As shipments of thousands more doses of the outpatient COVID-19 treatments Sotrovimab and Paxlovid arrive in Alberta, the provincial government says it may consider expanding who is eligible.
This comes at a time when Alberta has lifted nearly all public health restrictions.
Experts warn that demand for these specialist therapies will likely increase in the coming weeks – and they may help in certain high-risk situations – they should not be considered a replacement for COVID-19 vaccines.
Sotrovimab and paxlovid, both of which are available outside of hospitals, are available to a select group of high-risk Albertans who have tested positive by PCR and are not vaccinated, or who have only received a single dose.
This group includes people over 55, people with certain underlying health conditions, such as diabetes, chronic obstructive pulmonary disease (COPD), obesity and heart failure, and pregnant women.
Vaccinated and unvaccinated people who are immunocompromised due to transplants or treatments for conditions such as cancer and inflammatory diseases, including rheumatoid arthritis and lupus, are also eligible.
Both treatments are designed to treat mild to moderate COVID-19 and should be given within five days of the onset of symptoms.
According to Alberta Health Services (AHS), as of March 2, 1,349 intravenous infusions of sotrovimab have been administered since monoclonal antibody therapy became available in November.
AHS also said 213 prescriptions for the oral antiviral drug Paxlovid were dispensed in the first month it was offered.
The health authority said 235 of the people who received the treatments were either unvaccinated or had only received a single dose of the vaccine.
“These therapies aren’t right for everyone,” said Dr. Alain Tremblay, a pulmonologist at Foothills Medical Center in Calgary and a member of the COVID Therapeutics Task Force, which advises public health officials on COVID-19 treatments.
According to Tremblay, these treatments are expensive, difficult to administer, they come with side effects and can interact with other medications.
“If you’re fully vaccinated, your risk of having a serious effect is quite low. So you don’t really need to get these treatments, which is even better than being unvaccinated, getting sick and dying. then need these therapies which are a hundred times more expensive than the cost of a vaccine.”
However, Tremblay said, sotrovimab and paxlovid can be helpful for immunocompromised and unvaccinated people.
He said the committee was discussing the option of expanding eligibility to other high-risk groups of people.
“There are definitely a significant number of people in hospital who are vaccinated seniors who unfortunately have breakthrough infections,” he said.
“So the question is, would making these therapies available to this population would reduce the risk of hospitalization?”
Alberta Health does not rule this out.
“As supply increases in the province and data becomes available and is assessed, eligibility may be expanded, but no decision has been made at this time,” spokeswoman Lisa Glover said in an email statement to CBC News.
The province is beefing up its drug supply, just as it is eliminating nearly all public health measures.
In addition to the 3,200 Paxlovid treatments that arrived in January, another shipment of 4,300 is expected to arrive by the end of last week with more arriving later in the month.
AHS said late last week it had enough Sotrovimab to treat 2,200 Albertans and expected 720 more treatments by the end of the week.
While the drugs are provided by the federal government, Alberta must pay other costs, including patient assessments, prescription and administration of treatments.
For Sotrovimab, this can be a lot of work. In many cases, mobile paramedics come to people’s homes to administer drugs intravenously.
The province did not respond to CBC’s questions about those costs.
Treatment is also provided at select AHS clinics and by a third-party clinic, ACESO Medical, in Calgary and Edmonton.
University of Calgary infectious disease expert Craig Jenne said it’s important for people to understand that these treatments don’t prevent infection.
“These are intended to treat symptoms and slow the progression or stop the progression of a serious disease,” said Jenne, associate professor of microbiology, immunology and infectious diseases.
“We know there are a lot of other things that come out of COVID infections, like long COVID and other issues that aren’t necessarily resolved with these drugs.”
At the same time, Jenne said, the province must prepare for a potential increase in cases now that restrictions, including the provincial mask mandate, have mostly disappeared.
“We need to have as many tools as possible if infections go back up,” he said.
“The hope would be that this acquisition of additional courses of treatment is really a strategy of preparing for the worst scenario in the hope that we never need them, but being careful not to get pushed around and seek therapies if the numbers are starting to rise again.”
Experts warn that Sotrovimab and Paxlovid should not be considered a substitute for vaccination.
“I think what’s disappointing here is that we know that a number of these patients are probably unvaccinated… These are expensive, resource-consuming therapies that I believe in some cases, are used as a substitute for other health care measures that are much simpler,” Jenne said.
Calgary rheumatologist Dr. Paul MacMullan has similar concerns and hopes Alberta can work to increase lagging vaccination rates.
“The only simple message is to get vaccinated,” said MacMullen, who is head of the department of rheumatology at the University of Calgary and also part of the therapeutics task force.
“Vaccination is much more important and that’s where the effort should be because it gives you a lot more bang for your buck.”