The extra-contagious BA.5 variant of COVID-19 isn’t going anywhere, and a drug that helps temper the severity of symptoms is now more accessible in Tennessee. 

Paxlovid can now be prescribed directly by pharmacists, thanks to a new U.S. Food and Drug Administration approval for emergency use. Paxlovid combines two types of antiviral drugs used to prevent individuals from progressing into severe cases of COVID-19. It was prescribed to President Joe Biden recently.

“The FDA had recognized that pharmacists have an opportunity to better assist with giving patients access to Paxlovid,” said Anthony Pudlo, executive director of the Tennessee Pharmacists Association. 

Paxlovid is approved for those 12 years and older. To obtain a prescription, one must test positive for COVID-19 through an at-home or in-person test at the pharmacy. The patient must be exhibiting some symptoms and have at least one risk factor for serious illness, as evaluated by the pharmacist or clinician. Those could include cancer, chronic kidney disease, liver disease, any respiratory illnesses, diabetes, heart conditions, HIV infection or any other condition that could potentially cause a weakened immune system, Pudlo said. 

The cost of the product is covered by the federal government, though there may be pharmacist fees billed to insurance. The current main barrier to Paxlovid is health records, Pudlo said. Patients can bring their own, or pharmacists will request records from a local provider. It’s important that the pharmacist know if the patient has kidney or liver problems or is on any interfering medicines. 

Another barrier to Paxlovid success is the threat of a rebound infection, like Biden experienced after being prescribed the drug series. There is still a possibility of producing a negative test, then testing positive a few days later and having symptoms again. 

“We want this started as soon as possible once you have some confirmation for diagnosis, but within five days is what the data supports being the most effective to reduce the progression to some more severe cases of COVID,” Pudlo said.

Paxlovid is available at some area pharmacies, walk-in clinics and Walmart. 

The future of treating COVID-19 variants

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Dr. Donald J Alcendor 

BA.5, a subvariant of Omicron, is still making up most of the cases of COVID-19 in the United States at this time, said Dr. Donald J. Alcendor, associate professor in microbiology and immunology at Meharry Medical College. 

Though this variant is not more likely to cause death and hospitalization than previous variants, it is more likely to cause reinfection. Reinfections are at about 6.4 percent, as compared to the May rate of roughly 3.6 percent, Alcendor said. While vaccination still helps lessen severity of disease, Alcendor points to Biden as an example that reinfection is possible even if a person has gotten the original cycle and two boosters.

“This is a variant that has the greatest level of immune escape from all the variants we've seen thus far, including the original virus,” Alcendor said. “That makes it very difficult to deal with, not so much in terms of disease severity, hospitalizations and death, but this guy will cause people to come reinfected. The idea is that when you have something that's very contagious, like this one, it can cause an increase in reinfection.” 

Alcendor recommends that vulnerable populations with underlying medical conditions mask, even if they’ve been fully vaccinated and boosted. Anyone should also consider masking in crowded places with little ventilation, or where a number of people in the room have unknown vaccination status. 

There is an Omicron-specific booster shot on the horizon, which will be important to protect against a potential fall surge. 

“We are not out of the woods to come up with a variant that is more dangerous than the Delta variant,” Alcendor said, noting that Delta was a “real outlaw when it comes to killing people.” 

Long-term COVID-19 protection could look similar to the yearly influenza vaccine, Alcendor said. His concern is that the uptake and vaccine confidence for the flu vaccine is very low. 

“It's tougher than it used to be,” Alcendor said. “We used to talk about herd immunity. In vaccinating everybody, you would prevent virus spread. To prevent the development of variants you would have to vaccinate everybody and take care of those people that are reinfected. But if we continue to get variants that cause higher levels of reinfection and we continue to have pools of people around the country that remain unvaccinated, then we're looking at the possibility of continuing having the evolution of these variants over time.”