State plans to rely on quick testing and treatment, neither of which are certain
A major part of New Mexico’s pandemic strategy moving forward is to widely distribute antiviral medication to every pharmacy in the state, and to some health care offices.
The state’s plans are meant to make it possible for people who catch coronavirus to quickly get treatment, according to acting N.M. Health Secretary David Scrase.
Paxlovid is a pill shown to be potent against COVID-19 by independent lab testing. The FDA approved it in December, and it first arrived in New Mexico in January along with a similar drug, Molnupiravir.
Paxlovid reduces hospitalizations and deaths by 88%, Scrase said, and there will be other medications coming along soon, as well.
The last time there was a surge in New Mexico, he said, there were 7,000 cases per day and more than 700 people hospitalized with COVID-19. Because of the drug’s effectiveness, if there is another wave that size, he said there would only be about 80 people hospitalized.
“And we’d be able to handle that very, very easily,” he told reporters on March 11.
But senior Biden administration officials told reporters on Tuesday that without money from Congress, there will be a drop-off in the federal government’s ability to purchase and distribute tests, treatments and vaccines.
Along those lines, access to Paxlovid might wind up being more limited than what Scrase was relying on when he talked through the end of the public health protection measures in place in N.M., like masking.
Only a fraction of the supply of Paxlovid the White House promised in its National COVID-19 Preparedness Plan had actually been ordered by the federal government as of early March.
STAT News reports the White House delayed buying more than 9 million courses of Paxlovid because of budget problems, representing about half of the total the White House has publicly pledged to buy.
And there is no national home testing and delivery program like the one piloted in New York City.
The U.S. started distributing half a billion at-home tests by mail in December after widespread public pressure, but has no plans to make those kinds of deliveries a regular thing — nor does it have a plan to create some way for people to report the results of at-home tests to national health authorities, like they do in the United Kingdom.
Congress had set aside $15 billion for COVID supplies in the most recent government funding bill. Some of that was coming from money promised to the states, though. Speaker Nancy Pelosi scrapped that language in the bill in response to complaints from members whose states would have lost the most money.
“Without funding, the United States will not have enough additional boosters or variant-specific vaccines, if needed, for all Americans,” the White House wrote. “The federal government is unable to purchase additional life-saving monoclonal antibody treatments and will run out of supply to send to states as soon as late May.”
The federal government cannot purchase enough treatments for immunocompromised people, the White House wrote, and will not be able to test as often.
Without the funding, the U.S. would also be forced to scale back payments to health care providers who treat people for COVID-19 who are uninsured. If Congress does not approve more spending, those payments will completely stop in April.
There are about 215,000 New Mexicans who are uninsured, according to Health Action New Mexico, including 40,000 immigrants excluded from state health care coverage.
Many of the uninsured are people of color who disproportionately work frontline jobs like in food supply, child care and older adult care, said Barbara Webber, executive director of Health Action New Mexico. That puts them at higher risk of catching coronavirus.
To lose COVID funding, including testing for uninsured New Mexicans, would not only impact the community members who cannot receive services but will ultimately impact everyone in New Mexico.
– Barbara Webber, Health Action New Mexico
Scrase said for New Mexico to be ready for another variant, state health officials “need a bigger supply of oral agents” and need to get them into pharmacies.
He did not specify how long the state’s current supply will last, nor did he say where the state will get more. As of Wednesday afternoon, the Department of Health had not responded to questions about how the state is reacting to the White House raising the alarm about funding and possible shortages.
“I’m going to get every tool I can in place throughout the state, so even with a big wave of people getting sick, we completely and dramatically reduce hospitalizations and deaths as a result of early treatment,” he said.
To be effective, Paxlovid must be taken within five days of a positive test result, meaning people need fast access to testing when they feel symptoms of COVID-19.
Webber said testing is critical to reach a place where we can live with the COVID virus and its variants. It also allows high-risk people to get treatment in time to stay out of the hospital or avoid more severe disease, she said.
Around half of the testing in New Mexico is being done at home through a group of contractors who deliver tests to people’s homes, Scrase said. Another 43.5% of testing is being done at pharmacies and other health care providers’ offices, he said. The rest of the testing is done by DOH itself.
Scrase said he anticipates a “transition to at-home testing.” A week earlier, he said “hopefully” everyone has ordered and received free at-home tests from the state and federal governments. At-home antigen tests are less sensitive but turn around results in less time than molecular (PCR) tests at a laboratory.
To prepare for future waves, he said, the state is rewriting its contracts with testing companies and “developing plans” to get tests to pharmacies and mail them directly to “Human Services Department customers.”
Scrase is expecting another wave, but he says the state doesn’t need to track case numbers to see it coming.
Moving forward, hospitalizations “will be the trigger” for state officials to reconsider policies and procedures, he said. But, he added, part of that strategy relies on having effective treatments made widely available.
Hospitalizations, on the other hand, are a lagging indicator — a late warning sign of a coming surge. Case counts and surveillance measures like wastewater monitoring are early warning signs.
Scrase acknowledged this fact at a news conference but said effective treatments would make up for the delay.
“As long as we have effective treatment, we can weather what is now about an eight-day delay between cases and hospitalizations,” Scrase said.
With surges already happening in Europe and China, Webber said it is essential we make testing and treatment available to all New Mexicans if we are to be able to successfully contain the virus and “permanently return to everyday activities, in-person schooling — and protect our economy.”