The View is reported by Julia ZorthianTHE VIEW OPENER
A federal Test to Treat initiative
on the scale of our vaccination effort
could achieve, we estimate, at least a
50% sustained decrease in both na-
tional mortality and hospitalizations.
Ensuring availability of treatment
for all high-risk people, by linking it to
home tests, is our pandemic response
get-out-of-jail card. However, too few
people today know of or are able to get
these lifesaving oral medications. Test
to Treat (T3) makes free treatment
available to those who receive a diag-
nosis from a medical provider
at a “one stop,” approved Test to
Treat facility that has the medi-
cines in stock. In practice, per-
haps less than 10% of pharmacy
outlets have the providers and
clinics that can promptly evalu-
ate and deliver the treatment
all in one location. The result-
ing paradox is that while 9 out
of 10 Americans live within five
miles of a pharmacy, millions of
treatments —more than half of
the available supply—are sitting
on shelves unused because of
difficulty accessing this medical
diagnostic pathway.
Here’s a six-point road map
of how we can achieve this now:
First, set a clear initiative
goal. The goal of a national Test
to Treat program must be to
safely get the treatment course
of pills in the mouths of every
eligible COVID-19-positive per-
son within three days of onset of
symptoms. The country’s vul-
nerable population of 80 million
stands to benefit the most from
T3. Although they number less
than a quarter of the population, they
suffer over 80% of all deaths and hos-
pitalizations. For them these pills are a
lifeline.
Second, expand program eligibil-
ity. The “vulnerable” are defined as
those over age 65, immunocompro-
mised, or who have specific under-
lying conditions. The oral antivirals
are indispensable to this population
because their vaccine effectiveness
wanes most quickly.
When taken within the critical first
three days of symptom onset, Pfizer’s
Mary Ann Neilsen holds her last Paxlovid pills while
recovering from COVID-19 in California on Jan. 6oral antiviral Paxlovid can lower the
risk of severe disease by almost 90%.
Merck’s Lagevrio is an alternative that
lowers risk by 30%. Both are taken at
home as a three- to five-day course of
pills. Equitable and timely access to
these treatments is the delivery high-
way to get to our new normal while
cutting down on hospitalizations and
deaths.
As supply increases, extending
coverage to those less vulnerable will
have additional benefits: reducedmedicine through a local pharmacy,
health care provider, or direct delivery
to the home.
The only way to realize the goal of
reliably and rapidly getting oral treat-
ments to 80 million eligible Ameri-
cans is to bring the medicines directly
to the home. This could immediately
expand T3 from the current sparse
2,000 national locations to hypotheti-
cally every household in America.
Several testing companies are al-
ready doing this at-home testing
model with states, employers,
and individuals. (One of these
is eMed, where Dr. Mina is the
chief science officer.)
Fourth, ensure treatment is
provided safely. Drugs like Pax-
lovid come with potential sig-
nificant safety concerns. Side
effects and interactions with
other prescribed drugs are not
uncommon and must be evalu-
ated by a qualified health pro-
fessional. Whether at-home
or on-site, a thorough assess-
ment of current medications
and relevant past medical his-
tory is obligatory to assure safe
treatment.
Fifth, stand up an enhanced
federal program like Operation
Warp Speed. The only viable so-
lution to fulfill the promise of a
program of this scale is through
government leadership.
Sixth, we estimate the an-
nual cost of the enhanced T3
program to cover the 80 mil-
lion vulnerable Americans to
be in the $10 billion range. The
projected cost savings from
avoided hospitalizations alone
is about $15 billion. Additional econ-
omies will be captured through re-
ducing outpatient clinic visits, limit-
ing transmission, and avoiding more
costly on-site testing.
COVID-19 is both seasonal and
cyclical. It will surge again and
again in the not too distant future.
Now is the time to invest in
“endemic preparedness.”Phillips is vice president of science and
strategy at COVID Collaborative; Mina
is the chief science officer of eMedhospitalizations, enhanced virus clear-
ance in the community, and further
reduction in transmission. This will
diminish the need for isolation and
allow faster return to work or school.
Third, leverage reach and speed
through a new at-home program.
This requires a well-choreographed
one-stop system: 1) rapid test
diagnosis of COVID-19; 2) an
immediate telemedicine evaluation
and, if medically indicated, a
prescription by an authorized medical
provider; 3) rapid dispensing of the