February 24, 2022 — The Stop COVID Deaths Webinar No. 87 featured the latest updates on the medicines for COVID-19. With the COVID-19 vaccines and various medicines now widely available in the Philippines, knowing how to properly utilize these medicines is important, taking into consideration their effectiveness and accessibility.
The main speaker was Dr. Edsel Maurice T. Salvaña, director of the Institute of Molecular Biology and Biotechnology at the UP Manila National Institutes of Health and member of the DOH Technical Advisory Group. Salvaña discussed the important role of medication in decreasing mortality and morbidity, especially among vulnerable populations; and the medications that are indicated for patients with mild to moderate risk for progression and for those with severe disease. He emphasized that most people who are vaccinated (about 99%) but develop breakthrough infection will recover from COVID-19 without the need for medicine.
Salvaña also listed the medicines that are currently available in the country and with enough evidence for effectiveness against Omicron, which is the dominant virus causing the present surge in cases. These drugs are under Emergency Use Authorization and must only be used upon the recommendation of a licensed physician.
He showed a table showing the risk of dying that combined age and vaccination status and another table on the panel’s recommended therapeutic management for non-hospitalized and hospitalized adults with COVID-19.
These drugs are antivirals and immunomodulators. Remdesivir is used for at-risk patients and for severe cases. Molnupiravir and Paxlovid are used for mild/moderate-risk patients. As an ancillary, Dexamethasone is given strictly for severe/critical cases, and off-label drugs Tocilizumab or Baricitinib are for patients on oxygen via high flow nasal cannula (HFNC). He showed evidence of their effectiveness but pointed out that these studies were mostly among the unvaccinated population. There is still a need for more evidence among the vaccinated population, but he added that they don’t expect the results to be very different and the incremental benefit should still be the same.
Medications are important because there is still a residual 1% risk of death even among the vaccinated in the vulnerable population, and these medicines can decrease the risk by nearly 90%. The emergence of resistance and some decreased susceptibility due to mutation and Variants of Concern (VOCs) are possible, but these medicines are very important, especially for those who cannot get vaccinated for medical reasons.
“We are getting to the point where we are minimizing the societal impact of COVID in terms of how many people it’s going to kill and how many people are going to end up in the ICU. As the mortality from COVID-19 is about to approach that of the flu, [with the available] medications and vaccines, this [becomes] something that we can already manage,” Salvaña stated.
Dr. Mary Ann Lansang, an infectious diseases specialist and clinical professor of the Department of Clinical Epidemiology, UP College of Medicine, differentiated efficacy and effectiveness. Efficacy is based on evidence from well-controlled clinical trials with a small set of patients from selected populations. On the other hand, effectiveness is based on findings in the real world, where drugs are provided in the right situation perhaps in a larger set of patients who may not have the same characteristics as the clinical trials. She stated that the main problem in the real world is the accessibility and affordability of these medicines even if they are highly efficacious. A balance between the cost and effectiveness must be taken into consideration in deciding what medicine to give the patient. Lansang highlighted that these drugs must be used under the supervision of a licensed medical practitioner because there are many interactions and relative contraindications to their use.
The second reactor Dr. Maria Ofelia Ocana-Alcantara, municipal mayor of Tolosa, Leyte, shared the LGU perspective and their actual experiences on the ground. She presented the existing protocols, policies, treatment, and coordination needed in managing COVID-19 at the LGU level. She also mentioned the challenges such as persistent efforts to reduce the risk of spread and severity of cases, access to medicines, fake news and infodemics, and support for continued productivity and functioning of the asymptomatic and mild cases.
Mayor Ocana-Alcantara highlighted the importance of planning to make sure that there is access to information: what medicines to use, availment and procurement process, how to access medicine, which hospitals have drugs with emergency use authorization, available Apex hospitals, patient list, and their consent, budget allocation, and continued monitoring and data collection on the effect of these medicines for further study and research. She also emphasized the important role of Barangay Health Workers in educating their constituents and in responding to the cases. The availability of COVID-19 drugs and oxygen is limited, that is why allocating these resources requires careful decision-making.
Click here to watch the full episode.
