When Stephanie Launiu contracted Covid-19 in early June, she was at a loss about what to do. A day later, when her 93-year-old mother also tested positive for the virus, Launiu called her sister in California. It was then that the Hilo resident realized that at-home treatments for Covid existed.

Within 24 hours, Launiu said the pair had received prescriptions for antiviral pills, taken the first rounds of their medications and were feeling great.

Hawaii receives two oral antiviral treatments from the federal government, Paxlovid and Lagevrio, which both received emergency use authorization from the Food and Drug Administration in December. Amid the spread of the BA.4 and BA.5 omicron subvariants, local doctors predict a potential rise in the number of prescriptions for the pills in the coming weeks.

However, the treatments are complicated because they must be taken within five days of the onset of symptoms.

The antiviral treatments Paxlovid and Lagevrio aim to reduce the severity of patients’ Covid symptoms in order to prevent hospitalization or death. Cory Lum/Civil Beat/2021

Paxlovid received national attention Thursday after President Joe Biden announced he had tested positive for Covid and was taking the medication.

The Centers for Disease Control and Prevention recommend the drug for early-stage treatment of mild to moderate Covid among people at risk for progression to severe disease.

To qualify for Paxlovid or Lagevrio, Covid-positive patients must have underlying health conditions or be at least 65. The treatments are offered free of cost from the federal government, although patients may face fees associated with testing and consultations.

As of Thursday, Hawaii’s stock of antiviral treatments totaled 5,864 courses of Paxlovid, 883 courses of Renal Paxlovid and 4,679 courses of Lagevrio. The state went through 2,192 courses of the three medications between July 8 to 14, according to the Department of Health.

Renal Paxlovid and Paxlovid are the same medication but come in different doses to take into account varying levels of kidney function among patients, said Dr. Douglas Kwock, vice president of medical affairs for Hawaii Pacific Health.

Paxlovid and Lagevrio are both oral antiviral medications but have significant differences. Dr. Tarquin Collis, chief of infectious disease for Kaiser Permanente Hawaii, said Paxlovid has significantly greater success in reducing hospitalization and death for Covid-positive patients and is the first line of therapy in the NIH treatment guidelines and within Kaiser Permanente. Collis added that the antiviral drug Remdesivir and the monoclonal antibody Bebtelovimab are other excellent treatment options, but those must be administered intravenously at outpatient treatment centers or emergency rooms, which can create barriers to access for some patients and staffing difficulties for many institutions.

Dr. Albert Yazawa, a geriatrician at Hawaii Pacific Health, compared the antiviral pills to Tamiflu, a prescription medication known for its ability to lessen the severity and length of the flu.

Medical technicians prepare COVID-19 tests, for sending to labs, at the Blaisdell drive-through testing site in Honolulu, Monday, December 27, 2021. (Ronen Zilberman photo Civil Beat)
Covid patients must take oral antiviral medication within five days of the onset of symptoms for it to be effective. Ronen Zilberman/Civil Beat/2021

Because patients must take Paxlovid or Lagevrio within five days of developing Covid symptoms, doctors are not always able to prescribe the medication in a timely manner, Collis said. If individuals wait until they are experiencing severe Covid symptoms to contact their doctors, it is likely that they no longer qualify for the treatment, he added.

“It’s not intuitive, if you have early Covid and you don’t feel bad, that you should seek out treatment,” Collis said. “But if you’re high risk, you totally should.”

Dale Yasunaga, who tested positive for Covid in early June but had mild symptoms, agreed. He initially did not think to ask for an antiviral treatment when he informed his doctor of his positive test. However, within an hour of meeting with his doctor, he received a five-day prescription of Paxlovid from Longs Drugs.

He began feeling better within two days of taking the medication, although the pills left him with a metallic taste in his mouth, akin to sucking on the rind of a grapefruit all day, Yasunaga said.

Kwock said most patients have tolerated the antiviral medications well, although some have experienced the side effects of nausea, diarrhea, abdominal discomfort or an altered sense of taste, like Yasunaga. However, these symptoms tend to subside once patients complete the course of the treatment, Kwock added.

The state Department of Health is providing information on antivirals to both the general public and physicians through social media, webinars and other outreach campaigns, spokesman Brooks Baehr said.

The federal government has also allowed state-licensed pharmacists to prescribe Paxlovid. In the national test-to-treat program, individuals can visit select pharmacy-based clinics to test for Covid and determine if they qualify for Paxlovid. Hawaii has 27 test-to-treat locations.

At the same time, doctors and researchers continue to grapple with some of the unknowns of the medications.

Research is ongoing. A study that showed that Paxlovid was shown in clinical trials to reduce the risk of hospitalization or death by 88% when given to adults within five days of the start of symptoms was based on data from unvaccinated people during the delta surge.

Collis also said he has seen some patients with Covid rebound, in which individuals appear to recover from Covid but experience a second round of symptoms a few days later. The CDC issued a health advisory in May stating that, while some patients who have taken Paxlovid have exhibited the rebound, doctors should continue to prescribe the medicine to individuals at high risk for developing severe Covid symptoms.

Collis added that while the rebound may be more prevalent in patients treated with Paxlovid or Lagevrio, doctors have witnessed the phenomenon long before the use of antivirals. He also said that patients’ second round of symptoms tend to be mild, and ongoing research seeks to understand how to prevent the rebound.

“We’re probably a half a year away from really understanding why is it happening and what to do about it, if anything,” Collis said.

Patients and providers both agree on the need for greater communication about the availability of at-home treatments. Collis said the Kaiser emergency room sometimes sees Covid-positive patients who have been wrongly treated with steroids or antibiotics. These incidents point to the need for more public education around Covid treatments, he added.

Launiu said she would like to see the state and federal government do a better job of publicizing the availability of Paxlovid and Lagevrio. People – like herself and her mother – already know how to take precautionary measures against Covid, but the public needs to understand what steps to take if they do contract the virus, she added.

“If it wasn’t for my mother getting sick, I might not have called my sister,” Launiu said. “And she said, ‘Oh, you don’t need to suffer. Call your doctor.’”

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