All hospital staff should have access to COVID-19 oral antivirals: experts


By Siobhan Calafiore

30 Mar 2023

All hospital staff with mild-to-moderate COVID-19 should have access to the antiviral molnupiravir as this would reduce the infection burden and help alleviate staff shortages, Australian researchers suggest.

Currently, most healthcare workers are not eligible for COVID-19 oral antivirals via the PBS, which are only available to people under the age of 70  diagnosed with COVID-19 if they have risk factors for severe disease.

However, group of Infectious Diseases and Public Health staff from Barwon Health in Geelong, Victoria, argue that expanding molnupiravir access to healthcare workers could ease the “immense strain” on the system during future waves of COVID-19 by reducing illness severity and duration.

In a paper published in PLoS One they note that when commenced within five days of COVID-19 symptom onset, the antiviral can reduce illness severity and duration in people without identified risk factors for severe disease, and also reduce infectiousness and transmission by rapidly reducing viral load. There is also emerging evidence that oral antiviral treatment may reduce the risk of long-COVID, they say

In support of these clinical benefits, the clinicians report on a case series [link here] of 30 staff members at a tertiary hospital, including seven doctors and 15 nurses, who were offered molnupiravir (Lagevrio) outside of the PBS but free of charge.

The program was approved by the Victorian department of health for a limited period during the Omicron BA.2 wave in June 2022 to help deal with workforce pressures.

Participants had a median age of 43, were mainly female (73%) and most reported having no comorbidities (80%).

While COVID-19 vaccination status was not collected, it was a legislative requirement at the time for all healthcare staff to have received three doses.

All 30 staff who received molnupiravir completed their treatment course (800mg dose twice daily for five days) and had low rates of adverse events, which were all deemed to be mild.

They each reported improvement in symptoms within 48 hours of starting antiviral treatment. The reported duration of illness ranged from 1-16 days with a median of four days.

A negative rapid antigen test on the final day of treatment was recorded in 81% of the 27 people who tested, increasing to 93% for those who took molnupiravir within 48 hours of symptom onset.

Only 22% of participants reported household transmission after commencing treatment and 73% reported being well enough to return to work after completing seven days of mandatory isolation.

“One hundred percent of participants reported being satisfied (6/30) or extremely satisfied (24/30) with the program, and many independently sent messages to those implementing the program, expressing appreciation at being given access to the medication,” the authors wrote.

“The implementation of a policy allowing access to molnupiravir outside of PBS recommendations for healthcare workers with mild-moderate COVID-19 may have important individual benefits to workers health and wellbeing and help alleviate the acute staff shortages experienced currently by the Australian healthcare workforce,” they concluded.

However, the researchers acknowledged they could not definitively determine molnupiravir’s effectiveness on symptom severity and duration because their trial was not placebo-controlled.

The findings followed publication of a separate study in the BMJ, suggesting molnupiravir reduced hospital admission and death at 30 days in high-risk adults who contracted COVID-19.

The US-based study of almost 86,000 patients with SARS-CoV-2 infection in the community, also during an omicron wave, found those taking molnupiravir had a 28% reduced risk of hospital admission or death than those who had no treatment [link here].

The results are in contrast to those of the UK PANORAMIC trial, which led to a recommendation from Australia’s National Clinical Evidence Taskforce against the routine prescription of molnupiravir [link here].

It comes as some infectious diseases physicians and epidemiologists also advocate for expanded PBS access to COVID-19 antivirals, labelling the current restrictions “excessive” [link here].

On 30 March, health minister Mark Butler announced that people aged 60 to 69 will have access to the antiviral treatment Paxlovid under the PBS if they have only one risk factor for severe illness – instead of two.

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