COVID-19 drug usage limited by possible risks, supply issues, says N.L. health minster

While hospitalizations and deaths due to COVID-19 are rising in Newfoundland and Labrador, the provincial health minister says there are no plans to expand eligibility for Pfizer's new therapeutic pills yet.

John Haggie said supply issues and possible risks mean use of the pills will be limited to those who meet its criteria and have consulted with an infectious disease specialist.

"It's not an unlimited supply. It is issued by Health Canada on what they call a limited supply basis," Haggie told CBC News on Thursday.

"Obviously any drug has what we call an 'indication,' criteria for it being used. And as I said, as this drug mixes poorly with things like cholesterol pills and some blood pressure medication.… There has to be a discussion, we feel at the moment, with the infectious diseases specialist in St. John's to make sure the risk is worth the benefit."

The drug, Paxlovid, was given approval by Health Canada in January for use in people 18 years old or older. The pills help fight off symptoms of COVID-19.

As of Tuesday, Haggie said, the province had administered 148, five-day courses of the drug — 83 in the Eastern Health region, eight in Labrador-Grenfell Health, 16 in Western Health and 41 in Central Health.

He said the province received 500 courses when the pill was released, and another 300 were delivered in mid-March. A full course of treatment requires a patient to take 30 pills over five days — three pills, twice a day.

For now, Haggie said, the drug is being reserved for those who meet the criteria — much like other prescription medications —  and there's been no recommendation from the public health agency or from Canadian Agency for Drugs and Technology in Health (CADTH) to expand the indications.

The criteria, recognized Canada-wide and recommended by CADTH, is that the pills be administered to those who are COVID-19 positive within five days of symptoms, people who are moderately or severely immunocompromised, people over 80 who are not fully vaccinated, people over 60 who live in rural or remote communities and have not been fully vaccinated, residents of long-term care and members of Indigenous groups. 

"If you fall into those categories, your local care provider contacts the provincial on-call for infectious diseases. The reason for this is that the drug itself mixes poorly with a lot of regularly used medication in general practice," Haggie said.

"The discussion there is around risks or benefits. If the infectious disease physician feels that this person is a suitable candidate, then the regional health authority dispenses a course of five days to that individual at no cost to themselves."

In a statement to CBC News, the Department of Health said the province "is exploring alternatives to providing access to this COVID-19 treatment, however, Paxlovid prescribing at the primary care provider level, ie. physician or nurse practitioner, continues at this time."

Haggie said the province's hospitalization rate is is being monitored by Chief Medical Officer of Health Dr. Janice Fitzgerald and the public health team, but the drug is to prevent severe disease and, so far, the medication seems to be working.

He said it has prevented hospitalizations in all of the 148 patients in the province who have used it, though some of those are fairly recent and are in the process of completing their courses.