Frequent rapid testing now looks like the key to containing the next wave of the COVID-19 pandemic and reducing the steadily rising death toll — now more than 800,000 in the US.
But despite millions in federal assistance for the county health departments, local hospitals, schools and government — the testing options in Apache and Navajo counties remain fragmented and the public mostly confused.
The federal Food and Drug Administration last week approved a potential game changer — a drug that can reduce hospitalization and death by as much as 89%. One catch, the drug works only if taken within days of the first symptoms. That means a quick, early test result can prove lifesaving.
Moreover, the arrival of the omicron variant has also underscored the need for a dramatic increase in the availability of cheap rapid tests — with results in minutes rather than days. Omicron spreads at least twice as quickly as the now-dominant delta strain.
That means even a brief exposure can easily spread the virus. This means rapid tests followed by vigorous contract tracing holds the key to slowing the spread of Omicron, say public health experts.
Unfortunately, many people don’t know how to quickly get rapid tests — and many others lack insurance to foot the bill. The Census Bureau reports that 17% of the residents of Navajo County have no insurance.
The county also suffers from a high poverty rate.
Studies show that at least with previous strains, people may be spreading the virus most efficiently before serious symptoms develop.
The early spread relates to viral concentrations in the sinuses, before the virus works its way down into the lungs to cause most of the serious symptoms. Some studies suggest that omicron creates 70 times as great a viral load in the sinuses as delta — but may actually produce lower concentrations in the lungs.
This could account for very preliminary data suggesting omicron spreads far more quickly — but may produce somewhat less serious disease.
Arizona confirmed its first omicron death last week, an unvaccinated man in his 50s.
Health officials said they suspect the strain is already widespread in the state.
The FDA last week approved Pfizer’s new COVID-19 drug Paxlovid for patients older than 12.
The company started shipping out pills last week – but it may take weeks more for the pills to be widely available nationally.
Pfizer’s laboratory studies suggested the pills will likely work well against the omicron variant, as well as earlier strains.
The treatment involves 30 pills over five days. The treatment involves a pill that disables one of the proteins the virus needs to infect cells.
The full treatment also involves a pill originally developed to treat HIV, which helps the new drug stay active longer.
The pill reduced hospitalization for people with COVID-19 by 89%, but only if given within five days of the onset of their symptoms.
The federal government immediately ordered enough pills to cover 10 million people, at a cost of $530 per patient.
However, it will take a while for the pills to make it into local pharmacies.
Within a week, the US should have enough pills to treat 65,000 people. However, cases are currently rising at about 120,000 per day.
It costs about $96,000 to treat a “noncomplex” COVID-19 case in the hospital in Arizona and $361,000 to treat a “complex” case, according to Beckers Healthcare, which tracks hospital and healthcare costs.
Each day, between 70 and 100 new COVID-19 patients enter the hospital.
Pfizer has said it will deliver enough pills to treat another 200,000 people in January and 150,000 more in February before ramping up further.
People must test positive for the virus and get a prescription from their doctor within five days of the onset of symptoms in order to qualify for treatment.
Once the virus gets entrenched, the drug confers little benefit. Unfortunately, many patients now wait until their symptoms get serious before they seek testing — and it often takes days for the test results to come back.
By then, people may no longer qualify for the potentially life-saving treatment.
Other treatments have faltered.
Merek had sought approval of a different COVID-19 drug, but it proved only 30% effective in preventing hospitalization if given soon after symptoms developed.
The drug operates by causing mutations in the virus. FDA reviewers feared this could cause unforeseen problems — from causing mutations in human cells to speeding up the viruses already worrisome mutation rate.
Worse yet, the highly successful, existing monoclonal antibody treatments don’t appear to work as well against omicron.
A host of monoclonal antibody treatments in the hospital have reduced death rates by 90% if given soon after symptoms develop.
However, those treatments are much more costly with more serious potential side effects than the new drug.
Worse yet, only one or two of those treatments proved effective against Omicron in initial studies.
This has already created a shortage of those treatments.
The FDA reviewed Pfizer’s clinical trial of Paxlovid, which involved 2,246 unvaccinated patients at high risk of the disease.
Pfizer reported that 0.7% of the patients who received the drug were hospitalized within 28 days and none died.
Among the people receiving a placebo, 6.5% were hospitalized or died. In a group of 662 volunteers who had a lower risk of serious illness, prompt treatment with the drug reduced the risk of hospitalization by 70%.
In both trials, the volunteers were infected with the delta strain. However, laboratory studies showed the drug had almost the same effect against Omicron.
The news underscores the problem posed by the testing system in the US.
Many other countries have made rapid tests widely available.
Many have required high risk environments like schools, concerts, bars and other venues to offer instant tests regularly before people gather in large groups.
The US has relied much more heavily on the slightly more reliable swab tests, which healthcare providers send to a laboratory.
This can delay results for days. This could easily push people past the period when the new Paxlovid treatment can dramatically reduce the risk of hospitalization and death.
Fortunately, the Biden Administration last week vowed to buy at least 500 million rapid tests and distribute them widely.
That could give people options to get the tests for free, but will still likely handle only a fraction of the demand.
You can also buy the rapid tests at most pharmacies — but that could prove costly for routine use, depending on health coverage.
The lack of health coverage has also deterred many people in Apache and Navajo counties from getting tested or treated, say local doctors.
Last week in Navajo County, the state website’s reporting about 45 new cases daily in the non-reservation communities — and about 466 tests. About 12% of those tests were coming a back positive.
Each positive test should trigger additional tests for family, friends, coworkers and other close contacts.
Of course, those tests area the PCR swab tests. No one’s tracking the over-the-counter rapid response tests.
In Apache County, the state website was reporting 22 new cases daily and 222 tests — with 10% coming back positive.
The number of new cases reported in the past week has declined some 27% statewide, 28% in Navajo County and 49% in Apache County.
However, epidemiologists say omicron will likely cause those numbers to rise in the coming weeks as it becomes the dominant strain, which has already happened in several states.