'Test to Treat' gets COVID pills to at-risk patients fast but its reach is limited (2023)

A passer-by walks past a sign that calls attention to COVID-19 testing while departing a Walgreens pharmacy, Wednesday, Dec. 15, 2021, in New Bedford, Mass. (AP Photo/Steven Senne) Steven Senne/AP hide caption

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A passer-by walks past a sign that calls attention to COVID-19 testing while departing a Walgreens pharmacy, Wednesday, Dec. 15, 2021, in New Bedford, Mass. (AP Photo/Steven Senne)

Steven Senne/AP

Starting this week, high-risk patients with COVID symptoms will be able to walk into hundreds of pharmacy-based clinics for a free test – and walk out with a free course of COVID treatment pills.

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It's the start of a new initiative from the Biden administration, and it's a key feature of the President's national COVID preparedness plan. "I've ordered more pills than anyone in the world has," Biden said in his State of the Union address March 1, "And now, we're launching the 'Test to Treat' initiative so people can get tested at a pharmacy and, if they prove positive, receive the antiviral pills on the spot at no cost."

The program aims to speed up the process of getting COVID drugs for high-risk patients who need to start the treatment quickly for it to work. But it is limited by the requirement to have a prescriber on-site — which most pharmacies don't have — and will initially only reach only hundreds among the tens of thousands of retail pharmacies nationwide.

Americans can already get the COVID pills prescribed by their doctors, but Test to Treat is an additional pipeline for COVID pills that intends to streamline the process. Currently, getting the pills can be time-consuming and complicated, says Dr. Cameron Webb, senior policy adviser for equity on the White House COVID-19 response team.

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"[A high-risk person with COVID-19 would] have to identify that they have symptoms. They have to get a test, get a test result, contact a provider who can prescribe the medication, get that prescription sent over, and then go pick up that prescription. That's six different steps," Webb says.

Test to Treat will "compress that timeline," he adds, by identifying pharmacy-based clinics and community health centers where patients can get a test, get assessed and prescribed an appropriate drug course, and leave with the pills in one visit.

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Two COVID treatment pill options are currently authorized by the FDA – Paxlovid from Pfizer and molnupiravir from Merck and Ridgeback Pharmaceuticals. For both, "It's really important to start treatment within three to five days or so of the onset of infection if you really want to have the impact of that treatment," says Dr. Celine Gounder, an infectious disease specialist and a senior fellow and editor at Kaiser Health News.

The pills are antivirals, which means they stop the virus from making copies of itself in the body. In addition to helping an individual recover, "the treatment should also reduce their infectious period, and reduce the risk of onward transmission to others," Gounder says.

The test-to-treat program will help make treatments more accessible to some, but the initial rollout to pharmacies will be mostly restricted to some large chain stores with on-site healthcare services, such as CVS Minute Clinics.

"I think it's a step in the right direction in trying to make the process more seamless for patients," says Michael Ganio, a senior director at the American Society of Health-System Pharmacists

The program is starting with several hundred sites this week and will grow from there, but there's a limited number of pharmacies that can participate, says Natalie Quillian, deputy coordinator for the White House COVID response.

"Right now these pills must be prescribed by a prescribing authority," Quillian says, such as nurse practitioners, doctors, and physicians' assistants that are licensed to prescribe drugs.

Most pharmacies don't have them on-site. CVS, the nation's largest pharmacy chain, has almost 10,000 locations across the country – and just 10% of them contain Minute Clinics, with on-site prescribers, that would qualify them to become test-to-treat sites, a CVS spokesperson confirmed in an email to NPR.

"I don't think we'll get to the tens of thousands of locations – we're targeting those clinics and locations [like] pharmacy clinics, community health centers, Veterans Affairs clinics, where you have a prescribing authority that can actually prescribe the pills," Quillian says.

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There is a way that Test to Treat could become available almost everywhere: Pharmacists say if they were allowed to prescribe the pills themselves, they could help make the program ubiquitous.

In South Carolina, "the people that I need to get access to Paxlovid and molnupiravir don't necessarily have access to a pharmacy with an on-site clinic," says Julie Ann Justo, a pharmacy professor at the University of South Carolina College of Pharmacy and a practicing clinical pharmacist.

The COVID pills come with prescribing challenges –which pharmacists say they are well-qualified to handle. Pfizer's Paxlovid is considered highly effective, reducing the risks of hospitalization by nearly 90%, but it can interfere with many commonly prescribed drugs and cause health problems, if the drug dosages aren't adjusted. Merck's molnupiravir is less effective – cutting the risks of severe COVID by around 30%, according to data reviewed by the FDA – and it comes with reproductive risks.

"Pharmacists are medication experts," says Susan Davis, pharmacy professor at Wayne State University in Michigan, and past president of the Society of Infectious Disease Pharmacists, "We have been managing drug interactions and dose adjustments routinely for decades. We could handle this."

Last fall, the Biden administration amended the PREP Act, a law that applies during public health emergencies, to theoretically allow pharmacists to prescribe some COVID treatments. But pharmacists can't prescribe COVID pills specifically, because of regulations in some states and from the FDA, which specified in the pills' authorization letters that these drugs could only be prescribed by "physicians, advanced practice registered nurses, and physician assistants that are licensed or authorized under state law to prescribe drugs."

The suggestion is also controversial. The American Medical Association, which represents physicians, issued a statement saying that the pills should be prescribed by a doctor who knows a person's full medical history.

As it stands, health experts say the test-to-treat program needs good communications, public buy-in, and funding from Congress to succeed. Patients need to know about the program, and to know which pharmacies in their neighborhood are enrolled, in order to use it – and those pharmacies will need to have a consistent supply of those medications, Ganio says.

Biden administration officials say they'll be launching a "one-stop shop" website later this month, where people will be able to find test-to-treat locations, along with sites where they can get free masks, tests and vaccines.

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The test to treat program comes at a time when coronavirus cases are falling steeply in the U.S., and the supply of Pfizer's Paxlovid pill is ramping up. These are good trends, but it's not a time to be complacent, says Dr. James Hildreth, president and CEO of Meharry Medical College: "The virus is not done with us yet, right? And, if we do have another surge, having a system like this in place could have a huge impact on controlling it."

Hildreth says the program holds a lot of promise — so long as it expands its outreach to rural communities, indigenous groups, and other marginalized high-risk people that need it the most.

FAQs

Which antiviral drug is used in treatment of COVID-19? ›

Remdesivir is a nucleotide analogue prodrug that is approved to treat COVID-19 in certain patients.

What medications can I take to relieve the symptoms of Covid-19? ›

You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better.

Does Paxlovid make you feel better? ›

“Additionally, the company that produces the drug performed in vitro studies, which showed it maintained its efficacy against the omicron variant.” In her practice, patients typically say their COVID-19 symptoms start improving within a day or two of starting Paxlovid.

How long should I take Paxlovid? ›

Do not stop taking Paxlovid before you have finished all 5 days of the course without talking to your doctor first. If you stop taking Paxlovid, it may no longer protect you from the severe symptoms of COVID-19.

Is there an oral treatment for Covid? ›

COVID-19 treatments are most effective if started as soon as possible. COVID oral medication must be started within 5 days of symptom onset. Remdesivir outpatient treatment must be started within 7 days of symptom onset.

Which tablet is best for COVID-19? ›

However, the CDC now recommends taking medications, such as ibuprofen or acetaminophen, to relieve fever if you have COVID-19.

What to do to make Covid go away faster? ›

To care for yourself, follow these steps:
  1. Keep a daily routine, such as taking a shower and getting dressed.
  2. Take breaks from COVID-19 news and social media.
  3. Eat healthy meals and drink plenty of fluids.
  4. Stay physically active.
  5. Get plenty of sleep.
  6. Avoid use of drugs, tobacco and alcohol.

What is the fastest way to recover from Covid at home? ›

Most people with coronavirus (COVID-19) or symptoms of COVID-19 feel better within a few weeks.
...
Treating a high temperature
  1. get lots of rest.
  2. drink plenty of fluids (water is best) to avoid dehydration – drink enough so your pee is light yellow and clear.
  3. take paracetamol or ibuprofen if you feel uncomfortable.

What is the home remedy for Covid cough? ›

Use a hot shower, humidifier, vaporizer or other means of making steam. It will soothe a sore throat and open your airways, making it easier to breathe. Eat a frozen treat. The coldness may help numb the pain and soothe your throat if it is sore from coughing.

When are you no longer contagious with COVID? ›

When do you stop being contagious if you have COVID-19? It depends. If you have a mild illness and your symptoms are getting better, you're probably not contagious after 10 days. If you have a severe illness or a weakened immune system, you can be contagious for up to 3 weeks.

Should I take antiviral for COVID? ›

Who can take the COVID antiviral pill? The antiviral pills are not recommended for everyone who tests positive for COVID. The pills are intended for those who have symptoms from COVID-19 and who are not in the hospital, but who are more likely to become seriously ill.

When does COVID get worse? ›

A person may have mild symptoms for about one week, then worsen rapidly. Let your doctor know if your symptoms quickly worsen over a short period of time.

Who is eligible for Paxlovid? ›

Who Qualifies as High Risk? Examples of high-risk patient characteristics include older adults (age 50 yr+), asthma, smoking (current or former), overweight, diabetes, pregnant, immune compromised, mental health disorders, substance use disorders, and cardiovascular disease. Paxlovid is taken twice daily for 5 days.

Can Paxlovid make you feel worse? ›

Changes in taste, diarrhea, high blood pressure, or muscle pain may occur. If any of these effects last or get worse, tell your healthcare professional promptly.

How can I get a prescription for Paxlovid? ›

Depending on the clinical assessment, the pharmacist may not be able to prescribe Paxlovid to you but will refer you to a primary care provider (PCP) or MinuteClinic®. If you're eligible, your pharmacist will prescribe Paxlovid3 FOR PAXLOVID PRESCRIPTION BY PHARMACIST Disclaimer and provide an after-visit summary.

Is there a tablet for Covid? ›

Sotrovimab may be given to people if antiviral medicines are unsuitable for them to take. These treatments can help some people manage their COVID-19 symptoms and reduce the risk of becoming seriously ill.

When does cough start with Covid? ›

Based on what researchers have learned about COVID-19 thus far, the first symptoms—which generally occur within seven days after infection—can include the following, which are listed in order of their usual appearance: Fever or chills. A persistent cough.

How long does Omicron symptoms last? ›

How long do omicron symptoms last? Most people who test positive with any variant of COVID-19 typically experience some symptoms for a couple weeks. People who have long COVID-19 symptoms can experience health problems for four or more weeks after first being infected, according to the CDC.

Can COVID go away in 3 days? ›

Most people with COVID-19 get better within a few days to a few weeks after infection, so at least four weeks after infection is the start of when post-COVID conditions could first be identified.

How long will I test positive for Omicron? ›

During the Omicron BA. 1 period, 5 days after symptom onset, 80% of participants remained positive via a rapid antigen test. Meaning These findings indicate differences in symptoms in the BA.

How quickly do Omicron variant symptoms appear? ›

“Most patients are coming in with three or four days of incubation,” Meza said.

What do you drink COVID with? ›

Up your fluid intake.

If you have diarrhea or if you're sweating from a fever or chills, make sure you have salt or a little sugar in your fluids—think broths, fresh juices or electrolyte solutions like Gatorade—because salt and sugar can help you retain water.

What is a COVID cough like? ›

A dry cough is one of the most common coronavirus symptoms, but some people may have a cough with phlegm (thick mucus). It can be difficult to control your cough but there are a few ways to help.

What does a COVID headache feel like? ›

Researchers have discovered that some of the prominent features of a COVID-19 headache include: Having a pulsing, pressing, or stabbing sensation. Occurring bilaterally (across the whole head) Presenting with severe pressure that won't respond to typical pain relievers, like ibuprofen and acetaminophen.

Is it a dry or wet cough with COVID? ›

What Kind of Cough Is Common in People With the Coronavirus? Most people with COVID-19 have a dry cough they can feel in their chest.

What is the best cough syrup for COVID? ›

Best cough and cold medicines for COVID-19: DayQuil, NyQuil, Mucinex, Sudafed, or Theraflu?
  • DayQuil. DayQuil combination OTC products usually contain acetaminophen (for fever and pain), dextromethorphan (for coughing fits), and phenylephrine (for stuffy nose).
  • Mucinex. ...
  • NyQuil. ...
  • Sudafed. ...
  • Theraflu.
20 Oct 2022

What is mild COVID like? ›

Mild COVID-19 means you have symptoms — such as cough, sore throat, and fatigue — but no shortness of breath. Most of the time, people can treat mild COVID-19 at home. There are treatments specific to COVID-19 for certain people, so contact your healthcare provider to discuss your options.

When is Omicron most contagious? ›

We know that people tend to be most infectious early in the course of their infection. With Omicron, most transmission occurs during the one to two days before onset of symptoms, and in the two to three days afterwards.

Is COVID contagious after 7 days? ›

Those with severe COVID-19 may remain infectious beyond 10 days and may need to extend isolation for up to 20 days. People who are moderately or severely immunocompromised should isolate through at least day 20.

Can you test negative for COVID after 5 days? ›

If you were exposed to COVID-19 and do not have symptoms, wait at least 5 full days after your exposure before testing. If you test too early, you may be more likely to get an inaccurate result. If you are in certain high-risk settings, you may need to test as part of a screening testing program.

Do antivirals weaken immune system? ›

The inhibitory effects of antivirals on immune cells may contribute to the immune deterioration observed in patients following prolonged use of the drugs.

What puts you at high risk for COVID? ›

Certain underlying medical conditions increased risk for severe COVID-19 illness in adults. Having multiple conditions was also associated with severe COVID-19 illness. Obesity, diabetes with complications, and anxiety and fear-related disorders had the strongest association with death.

Can you get COVID back to back? ›

Reinfection with the virus that causes COVID-19 means a person was infected, recovered, and then later became infected again. After recovering from COVID-19, most individuals will have some protection from repeat infections. However, reinfections do occur after COVID-19.

Can Covid get worse after 10 days? ›

A hallmark of COVID-19 is its ability to get worse quickly and aggressively. While the 10 to 12 days after a positive COVID-19 test are when many patients are hospitalized, researchers do not understand what changes occur early in the disease and how they may predict hospitalization later.

What day is day one of Covid? ›

Isolate when you test positive for COVID-19, to protect others. Day 1 is the day after symptoms start (or after the day of your first positive test if you don't have symptoms). Count from Day 1 and test on Day 5 (or later).

How long does Covid cough last? ›

In the case of COVID-19, this cough could last for as long as six months after the viral infection, especially if the patient contracted Omicron because it is more airway dependent than the original strain.

Who is eligible for molnupiravir? ›

Eligibility: The molnupiravir EUA covers adults 18 years of age and older who are at high risk for progressing to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.

Who is eligible for Bamlanivimab? ›

Treatment This EUA is for the use of the unapproved products bamlanivimab and etesevimab administered together for the treatment of mild to moderate COVID- 19 in adults and pediatric patients, including neonates, with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to ...

Does CVS have Paxlovid? ›

If you are eligible, CVS® pharmacists can now prescribe Paxlovid, a COVID-19 antiviral medication.

Do dogs get COVID? ›

The virus that causes COVID-19 can spread from people to animals during close contact. Pets worldwide, including cats and dogs, have been infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. The risk of pets spreading COVID-19 to people is low.

Why do I have a metallic taste in my mouth with COVID? ›

There is evidence that COVID can affect taste as well as smell. This loss of smell and taste may cause your favorite foods to taste and smell differently following your COVID illness. Food may taste bland, sweet, or metallic.

What are COVID symptoms 2022? ›

Symptoms
  • Fever or chills.
  • Cough.
  • Shortness of breath or difficulty breathing.
  • Fatigue.
  • Muscle or body aches.
  • Headache.
  • New loss of sense of taste or smell.
  • Sore throat.

What medications can I take to relieve the symptoms of COVID-19? ›

You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better.

Can Walgreens prescribe Paxlovid? ›

25, 2022 - Today, answering the President's call to action, Walgreens announced free prescription delivery of Paxlovid, a COVID-19 oral antiviral therapy, directly to the doorsteps of those in need, with the help of delivery partners DoorDash and Uber Health.

Can I get a prescription for Tirzepatide? ›

Tirzepatide is now becoming more widely available by prescription. Production and distribution of tirzepatide to pharmacies began in June 2022.

Is it OK to take ibuprofen with Paxlovid? ›

No warnings were found for your selected drugs.

How long after Paxlovid will I test negative? ›

In addition, a small number of people who have been treated with the oral antiviral drug Paxlovid have tested negative on rapid antigen tests, with no symptoms, only to “rebound” seven to 14 days after their initial positive test.

What is the mechanism of action of Paxlovid? ›

Nirmatrelvir-ritonavir (Paxlovid) is an oral antiviral drug combination with activity against SARS-CoV-2. Nirmatrelvir is a protease inhibitor, which acts to inhibit viral replication by cleaving viral polyproteins involved in replication.

Can you get COVID again after taking Paxlovid? ›

Recently case reports have documented that some patients treated with Paxlovid experienced rebound COVID-19 infections and symptoms 2 to 8 days after completing a 5-day course of Paxlovid3.

What medications prevent you from getting Covid vaccine? ›

Do not take a pain reliever or fever-reducing drug before receiving a COVID-19 vaccine because these drugs may impact the immune response to the vaccine. If you experience side effects after getting vaccinated, it is safe to take these drugs as needed to treat pain.

Does Sudafed help with Covid? ›

Best cough and cold medicines for COVID-19: DayQuil, NyQuil, Mucinex, Sudafed, or Theraflu? Many over-the-counter (OTC) medications can help relieve symptoms of the common cold, the flu, and COVID-19.

What should you not mix with ibuprofen? ›

People should avoid taking naproxen and ibuprofen together. Also, they should avoid taking more than one NSAID at a time because this may increase the risk of side effects.

Is it possible to have COVID and test negative? ›

However, false negatives can occur for a number of reasons, including people being tested too soon after exposure to the virus (which may not let enough of the virus build up to a level that is detectable), differences in how well the coronavirus is able to make copies of itself in one person compared to in another ...

Can you be positive one day and negative the next COVID? ›

Unfortunately, yes—it is possible.

What is the action of Molnupiravir? ›

Molnupiravir is an orally available antiviral drug candidate currently in phase III trials for the treatment of patients with COVID-19. Molnupiravir increases the frequency of viral RNA mutations and impairs SARS-CoV-2 replication in animal models and in humans.

Is Molnupiravir FDA approved? ›

A: No. Lagevrio is not FDA-approved to prevent or treat any diseases or conditions, including COVID-19. Lagevrio is an investigational drug.

What is the mechanism of action of pleconaril? ›

Pleconaril binds to a hydrophobic pocket in viral protein 1, the major protein which makes up the capsid (shell) of picornaviruses. This renders the viral capsid rigid and compressed and prevents the uncoating of its RNA. As a result, the virus is stopped from attaching to the host cell and causing infection.

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