Canada’s abundant supply of Paxlovid, the potentially life-saving COVID-19 treatment, has largely gone unused — an oversight that experts say has likely caused a number of unnecessary deaths.
Patricia Johnston, 72, of Edmonton recently contracted a bad case of COVID-19. She said she sought a prescription for Paxlovid from her doctor to help stave off the worst effects of the disease.
The treatment, which was approved by Health Canada in January, has reduced the incidence of hospitalization and death in clinical trials and real world circumstances.
Paxlovid treatment must be started within five days of the onset of symptoms. Johnston said she asked for a prescription on day three.
Johnston said she was turned down, that she was told she didn’t meet Alberta’s guidelines for the oral treatment — a pill regimen designed for high-risk patients such as seniors and the immunocompromised, among others.
‘I was terrified’
Shortly after she was denied access, she said, her condition took a turn. What started as a bout of the usual symptoms — a sore throat and chest cough — quickly deteriorated into COVID-related gastrointestinal issues.
She said her symptoms were so severe — an agonizing headache and persistent dehydration — that she required immediate medical attention.
“I got very, very sick. I had this terrible headache. I had nausea, dizziness and severe vomiting such that I had to go to the emergency room,” Johnston told CBC News. “I was terrified.”
Johnston said her COVID ordeal continued after she was discharged. She spent nearly a month feeling unwell, even after she started to test negative.
She said Paxlovid should have been made available to her, a senior, to help make the whole experience less taxing.
“COVID is a brutal, brutal virus to have. I wanted to protect myself,” she said.
Johnston said Alberta’s Paxlovid guidelines for outpatient use are too restrictive.
And Alberta’s criteria are more onerous than those in some other jurisdictions.
Under Alberta’s rules, a patient aged 70 or older like Johnston can access the treatment only if they have COVID and at least two other pre-existing health conditions — such as diabetes, obesity, congestive heart failure, chronic kidney disease or chronic obstructive pulmonary disease (COPD). Younger people, the unvaccinated and First Nations have a different set of criteria.
In Ontario, by comparison, any COVID patient over the age of 60 qualifies for a Paxlovid prescription. Younger people in Ontario can also access the treatment if they’re immunocompromised or face a high risk of a severe case of COVID.
“I think a decision as to whether or not a patient should get Paxlovid should be between the doctor and their patient. The guidelines should definitely be there but the final decision should be with the physician. The government should not be involved,” Johnston said.
“I believe I wouldn’t have had to suffer through all that had I had Paxlovid. We can mitigate the disease’s effects if we use all the tools that are available.”
Alberta Health Minister Jason Copping denied CBC’s request for an interview.
In a media statement, a spokesperson for Alberta Health Services (AHS) said the eligibility rules have been expanded since Paxlovid was introduced earlier this year, and that “evidence is reviewed regularly and eligibility may be adjusted, based on the review of evidence by and advice of the clinical expert committee.”
AHS said low uptake “reflects, in part, patient and prescriber choice.”
While some may be eligible for the treatment, patients “may choose not to use it,” the provincial health service said.
Dr. Zain Chagla is an infectious diseases expert and a professor of medicine at McMaster University in Hamilton. Chagla was among the first physicians to start a COVID treatment clinic in Canada.
Chagla told CBC News that while COVID-19 is less of an issue now than it has been in years past, it’s still a deadly virus.
Nearly three years since the start of the pandemic, 40 people are still dying of COVID every day in Canada on average.
“We aren’t seeing the same significant health care burden as we did in years past. But there are definitely still groups that are getting sick, and sick enough to land in hospital and … sick enough to die. We need to use all the tools we have to navigate this pandemic,” Chagla said.
He said Paxlovid is “absolutely a useful tool but it’s only useful if it’s actually given to people.”
‘It’s … incredibly simple to take’
Data from Israel, the U.S. and Ontario has shown the drug can “markedly reduce hospitalization and reduce death in high-risk people,” Chagla said.
“It’s also incredibly simple to take. It’s only five days worth of pills.”
Speaking to reporters at a briefing Wednesday, Dr. Theresa Tam, Canada’s chief public health officer, said the Paxlovid rollout has been imperfect. She said there’s more the federal public health establishment can do to bring doctors along.
“I think increased awareness and education among health professionals is something we can assist with,” Tam said.
Doctors themselves also should do more to educate the public about the potential benefits of the treatment, she said.
“We can collectively do more in that area, particularly those with high-risk conditions or seniors,” Tam said. “It can significantly reduce hospitalizations and deaths in high-risk groups, particularly in seniors.”
Federal Health Minister Jean-Yves Duclos said supply shouldn’t be an issue for the provinces and territories — there’s plenty to go around.
“We’ll be there to share whatever provinces and territories require to care for patients,” he said.
The federal government has ordered 1.5 million Paxlovid treatment courses.
According to federal health department figures, Canada has budgeted $2 billion for COVID treatments — not including vaccines — and a significant portion of that sum has been earmarked for Paxlovid.
To date, 745,465 treatment courses have been distributed to provinces and territories, Correctional Services Canada, the Department of National Defence and Indigenous Services Canada.
Another 754,535 treatment courses will be delivered over the next two weeks.
But given how little it’s been used to this point, there’s a risk those Paxlovid kits could go to waste.
Alberta has received 86,000 doses of Paxlovid from the Public Health Agency of Canada. As of Dec. 12, about 10,200 Albertans have received the treatment.
In Saskatchewan, the number is even lower. Of the 24,050 courses the province has received, only 1,529 had been used as of Dec. 11. That’s about six per cent of the total.
To help ease access, Ontario recently joined Quebec, Alberta, Saskatchewan and Newfoundland and Labrador in allowing pharmacists to prescribe Paxlovid.
That means most patients in those provinces can skip a call to the doctor altogether — something that will make it easier for sick patients to get treatment within the five-day timeframe.
A spokesperson for Ontario’s health ministry did not respond to a request for comment.
Scott Watson is a pharmacist at Watson’s Pharmacy in Ottawa. He said he’s heard from a number of COVID patients eager to get Paxlovid. Those calls often come in the evening or on the weekend when access to a family doctor is limited, he said.
Before the Ontario government cleared pharmacies to prescribe Paxlovid, Watson’s hands were tied. Now, the pharmacy can be a one-stop shop.
But Watson cautioned that Paxlovid is not for everyone. It doesn’t mix well with some drugs.
Health Canada has published a lengthy list of medications that could interact with Paxlovid.
“We have to do some research to make sure there’s no interactions, that their body function is OK — their liver and kidneys,” Watson said.
“So, if it’s a difficult case then we will probably refer them to a doctor. But if it’s OK and we think it’s OK — it’s a very good option. It’s a very efficient process.”