The main policy we need to end the pandemic is being ignored

BILLIONHis goals were made clear in President Joe Biden’s State of the Union address: Test for treatment. He challenged America to “get back to work and fill in our great recessions”. He no longer claims to be independent of the virus, adding, “I can’t promise you a new variant won’t emerge. But I can promise you that we’ll do everything in our power to be ready if it happens. ”

The opportunity to fulfill that promise is here. Weeks later, in the shadow of BA.2 . variant, the country is still experiencing an unacceptable average of 600 daily COVID-19 deaths, 1,500 new hospital admissions and 2,000 ICU patients. This is a major obstacle to a safe return to normal life.

The good news is that this challenge can be directly met by redeploying our already formidable public health and medical arsenal. With vaccination rates touching a wall and Plateau boosters In terms of effectiveness, relying on new highly effective oral treatments is the most important strategic step to enable society to return to a safe new normal. With early treatment of those who do get sick and continued focus on reducing transmission, we can sustainably roll back the pandemic scales in our favor. With our federal initiative to scale immunization efforts, our conservative estimate is that we could achieve a sustained reduction of at least 50% in both mortality and hospitalization across nationwide.

Ensure treatment is available to all people at high risk, in combination with home test, is the card out of prison for our pandemic response. However, today too few people know or can afford these life-saving oral drugs. President Biden knew before launching the Trial for Treatment initiative during his speech. It offers free treatment to eligible people who can get a diagnosis from a medical provider at a “one-stop” approved Trials for Treatment facility and can only be purchased while the medicine is in stock. In fact, perhaps less 10 percent pharmacy stores have suppliers and clinics that can quickly evaluate and deliver all treatments in one location. The result is paradoxical that while nine out of 10 Americans live within 5 miles of a pharmacy, Millions of treatmentsMore than half of the available supply, is sitting on unused store shelves, due to the difficulty of accessing this path of medical diagnosis.

To fully reach its powerful life-saving potential with the urgency it needs, significant improvements to this program must be made and barriers removed. There are difficult but surmountable productions, logistical, regulatory and financial challenges. But there is precedent for overcoming these in previous federal vaccine programs and rapid at-home testing programs. We can’t wait months to deliver these life-saving drugs to vulnerable Americans. Here’s a six-point roadmap on how we can achieve this right now:

First, set a clear initiative goal

The goal of the national Trial to Treatment (T3) program should be to get a drug course of medication into the mouth of every eligible COVID-19 positive person within 3 days of symptom onset. proof. This country’s 80 million vulnerable population will benefit most from T3. Although less than a quarter of the population, they suffer 80 percent of all deaths and hospitalized. For them these pills are a lifesaver.

Second, expand program eligibility

“Vulnerable persons” are defined as persons over 65 years of age, immunocompromised, or those with specific underlying conditions. This subject cannot lack oral antiviral drugs because their vaccine effectiveness decreases fastest. They depend on these drugs when they are sick.

When taken within the first 3 critical days of symptom onset, Pfizer oral antivirals Paxlovid can reduce the risk of serious illness by nearly 90%. Merck’s Lagevrio is an alternative that reduces the risk by 30%. Both are taken at home as a 3-5 day pill. Timely and equitable access to these treatments is the way to return to the new normal while cutting hospitalizations and deaths even as some diseases spread in the community. definitely continues.

As supply increases, expanding coverage to those less vulnerable will have additional benefits: reducing hospitalizations, enhancing community clearance of the virus, and reducing transmission. more. This will reduce the need for isolation and allow for a quicker return to work or school. As more data accumulates, we may optimistically see that oral antivirals may reduce the risk Long COVID-19too.

Third, take advantage of the reach and speed through a new home program

This requires a well-staged one-stop system: 1) rapid diagnostics for COVID-19; 2) evaluation and, if medically indicated, prescription by an authorized healthcare provider; 3) rapid drug delivery through your local pharmacy, healthcare provider, or direct-to-home delivery.

The CDC recommends that people who test positive stay home so they don’t spread the virus. T3 is based on requiring infected people to leave their homes when sick, often use public transport, and enter crowded medical facilities. A dangerous recipe that can be avoided with home testing.

Given the limitations of this facility-based system, the only way to achieve the goal of providing rapid and reliable oral treatments to the 80 million Americans who qualify is to supplement the system. This system is a new federally authorized home user channel. This can instantly expand T3 from the current sparse 2,000 locations nationwide hypothetically every household in the US. It will leverage the same distribution channels the government already has in place to deliver hundreds of millions of free rapid tests to American households. This will be an exponential force exponential.

Components of the necessary one-stop, verified, and secure-at-home T3 program already exist. The “T3 enabled” QR code quick test box can be used anywhere to perform a virtually unsupervised TV wellness exam. If positive and medical indications are met, the patient can be evaluated immediately and prescribed treatment. Medicines will be delivered from the nearest provider’s pharmacy. All from the convenience of home and with high quality, safety, security and timeliness. Patients can begin treatment a few hours from symptom onset and achieve maximum health benefits with minimal friction.

Several pilot companies have demonstrated the proof-of-concept feasibility of this home delivery model with states, employers, and individuals. (One of these is eMed, where Dr. Mina is Chief Scientific Officer.) Another important public health benefit of T3 at home is that it encourages individuals to report results, both positive and negative. Polar, automated, and real-time for public health agencies that don’t rely on unverifiable endorsements. This helps to close a large gap in disease surveillance due to the prevalence of unreported self-testing.

Fourth, make sure treatment is delivered safely

Drugs like Paxlovid come with significant safety concerns. Side effects and interactions with other prescribed medications are not uncommon and should be evaluated by a qualified medical professional. Whether at home or on site, a thorough assessment of current medications and related medical history is imperative to ensure safe treatment. Since this is already part of the telehealth assessment protocol, high safety standards need to be met.

Fifth, develop an enhanced federal program

The only possible solution to deliver on the promise of a program of this scale is through government leadership. The complexity and scope of end-to-end supply chain management required, multiple clinical, retail, and in-home distribution channels, enabling regulatory approvals, and large-scale financial backing make the initiative great. ​This enhanced T3 becomes a leading candidate for the Speed ​​of Operation of this type of government-private sector partnership. The initiative has the potential to replicate the success of vaccines and rapid at-home testing programs that have reversed previous pandemics.

Sixth, the return on investment in human and financial terms cannot be calculated

We estimate the annual cost of the enhanced T3 program to cover 80 million vulnerable Americans will be in the range of $10 billion. This “backpack” forecast is based on a premium estimate of 20 million symptomatic cases of COVID-19 per year, $500 per treatment drug cost, and $50 per person eligible for out-of-pocket expenses. distribution and support fees.

Tangible cost offsets are associated with savings from medical visits, hospitalizations, and avoidance of deaths. The Average costs for Medicare for a single COVID-19 hospitalization is about $21,000, and $42,000 for a private payer. The projected cost savings from avoiding hospitalization is approximately $15 billion. Additional economies will be gathered through reducing outpatient visits, limiting transmission, and avoiding more costly on-site testing. In addition, there are incalculable “soft benefits” in terms of individual and social mental and physical health, productivity, and related economic benefits.

Test to Treat is by far the highest return on investment in the “living with the virus” phase. With political will, this route to success can be realized. Just like developing a vaccine, the urgency and value of time is great — we have to support these improvements to T3 so that every eligible American can start treatment within 3 days. when there are symptoms.

COVID-19 is both seasonal and cyclical. It will increase sharply again in the not too distant future. Now is the time to invest in “endemic preparedness.” We can avoid a repeat of the medical system overload, business closures, social distancing, virtual schools, and most importantly, the loss of lives. Let’s play our society’s prison escape card.

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