The problem is, in part, that production is still increasing, and drug production can take five to eight months.
Although supply is expected to improve significantly in the coming months, doctors they now require pills, not only because omicron causes an explosion of cases, but because two antibody drugs that were once popular treatments don’t work so well against this version.
“It should be a really happy time because we now have very effective antiviral pills,” said Erin McCreary, pharmacist and administrator at the University of Pittsburgh Medical Center. “Instead, it seems to be the hardest and most chaotic part of the pandemic.”
Tablets – and other medicines for COVID-19 – are carefully distributed, reserved for patients at highest risk.
“January will be a terrible month with millions of cases a day,” said a University of North Carolina virologist. Myron Cohen. “Most people will do perfectly well, but we need to pick people who won’t and give them the drugs we have available.”
The Food and Drug Administration has approved two tablets from Pfizer and Merck end of last month based on studies showing that they reduce the risk of serious illness and death if given soon after the onset of symptoms. These are the first COVID-19 treatments that patients can take at home and could reduce the burden on hospitals.
The US has not made mass purchases in advance as they have vaccines.
Pfizer’s Paxlovid pill is considered much better than Merck’s, but because of the six to eight months it takes to produce, the company says it can only provide about 250,000 courses of treatment by the end of this month.
The U.S. has ordered enough Paxlovid to treat 20 million people, but the first 10 million orders will not be delivered until June.
White House COVID-19 coordinator Jeff Zients said this week that the government has worked with Pfizer to help accelerate pill development for several months, and that officials continue to work with the company to find ways to increase production.
Pfizer said it is increasing capacity: “We expect to leverage our strong manufacturing capacity and our extensive network of suppliers to continue to improve production rapidly.”
Merck’s pill, molnupiravir, was produced in large quantities in advance. Production takes six months, although the company says it can be compressed to five months if needed.
But final testing showed that the drug was much less effective than the Pfizer pill and had high risks, including the possibility of birth defects if taken pregnant woman. Consequently, it is considered a last resort under federal guidelines.
Merck said it has delivered 900,000 servings of the drug and is on track to ship all 3 million ordered by the U.S. by the end of the month.
Since last month, the government has sent enough Pfizer tablets to countries to treat 164,000 people, distributing them by population. This approach is under attack by some countries with more cases.
The amount allocated to New York – enough to treat about 20,000 people – is insufficient, said Health Commissioner Dr. Mary Bassett.
“We need more of these drugs to change the course of the pandemic and reduce hospitalization,” she said.
National guidelines generally recommend that physicians give priority to medications to those most at risk, including cancer patients, transplant recipients, and people who have lung disease or are pregnant. The New York Guidelines also recommend that certain racial and ethnic minorities be given priority over their higher rates of serious illness and death.
States distribute tablets differently.
In Michigan, all initial shipments went to 10 pharmacies in the most affected areas. Pennsylvania, Maryland, Texas, and many other states have distributed the tablets more widely, with at least one pharmacy in each county carrying the drug.
Despite strict prescribing guidelines, some patients were able to get the pills with luck and perseverance.
Craige Campbell, head of the website from Desert Hot Springs, California, started leaving messages to his doctor right after he tested positive for COVID-19 and developed a fever of 101 degrees. Even though he had no health problems, he was soon able to get a prescription.
The only pharmacy that dispensed the medicine was more than an hour’s drive away, so Campbell had a friend pick it up.
“In a way, I felt a little privileged,” he said. “The chances of him landing on my plate at the right time were pretty remarkable.”
At the same time there is a lack of antibody drugs, infused or injected drugs that can prevent death and hospitalization. Only one of them, from GlaxoSmithKline, seems effective against omicron, and he, too, is in the deployment.
Federal officials limit it to about 50,000 doses a week. This week, the government announced it was buying another 600,000 doses, in addition to the 400,000 purchased in November.
In the UPMC hospital system in Pennsylvania, staff can treat less than 1,000 patients a week with antibodies, less than 4,000 before a pandemic.
Doctors and nurses across the U.S. have developed sophisticated means of deciding who should receive rare medications, based on a patient’s symptoms, their underlying health risks, where they live, and whether they are healthy enough to travel for an infusion.
“What do we have on hand?” is the first question, said Dr. Greg Schrank of the University of Maryland Medical Center. “Which of these therapies is the most effective and how can we target it to the people we know are most at risk?”
An increasingly complex picture of treatment emerges as exhausted, frustrated hospital staff try to cope with the growing number of admissions.
As of Sunday, nearly 128,000 Americans were in hospital with COVID-19, surpassing the all-time high of about 125,000 last January. While fewer patients with COVID-19 now need intensive care, the hospital’s increasing pressure is at a tipping point.
Given this threat, the Pfizer pill arrived just in time, Schrank said.
“This will not change the total number of cases, but it could really help reduce the impact on hospitals,” he said.