By Jeffrey D. Klausner
Special to CalMatters
Americans love a medicalized approach to treating disease. So, we must accept the fact that many Americans would rather take a pill than exercise or follow a diet to prevent disease.
Similarly, there has been tremendous push back against non-pharmaceutical interventions like masking, physical distancing or avoiding indoor gatherings to prevent the spread of COVID-19. However, we can update our response to the pandemic and follow the typical American path toward treating disease with medication.
With every newly reported case of infection among those with risk factors for severe disease – age greater than 65 years, obesity, chronic lung or kidney disease – public health workers could facilitate timely treatment with medical interventions such as monoclonal antibodies and fluvoxamine, which has shown to have a “potential therapeutic role.”
Fluvoxamine is safe, inexpensive and widely available by prescription. A recent study showed that among COVID-19 patients who took at least 80% of their medication, mortality was reduced by 90%. New formulations of monoclonal antibodies allow for rapid infusion or injection under the skin by a nurse or pharmacist. Combination monoclonal antibody use lowered the risk of hospitalization or death by 70%.
To make those treatments quickly available, public health authorities could create standing protocols and county or statewide medical orders bypassing the need for a costly or difficult-to-obtain medical visit that would delay the initiation of therapy. Pharmacy chains could also offer direct medical treatment based on certain criteria.
Additionally, large commercial clinical testing laboratories that detect new cases could join the response. Laboratories could prioritize cases by age or other risk factors for immediate direct notification from the laboratory to the patient. Laboratory personnel could help with linkage to treatment sites with an electronic message or telephone call.
Many laboratories might say that such notification and treatment facilitation is not within their scope of work, however, in a public health emergency we must break down the existing silos to optimize our epidemic response. Our failure to work across systems has been a key factor in our inability to control the pandemic.
When I was a public health official in San Francisco we had standing protocols for testing and treatment that accelerated notification and therapy for serious conditions. One example was field delivered therapy where under my physician orders the public health staff could deliver medications to new cases of curable infections. Another was a program whereby those age 18 years or older could download a completed and signed prescription for emergency contraception.
Given the continued high death rates due to COVID-19 – which is now a highly preventable outcome – we must pivot our public health approach away from the controversial and poorly-adhered-to mask mandates and physical distancing orders to the pharmaceutical interventions proven to work.
We have been very successful with vaccination – creating the largest vaccination program in modern times reaching more than two-thirds of the U.S. population. We have created new evidence-based policies to increase vaccination further in different settings but have probably reached a plateau.
New innovative approaches are necessary. With the anticipated authorization of additional new antiviral medications, the time to shift our focus is now. To make that shift, health officials and political leaders will have to update their response adopting the new treatments for this pharmaceutical phase of dealing with COVID-19.
Dr. Jeffrey D. Klausner is a clinical professor of medicine, population and public health sciences at the University of Southern California Keck School of Medicine.