As the number of confirmed cases of COVID-19 continues to rise in Taiwan — measured daily in the tens of thousands rather than the single digits — there has also been an increase in the number of cases with medium to severe symptoms and even deaths.
Particular attention should be paid to elderly people and those with compromised immune systems — such as patients with diabetes, cardiopulmonary diseases, kidney disease and body mass indices over 30 — with authorities ensuring that they receive their booster shots.
Those with weak immune systems and minor symptoms of COVID-19 should be treated with an antiviral to keep their symptoms from becoming severe.
Taiwan has received half of an order of 700,000 courses of the antiviral drug Paxlovid, but this can only treat a little more than 800 hospitalized patients.
This makes no sense, because the most efficient use of the drug is to administer it when a patient has mild symptoms, to prevent their condition from worsening.
When Taiwan was hit with an influenza epidemic in August 2009, regulations stipulated that government-funded prescriptions of the antiviral Tamiflu were only available at hospitals, while people treated at clinics had to pay out of pocket for it, or claim it on their National Health Insurance. Few clinics stocked it.
Naturally, people with simple fevers flocked to major hospitals, exposing themselves to further infection from people with the flu, causing a major headache for doctors and patients alike.
I wrote an article about the situation at the time, and the Centers for Disease Control (CDC) perhaps took note because five days later, the agency announced that clinics could also prescribe the drug, taking the burden off hospitals. Just like that, the problem was solved.
Taipei and New Taipei City are experiencing a similar situation, but the Central Epidemic Command Center (CECC) has neglected to allow clinics to take some of the burden from hospitals in the initial stages of this outbreak.
Paxlovid is most effective when administered to members of at-risk groups before their symptoms worsen, to prevent severe symptoms or even death. If the right to prescribe the drug is restricted to hospitals and not extended to clinics — usually the first line of contact with older people — history is likely to repeat itself.
Paxlovid is expensive and supplies are limited, so its prescription needs to be targeted to those most in need. The priority must be clinics with pulmonologists, internists and family doctors; clinics caring for house-bound patients; and clinics conducting polymerase chain reaction (PCR) testing for at-risk groups.
Clusters of specialist clinics in local communities could choose one in the community to prescribe antivirals, ideally leaving the decision to the one selected.
The CECC has been cautious, carefully considering the counsel of its panel of experts at every stage, but this has slowed the process. The rapid rise in COVID-19 cases with medium to severe symptoms has added urgency to the correct, targeted use of antivirals. If at-risk groups need to line up at hospitals for PCR testing, wait for the results and be admitted to receive medication, the prescription of antivirals should be left to clinics.
I strongly recommend that Deputy Minister of Health and Welfare Shih Chung-liang (石崇良), CDC Deputy Director-General Philip Lo (羅一鈞), Taiwan Medical Association president Chiu Tai-yuan (邱泰源), National Taiwan University Children’s Hospital superintendent Huang Li-min (黃立民) and others convene a virtual meeting on the matter — and give people in at-risk groups the news they have been waiting for as soon as the following day.
Wang Fong-yu is chairman of the Kaohsiung County Medical Association.
Translated by Paul Cooper
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