The newly published efficacy of a repurposed antidepressant, fluvoxamine, heralds an important shift for primary care.
Test and treat should begin to be scaled-up-with the tools available now, and the promise of more to come.
The Lancet Global Health
Emily B Wroe; Kwonjune J Seung; Brook K Bake; Paul E Farmer
December 22, 2021
mountsinai
The treatment landscape for COVID-19 is changing substantially, representing a golden opportunity for pandemic control, especially in impoverished countries.
Until recently, most treatments targeted the minority of patients requiring hospital care.
But the newly published efficacy of a repurposed antidepressant, fluvoxamine, heralds an important shift for primary care.
But the newly published efficacy of a repurposed antidepressant, fluvoxamine, heralds an important shift for primary care.
Fluvoxamine is joined by promising novel antivirals, Merck’s molnupiravir and Pfizer’s Paxlovid, but commodities alone are not a magic bullet-how they are positioned for success is critical.
Fluvoxamine is joined by promising novel antivirals, Merck’s molnupiravir and Pfizer’s Paxlovid, but commodities alone are not a magic bullet-how they are positioned for success is critical.
Patients with COVID-19 must begin these therapies soon after symptom onset, which is a substantial challenge in settings such as sub-Saharan Africa, where the large majority of cases go undetected and only one in 20 people have ever been tested(5%).
Treatment must be closely linked to testing and integrated into primary care.
Fortunately, test and treat is a tried-and-true approach in which early diagnosis and outpatient treatment prevents disease progression and transmission.
As the key planks of this strategy come into focus, crucial steps remain ( panel).
Treatment must be closely linked to testing and integrated into primary care.
First, COVID-19 testing needs to be much more widely available.
Antigen rapid diagnostic tests are fast and easy, but they are underused globally.
Primary-care facilities and community health workers can use them in the same way as testing for malaria or HIV, facilitating early diagnosis.
Additional decentralisation can be achieved through home self-testing.
A global push for test and treat should focus on antigen rapid diagnostic tests and self-testing, for which demand will be amplified by the availability of effective treatments.
Second, we need to ensure equitable access to therapies.
Fluvoxamine and new antivirals show promise in reducing hospitalisations and deaths, and WHO needs to move fast to assess therapies and issue treatment guidelines.
Furthermore, deliberate steps must be taken to ensure that access for people living in poverty will not be restricted by the patent protections, price barriers, or nationalism that plague the vaccines.
Where middle-income countries are excluded from licences and face predatory pricing, decisive action to override these barriers must be pursued.
Finally, test and treat must be embedded within primary care using multipronged and sustained strategies.
Seizing this opportunity requires collective action to shape supply, staffing, training, test and treat literacy, and referral pathways, positioning primary care for long-term success.
Otherwise, the global community will be trapped preparing hospitals for the next deadly surge.
Test and treat should begin to be scaled-up-with the tools available now, and the promise of more to come.
About the authors & affiliations
Emily B Wroe; Kwonjune J Seung; Brook K Bake; Paul E Farmer
Partners In Health, Boston, MA 02199, USA (EBW, KJS, PEF);
Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA (EBW, KJS, PEF);
Northeastern University School of Law, Boston, MA, USA (BKB)
EBW and BKB are volunteer civil society representatives to the Access to COVID-19 Tools Accelerator. BKB is a volunteer senior policy analyst and board member at Health Global Access Project. KJS and PEF declare no competing interests.
References
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Originally published at https://www.thelancet.com.
