Alberta stockpiles at-home COVID-19 treatments, ponders expanding eligibility
1,349 Albertans have received IV infusions of Sotrovimab, 213 have taken oral medication Paxlovid
As shipments containing thousands more doses of the outpatient COVID-19 treatments Sotrovimab and Paxlovid arrive in Alberta, the provincial government says it may consider expanding who is eligible for them.
This comes at a time when Alberta has lifted nearly all public health restrictions.
Experts warn while demand will likely rise for these specialized therapies in the coming weeks — and they can help in some high-risk situations — they should not be considered a replacement for COVID-19 vaccines.
Sotrovimab and Paxlovid, which are both offered outside of hospitals, are available to a narrow group of high risk Albertans who've tested positive through PCR testing and are unvaccinated, or have received just one dose.
This group includes people over the age of 55, those with certain underlying health conditions — such as diabetes, chronic obstructive pulmonary disease (COPD), obesity and heart failure, and those who are pregnant.
Both vaccinated and unvaccinated people who are immunocompromised due to transplants or treatments for illnesses such as cancer and inflammatory diseases, including rheumatoid arthritis and lupus, are also eligible.
Both treatments are designed to treat mild to moderate COVID-19 and must be given within five days of symptoms starting.
According to Alberta Health Services (AHS), as of March 2, 1,349 intravenous infusions of Sotrovimab have been administered since the monoclonal antibody treatment became available in November.
AHS also said 213 prescriptions for the oral antiviral medication Paxlovid have been handed out in the first month it has been offered.
The health authority said 235 of the people who received the treatments were either unvaccinated or had just one dose of the vaccine.
"These therapies aren't for everyone," said Dr. Alain Tremblay, a respirologist at Calgary's Foothills Medical Centre and a member of the COVID therapeutics working group, which advises public health officials on COVID-19 treatments.
According to Tremblay, these treatments are expensive, difficult to administer, they come with side effects and they can interact with other drugs.
"If you're fully vaccinated, your chance of a severe endpoint is quite low. So you don't really need to get those treatments, which is even better than being unvaccinated, falling sick and then needing these therapies that are a hundred times more expensive than the cost of a vaccine."
However, Tremblay said, Sotrovimab and Paxlovid can be useful for immunocompromised and unvaccinated individuals.
He said the committee is discussing the option of expanding eligibility to additional groups of high risk people.
"There's certainly a substantial number of people coming into hospital that are elderly people that are vaccinated and unfortunately have breakthrough infections," he said.
"So the question is, would making these therapies available to that population reduce the risk of hospitalization?"
Alberta Health is not ruling this out.
"As supply increases in the province and data becomes available and is assessed, eligibility may be expanded, however no decisions have been made at this time," spokesperson Lisa Glover said in an email statement to CBC News.
The province is building up its supply of the drug, just as it eliminates nearly all public health measures.
In addition to the 3,200 treatment courses of Paxlovid that arrived in January, another shipment of 4,300 was expected to arrive by the end of last week with more arriving later in the month.
AHS said late last week it had enough Sotrovimab on hand to treat 2,200 Albertans and was expecting an additional 720 treatment courses by the end of the week.
While the drugs are being supplied by the federal government, Alberta is on the hook for other costs, including patient assessments, prescribing and administering the treatments.
For Sotrovimab, that can be labour intensive. In many cases, mobile paramedic units are travelling to people's homes to administer the intravenous medication.
The province did not answer CBC's questions about those costs.
The treatment is also provided at some AHS clinics and through a third-party clinic, ACESO Medical, in Calgary and Edmonton.
University of Calgary infectious disease expert Craig Jenne said it's important people understand that these treatments do not prevent infection.
"These are meant to treat symptoms and to slow progression or stop progression of severe illness," said Jenne, an associate professor of microbiology, immunology and infectious diseases.
"We know that there are a lot of other things that follow from COVID infections, such as long COVID and other problems that are not addressed necessarily with these drugs."
At the same time, Jenne said, the province needs to prepare for a potential surge in cases now that restrictions, including the provincial mask mandate, are mostly gone.
"We need to have as many tools as possible in place if infections go back up," he said.
"The hope would be this acquisition of additional treatment courses is really a strategy of preparing for a worst case scenario in hopes that we never need it, but ensuring that we are not left scrambling and looking for therapies if numbers do begin to pick up again."
Experts warn Sotrovimab and Paxlovid should not be seen as a replacement for vaccination.
"I think the disappointing thing here is that we know that a number of these patients are likely unvaccinated...These are expensive and resource consuming therapies that I believe in some instances are being used as a substitute for other health-care measures that are much simpler," said Jenne.
Calgary rheumatologist Dr. Paul MacMullan has similar concerns and hopes Alberta can work to increase lagging vaccination rates.
"The one simple message is get vaccinated," said MacMullen, who is head of the department of rheumatology at the University of Calgary and also part of the therapeutics working group.
"Vaccination is much more important and that's where the effort should be, because that gives you much more bang for your buck."
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