Alaska’s supply of drugs meant to treat people with COVID-19 infections continues to remain in flux: Some treatments are becoming more available while others remain scarce.
But, health officials say, the treatments aren’t right for everyone and need to be discussed between patient and provider. For instance, many vaccinated people likely won’t need treatment in the first place, given the likelihood that they won’t become severely ill from a COVID-19 infection.
Plus, getting a prescription for one of the treatments may also depend on a person’s health conditions, the medications they’re taking and when they started experiencing symptoms, in addition to their vaccination status and the availability of the treatments.
The lightning spread of the omicron variant has sharply pushed Alaska’s daily case counts into unprecedented highs. But the variant appears to be making people less sick compared to the previous delta variant.
The most tightly constrained treatment drugs are the ones people might be most familiar with: monoclonal antibodies, which have been used to treat people at risk for serious COVID-19 infections for the past year or so. But after research showed that only one monoclonal antibody treatment — sotrovimab — was effective against the currently dominant omicron variant, its supply tightened.
That means only a small portion of Alaskans are able to get the treatment right now under the current prioritization guidelines, compiled by the state’s crisis standards of care committee this month.
The groups at highest risk for severe illness from an omicron infection who are prioritized to receive the drug include people with moderate to severely compromised immune systems regardless of vaccination status and older people who aren’t up to date on vaccinations as well as pregnant people.
However, a newer COVID-19 treatment, a drug called molnupiravir, is becoming much more available, according to state pharmacist Dr. Coleman Cutchins.
The drug isn’t administered the same way antibodies are, through an infusion. Instead, molnupiravir can be taken orally and picked up at community pharmacies. That means it’s easier to take and easier to manufacture and ship, he said.
Over the next two weeks, Alaska is receiving enough of the monoclonal antibody to treat 144 people, enough of the oral medication molnupiravir for 720 people as well as 180 treatments of Paxlovid, a different oral COVID-19 treatment.
Remdesivir, a separate COVID-19 treatment drug that’s been approved by federal regulators for about a year, was recently approved for outpatient therapy after it had been limited to only hospitalized patients, according to Cutchins. It’s available through the free market and not allocated to states the way the other drugs are.
The state’s crisis care committee took molnupiravir off its prioritization list this week, given that more than 700 of doses were allocated to Alaskans. But who gets what drug really comes down to a conversation between patient and provider, Cutchins said.
“Yes, there are treatment options available,” he said. “But you need to work with a health care provider to figure out which one, if any, are right for you.”
While molnupiravir will be more abundant than monoclonal antibodies and the other oral medication, it has a potential increased risk of side effects and seems to have lower effectiveness, which means patients and their providers have to weigh the risks and benefits of taking the drug, said Anchorage infectious disease Dr. Benjamin Westley.
“If there was enough medicine for everybody in the whole world, it still wouldn’t mean that everybody in the whole world needs to take a medicine if they get COVID, or even should take a medicine if they get COVID,” Westley said. “People that are likely to benefit from a medication should take it.”
Most people who received a COVID-19 vaccine and booster or have had a prior infection probably don’t need any treatment, Westley said. They’re at a low risk for progressing to severe illness, hospitalization or death.
“The people that we are really worried about as physicians right now are people with risk factors for severe disease, who are not vaccinated and who have not had COVID before,” Westley said.
There are multiple considerations when thinking about which COVID-19 treatment to prescribe, said Dr. David Scordino, an emergency physician and medical director at Alaska Regional Hospital. For one, availability should be considered, plus feasibility. While the supply of remdesivir is increasing, it’s an infusion drug that is supposed to be administered over three days in an outpatient setting.
“The logistics of that are more challenging, so that may not be an option depending on the community that the person is practicing in,” Scordino said.
Next, Scordino said, it’s important to consider duration of symptoms. Some drugs are for people who have only had symptoms for five, seven or 10 days. Additionally, a patient’s other conditions and medications can impact which drug that might be best and may eliminate some options, he said.
Dr. Thomas Quimby, medical director of the emergency department at Mat-Su Regional Medical Center and a full-time emergency physician, said he worries that the treatments may also become a distraction from what is actually effective: vaccination.
“Of all the options available to protect yourself, it’s really clear statistically that just getting vaccinated is the best thing you do,” Quimby said. “All of these therapies while they may have some benefit, statistically, they’re just not super effective miracle drugs.”
By far, the best way to prevent severe COVID-19 infection, health officials say, is by getting vaccinated.
“There’s an old saying in viral infectious disease,” said Cutchins, the state pharmacist. " ‘Mitigation, not medication’ — that it’s easier to prevent infection through things like vaccine than it is to treat people once they’re infected.”