Covid-19 treatments are widely available to at-risk New Yorkers, but many who could benefit from them may not even know they exist.
One of those treatments, an antiviral drug called Paxlovid, is highly effective, said Dr. Ted Long, director of the New York City Test and Trace Corps, a city program that provides free testing and support to New Yorkers. with covid-19.
“For every 20 New Yorkers we treat with Paxlovid, we prevent one New Yorker from getting so sick they need to be hospitalized,” said Dr. Long.
Coronavirus cases in New York City have risen 6 percent in the past two weeks, according to The New York Times tracker, driven in large part by Omicron’s highly contagious BA.2 subvariant. Hospitalizations are up 23 percent during the same period of time.
Across the country, hundreds of thousands of Paxlovid pills have gone unused, and the White House announced plans this week to expand access.
The city’s health department did not say how many pills had been distributed in New York, although Dr. Ashwin Vasan, the health commissioner, said uptake had been “significant.” This city has worked to spread the word through newspaper ads and public service announcements.
“We are in a new phase of the pandemic response, where we have a variety of tools at our disposal,” said Dr. Vasan.
But some experts believe that very few people know about the treatments.
“I’m really not sure that the average person who needs Paxlovid — I mean older people, people with comorbidities, or people who are medically vulnerable and unvaccinated — are aware of this critical information,” said Dr. Denis Nash, professor of epidemiology. at the City University of New York.
Paxlovid, a Pfizer drug that was authorized in late December, is one of several available treatments that have proven effective against covid-19. It is preferred by the federal government and New York City officials because of how effectively it reduced the risk of death and hospitalization from COVID-19 in unvaccinated high-risk adults during trials.
Here is an overview of the various Covid-19 treatments and how to obtain them in New York City.
What Covid-19 treatments are available?
Both oral antiviral treatments and monoclonal antibodies are available. Antiviral pills work by interrupting the cycle of viruses that infect cells and then take over those cells to replicate in the body, Dr. Vasan said. Monoclonal antibodies work by killing the proteins that viruses make, which in turn helps boost a person’s immune system.
There are two oral antiviral pills available for COVID-19 in New York City: Paxlovid and molnupiravir.
Paxlovid is prescribed as three pills to be taken twice a day for five days, while molnupiravir (licensed for use in December) is prescribed as four pills to be taken twice a day for five days.
Both pills are available through an online pharmacy, Alto, and at a select number of pharmacies throughout the city. You can find a list of those nearby on a federal website.
Most New Yorkers seeking antiviral treatment should expect to receive Paxlovid, given its effectiveness, Dr. Vasan said.
There are also two antibody treatments that appear to be effective against BA.2 in laboratory studies: Bebtelovimab, licensed for use in February and administered intravenously, and Evusheld, licensed for use in December, for people allergic to vaccines or immunocompromised.
Who is eligible for treatments?
For most treatments, city officials are prioritizing people who have not only tested positive for coronavirus, but also have mild to moderate symptoms and are at higher risk of developing severe illness. (Evusheld is given to people before they test positive.)
You are considered to be at high risk of developing serious illness from Covid-19 if you are 65 years of age or older, or if you have health risks such as diabetes, hypertension, or heart disease. Immunocompromised people are also considered high risk.
The federal government has urged providers to prioritize treatments for people who are not vaccinated or not yet fully vaccinated.
You must be over 12 years old and weigh more than 40 kilograms, or about 88 pounds, to receive Paxlovid, bebtelovimab, and Evusheld. But you must be at least 18 years old to take molnupiravir.
People with severe kidney or liver disease may not be eligible for Paxlovid, and molnupiravir cannot be used during pregnancy. Pregnant or lactating women should talk to their health care providers before taking Paxlovid, according to the FDA’s treatment fact sheet.
It’s important for patients to talk to their providers about the medications they’re taking, as they could negatively interact with treatments, said Dr. Andrew Wallach, medical director of ambulatory care at New York City Health and Hospitals.
How do I get them?
After testing positive, you must inform your doctor or call the city’s Covid hotline, 212-COVID19 (212-268-4319) and press 9 to be connected with one of the city’s doctors to determine your eligibility. You can also visit Virtual Express Care to schedule a phone or video visit or complete the City Screening Tool as well.
After a doctor decides which treatment is right for you, it will be sent to a nearby pharmacy or to your home. The city’s partnership with Alto Pharmacy makes same-day home delivery possible.
The Biden administration also recently introduced a “test-to-treat” initiative, which allows you to get tested for the coronavirus at certain pharmacies and, if you test positive, receive free antiviral pills on the spot. You can find locations on the federal website.
I have to pay?
They are currently free to all New Yorkers, Dr. Vasan said.
Are the treatments effective?
Oral treatments have been shown to reduce hospitalization and death from Covid-19 if taken soon after the onset of symptoms.
Paxlovid reduced the risk of hospitalization and death in unvaccinated high-risk people by 88 percent when taken within five days of symptom onset in a Pfizer trial published in December, before the Omicron wave. .
Molnupiravir reduced the risk of hospitalization and death in unvaccinated high-risk people by 30 percent when taken within five days of symptom onset, according to a Merck analysis published in November.
Bebtelovimab, which must be given within seven days of the start of symptoms, has not been tested in a study that can show whether it can prevent serious illness, and the Food and Drug Administration said it should not be a preferred treatment.
Evusheld, which can be given every six months, was found to be highly effective in preventing covid in a clinical trial.
Are there any side effects?
Paxlovid is “well tolerated,” said Dr. Wallach. Side effects that have been seen in small numbers in clinical trials include diarrhea, high blood pressure, and pain.
Because bebtelovimab is given intravenously, some people may experience a rash at the injection site.
How many New Yorkers have received these treatments?
It’s hard to say. The health department was unable to provide data, in part because it did not have “visibility into the entire universe of pharmacies” that distribute many of the treatments, said Patrick Gallahue, a spokesman.
There is an immunization registry that tracks vaccinations, but there is no prescription drug registry, Dr. Nash said.
“It is a problem that they do not have their finger on the pulse of this, because it is the main thing that is going to help us contain these waves, hospitalizations and deaths,” he said. “That plus vaccines and reinforcements.”
Dr. Nash was concerned that the inequalities seen during each phase of the pandemic, even with the implementation of tests and vaccines, would reappear with these treatments.
“If you don’t anticipate that underlying inequalities in access to health care will be magnified, if you don’t plan for it, then you’ve done a poor job of caring for the most vulnerable people. in the city,” said Dr. Nash.
How has the launch been so far?
Treatments are now available through Alto Pharmacy and community health centers. The health department is also working to expand access to physical pharmacies throughout the city. Ultimately, state officials decide how to allocate treatments to pharmacies.
Colombo’s Pharmacy in Queens is one of the places that now offers Paxlovid and molnupiravir.
He received his first batch, 20 doses of each drug, earlier this month. Dr. David Kandov, the pharmacist, said only about five people had applied for the treatments so far.
Dr. Kandov expressed frustration with the time it took to receive the first batch, saying that the network he belongs to had been trying unsuccessfully to access the drugs since December, when they were first authorized.
He blamed the health department. “They effectively shut us out and cut off access in the communities,” Dr. Kandov said. “Because at the end of the day, as much as things are available virtually, mail order and that sort of thing, that’s not the same as patients having it right there in their community.”
“The city offers a delivery model that ensures quick access to any address in New York, which began at a time when supplies were insufficient to stock traditional pharmacies across the city,” said Mr. Gallahue. “As supplies have improved, more pharmacies have come on board.”