• 10 Feb 2022
  • 35min 35
  • 10 Feb 2022
  • 35min 35

In this episode, NPS MedicineWise medical advisor Dr Caroline West speaks to Dr Kate Annear, NPS MedicineWise medical advisor and Associate Professor Charlotte Hespe, GP, head of General Practice at Notre Dame University, and chair of the New South Wales ACT Faculty of the RACGP discuss the new oral antiviral COVID medications that have been provisionally approved for use.


Further reading

NPS MedicineWise https://www.nps.org.au/coronavirus/faqs-covid-19-antivirals-in-racfs

Transcript

Caroline West:

Hello, and welcome to the NPS MedicineWise podcast. I'm Dr. Caroline West. I'm a practicing GP and an NPS MedicineWise medical advisor. Now, with a number of COVID infections, surging over summer in Australia. Attention is turning not just to our first line measures of prevention with vaccines and their boosters, but also to medications to treat COVID. In a welcome development, two new oral COVID antivirals, molnupiravir (Lagevrio), and nirmatrelvir and ritonavir, which is also known as Paxlovid, bit of a mouthful there, have hit our shores and have been provisionally approved for use. GPs are getting ready, once again, to provide frontline management with these oral antivirals, particularly for those who are managing their infections at home. So, on today's podcast, we're going to explore the questions around these medications. Who's eligible? How effective are they? And most importantly, once a decision is made to go ahead with a COVID antiviral, how do you go about getting a script and supply? To talk through all of this and more, Associate Professor Charlotte Hespe and Dr Kate Annear join me. Welcome to both of you.

Charlotte Hespe:

Hi Caroline.

Caroline West:

Now those of you who have been watching any of the webinars with the RACGP will be familiar with Charlotte Hespe's work. She is a practicing GP. She's also head of General Practice at Notre Dame University, and chair of the New South Wales ACT Faculty of the RACGP. Dr. Kate Annear is also a GP and is the medical advisor to NPS MedicineWise. Kate is a regular on our podcast team. So perhaps if I can turn to you first Charlotte. The arrival of these new antiviral medications for COVID, these oral medications is certainly a welcome development, and it may influence the landscape of managing COVID at home. What's your take on this?

Charlotte Hespe:

Thanks Caroline. Look, I do think it is a very welcome addition to our armamentaria of how we can deal with COVID, but I would put a sort of a cautionary note on that in that it is very much, what I would call third tier and still not particularly well evidence based, in terms of our approach to managing Omicron. And if we look at emerging data, for us in Australia, the most powerful tool that we have is vaccination. And I'll say that again, it's vaccination and then not just one and two, but it's actually the booster that's really providing the most powerful tool for us in the Omicron environment. I think we are getting even more data out as we go down the track, remembering that really Omicron only really suddenly hit in the middle of December. So, we are not that far down the track in looking at it. We sort of have forgotten that because there's been so much of it. Well certainly in the East Coast of Australia anyway, Western Coast has obviously remained fairly protected due to their closed boundaries, but for us, the infectivity and spread has been very, very scary for a lot and a real learning lesson. But the most powerful thing we've done is that booster dose. So that's why the push was boosters in the first place. And certainly, also to try and get the younger children included in vaccines, but we know that we still have vulnerable population groups and that might be despite boosters. So, we all have got tails of people with boosters being in intensive care and or unfortunately dying. So, who are those vulnerable patients? Exactly the ones that we have been worried about right from this start. So that's people in age care facilities, Aboriginal and Torres Strait Islander populations and immunocompromised patients. So, that's where it's nice to have an extra gun in our pocket, so to speak, to try and actually protect those patients. The big thing for me, and I know for everybody in the audience is that you have to access it early. So, it's a bit like thinking about shingles. If we wait too long, then the power of the medication goes and that's exactly the same with these antivirals. We need to try and get them in the first five days. And after that, then the usefulness is definitely not evidence based. And quite honestly, the testing of these drugs has been, not too bad, but it's in a non-Omicron population. So, the power is from the Delta numbers and also in an unvaccinated population. And so in Australia, that's why we still are prioritizing anybody who's not vaccinated. So not vaccinated, not fully vaccinated and who doesn't have a booster, other people that do a tick of the first box. And then as you work through your sort of tick box, it's about how more vulnerable are they and getting into that first five days.

Caroline West:

That's really the key. And I guess as you've talked about getting that message out there about vaccine being our best protection, because this is a treatment, it's not a preventative measure. This is once you've got COVID, that these may be included in the lineup. But as you say, for those vulnerable groups, it may be an added extra that we can at least offer in certain circumstances that could make it a big difference. I guess when we are looking at these two oral antivirals, if I can turn to, you Kate can you take us through we'll back step and we'll go back to the basics. What are these two medications that we're talking about and how do they actually work?

Kate Annear:

Sure. As you said, Caroline, they're both antiviral medications. So, they're designed to interfere with the virus's ability to multiply, keeping virus levels low in the body and therefore reducing the severity of disease. So, if we look first at molnupiravir, it's nucleoside analogue. It mimics some of the building blocks of RNA. So, it gets incorporated into viral RNA and causes an accumulation of errors in the viral genome. When enough mutations accumulate, the viral population collapses. Now, if we look at Paxlovid, this is a combination treatment. The nirmatrelvir component is a protease inhibitor that interferes with the SARS-CoV-2 replication cycle. Ritonavir is a strong cytochrome P450 inhibitor used as an enhancer to increase the exposure of nirmatrelvir. 

Caroline West:

So basically, what we're doing is we're sort of exaggerating the effect of the active ingredient.

Kate Annear:

That's exactly right.

Caroline West:

The ritonavir, yep.

Kate Annear:

Now the significant and complex drug-drug interaction, potential of Paxlovid is primarily due to the ritonavir component of the combination.

Caroline West:

And I've had a look at the contraindication list. It's pretty big, I have to say. So, there are a lot of things to consider and often with a vulnerable group, there'll be one of those medications on the list that they're actually taking. How do people actually go and have a look at that list of things to consider?

Kate Annear:

Well, it's a very extensive list as anyone who's had a look at these medications will know, and that includes things like statins, medications such as oral contraceptives, antifungals, antibiotics, it's a very long list and probably the best way for GPs to have a look and see if they've got any of these potential interactions with the patient is to look at the TGA website, the product information for Paxlovid is on that website. Also, the University of Liverpool has a COVID-19 drug interaction tool. And the link to that is available through the National COVID-19 Clinical Evidence Taskforce website. And that's a really effective tool to use as well to look for those interactions.

Caroline West:

We are talking about nirmatrelvir and ritonavir here, which is Paxlovid. So just for the audience, to simplify purposes, we will just be referring to Paxlovid, which is obviously the brand name, not the generic, just to make it easier. So, that's the one we're talking about with this long list of things to consider in terms of contraindications. And what's a story with this medication too, in terms of risk for pregnancy, conception?

Kate Annear:

Actually both medications, so Paxlovid and Lagevrio are not recommended in pregnancy or in breastfeeding, and that's for the period of time that you're taking the treatment and also for a period of time after it, which varies between four to seven days, depending on the medication. And it's also important that men with a partner who could become pregnant use contraception during, and for three months after treatment with Lagevrio.

Caroline West:

Ok so that’s something else to think about. Certainly, as we have said the contraindications list for the combination nirmatrelvir and ritonavir known as Plaxlovid is pretty long and also factors like kidney, liver function needs to be considered too. Just a bit of background, when we look at the other oral antiviral COVID medication molnupiravir or Lagevrio we know that there are no known drug interactions -except for hypersensitivity to active ingredients although data is limited, and that is why GPs will find it is only Lagevrio that is been sent to residential aged care facilities at this stage. If I can now go back to you Charlotte, what have people already been asking about when it comes to the efficacy of these two medications. Is it already on people’s minds yet?

Charlotte Hespe:

Yeah. And I think that's the difficult question to answer, because as I said, most of the evidence so far is around the use of it in the Delta and also in the, as I say unvaccinated. So, it's a bit tricky to fully answer that question for everybody. Is it going to be efficacious? Well, we don't really know, but we know that there is evidence of it helping. And so that's why there'll be certain patient population groups that if you've tick the boxes and you're in the timeframe, it's worth them considering and deciding for themselves, if that's an option that they would like to try.

Caroline West:

And getting back to your previous points where we were talking about the importance of stressing vaccination, have you found that some people have taken the line, "Oh, well, I'm not going to get vaccinated because these drugs are available and I'm just going to take them on an as needs basis."

Charlotte Hespe:

Yeah. And my line is, well at the moment, you may well not qualify because you don't tick those other boxes, certainly down the track, hopefully there will be enough medication around for the access to open up more widely, to more people. But if they aren't vaccinated, then certainly they tick the first box and it's difficult, isn't it? If you're very firmly in the camp of not vaccinating, then there's been very little as we know, that's actually being able to change that level of consciousness, I suppose. And so, it is nice as a doctor, because we don't like to think our patients are fully vulnerable, to be able to offer something to treat them if they do end up getting the infection.

Caroline West:

And we've talked already about the priority groups where we've got this sort of national stockpile of medications, which is there for emergency use and also to regulate the supply in a prudent fashion. So, we've got the residential aged care facilities. We've got the national Aboriginal Community-Controlled Health Organisations. I've talked to some groups already and they've already received their first doses, which don't have to be stored in the fridge. They're just kept, I think under 30 degrees. Is that right Kate?

Kate Annear:

Yeah, that's correct. Yeah. They don't require refrigeration.

Charlotte Hespe:

There's a lot of tablets, can I say that's the big disadvantage and I don't think we mentioned that.

Caroline West:

Yeah, let's talk about that Charlotte, you have to swallow, is it four every 12 hours?

Charlotte Hespe:

Yes. I think it's twice a day dosing and there's four or five capsules for one of them. Anyway, it's a lot of capsules to swallow. And so, one of the disadvantages is that in our frail elderly population, that's actually quite difficult for them. And so again, it's a consideration with respect to how you might take it. They are capsules. And so, there was talk about whether you can take them out of the capsules, but I believe that's not really recommended.

Caroline West:

Yeah. It's very interesting you say that because we've just today gone live with some residential age care facility Q&A, commonly asked questions and this has come up because the manufacturer, your dead right has said, look, they're supposed to be staying in their capsule form, but they recognize that there's a population that either have a nasogastric tube or they actually can't swallow one tablet or capsule, let alone four. And so, there are actually provisos given that the Lagevrio, which is the... Help me with the pronunciation of the name....

Kate Annear:

Molnupiravir.

Caroline West:

Thank you, Kate. That you can actually-

Charlotte Hespe:

I think you have a special tongue to be able to say so those names

Caroline West:

I think so. Look, I think that's why they've always got marketing to come up with a different name. Because they're actually quite a mouthful, especially when they've combo treatment. But Kate, I know that this is something that's only just come out on our website, as I said, literally, I think today, which is guidance around, can you do this? Even though it's sort of slightly out of bounds, we thought that in the past, what is our thinking on that? And what have we got that's available for GPs working in residential age care.

Kate Annear:

Look, we've got some information on how you might dissolve the capsules to be administered in a liquid form. And it's while this is an off-label use and there isn’t evidence around this yet, we recognize the practicalities and that in the residential age care facilities, it may be necessary to do that. And so, we've got some detailed information on that, on our website.

Caroline West:

Yeah. Yeah. So that may help get around some people because call frankly, if you had somebody that couldn't swallow and they had to take it in the capsule form, it may just be completely off the table. The other thing is that I don't know what your experience is Charlotte, but I was talking to somebody, a GP that looks after people in residential age care. And they were saying that it's quite surprising, and it's a sign of the times, especially in remote regions, that a lot of the residents do not actually have a GP, which was incredible because it means that they don't have an advocate and a go-to person when something happens around COVID.

Charlotte Hespe:

Yeah, that horrifies me actually, Caroline. And so that might be something that we need to take off. I hadn't actually heard that because I didn't know that you're allowed to be admitted to an aged care facility without having clinical governance in place, which would actually mean you need to have a prescribing GP.

Caroline West:

I'm sure that's the case. I guess that what they're referring to was somebody that was sort of actually assigned to them that was a very clear portal for, this is your GP. They were saying only because services have been very patchy through COVID in a lot of the regional areas and getting GP access has actually been very tricky. And so a lot of the GP left, or their usual GPs gone, and nobody's picked up the... I think that there are probably some people that have fallen through the gaps.

Charlotte Hespe:

So, I'll go back to the clinical governance though. So, the nursing home definitely needs to make sure there is a GP and that there is someone that is prescribing it and they won't be allowed to have supplies of the medication if they don't actually have that clinical governance in place, and I don't want any aged care facilities to not. So, let's hope we can make sure that, that is enabled across the more remote and rural spots across Australia, really. This is very much a national issue.

Caroline West:

And so getting back to sort of access and being regional and remote, and even in the cities, this has happened where through COVID, Telehealth has been encouraged to reduce the transmission rate within surgeries. And if something can be triaged on the phone, that's how it's done at the moment. What's the story with doing a Telehealth consult, and then prescribing, is there any sort of onus to actually review the patient as would've happened in a respiratory clinic in the past, I guess, to actually then decide that they're at that point, or can you just do it on, you've had it for less than five days you're in this risk group. Let's go.

Charlotte Hespe:

Can I say that the model is exactly the same as all the virtual clinics? So, none of the respiratory clinics required face to face contact. The models have been set up as virtual care. And certainly, in New South Wales, in my patch, that's been the care for COVID and people have not required face to face care. So, it has been very much around symptoms. So, when I say they don't require face to face care, of course, they get face to face care in hospitals and, or review in a respiratory clinic if required. But if we're going back to the protocol for prescribing the antivirals, no, there is no requirement to have a face to face, it's all enabled through Telehealth. And one of the things that we've really pushed for big time in New South Wales is that the GP who knows the patient is the person who has that conversation and prescribes, if it's actually deemed to be appropriate with each patient, which for me is the best possible outcome. Because we know as GPs, we know our patients and most people would know who in their books were the ones that they would absolutely push for and try and fight for to get the access to antiviral if they got COVID infections.

Kate Annear:

I was just going to ask Charlotte, how do you think that will fit in with the recommendation that a Rapid Antigen Test is clinically administered? Because that was something that I had wondered about.

Charlotte Hespe:

Okay. So, the biggest thing is basically having a confirmed case of COVID. And so, there's a couple of issues around that. So, what we've said in New South Wales is that you don't need a PCR, but you do need to have a registered test that is positive, uploaded into our system to actually then enable you access to that medication. So, that will mean a RAT test. Now there's been well, when I say it means a RAT, for most people, it's either been a RAT or a PCR. The PCRs can I say are much more accessible again. So, it wasn't like that awful glut over Christmas when we just couldn't do anything. So hopefully that everyone can get one because RAT tests now are actually quite easy to access again. I appreciate in some circumstances it's not. And what we are trying to make sure is if someone is for instance, in a nursing home facility where there is confirmed infections with PCR positive and you've then got more, then it's not the biggest deal. It's basically being pragmatic and saying, if they've got symptoms, then they've probably got it. But then hopefully the nursing homes have got access to the RATs as well. Same with the AMSs. And again, for me as a GP in the community, if someone's in a family situation where there's someone who's positive and then a vulnerable person gets symptoms, it would be to try and make sure someone quickly accesses a RAT for them or for us to try and find one so, we can get them registered into the system with that RAT and get the prescription organized for them as quickly as possible. And quite honestly, you can do that in a 24-hour period of time. If you can sort of call together some of those networks, acknowledging that there are some rural remote where that's difficult, and I think that's where you might organize the prescription to get forwarding at the same time as making sure you've got some ability to get that formal registration happening.

Caroline West:

And Charlotte, what's your prediction for the landscape over the next three to six months, obviously at this stage, this is new turf for GPs. They're just getting their heads around what these medications are, what their role is in prescribing. What do you think will happen as the pandemic continues? I know everybody has a crystal ball, it's never quite as accurate as we'd like, but what do you reckon?

Charlotte Hespe:

Well, great question. If I'm talking about antivirals, what I can see is going to happen and what we are certainly trying to make sure the systems are in place is that access will be freed up so that there's more supplies available, and more people will be able to qualify for them who we deem to be more vulnerable to get in infections. So, the chronic diseases, at the moment anyone with immunocompromised is qualifies certainly in New South Wales, I can write a script for anybody doesn't matter how vaccinated they are. So just that will even out the supplies at the moment, we have to do a special script in New South Wales. And I'm well aware that other states have not been given that access. So hopefully the other states will open up to GPs being able to use their state-based prescribing to access until the federal government opens up us doing a freely accessible GP generated PBS script that will be on our software.

Caroline West:

Yeah, because that's a bit of a barrier at the moment because it's not on medical software. So, what I'm hearing from GPs is that they're having to scrounge around with website links and the like to get the lists.

Charlotte Hespe:

Yeah look, can I say, well in New South Wales, they shouldn't have to scrounge around. I'd really encourage everybody if you aren't already doing it, use your HealthPathways. Every GP in New South Wales and most GPs in the rest of Australia do have a HealthPathways. I know that probably New South Wales has got the most resources up there, but for doing this prescribing, every single form you need is there. So, you only have to go to one place and whatever form you need. And it is the right, it's a particular form that is the prescription. And it is because of the special legislation that was needed in order to grant GPs access to prescribing that this has had to happen. And it's crazy, but you do actually have to print it. You do actually have to put a physical signature on it and then you do have email it, but you don't need to use crisis. This seems you don't need to use a special email. You just email it to the pharmacy that is aligned with your region that can dispense the medication. And that list will be on the HealthPathways website as well. So, sort of all that information is there, if you're in New South Wales. It's not everywhere around Australia, feel green with envy, go ahead. Unfortunately, it's not so easy, but hopefully we are advocating that it will become broader. If it hasn't happened in the meantime, hopefully it won't be too long until it's just our medical software that does that script.

Caroline West:

Yeah. Yeah. Because I think at the moment people are not being given the script physically, as you say, it's got to be emailed or faxed through. And that's also to I guess regulate the transfer of that script. So it doesn't go elsewhere, or get a duplicate.

Charlotte Hespe :

That's absolutely important thing to know. The patient must not be given the physical script because the physical script, the only place it goes is that pharmacy and the patient just has to, well, they will be contacted by the pharmacy about how that medication is then delivered to them. So the biggest thing to reassure them is they don't need a physical script. The script goes to the pharmacy and the pharmacy will get the medication to them.

Caroline West:

It's interesting, isn't it? And I guess that if we are sort of thinking about what the potential is for this to really change the direction of COVID in terms of managing at home, already we've got COVID in the home and we, as GPs frontline with managing people in the community wherever possible. But if I can go to you Kate, what do you think it's going to be like in terms of the future of offering different opportunities to manage COVID, to really align with what the patient wants to do as well?

Kate Annear:

Well, I think we've had an array of treatments for COVID infections. So, we've had various things available, immune modulators, monoclonal antibody treatments, and now obviously the more readily available oral antivirals. So, I think it's an interesting space and I think these oral antiviral treatments, really the benefit is that you can have them in the comfort of your own home or the residential age care facility. So, I think they will be utilized, but as Charlotte's mentioned, it's really in a subset of the population and it's only for people that are considered to be at high risk, of a serious illness, who for whatever reason have not been fully vaccinated or are you not immunocompetent or immunocompromised.

Caroline West:

And I, and I guess that we can't lose sight of this sort of sense of a shared decision-making approach as well. That it's really important too, that consumer's patients ask questions of their provider to work out well, how can I think about this medication? Is it really the best thing for me to take? What are the benefits, risks? Is there some way to sort of put a framework around, that may be helpful for doctors and their patients in terms of what they need to be thinking about?

Kate Annear:

Absolutely. Well, the Choosing Wisely framework is always useful in this context. So, questions to ask your health provider about whether or not you should take these medications might include things like, do I really need this treatment? So have a discussion around the risk factors you might have and what are the factors that might make you, as an individual more likely to experience severe illness from COVID 19. Additionally, what are the risks? Talk about the possible side effects, any drug interactions that might occur, ask if there are any simpler or safer options, is it possible that the risk of side effects or interactions might outweigh any potential benefit in your individual case? And obviously the question of cost is always something that should be discussed, but we know with these medicines that at the moment, there's no cost to the individual, but that may change in the future as the medication goes on the PBS.

Caroline West:

Yeah, definitely. And I guess that's a matter of time and lines up with what the evidence base is for that drug to be moved off the provisional list. Is that right, Charlotte?

Charlotte Hespe:

Yep, absolutely. And we're all obviously keenly awaiting or information about its power and efficacy in the Omicron space.

Caroline West:

What has impressed me though through this pandemic, which has been quite extraordinary is the rate at which vaccines have come to market and been delivered in the community. And now this array of medications, it's very impressive and my hat goes off to those who are the scientists on whose shoulders we stand as clinicians, who've made that happen so rapidly. It's quite amazing.

Charlotte Hespe:

Can I say there's been an amazing sharing of people's work. I've never seen so much collaboration, which is fantastic, but then a lot of hard work. If you look at the TGA, they're putting extraordinary hours as do ATAGI, as they try to weigh up the evidence and make the best decisions for us as a population.

Caroline West:

Yes. And I have great confidence in those bodies coming up with an expert opinion that I can depend on. I know that there are sceptical voices in the community, often echoed in social media platforms. But when I'm talking to patients, I bring it back to this. I do have a sense of trust that the evidence is reviewed with a level head. And in these times, some things are accelerated through the gates slightly faster than would normally happen with provisional registration. But I guess that the endpoint is to really deliver options to the community that are going to improve people's health and outcomes. Here we are still dealing with, thankfully in Australia, small numbers that are going to hospital, but you know, this is still a terrible virus that wreaks havoc on your system and can have ongoing consequences in terms of long COVID. And I don't think we can be lulled into this sense that, oh, Omicron's not such a big deal. And everybody knows people that have had mild doses of it, but we just need another variant to appear, or you just need to be in a vulnerable risk group. Or there are other factors at play and COVID is a nasty infection that kills certain people who are particularly vulnerable. We can't sort of ever, I guess, get away from that central imperative.

Charlotte Hespe:

Could not but agree.

Caroline West:

How are you going Charlotte with just managing the COVID flow and the whole sense of answering questions to patients as they come in? Are you taking a proactive step to sort of contact certain people or are you waiting for people to contact you? How's it working?

Charlotte Hespe:

Great question. One of the things that certainly we've done in our practice is that we have put together the database of patients that we have more heightened awareness of vulnerability. So those who are immunocompromised or immunocompetent, not immunocompetent, and we've sent out messaging to them about the availability of antivirals so that they can be aware that if they contract Omicron or they think they might have it, that it's really important and to make contact with us as soon as they can, so that we can actually then have that conversation. And we've also accessed them to the sorts of resources that you've talked about, so that they're as informed as they can be. And if they're not interested, then that's fine. But if they would like to, then they can get it easily and quickly within the right frame. And in the same way, we've done the same thing with patients in nursing homes and or who are Aboriginal Torres Strait Islanders, to make sure they're also equally aware of the ability to access the medication if they qualify for it.

Caroline West:

And I suppose it's also a matter of staying up with the latest updates. I know this is a constantly moving space and it can be pretty exhausting for GPs to stay on top of everything. They're frontline, their books are overflowing. They're doing masses of Telehealth and trying to triage and then giving this extra advice. So, it's sort of a very interesting time for them to then take on board new medications and get the confidence to start prescribing, because when something new comes on the market, you sort of get a bit tentative initially, because you haven't got the prescribing experience. And it does take a little while for GPs to sort of understand how the system's going to flow and where the role of these medications fits in.

Charlotte Hespe:

Yep. Again, couldn't agree more. It's been a roller coaster ride for the last two years. And I fear that we've got a little bit more to go before the speed of that settles down, but like the webinars, the fantastic resources, so NPS, HealthPathways, New South Wales Health, can I say, have got a fantastic set of resources. So even if you are from, not in New South Wales, please go to the ACI where they actually have the most amazing database where they've been putting together all of the research as it comes in. And it is just really fantastic just to be able to very easily see, they've just got this group of doctors who are constantly working away at the evidence as it comes in. And then, the college webinars, which are a partnership with New South Wales Health have been fantastic, because everything that we've tried as everything comes aboard, we've been able to access the experts and be able to present the information. So, just about the antivirals, the webinar that we did last week is still a relevant resource in terms of how to do it and also provide some links to the paperwork that you were talking about.

Caroline West:

Yeah. I had a look at that webinar, and I was very impressed because it was really practical. They even had slides of the paperwork to take you through, boxes to be ticked, and what you needed to fill in with that handwritten signature. But I thought it was really practical and it's great to see the RACGPs generated so many practical resources for GPs because quite frankly, there's so much buzz on the internet when you sort of go in there and you try to find information, there's a lot of noise out there. And so, finding reputable sources is really key to making sure that your information is up to date and credible.

Charlotte Hespe:

Can I say, the difficulty is too as GPs, we have to navigate the national stuff as well as the state and territory stuff. And that's been absolutely in our faces the whole time, because there's an alignment, but not an alignment. So you sort of hear one thing, but then it's actually done a little bit differently within your state or your local region. And I think that's even made it harder for us as we sort of have to navigate it. And we are at the coal face, like it or not, we are the ones who have to help our patients walk through what it means for the them, the testing, the vaccinations, the managing at home, the everything else. So, we're the experts. When often we learn about what we have to be experts in from the media, as it gets relayed through The Guardian, The Sydney Morning Herald, The Australian before we've even been told official lines.

Caroline West:

Yeah. Or press releases that come out detailing the release of certain medications or whatever. So yes, and sometimes it will be a patient that alerts us to something that has rapidly changed overnight. And that's always interesting as well. I'm finding that a lot of patients are actually, COVID has been a great opportunity to sort of increase health literacy in a way, because a lot of people understand the basics about viruses now and understand things that they perhaps didn't in the past because they've become very focused because obviously this has been a crisis. So, it's extraordinary to see how it rolls off people's tongues when they talk about the COVID virus.

Charlotte Hespe:

Everybody's a public health expert and an epidemiologist.

Caroline West:

They are. They've all got opinions. So, and on the back of those resources, Kate, can you just remind us again, NPS MedicineWise is endeavouring to really keep everybody up to date with practical information. What can people access on the website at the moment and what's in the pipeline?

Kate Annear:

Sure. Well, look, we've got a whole heap of information on residential aged care facilities and using antivirals in this context. And that's mainly because we're getting lot of questions coming from people working in this sphere. So that's already up and ready to go on our website. And we hope to add to that as the experience and evidence grows and expand it to apply to broad use in the broader community over time. We're also preparing a medicine table that summarises key information about the two oral medicines and also sotrovimab, as well. And new drug summaries by Australian Prescriber, on molnupiravir and the Paxlovid and another monoclonal also called Ronapreve will also be available early next week. So, we intend to keep adding content resources and links as more information becomes available.

Caroline West:

So that's nps.org.au if you'd like to access any of those resources, whether you're a consumer, patient or whether you're a medical professional. Thank you, both of you for your time today. It's a really interesting time I think, for our community. And I think that the arrival of new players on the field in terms of oral anti-COVID medications will be a welcome addition. As you say, both of you that it doesn't in any way replace the need for vaccination as our most urgent preventative measure. But it's interesting to see this space evolve and to give access to GPs, to this medication so that people can be more easily managed at home because a lot of people that is definitely their preferred place to be, and it's a territory and an area of medicine that's constantly evolving. So, I'm mindful of that. And it may be that this podcast has lost its relevance in just a few months from now, because there may be even more options to discuss. And so I'm mindful that this will be a continuing conversation and thank you to all the frontline workers and those behind the scenes who are working so hard during this pandemic to keep our community safe and well, and to GPs like you Kate and Charlotte for just doing the hard grind of day to day, being with people and helping them make these decisions to keep them in the best shape possible. So, thank you both of you for being with us.

Kate Annear:

Thanks, Caroline.

Charlotte Hespe:

Thank you.

Caroline West:

That's all we have time for. So once again, for more information, you can go to nps.org.au and CPD points are available for this podcast, if you go to our website for details. I'm Dr. Caroline West from NPS MedicineWise, bye for now.