By Dr. Anthony Policastro

One of the advances in COVID-19 treatment is the use of antiviral drugs. At this point emergency use authorization has been given to two of them. Pfizer makes Paxlovid. Merck makes molnupiravir.

Many people do not understand the complex rules associated with the use of these drugs. The most important one is that they are not useful for patients with illness severe enough to require hospitalization. They can only be used during mild illness to prevent hospitalization.

A second rule is the misconception that they can be used to prevent COVID-19 infection. That is not the case. They are not preventive medications. In addition, they cannot be taken for more than five consecutive days. Therefore trying to take them on a regular basis to prevent an infection makes no sense. It also is a dangerous approach.

These drugs must be used within five days of the onset of symptoms. Thus, if someone has symptoms, an early diagnosis is necessary. Those who put off making the diagnosis early will no longer be eligible to receive the medications. 

By now, everyone should have applied for and received the home testing kit. While these are not perfect, they are certainly helpful in making an early diagnosis.

These drugs also interact with multiple other medications. Some of those are drugs used for heart disease. Some are those used for cancer. Some are used in HIV patients. Some of those are drugs used to provide immunosuppression to patients.

The drugs can make renal impairment worse. They can make liver impairment worse. Thus there are issues with using them in this group of patients as well.

All these diseases have one thing in common. They put the patient at increased risk of dying from COVID-19 infection. The people who need the drug the most might not be able to take it.

Even patients who qualify for the medications may not get them. Some physicians have found that about 30 percent of their eligible patients refuse the medications. There are multiple reasons for that.

There are several important pieces of this. Home testing is very useful. Medications must be used early in the course of the illness. Patients need to make sure the prescribing physician knows what other medications they are currently taking.

Antiviral drugs have a place in treating COVID-19 infections. They are not useful unless they get to the right patients in a timely fashion.

COVID update- Sussex County continues to remain in the low zone for COVID-19 hospitalizations.

The national number of new cases went from 236,000 last week to 211,000 this week. Sussex County new cases were at 181. We have been below 300 new cases per week for four consecutive weeks.

Mortality passed another milestone this week. It hit 3,000 deaths for every one million Americans. Overall total deaths are now above one million.

A new study from the Mayo Clinic showed that the hospitalization rate for vaccinated individuals was six per 10,000 infections. 

For those individuals who had been vaccinated and previously also had natural COVID infection, the rate of hospitalization was one per 10,000 new infections. That is consistent with the previous findings that immunity levels are higher with those who had both vaccine and natural infection.

Another study from the CDC looked at vaccine protection against the Omicron variant in breakthrough infections. Individuals with two doses of vaccine showed protection rates of 79 percent against the need for being on a ventilator or dying. 

Those with two doses plus a booster showed a 94 percent protection rate against the need for being on a ventilator or dying.