Our country has done incredible things during the Covid-19 pandemic. Some of the world’s brightest innovators have come together to rapidly develop our vaccines and Covid-19 interventions.
Now, to reach a “new normal,” the Biden administration and states like California have turned their attention to Equitable and timely distribution of life-saving treatment. But in order to truly achieve this, we must carry the spirit of innovation to the “last mile” of healthcare: manufacture The leap from positive detection to treatment.
Dr. Tyson Bell, director of the University of Virginia Health Medical Intensive Care Unit, was recently cited in an article NBC News Article Says “…the communities that need it the most are those with the least access, which of course includes low-income people and communities of color.”
Exposure to people at highest risk of hospitalization and/or death
For at-risk Covid-positive patients, the biggest barrier to receiving early, effective Covid treatment boils down to the fact that they must have a prescription from a doctor. Many underserved patients do not have access to primary care physicians; even if they were willing and able to afford it, challenges may include lack of transportation, child care, or the inability to take time off work.
As of Feb. 22, Mississippi had 138 COVID-19 patients in intensive care units, with 63 percent of ICU patients on ventilators.Mississippi Department of Health).A sort of Mississippi Free Press Articles The state’s supply of antivirals is reported to be low, with some hospitals using only 10 percent of the available Paxlovid courses. Mississippi is an example of what is happening across the country: There is a gap between those who can benefit from ART and the treatment itself.
We must collectively stop ignoring the last mile of our most at-risk populations and sit back and pay attention to other key stakeholders in the infectious disease field who have been innovating the last mile for decades.
I have worked in the HIV/AIDS field for many years. While processing some of the most sensitive health information in the nation, we’ve been able to text/email patients about their health status, meet them where they are (on their phone), and help them get answers and important information Medication is faster. We know that with appropriate outreach, coupled with mobile-friendly treatment modalities, patient adherence to treatment increases dramatically. They live better and care for less. We should think of this and other situations as analogies.
In my experience working with communities inequitably impacted by healthcare, when patients receive a positive Covid test result, they are less likely to have access to traditional care settings where they can receive new early intervention treatments, Paxlovid and Mono Lave. More likely, they will suffer isolation or use the nearest emergency room with others seeking more acuity care.
The White House recently held a news conference on the equitable distribution of these life-saving antiviral drugs. But distribution efforts are largely focused on manual distribution and increasing the pharmacy footprint, and are subject to subjectivity. Antiviral medication must be taken within five days of the onset of symptoms to reduce the risk of hospitalization. It’s not a lot of time. We understand that there are real risks with these new treatments, and a doctor’s assessment is critical. So how can we innovate to get these medicines into the hands of priority populations faster and more efficiently?
Take advantage of telemedicine
We already know that more at-risk communities rely on their mobile devices, and many public and private labs utilize Windows 95-like patient portals to provide positive test results. But most public health departments are willing to do more and use modern technology. Can we use telehealth to close the last inch and tie the treatment of these patients to their positive test results?
We’ve all read journalist Rebecca Robbins’ New York Times story About her futile and outrageous efforts to find antivirals for her sick and Covid-positive parents. In this case, she is also unable to obtain prescriptions through telehealth services.
Telehealth laws vary from state to state, but the discretion to govern Covid antiviral prescriptions generally rests with the service provider. Telehealth laws in many states allow completion of a simple mobile-friendly dynamic questionnaire before prescribing these life-saving antivirals. Even better, some online pharmacies and telehealth companies could partner to deliver medication to a patient’s address the next day, rather than having a sick patient drive, take public transportation, or walk to the pharmacy.
Early Intervention = $50 vs. $500,000
In California, where I live, the average cost of treating a non-complicated Covid-19 patient in a hospital is $111,213.According to one analysis, for a complex case, we are looking for close to $500,000 Becker’s hospital review. In addition to the benefits of patient access, the cost of a telehealth solution and next-day drug delivery may be approximately $50 (excluding the cost of drugs currently covered by HHS). The contrast is staggering and could be a game changer.
In the United States, there is hesitancy to use telemedicine for some treatments and a preference for traditional in-person visits. But again, with an equity focus, we must meet patients and innovate in the last mile to ensure their health and well-being.
Fixing the last mile may not be as sexy as sprinting to develop an mRNA vaccine or our first antiviral treatment, but tackling it is the only way we can improve outcomes for those who need it most.
