At-home treatment for COVID-19 arrives in Alberta — but there's only enough now for 3,200 people

Edan Nelson, an immunocompromised Calgarian, woke up Sunday morning with a scratchy sore throat.

A rapid test showed he had COVID-19.

On Monday, he became one of the first Albertans to get a prescription for Paxlovid, a pill newly available in the province that is designed to prevent severe COVID-19 symptoms in eligible adults.

"It's like an anxiety-relief, having this option available," said Nelson, whose doctor told him he might be the first in the province to get the prescription.

"And it's kind of a silver-lining moment, that I got sick the day before this all comes out and I have this option presented to me."

The antiviral treatment — the first COVID-19 therapy that can be taken at home — is designed to help the body fight off the SARS-CoV-2 virus, reduce symptoms from an infection and shorten the period of illness. 

Only those patients who have a higher risk of hospitalization will qualify, and the medication must be taken within five days of the onset of symptoms.

Three prescriptions were issued for Paxlovid on Monday when the medication became available to eligible patients, Alberta Health Services spokesperson Kerry Williamson said in a statement.

Supplies low

The province has an initial supply of 3,200 sets of pills but Alberta Health says its stockpile should double by the end of next month when another 3,200 courses of treatment are expected to arrive from Health Canada.

"Current supplies are limited and are being reserved for Albertans who would benefit the most from it," Alberta Health spokesperson Jason Maloney said Tuesday in a statement.

There are currently 134 pharmacies in Alberta that have received an initial supply of Paxlovid.

More pharmacies, and more patients, could have access to the drug as the federal supply expands and stabilizes, Alberta Health said. 

Canada has purchased one million doses. The first batch, consisting of 30,000 sets of pills, is being distributed now. 

More than 120,000 additional treatments are expected across the country by March.

The drug is an effective treatment that will help prevent hospitalizations and deaths among vulnerable Albertans, said Craig Jenne, an associate professor in the department of microbiology, immunology and infectious diseases at the University of Calgary. 

"The strategy here is not to stop illness, but to stop illness from becoming severe," Jenne said. 

"This is not an everyday treatment for the masses, but will be an important tool for those most at risk of severe disease."

No drug, including Paxlovid, is a substitute for vaccination or public health measures aimed at reducing transmission, Jenne said. 

"This is a treatment designed to preserve life, not to limit viral numbers or viral spread." 

Restraining the virus

Paxlovid is a protease inhibitor. It restricts the virus that causes COVID-19 from replicating. 

"After you're infected, the virus is trying to copy itself and to do that, it has to make several large proteins," Jenne said.

"They make these large proteins that have to be cut up into little functional pieces …[the drug] actually inhibits the scissors that cut up those big proteins.

It stops the virus from assembling new viruses to go on and infect other cells or other people.-Craig Jenne

"It stops the virus from assembling new viruses to go on and infect other cells or other people."

The medication consists of two antiviral drugs, nirmatrelvir and ritonavir. Patients take three pills twice a day — two of nirmatrelvir and one of ritonavir. 

The full course of treatment is 30 pills over five days.

The two drugs work together to combat infection. Ritonavir enables nirmatrelvir to remain in the body longer while nirmatrelvir works to disable the virus's ability to replicate and multiply.

The drug will only be prescribed to patients who have a lab-confirmed COVID-19 infection and are able to receive the treatment within five days of feeling sick. It should only be taken by adults with mild to moderate symptoms.

The drug will be available to unvaccinated Albertans who are 65 and older. Unvaccinated adults with pre-existing health conditions — including diabetes, chronic kidney disease and congestive heart failure — also qualify. Unvaccinated pregnant women are also eligible.

Immunocompromised Albertans with certain health conditions qualify, regardless of their vaccine status. 

Using the drug in a targeted way makes sense, Jenne said.

Widespread use of the medication could result in COVID-19 becoming resistant to the drug in the long term, he said. 

"Unfortunately for this virus, we don't have a lot of tools," he said. "This is an impactful one, but we want to make sure that we're not using this on everybody.  

"We want to make sure we use it sparingly and we use it only where necessary in order to prolong its efficacy in the community."

'Feeling lucky'

After Nelson got his lab results confirmed early Monday morning, the pills were delivered to his Calgary apartment within hours.

He still has symptoms but his fever has cleared.

"I feel pretty lucky," he said.

Patients who qualify for Paxlovid and have a positive lab test are encouraged to call Health Link at 1-844-343-0971 where they will be screened and referred to a prescribing physician.