The Chief Medical Officer of Health, Dr. Kieran Moore, recently said the health system will see a “triple threat” of COVID-19, a bad flu season and the resurgence of a childhood respiratory virus this fall and winter. Finding ways to ensure greater availability of drugs to keep people with COVID-19 out of the hospital is especially important for more rural communities, he said. “I know the government is reviewing the ability of pharmacists to be able to prescribe it directly after a positive test,” Moore told The Canadian Press. “There was concern particularly in isolated areas. Where you might not have good access to a primary care physician, you might have access to a pharmacist. So that gap was looked at and I think they’re working aggressively on it.” Many health practitioners across the province raised the issue, Moore said. “I think it’s a solution to increasing access,” he said. A spokesman for Health Minister Sylvia Jones said the province “continues to look at different ways to ensure Ontarians have access to as many tools as possible to stay healthy and prevent unnecessary hospital visits,” but did not provide more details. Justin Bates, CEO of the Ontario Pharmacists Association, said his group is pushing for pharmacists in the province to be able to prescribe Paxlovid, as colleagues in many other provinces already can. “Given our experience in point-of-care testing, our knowledge of drugs — particularly complex drugs like Paxlovid, where there are many drug-to-drug interactions — and more, I would say, in-depth patient consultation that is required, the pharmacists are able to provide this as a turnkey solution,” he said. Paxlovid is an antiviral medicine that is taken by mouth within five days of the onset of symptoms. It is recommended for people at high risk of complications from COVID-19, such as those over 70 and some immunocompromised people, especially those without at least three doses of the vaccine. It can be prescribed by a primary care provider or at a COVID-19 clinical evaluation center. Having pharmacies as another avenue for prescriptions will allow faster access and therefore keep more people out of the hospital this winter, Bates said. “The sooner you start it in five days, the better in terms of preventing serious symptoms and illnesses that will require you to go to the hospital or, even worse, the hospital ICU,” he said. Paxlovid is currently “sitting on the shelves,” Bates said. “The volume going through the stores, anecdotally, is very low,” he said. In September, CBC News reported that Health Canada has distributed enough of the antiviral Paxlovid to treat more than 700,000 people with COVID-19, yet the provinces had given only a fraction of the drug to patients. Moore said about 3,500 Paxlovid treatments are currently being prescribed each week, noting that demand appears to be increasing as COVID-19 activity increases. Ontario has already announced that as of Jan. 1, it is expanding pharmacists’ prescribing powers to include medications for minor conditions such as conjunctivitis, dermatitis and hemorrhoids. If the government further expands the powers to include not just Paxlovid, but all antiviral drugs, pharmacists could also prescribe Tamiflu – which has fewer drug interactions than Paxlovid – before a bad flu season, Bates said. . Dr. Zane Chagla, an infectious disease specialist at St. Joseph’s Healthcare in Hamilton, said he thinks it’s a good idea for pharmacists to prescribe Paxlovid, saying it could prevent people from being hospitalized for COVID-19. “These are preventable health care outcomes,” he said. “It really needs more of a push to make it more accessible and pharmacies have done an incredible job helping with the COVID vaccines… The biggest issue with Paxlovid is drug interactions and so for pharmacists to prescribe it is absolutely logical”.
