Sonoma County has only 120 courses of new antiviral COVID-19 drugs, even as transmission soars

Sonoma County this week received its first shipment of oral antiviral medications to treat COVID-19.

Unfortunately, that first shipment is only enough to treat 120 people, in a county with a population of nearly half a million residents that is currently averaging about 232 new cases of COVID-19 every day.

County health officials said another shipment of Pfizer’s paxlovid and Merck’s molnupiravir medications could come from the state possibly next week, but that’s not certain.

“That’s it. For the whole county,” said Dr. Kismet Baldwin, county deputy health officer. “It’s just a super, super scarce resource right now, and the state has signaled that at least one of them, paxlovid, will continue to be scarce for a little while longer.”

Providence Sonoma County, which runs Santa Rosa Memorial, Petaluma Valley and Healdsburg hospitals, confirmed that the new antiviral drugs are currently only distributed through county health departments.

The provider said it’s been in contact with county officials “requesting access to the drugs and we are still waiting for them to make this available to our hospitals.”

Both paxlovid and molnupiravir were granted emergency use authorization by the U.S. Food and Drug Administration on Dec. 22 and 23, respectively for the treatment of mild-to-moderate COVID-19, the disease caused by the novel coronavirus.

Paxlovid is prescribed for adults and young patients 12 years of age and older, weighing at least about 88 pounds, who have tested positive for COVID-19 and are at risk of progressing to severe COVID-19, including hospitalization or death, according to the FDA.

Molnupiravir is prescribed for adults 18 and older with a confirmed case of mild-to-moderate COVID-19 who are at high risk of severe COVID-19 illness, hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate.

Both drugs are meant to be administered within five days of the onset of symptoms, said Baldwin. “It really needs to be initiated as soon as possible,” she said. “You’re not going to want to start someone on day eight, after symptoms have started.”

Baldwin said the drugs work in different ways; paxlovid is a viral protease inhibitor that prevents the coronavirus from generating the proteins it needs to replicate. Molnupiravir results in mutations in the virus that eventually kill it.

Officials with the California Department of Public Health said initial allocations from the federal government have begun to arrive in counties across the state, and that they will be distributed to selected providers and pharmacies. The state said the number of doses each county gets is tied to the level of virus transmission. Sonoma County ranks 20th out of California’s 58 counties in case rate. Los Angeles County and San Francisco rank No. 1 and 2 respectively.

Because supplies of the drug are so limited, Baldwin said ensuring equitable distribution is a “definite concern.” She said the county tried to get the state to select pharmacies in underserved communities in various parts of the county.

The state came back and selected three local pharmacies — all in Santa Rosa. Baldwin said the county has since gotten the state to expand the list of pharmacies in other parts of the county, taking into consideration underserved communities that have been disproportionately affected by the pandemic.

“We were able to get some other pharmacies added for the next allocation, but I’m not sure when that next allocation will come,” she said. Maybe next week sometime.”

Dr. Irene Balyut, medical director of quality and informatics at Santa Rosa Community Health, the county’s largest consortium of health clinics, said she hopes the antiviral medications will soon be distributed to her organization’s three clinic pharmacies. SRCH patients are at higher-risk of COVID-19 infection and severe illness and are likely to have difficulty accessing the new treatments.

“We are concerned that if these medications are offered in just a few branches of the big-name pharmacies that our patients won’t be able to benefit from early treatment in the same way as people who have more resources,” Balyut said.

Pedro Toledo, chief financial officer of the Petaluma Health Center, which runs large clinic in Petaluma and Rohnert Park, as well as school health clinics, said every effort should be made to get the antiviral drugs to low-income essential workers who have been put at risk throughout the pandemic.

Toledo said he believes federally-supported health centers like SRCH and Petaluma Health Center will eventually receive shipments directly from the federal government. “We have not received the medications yet, though,” he said.

West County Health Centers has been unable to get the medications at its pharmacy, said Dr. Jason Cunningham, the organization’s CEO. Cunningham said distribution of antivirals is not hindered by the same logistical and production issues that plagued vaccine distribution.

“I am hopeful it will improve over time and we can work through our normal channels to ensure our vulnerable communities have access to the treatment,” he said.

Physicians at Kaiser Permanente’s San Francisco Medical Center will begin dispensing the medication this week to patients who are eligible to get it, the provider said in a statement Friday. Other Kaiser medical centers, including Santa Rosa, will follow as inventory is received.

Kaiser officials stressed that paxlovid is not authorized for the pre-exposure or post-exposure prevention of COVID-19, and it’s not a substitute for vaccination for those who are eligible to receive COVID-19 vaccine and booster doses. Kaiser said people should get their COVID-19 vaccinations and boosters when eligible, as well as a flu shot.

Because of limited supplies, state health officials recommend that treatment be prioritized. They say the first to get treatment should be unvaccinated or incompletely vaccinated people; vaccinated people with weakened immune systems, such as individuals who are immunocompromised or on immunosuppressive medications; and people 65 and older.

State officials said that if supply continues to be limited, providers should additionally prioritize high-risk patients with moderate illness, in the following order: those who are immunocompromised or on immunosuppressive medications; incompletely vaccinated and over 65 years with risk factors for severe disease; over 65 years with risk factors for severe disease.

Neither oral option is authorized for treatment in patients requiring hospitalization due to severe or critical COVID-19.

For a complete list of risk factors for disease progression, including information on the relative risk of severe disease, see the CDC webpage “Underlying Medical Conditions Associated with High Risk for Severe COVID-19.”

While COVID-19 hospitalizations and deaths have declined significantly in the post-vaccine era of the pandemic, the unprecedented number of local infections driven by the highly transmissible omicron variant is beginning to result in more severe illness.

On Friday, county health officials reported two deaths from COVID-19 complications, a man between 80 and 90 who died Dec. 27 and another man 60 to 70 who died Jan. 2. Both were fully vaccinated with underlying health conditions, officials said.

The deaths bring the total number of pandemic deaths to 421. As expected, COVID-19 hospitalizations are increasing in the wake of omicron infections. As of Jan. 6, there were 49 COVID-19 patients in local hospitals, six of them in intensive care units.

Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.