This is an extract from a recent edition of The Journal’s coronavirus newsletter, which cuts through the noise and misinformation to give you clear, accessible facts about the coronavirus, Ireland’s fight to contain it, as well as developments further afield.
This is your one-stop-shop for Covid news during a time when it can be hard or overwhelming to try and stay up to date with the latest.
You can read the full edition here, sign up to receive the newsletter here or at the bottom of the page. This version contains additional updates.
IN THE EARLY days of the pandemic, the holy grail in the fight against Covid was always seen as a safe, effective vaccine.
We got just that in late 2020, but the motley crew of variants we’ve come up against, as well as waning immunity, have put paid to the notion that a simple primary course of vaccination is all we need.
Boosters help for the vast majority of the population, and in addition to that, a healthy lifestyle isn’t going to go amiss.
But the fact also remains that the vaccines are not 100% effective at preventing severe illness and that some people, particularly those who are immunocompromised, may not develop a strong immune response in the first place.
New treatments
Enter the need for other frontline treatments which can be used to effectively stop at-risk people from becoming severely ill.
You might have heard of dexamethasone, a commonly available steroid that was found to be effective at treating Covid, but only in patients who are already severely ill.
Remdesivir has proven to be of some use. It is utilised in Irish hospitals, but it requires three courses of intravenous treatment and so is time-consuming to administer (when it has been used, it is usually given to inpatients due to the logistics involved).
Arthritis drug baricitinib is showing some promise.
Others, mainly hydroxychloroquine and ivermectin, have proven not to be effective despite some early hype and lasting notoriety, although they remain good treatments for other illnesses.
We’re now seeing newly developed treatments become available, and Ireland has three at its disposal.
Monoclonal antibodies
One is sotrovimab (also known as Xevudy), a monoclonal antibody treatment developed by GSK that can reduce the chance of adults at high risk of severe illness from Covid being hospitalised by as much as 79%.
Monoclonal antibody treatments is essentially an IV infusion of those antibodies your body produces in response to a vaccine or an infection, targeting the spike protein of SARS-CoV-2 that we’ve become familiar with.
You might remember that former US president Donald Trump was given this when he caught Covid.
It must be administered early in the course of an infection.
There is some concern that sotrovimab is less effective against Omicron, but it does currently appear to retain the ability to fend off the worst effects of the virus (other antibody treatments, such as those developed by Regeneron and Eli Lilly, no longer work).
In addition to sotrovimab, we also have two antiviral pills with equally uncatchy names.
One is MSD’s Lagevrio (aka molnupiravir) and the other is Pfizer’s Paxlovid (a combination of two drugs, ritonavir and PF-07321332 aka nirmatrelvir):
Lageviro halves the risk of hospitalisation for adults with at least one risk factor (such as old age or heart disease, for example), but Paxlovid is even more effective, cutting the risk of hospitalisation by as much as 90%.
Crucially, in studies examining both treatments, some deaths were recorded in the placebo groups but none among those receiving the pills.
Both drugs are safe. A complication with Paxlovid is that it can interact with other medicines.
Ireland is putting €90 million towards these three treatments – both the antiviral pills and the antibody treatment – but exactly how we will roll them out isn’t crystal clear.
Referral pathways
While instructions have been issued to relevant healthcare workers on when to administer sotrovimab in Ireland, it is understood that referral pathways (how you access the treatment) for patients are still not well-defined.
They are popping up on an ad-hoc basis in some cases.
Essentially, most people who would be eligible for sotrovimab are in the very high-risk category, and are likely to be in regular contact with people specialising in their care.
Once they are confirmed to have Covid (anecdotally via PCR only), their care team can refer them for the antibody treatment, but it still might require them to be proactive.
The HSE said in a statement to The Journal that provision has been made “for high-priority patients requiring such treatment to be referred to hospital by GPs to avail of sotrovimab on an interim basis pending the establishment of a permanent community pathway”.
Dr Brian Kent, a respiratory specialist at St. James’s Hospital in Dublin, told this newsletter that it’s important for people with a high-risk medical condition or weak immune system to act quickly if they suspect they have Covid, stressing that the window of opportunity to administer the treatment is narrow:
What’s important for people to understand is that if they are in a vulnerable group, or if they’re concerned that they might be in a vulnerable group, if they do test positive that they should contact their managing team with a view to getting an opinion as to whether they need this [antibody] treatment.
He explained that vaccination has helped make Covid less of a threat for some at-risk groups – such as those with hypertension, older people, and diabetics – but risks remain for people with compromised immune systems or on therapies that suppress their immune system.
Dr Kent said:
It has been great having access to sotrovimab, it has meant that we’ve been able to intervene nice and early on people where we would have been very concerned about them running into very significant difficulties.
And pills? Well, about those.
The HSE said a delivery of Paxolvid is expected at the end of this month, after which the plan for administering it will be communicated with the public.
Discussions with Lagevrio’s manufacturer are still ongoing.
Dr Kent said it is likely that these will be more accessible than the antibody treatment and available to a broader – but as of yet, undefined – group of people.
This is because it is easier to administer and more widely available than the antibody treatment (all hospitals have sotrovimab, but there are only an estimated 2,000 doses available for the year, with 207 doses administered to date), although it might not be over-the-counter (especially given the potential complications of Paxlovid).
In the UK, Paxlovid is available on prescription, but it remains to be seen if such ease of access will occur in Ireland.
This is an extract from a recent edition of The Journal’s coronavirus newsletter, which cuts through the noise and misinformation to give you clear, accessible facts about the coronavirus, Ireland’s fight to contain it, as well as developments further afield.
This is your one-stop-shop for Covid news during a time when it can be hard or overwhelming to try and stay up to date with the latest.
You can read the full edition here, sign up to receive the newsletter here or at the bottom of the page. This version contains additional updates.
To embed this post, copy the code below on your site
have your say