Hospital approved for COVID-19 treatments; doctor foresees upswing in new sub-variant

Sault Area Hospital has been given approval to offer the medication Paxlovid, a new treatment of mild to moderate COVID-19 symptoms in adults who are at high risk for progression to severe COVID-19 symptoms.

“It’s a new drug,” said Dr. Lucas Castellani, SAH medical director and chief of infection prevention and control, speaking to SooToday.

Paxlovid was specifically designed to treat COVID, Castellani said.

“It’s basically designed to attack the machinery of the virus. It’s actually two drugs in one. One drug is used to boost the effect of the other drug. The active drug is called Nirmatrelvir. The boosting drug is called Ritonavir which is something that’s been used for years in the HIV world because it works on the liver to boost the efficacy of the drug on the body.”

A patient will experience cold or flu-like symptoms for the first seven days of COVID.

A transition to a more inflammatory state takes place from day eight through day 14, leading some people to end up in hospital with more severe symptoms.

“The goal of Paxlovid is to limit the progression to that inflammatory state. If you can reduce the virus early on then you can hopefully reduce the body’s inflammatory response to the virus,” Castellani said.

Paxlovid was added to the Sault Ste. Marie medical community’s arsenal of anti-COVID weapons about a month ago.

Getting it to northern Ontario was a factor.

“It took us a bit but we finally were able to become a distribution centre,” Castellani said.

Paxlovid has not - so far  - been prescribed a lot in the Sault due to the availability of another COVID treatment known as Sotrovimab, Castellani said.

Sotrovimab is a one-time intravenous treatment - administered solely at SAH - for COVID patients who are at high risk for developing severe symptoms and becoming hospitalized.

“Unfortunately, given this new COVID sub-variant called BA.2, the FDA itself in the U.S. has revoked its emergency use authorization in states where 50 per cent of COVID cases are BA.2, suggesting they don’t think it works for people with BA.2. We have that option here in the Sault. We’ve been using it in our COVID clinic but we’re going to probably lose that very shortly,” Castellani said.

The doctor estimated SAH has treated over 100 patients with Sotrovimab.

Castellani said “less than a handful” of patients have been treated with Paxlovid.

Now, with an expected upswing in BA.2 sub-variant cases, Castellani said “I suspect in the coming week or two we will be ramping up significantly our use of Paxlovid.”

Age, cardiovascular disease, diabetes and lung disease factor into some COVID patients being at higher risk for severe COVID symptoms and hospitalization.

“The down side to this Paxlovid is there’s some drug interactions. They aren’t fully overcomeable. You can overcome them, but some of them you can’t. Someone with a transplant and is on medication for that transplant, often it’s near impossible to safely put them on Paxlovid. Not impossible, but very close, so you prefer to get someone on Sotrovimab. Patients themselves often like a medication that’s one time versus a few days. You have to take Paxlovid for a few days as opposed to the Sotrovimab which is a one time deal,” Castellani said.

Paxlovid pills are usually taken twice a day for five days.

“These medications do work,” Castellani said.

If a person in a high risk group feels sick, Castellani urges testing as soon as possible.

Such a person can call the SAH COVID-19 Assessment Centre for testing.

If found to be COVID-positive, the individual can liaise with his or her primary care provider for referral to SAH’s COVID clinic, or the Assessment Centre itself can make the referral for the individual.

Paxlovid would then be prescribed - taking factors such as any other medical conditions and medications into consideration - the patient then taking the pills at home.

Castellani said a key message to put out is that COVID hasn’t gone away because of Ontario’s lifting of most COVID-19 restrictions, urging anyone who feels sick to get tested right away.