We have highly effective new drugs for fighting COVID. Reporters should track who’s getting them and how.

COVID-19 antiviral pills can reduce the risk of hospitalization and death and curtail symptoms. But getting these medications is a race against the clock, requiring well-timed steps and ready access to the health care system.

First, someone must test positive, which requires a home rapid test or visiting a testing center. After that, the patient must seek a provider to write the prescription. Then, they’ll need to find a pharmacy with the right medication on hand. All this must be accomplished within five days of symptom onset, a challenging feat that is heavily biased in favor of those with free time, persistence and good access to the health care system.

“For those with means and those who know how to work the health care system, it will work out fine,” said Dr. Aaron Carroll, a distinguished professor of pediatrics and chief health officer at Indiana University, in a Center for Health Journalism Covering Coronavirus webinar. “In many ways, COVID has exposed and exacerbated a lot of the health disparities we see throughout the United States.”

Carroll was joined by Dr. Annie Luetkemeyer, a professor of medicine at the University of California, San Francisco, and Miami Herald health care reporter Daniel Chang to discuss COVID therapeutics, their efficacy and the barriers that prevent them from getting to people who need them the most. They also shared story ideas and fresh tips for covering the pandemic as it stretches into its third year.

What’s now available to fight COVID?

It’s an extraordinary achievement that we now have effective oral medications to treat COVID, Luetkemeyer said. The medications — which aren’t intended as a substitute for vaccination — are currently restricted to those who test positive for COVID, are symptomatic and have one or more risk factors for disease progression, such as being over 65 or immunocompromised.

The current options include:

• Paxlovid: Patients take three pills, twice a day for five days. The treatment reduces the risk of hospitalization and death by 85%. The catch: It needs to be given within five days of symptom onset, and can interact negatively with other drugs people may take.

• Molnupiravir: Patients take four pills, twice a day for five days. This has been shown less effective against omicron, with the relative risk of hospitalization and death reduced by 30% to 65%, depending upon the study. It also needs to be given within five days of symptom onset.

• Monoclonal antibodies (such as sotrovimad and bebtelovimab): These IV treatments reduce the risk of hospitalization and death by 85% (bebtelovimab) and can be administered up to seven days after symptom onset. Patients need to be in a medical setting.

• Remdesivir: This is a once daily IV infusion over three days. It has an 87% relative reduction in hospitalization and death among high-risk patients. It needs to be administered within seven days of symptom onset.  This also requires a medical setting.

While there are some government guidelines for which of these therapies a given patient should receive, most providers look at what’s available and the best fit for the patient, Luetkemeyer said. For example, some thereapeutics aren’t used for patients with severe kidney or liver disease or those who are pregnant.  

Addressing system disparities

The U.S. health system’s playing field is “already tilted,” which means it’s more difficult for many people to receive these therapies, Carroll said.

Extra work is necessary to address these structural inequities around race and ethnicity, speakers said. This could include outreach to diverse communities, to ensure that more people are aware of the treatments and the timelines, Luetkemeyer said. Health officials should seek input from the communities involved and address any misinformation that could be circulating.

Health providers could also do more to identify at-risk patients and distribute antigen tests and pills in advance. Still, that would miss people who don’t have regular health care, so another strategy could be to distribute COVID drugs at community sites. Pharmacies offer another possibility or sending medications to COVID testing sites.

“I don’t know that there’s going to be a one-size-fits all solution,” Luetkemeyer said. “I want us to continue to think of multiple ways to solve this access issue.”

Covering the story

After fielding a reader tip, Miami Herald reporter Daniel Chang investigated how monoclonal antibody were being distributed in Florida. He started by looking at a federal website to see where the therapeutics were going by state, and followed the distribution chain to a little concierge clinic serving comparatively well-off patients in South Florida. By doing so, the state was bypassing a major transplant hospital where immunocompromised patients may have benefited more.

After the story ran, the state reversed its “first-come, first-serve” policies, Chang said.

Moving forward, Chang is tracking the availability of COVID testing as the state’s testing infrastructure is downsized. He’s also interested in exploring what happens to treatments authorized under emergency use once the public health emergency declaration expires.

For Luetkemeyer, journalists fulfill a crucial mission of providing nuance and color on the fast-changing arena of available treatments, long COVID, and emerging variants.

“The really great reporting that I’ve seen has helped people contextualize this,” she said. “I think that’s been extraordinarily helpful when everyone is looking for a very black and white solution.”

For Carroll, journalists can shine a light on the need to improve public health infrastructure. Whether it’s a resurgence of COVID or another pandemic, this isn’t the only health emergency we’ll face.

“We were absolutely unequipped and unprepared for this one and I’m still not convinced we’re prepared for the next one,” he said. “While we’re still remembering how bad this was and how bad it might get, we need to make sure that we invest and not put our heads back in the sand and hope this doesn’t happen again.”

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Watch the full presentation here: