription because they don’t have enough money.
In the US, they are BQ.1, Bq.1.2, BH.7 and BA.25 and 2. In other countries, the recombinant variant XBB has been rising quickly and appears to be fueling a new wave of cases in Singapore. Cases are also rising in Europe and the UK, where these variants have taken hold.
According to Dr Peter Hotez, who co- directs the center for Vaccine Development at Texas Children’s Hospital, they use letters that get high scores in the game like Q and X, which makes them akin to Scrabble.
How Covid-19 runs through the Omicron family tree in the US during the peak of the pandemic, and how the U.S. response is prepared
As the US moves into the fall, Covid-19 cases are dropping. Normally, that would be a reason for hope that the nation could escape the surges of the past two pandemic winters. This gaggle of newvariants may allow the downward trend to reverse itself.
It’s not clear whether this gang of new variants will continue to run around together, each sharing a piece of the Covid-19 infection pie, or whether one will rise to outcompete the others, as has happened in previous surges.
The poor uptake of the new boosters, combined with the immune evasiveness of the new variants and the waning of population immunity, is almost surely a recipe for rising cases and hospitalizations in the weeks ahead.
Though they each descend from slightly different branches of the Omicron family tree, these new offshoots have evolved to share many of the same mutations, a phenomenon known as convergent evolution.
According to some experts, this means that the evolution of the virus has entered a new phase and it will see several variations at the same time.
“What is likely to happen is that we have several co-circulating, semi-dominate lineages going into the winter season,” said Nathan Grubaugh, an associate professor of epidemiology at the Yale School of Public Health.
“That’s because with convergent evolution, perhaps several different lineages can independently obtain similar transmissibility levels versus a single new variant taking over.
“This is what predominantly happens for most pathogens, such as the flu and RSV,” Grubaugh wrote in an email. “Now that the virus has adapted pretty well to human transmission, most of what is circulating has high fitness.”
Maria Van Kerkhove, the Covid-19 response technical lead for the World Health Organization, said Wednesday that the large mix of new variants was becoming more difficult for WHO to assess because countries were dialing back on their surveillance.
We have to be prepared for this. To be able to deal with increases in cases, and also deal with increases and hospitalizations, a country needs to be in a good position. We haven’t seen a change in severity yet. And our vaccines remain effective, but we have to remain vigilant,” she said.
The Omicron subvariant has the top spot in the US. According to CDC estimates, it caused about 68% of new infections in the US last week, but it is quickly being outcompeted by several new sublineages – notably BQ.1 and BQ.1.1.
Most people think that BA.5 will be the dominant variant when the projections are released, Fauci told CNN.
The BA.4 and BA.5 genes are related to these, but they are different. They have a lot of parts in their genomes with that virus.
The changes are not as big as what happened when the original Omicron arrived. That strain of the virus, which is now long gone, came out of genetic left field, leaving researchers and public health officials scrambling to catch up.
“It isn’t that different from BA.5 that it would completely escape the protection that you would get from vaccine” – if people would just get the shot, Fauci said.
The original strain of coronaviruses can be protected with the bivalent booster vaccine.
Almost 15 million people have received a new bivalent booster in the last six weeks as a result of the campaign. That’s less than 10% of the population that’s eligible to get one.
The Covid-19 response has not reached the MA.5 or B.5 wave, but it’s likely going to be bigger than BA.5
Mark Zeller, project scientist who monitors variant at theScripps Research Institute, said that he expected the wave to be bigger than the BA.5 wave. But Zeller says he doesn’t expect this winter’s surge to reach heights of January’s Omicron wave.
These genetic changes seem to help people escape the immunity created by vaccines, which is a recipe for re infections and breakthrough infections.
People with immune function that has been weakened by drugs, disease, or age are more likely to benefit from the use of antibody therapies. These are the same people whose bodies don’t respond robustly to vaccines.
Even if we got money now, it would not be enough to bring a product into the marketplace in the next few months.
The administration has been thinking about ways to commercialize some parts of the Covid-19 response – to get out of the business of buying vaccines and therapies – ultimately passing the costs on to consumers and insurers. The process must be guided by needs on the ground and realities of the virus, according to Jha.
He says current realities require that the government continue to incentivize the production of new therapies, and he expects that the Biden administration will again try to ask Congress to pass more funding to do that.
The government is also reopening Covidtests.gov for a limited time so more Americans can get access to free tests. Each household in the US can order up to four at home tests that ship as early as next week.
It’s the fourth round of free rapid tests this year. The White House stopped the program in September because Congress denied requests for additional funding, which makes it difficult to send more kits. But the administration shuffled around funds to buy more of the tests for the national stockpile, the official said.
The Rise of Covid-19 in New York City, Los Angeles County, and Phoenix, and the First Week of December Hospitalizations in the US
“We know that the virus will circulate more quickly and easily as folks gather indoors for the winter holiday season,” the official said, speaking on condition of anonymity. After the Thanksgiving holiday, there could be another increase in cases after December celebrations.
Testing is available at community testing sites and through Medicare. Private health insurance plans will reimburse people for eight tests per month.
The government wants to offer Paxlovid to the people who get the virus, as well as getting the booster shot for nursing homes and long-term care facilities.
After thinking it was safe for your Auntie Mary to come for a holiday visit, Covid-19 numbers are on the rise again.
The number of cases has gone down, but the number of people who are in areas that meet the Centers for Disease Control and Prevention’s criteria has gone up. New York City, Los Angeles County and Phoenix’s Maricopa County are among those areas.
Covid-19 hospitalizations have been on the rise since early November, and older people are bearing the brunt of these serious illnesses. The hospitalization rates are four times higher for seniors.
The US had the most deaths in the first week of December. Even with vaccines and treatments widely available, the CDC reported nearly 3,000 deaths for that week.
The White House Resolved the Covid-19 Season: Instruments, Infrastructure, and Resources for the Post-Biden Emergency Response
“We have the tools, we have the infrastructure, and we have the know-how to manage this moment,” White House Covid-19 response coordinator Dr. Ashish Jha said at a briefing.
The Biden administration has been in daily contact with state and local public health leaders, monitoring hospital levels, he said. And the federal government has medical personnel, supplies and other resources ready if states and communities need them.
Those with chronic conditions, as well as people 50 and older who test positive for Covid-19 should be evaluated for treatment, according to Jha.
I think if people use those tools, we could get through the Covid-19 season, because the tools are so readily available.
A district representative said that when children return from the winter break in Philadelphia, they will be required to wear masks for 10 days to reduce the spread of respiratory illnesses.
The CDC recommends masking for anyone who’s on public transportation. It suggests wearing one in places with high Covid-19 community levels. People who are at high risk of severe illness are urged to wear masks even in areas with only medium community levels.
Editor’s Note: Dr. Megan Ranney is the deputy dean at the School of Public Health at Brown University and a professor of emergency medicine at the university’s Warren Alpert Medical School. The opinions expressed in this commentary are of her own. CNN has an opinion on it.
It’s true that four tests per family are not a lot. They are an example of a larger group of victories against Covid-19, which should be celebrated and examined closely for lessons learned.
The first under-valued fact is that Covid-19 testing for all still remains a top priority, as rapid at-home testing for the disease is now available to almost all of us. Performing an at-home test before you go to a holiday party, a few days after you’ve been exposed to the virus or when you’re feeling ill reduces the chance of unintentional virus spread.
It isn’t possible to remember, but in the spring of 2020 at- home testing became available to the public. They were difficult to find at that time. Not surprisingly, huge disparities in use were observed in those early months. Minorities, the elderly and low-income people were less likely to use them.
Thanks to the flexibility that a public health emergency declaration provided to the FDA in early 2020, and the federal government’s connections and buying power, there is plenty of at- home Covid-19 tests.
The new partnership was announced last week by Walgreens, DoorDash and Uber Health, and will allow users to have Paxlovid delivered to them in less time than it takes from the pharmacy. According to Walgreens, this program can reach 92% of Americans. In combination with existing prescription delivery services from CVS and RiteAid, this newest partnership may reduce the chance that someone sick has to go out and expose others in order to get their Paxlovid prescription. It also provides immense benefit to those who can’t get transportation or child care or are disabled.
There is no FDA-approved rapid vaccine or home test for flu. oseltamivas is a bit less effective than Paxlovid and there are no good treatments forRSV. Moreover, telehealth has already been shown to increase over-prescription – and unnecessary prescription – of some treatments, such as antibiotics; any wider scale test-to-treat program would have to be careful to make sure it doesn’t further worsen overuse of antivirals and antibiotics. And as opposed to payment for Covid-19 tests and treatment, access to other types of telehealth and medications is largely dependent on one’s insurance – or ability to pay out of pocket.
We have seen some failures in Covid-19, but it may be that these failures and small successes can lead to more public health innovation.
We have developments to celebrate this holiday season. We now have some amazing new tools that reduce disease and severe illness, and they’re truly available to all.