Corona therapy – drug federalism – Wiener Zeitung Online

First the good news: there is no shortage of Covid medication. Austria is currently sitting on 277,016 doses, so far 30,000 people have been treated with one of the five available preparations. But if you look closely at the data from the federal states, the view becomes cloudy. Because either the people between Bregenz and Eisenstadt fall ill with Covid in very different ways – or the disadvantages of federalism are also rampant on this topic. The second is probably more plausible.

In Vienna, the preparations Lagrevrio and Paxlovid (see box) have been administered in the case of a corona infection, namely 12,550 packages with a total of slightly more than 17,000 drug treatments. Now Tyrol with its 760,000 inhabitants is much smaller, but why only around 300 of these two drugs were distributed in Tyrol is irritating. The proportion of people with risk factors may be higher in the big city, but not tenfold.

There are also noticeable differences between Tyrol and Vorarlberg. While sufferers in Tyrol received Lagrevrio twice as often as Paxlovid, in Vorarlberg it is exactly the other way around. In both federal states, the monoclonal antibody Xevudy was primarily administered, which only happens in hospitals; in Vienna, on the other hand, this preparation played a subordinate role. It is also striking that twice as many people received Evusheld prophylaxis in Tyrol than in the much larger Upper Austria. This drug is intended for people who are unable to build up protection despite vaccination, for example organ transplant recipients.

The data available to the “Wiener Zeitung” is not complete. Only the state of Carinthia did not respond to the query from this newspaper, but Salzburg, Lower Austria and Styria stated that they did not have any figures. Instead, reference was made to the health insurance company ÖGK and to the individual hospital operators. Because either the drugs would be prescribed by resident doctors or administered in the hospital. Despite the similar system, very precise data came from Tyrol. As the only federal state, the Tyroleans were even able to specify the age distribution of the recipients. Around three quarters of the drugs go to people over 60 years of age. It is not clear why the data is so different.

More than half of all medicines in Vienna

At the end of July, Health Minister Johannes Rauch (Greens) announced that he wanted to “significantly expand” the delivery of Covid drugs. 480,000 packs have already been ordered, but only five percent of them went to people at risk. Most of it was administered in hospitals.

The ministry sees a need to catch up in the private sector. This concerns the prescription of Paxlovid. In fact, this drug had only been prescribed 2,000 times by mid-July – with around 350,000 infected people over the age of 55 since the preparation became available. 1,700 of them died.

The ÖGK data also indicate very different practice in the federal states. In Styria, 9.8 packs of Paxlovid per 100,000 inhabitants were billed by the health insurance fund, while in Burgenland it was 37.8, i.e. about four times as much. In Vienna, most packs of Paxlovid are delivered by bicycle messenger after a telemedicine consultation. The preparation is actively offered to everyone over the age of 50 if they test positive. As of the end of July, more than 6,000 people received Paxlovid, in Upper Austria there were only 190.

According to information from the ministry, the state governors recently promised to improve access to the Covid drugs. In the future, every positive test result should also indicate the medication. It is crucial for the effectiveness that the antiviral preparations are taken in the first phase of the infection. In practice, however, those affected often come to the doctor too late. This is also the result of an internal survey by the Austrian Society for General Medicine (Ögam) among its members. Delivery must occur within the first five days of infection.

proven benefit,
but not for everyone

It has not yet been finally clarified how effective the drugs actually are or for whom. In the case of Lagrevrio, which is administered quite frequently in Austria, there is unclear data on the effectiveness and no approval either. It is used off label. In the case of Paxlovid, on the other hand, the approval study showed a clear benefit for unvaccinated people at high risk. However, the continuation of the study for vaccinated people no longer showed any significant benefit. However, there is epidemiological data from Israel and Hong Kong that also recognized some benefit, albeit a much smaller one, in vaccinated people.

It is also interesting to compare Vienna with Upper Austria. Because although people infected in Vienna receive antiviral drugs six times as often as in Upper Austria, the Covid mortality rate among older people in Vienna is not lower, but actually slightly higher. As the “Wiener Zeitung” reports from several federal states, the willingness to take Paxlovid is very low, especially among unvaccinated people. They reject not only the Covid vaccination, but also the drug. The benefit for this group has been proven.

Paxlovid with delicate interactions

With Paxlovid it can sometimes happen that the virus returns, as happened with US President Joe Biden. However, this “rebound” effect is not synonymous with a health hazard. “The occurrence of rebounds does not diminish the importance of the drug in Covid treatment,” says infectiologist Herwig Kollaritsch.

A relevant problem with Paxlovid, however, are interactions with other drugs. That is why general practitioners insist on personal contact with their patients. “A call center cannot prescribe any substitute preparations,” says Susanne Rabady, President of Ögam, which has one for its members Guide to the use of the medication published.

The crisis coordination Gecko also dealt with the new drugs on Friday. The gecko experts locate you insufficient knowledge about treatment options. Therefore, the target groups should be better informed and the pharmacies should be more involved in the strategy. And then it says, as usual politely formulated: “With regard to the supply side, the processes in the federal states could possibly be more standardized.”

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