What is the new COVID-19 pill and how will it be used in B.C.?

British Columbia has another tool to fight COVID-19, courtesy of Paxlovid, the first oral at-home prescription medication cleared for use by Health Canada.

The drug, developed by Pfizer, is designed to prevent more serious illness if given early in the infection.

It is for people with a mild to moderate illness and are at the highest risk of ending up in hospital, according to Dr. Bonnie Henry.

B.C.’s top doctor said the province will receive a limited supply of just 4,000 treatment courses within the next few weeks.

“This is very good news, but it is not going to change the trajectory of our pandemic right now,” she said. “But it is … another tool to help those people who do get sick and are at more risk of ending up in hospital.”

She said that includes people over the age of 70, the clinically extremely vulnerable, immune compromised, and younger people with additional medical conditions and can’t be vaccinated.

The pills must be given within five days of symptom onset. Henry said work is ongoing with the clinical care advisory team to get the pills to where they can be most effective.

What is Paxlovid?

Paxlovid is a combination of two anti-viral medications that must be taken together.

The first, nirmatrelvir, helps block the replication of the virus in the body. The second, ritonavir, essentially helps keep nirmatrelvir working in the body longer. Ritonavir is commonly used in HIV treatment.

The patient takes three tablets, twice a day, for five days. The pills can’t be taken for more than five days or given to anyone under 18.

However, Henry warned there can be a lot of drug-drug interactions, saying Paxlovid is “not an innocuous medication.” Health Canada has published a laundry list of medications it should not be taken with. People with kidney and liver problems, or have HIV, are warned about taking the drug.

How Well Does It Work?

In a randomized, double-blind study of non-hospitalized adult patients with COVID-19, an 89 per cent reduction in the risk of hospitalization or death in patients with the virus was recorded among those who took the pill within three days of becoming symptomatic.

No deaths were recorded among people who took the pill, compared to 10 who received the placebo.

That is only according to data from Pfizer. None of it has been peer-reviewed.

Who Might Get the Pill?

Due to limited supplies, the Public Health Agency of Canada has asked provinces to be careful and targeted with treatment

Henry said health officials have developed a heatmap of sorts to determine who could be best served from the treatment. Risk is weighed based on criteria such as age, underlying health conditions, and vaccination status.

“How do we ensure those people that are most at risk are able to access testing and the drug as needed in the shortest period of time?” Henry said of plans being worked on.

Keeping people out of hospital where hospital care can be hard to access is also being considered. This includes remote and First Nation communities.

“We are working here to look at how we can have rapid access in those communities where we know there is a higher risk of people needing care,” she added.

Not Vaccine Substitute

Despite strong clinical trials, Paxlovid it is not a substitute to a vaccine.

“Vaccination remains the most important tool in preventing serious illness from COVID-19 infection,” Health Canada has said.