On a Bay Area “test to treat” site, few takers of free antivirals

BERKELEY, Calif. — After avoiding movie theaters, restaurants and gyms for more than two years, Helen Ho decided to take her first big risk since the pandemic began to attend her graduation.

In late May, Ho, 32, flew to Cambridge, Massachusetts, to get her doctorate. in public policy from Harvard University. A few days after returning home to the Bay Area, she tested positive for covid-19. At first, the Ivy League-trained researcher didn’t know what to do.

“The protocols for how to react after a positive test are extremely confusing,” Ho said.

But a few days later, after speaking to a nurse consultant, she found herself in the overgrown yard of a former West Berkeley senior center that had been turned into one of the new ‘test-to-be’ sites. -treat” of the state.

The senior center is one of 138 free covid testing sites that California has expanded into one-stop treatment sites to improve accessibility of antiviral drugs. The state’s initiative is inspired by that of the Biden administration “test to treat” program, announced in March, which aims to provide high-risk patients who test positive with instant access to antiviral drugs. To do this, California is contracting with OptumServe, a Minnesota-based managed care company, to spend $18.2 million a year on the effort.

One month after the start of the initiative on the sites from Eureka to San Diego, state health workers are slow to get Pfizer’s Paxlovid and Merck’s molnupiravir into the hands of patients, who must take them within the first few days of symptoms to avoid serious illness. Officials say fewer than 800 people statewide received prescriptions at OptumServe sites despite new covid infections averaging nearly 14,000 a day in early June in California.

And while the initiative aims to serve the uninsured, about two-thirds of those who get screened already have insurance. For those with health coverage, OptumServe bills the insurer and then reimburses the state.

Dr. Tomás Aragón, the state’s public health official, said the aim of the “test to treat” campaign is to “ensure that high-risk patients have access to treatments that can prevent them to go to the hospital”.

The state says its priority is to make the pills accessible to millions of older, chronically ill and disabled Americans, especially the poor and uninsured, even though few people have heard of the drugs.

Liliya Sekreta, chief nurse at the OptumServe site in West Berkeley, has seen demand for tests and treatment fluctuate. During the winter covid surges related to the omicron and delta variants, the line for testing extended to the corner of the senior center.

“We had the National Guard here and extra personnel on duty to make sure people didn’t get angry or upset,” Sekreta recalled. At the time, rapid tests were not widely available.

Today, the site is run by a small staff of two young nurses, a few medical assistants and a burly Spanish translator. Located a few blocks from University Avenue, Berkeley’s main thoroughfare, it’s in a former working-class neighborhood of stucco bungalows.

On a foggy morning in early June, medical assistants remained glued to their phones between patients, who rushed for covid tests at the rate of one every five minutes.

Ho was one of them. She is one of millions of Californians who are at risk of becoming seriously ill from the virus — in her case, from taking immunosuppressive drugs for chronic arthritis. Ho has health insurance, but a nurse who answered the advice number at the bottom of the text message informing him of a positive covid test result suggested it might be easier to return to the OptumServe site in West Berkeley where she had taken her test to find out if she was eligible for antivirals.

Although she felt fine, Ho knew it was important to get treatment early. The Centers for Disease Control and Prevention say paxlovid and molnupiravir are nearly 90% effective in reducing covid hospitalizations and deaths if taken within the first five days of symptoms.

The FDA cleared the pills in December for emergency use, but supplies were initially scarce. By April, production had increased but, at that time, few doctors appeared to be prescribing the drug, with pharmacists across the country. reports stacks of unused antivirals on their shelves.

“I had read the reports about who should be on these drugs,” Ho said. “But they just didn’t know about them.”

She was also worried about infecting her elderly mother, who she lives with with her husband and 14-month-old son in the city of Albany.

Ho sat at a folding table across from a nurse draped in yellow plastic and answered questions to determine her eligibility for the pills. Afterwards, Ho spoke via iPad with a doctor who concluded that Ho would be eligible for a prescription if she had symptoms. Eligible people can go home with the drugs without having to go to the pharmacy.

“I was glad I had a place to go that was accessible,” Ho said. “But honestly, it wasn’t advertised very well. Not everyone has time to call like I did and ask, “What do I do next?”

Screenings for treatment can take up to an hour and a half. Workers should ensure the patient is not taking any medication that may interact with antivirals, including cholesterol-lowering drugs and some birth control pills. Sekreta, the head nurse, said patients who may be eligible include people 65 and older, people with chronic conditions and those who are obese or unvaccinated. People should not take the pills if they are too sick or not sick at all.

Such in-person screenings have made the test-to-treat model confusing and ineffective, said Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California, San Francisco.

“It should be easy – if the doctor says yes – to get these pills via telehealth,” she said.

So far, staff members say, demand for the drugs has been low enough that no one in need has had to wait long. Officials said 1,219 people statewide had been screened for the drugs at OptumServe sites by mid-June, and 768 of them came away with Paxlovid pills.

“I think it’s a new concept that people are still getting used to,” said Katharine Sullivan, a City of Berkeley employee who oversees the West Berkeley site, which has served as a community testing site since the start of the pandemic.

Some residents prefer the peace of mind of talking to a nurse or doctor rather than taking a test at home.

When Mary White, an art teacher and Berkeley resident of 53 years, developed symptoms of a cold in late May, she got on her folding bike and drove to the West Berkeley center for a PCR test, where she is gone for tests since the first few months. of the stop. White has health insurance, but said she finds it more convenient than the hassle of trying to schedule an appointment that could be days away at a Kaiser Permanente location in nearby Oakland.

For the first time, his test came back positive.

“I was just like, ‘Oh no! What can I do? I have to do something!'” White, 74, said.

She returned to the center and was tested for viruses. After meeting with a doctor remotely in Chicago, she walked away with a full five-day course of Paxlovid, which she took for just two days before quitting because the drugs were making her nauseous.

Returning for a follow-up test a few days later, White said he felt much better after the age-old remedy of rest and fluids. She added that with no end to the pandemic in sight, she was grateful for a community facility where residents could simply walk in and speak to a health worker.

“For people like me,” she said, “it’s very heartwarming.”

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