Here’s why a Tufts doctor says you should ask for COVID medicines

COVID

“For 2 years we said that effective and widely available treatment would be a game changer. Well, the game could be changed but how do we get the word out to doctors and patients?”

Boxes the Paxlovid antiviral medication being arranged in a warehouse in Shoham, Israel, Jan. 18. Kobi Wolf/Bloomberg

Even as cases are lower in Massachusetts than they were a few months ago, hospitals are still seeing people admitted with COVID most days, according to Dr. Shira Doron, the hospital epidemiologist at Tufts Medical Center. 

She said they are mostly unvaccinated, but not exclusively. What is more universal is that they have almost never started on any kind of treatment for COVID-19, despite there being widely available outpatient treatments.

“For almost two years. It’s been, ‘There’s nothing we can do until you need to go to the hospital. So, rest and drink fluids.’ But that’s not how it is anymore,” Doron said in an interview with Boston.com. 

A range of treatments are available, including Paxlovid, an oral medicine that is the preferred treatment for most patients who are at risk of severe disease, according to the Massachusetts Department of Public Health; remdesivir, a antiviral therapy administered intravenously; and monoclonal antibodies.

Doron said she has heard people ask if they should wait to see if their symptoms progress and then take the medicines, but Doron said that is not how the medications are designed to work. 

“The way it works is preventing it from getting worse,” Doron said. “Once you’re getting worse, your immune system is what’s kicking in and going a bit haywire and causing the worse symptoms, and the medications are not for the immune system, they are for the virus. The medications will kill the virus [and] that has to be done before that second phase of the illness sets in.”

The treatments currently authorized have been shown to help prevent hospitalization and severe illness, Doron said.

For so much of the pandemic, treatments either hadn’t been developed yet or were in short supply — but Doron said that is no longer the case. 

In general, COVID-19 treatments should be started as soon as possible — for example, Paxlovid is supposed to be started within five days of symptom onset.

COVID-19 treatments are available to a wide range of people — nearly 40% of Massachusetts residents, according to Doron. Risk factors are laid out by the Centers for Disease Control and Prevention’s guidelines and vary widely.

“We have so much treatment right now that we really aren’t limiting it to people with any specific risk factors. The state has tiers in terms of risk factors that it uses when there is a shortage of supply,” Doron said. “But there is no shortage of supply right now. In fact, the goal right now is really trying to get the word out so that more people take advantage of it.”

During omicron the picture wasn’t quite the same — especially for the oral agents, like Paxlovid, there wasn’t a strong supply set up before the spike. 

Doron recommended people test often and if they are positive to contact their primary care doctor immediately. They should be able to help patients determine if they qualify and what route to take.  

“It’s really important during a pandemic that everyone have a primary care doc,” Doron said. “We see that COVID isn’t going anywhere. It’s not going away. … There’s just so much evidence that your risk is very much tied to your underlying medical conditions … This is the time to get a primary care doctor and get any of your underlying risk factors better controlled.”

Though she strongly encourages everyone to get a primary care doctor, there are ways to get COVID-19 treatments without a primary care referral. For example, there are several state-sponsored Gotham sites that can connect patients with treatments. Massachusetts has a COVID-19 Therapeutic Locator which lists all the sites the drugs are available.

While Doron said there is a “real theoretical possibility” that the SARS-CoV-2 virus could become resistant to current treatments, that didn’t outweigh her current support for utilizing treatments.

Doron said on Twitter that she “*will* take Paxlovid when I get COVID” and cited high levels of effectiveness and safety associated with the drug. 

“I just really believe everyone’s gonna get COVID,” Doron said. “Just like everyone gets the other four coronaviruses that have been circulating for who knows how long in our society and will never go away. COVID will never go away. We know that for sure.”

Here is Doron’s full Twitter thread:

Here’s why a Tufts doctor says you should ask for COVID medicines