Effective treatments for COVID are now available. Why are they not being used?

At the beginning of the year it was hard to access treatments for COVID-19 because they were in high demand and supply was tight.

Now, antiviral treatments like Paxlovid are readily available, but not many people are benefiting because they don't know the drugs exist.

"There are so many doses sitting on shelves not being used because of a lack of education among physicians," said Dr. Daniel Griffin, an infectious disease specialist at Northwell Health in New York.

"It's a miracle drug. It's just not being utilized," agreed Dr. Peggy Duggan, executive vice president and chief medical officer at Tampa General Hospital.

That's largely a result of shifts in the pandemic, Duggan said.

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Fewer people are falling sick today compared with the numbers infected in December and January, so treatments aren't top of mind, she said.

Also, while specialists and hospitals were most likely to see COVID-19 patients earlier in the pandemic, primary care doctors are now on the front lines, and it's hard to educate this much larger population of doctors about available treatments, she said.

Primary care doctors treat a variety of ailments with symptoms similar to COVID-19, such as allergies, so they may not immediately think their patient is infected and could benefit from early interventions. "In the mix of things they're caring for, it doesn't always rise to the top," Duggan said.

Awareness varies considerably across the country, depending on the effectiveness of state and local health departments' communication efforts, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

"Somehow, the entire federal, state and local public health structure has not anticipated the extent of education that's really necessary," he said. "They probably don't have the resources."

To be effective, all treatments need to be started as soon as possible after symptoms begin and definitely within five to seven days, so there's not much time to lose.

A prescription is required, so a patient must get results from a test and then see a physician before getting access to the drugs, a process that can be time-consuming and difficult, particularly for people without a primary care doctor.

The federal government pre-purchased the drugs, so they are available at no cost to patients.

The antiviral Paxlovid, from Pfizer, has been shown in studies to be 90% effective at preventing hospitalization in an infected person at high risk for severe COVID-19.

There are other treatments for early-stage disease in high-risk people, including the antiviral molnupiravir from Merck and Ridgeback Therapeutics and the monoclonal antibody bebtelovimab from Lilly.

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Schaffner said he's partial to Paxlovid. "The doctors in my neck of the woods would try to get you Paxlovid. That looks like it's working the best."

Schaffner said he wishes every nursing home and assisted living facility had a mechanism in place to get Paxlovid to residents as soon as they test positive for the virus that causes COVID-19. "They ought to all have a plan," he said.

Griffin said he finds it embarrassing that more doctors don't know about the treatments.

"I try to not get emotional but find it really difficult every day when I hear about a high-risk person who is being told by their providers to wait and see how they do as the window of opportunity closes for these highly effective treatments," he said.

"I think not getting access to early treatment before the window closes is still the rule and not the exception."

Those who do get access to drugs like Paxlovid tend to have more advantages – perhaps including a doctor in the family – which reinforces the disparities seen repeatedly during the pandemic.

Access to Paxlovid is not a problem in the Washington, D.C., area, said Dr. LaTasha Perkins, a family physician there.

"I have not hesitated to write a prescription for the oral antiviral medication and have found a pharmacy that was able to fill it," she said by email. "My recommendation is to contact your family physician as soon as you receive a positive test result for COVID-19 to determine if you are eligible for these treatment options, especially since symptoms are typically the worst within the first three days."

Treatment approaches change quickly during a pandemic, and primary care doctors and patients need to make the effort to educate themselves, said Dr. Camille Kotton, an infectious disease expert at Massachusetts General Hospital in Boston.

"It's hard to keep up on what the newest recommendation is, so people do need to be prepared for that," Kotton said. "The information is out there. We all need to be very nimble."

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: COVID treatments: antivirals, monoclonals are available but not used