In Tuesday's State of the Union speech, President Joe Biden announced a new "test to treat" plan for COVID-19 using Pfizer antiviral pills.
"And now we're launching the test to treat initiative so people can get tested at a pharmacy and if they prove positive, receive the antiviral pills on the spot at no cost," Biden said.
Director of the Scripps Research Translational Institute Dr. Eric Topol joined Midday Edition Wednesday to talk about what the Biden administration announced in the fight against COVID-19, as well as recent updates in masking guidance in California. The interview below has been lightly edited for clarity.
Q: So, let's start with this announcement from President Biden. Why is a "test to treat" plan like this needed?
A: Well, this is a significant part of a new 96-page plan released today. It is certainly something we need — that is Paxlovid is in short supply. It is a very potent pill that's safe, that has a near 90% reduction in hospitalization. But when it gets into better supply, the plan is later this month, at CVS and Walgreens — at least some of the stores, to have this test to treat loop available so that if you had symptoms of COVID, you could get a quick rapid test and a prescription for the five-day treatment. This is great. It will be for high-risk people. Obviously, we'd also like it to be available right at home where it delivered to the person's home without having to go to the pharmacy, but it's a definite step in the right direction. It does require coordination with pharmacists because this medicine — while highly effective and safe — has some significant interactions with common medicines that the pharmacist and physician will need to be aware of when that occurs.
Q: So, you mentioned that coordination. How well do you think this plan will work?
A: It's something we want to do. It's a really innovative plan. It's one of the best things that has been initiated by the administration since the pandemic began. It's only real limitation is that the supply of the pills is so limited right now.
Q: The test to treat plan is just one of the strategies the Biden administration is announcing as part of the National COVID-19 Preparedness plan. What else are you seeing in the plan that you think will address unmet needs?
A: Well, there's many components, things like countering misinformation, which has never been taken seriously by our administration and has led to a very limited vaccination. That is, we're 57th in boosters and 64th in the world in countries for primary vaccinations, we have to get that markedly improved. There's better digital capture and surveillance that's planned, things like a pan-coronavirus vaccine that we're working on, a Scripps Research and many other academic centers in the country. These are some of the priorities laid out on the plan, and they're really important ones.
Q: Also this week, masking in the state is now recommended for everyone regardless of vaccination status. CDC guidance on masking says to wear a mask indoors in public, in communities with high rates of transmission, like we have in San Diego and Imperial counties. From your perspective, is recommending masks enough at this point?
A: Well, you really nailed it because we are a high transmission place right now in San Diego County. So the recommendation may not be strong enough, but hopefully people will have their own good sense to wear a mask indoors, particularly people who are vulnerable, of advanced age, obviously, if they're immunocompromised, they're very sensitive to this issue. But we're not at a point to abandon mass, not in San Diego, not until the circling virus is much lower than it is today.
Q: California officials are touting a new plan for living with the pandemic. We've heard from local officials that we will prepare for COVID-19, the same way we prepare for cold and flu. Does the science on COVID-19 support this guidance?
A: Well, I recently wrote in the La Times that this is not really what we should be thinking about. Not only is there an enormous toll of long COVID, but that still is the threat of infections, whether it's omicron or whatever the next variant that we'll see. So living with it, yeah, we'd like to move on and get to some kind of semblance of pre-COVID life, but we need to continue to respect this virus, that it has been unpredictable in two years, and the last chapter of this virus still lies before us.
So, yes, it's good that we can make some adjustment, but we're looking at a quiescent phase, likely maybe a couple of months. But there's too many things, including animal reservoirs, immunocompromised people, lack of containment of the virus throughout the world, all these things lead to the generation of a new and significant variance in the months ahead.
Q: Can you talk a bit more about what's different between COVID compared to cold and flu?
A: Well, so much. The point is, just yesterday we saw from Northwestern an important paper on invasion of the male genital tract through non-human primates through the testes and the penis. And that's the mechanism where erectile dysfunction occurs. We have penetration of every organ through COVID, like what we can see with myocarditis, the kidneys. The damage, the long COVID story, is nothing like we've ever seen with a prior pathogen, in terms of the millions of people who have been affected. And we just saw evidence of the heart and vascular complications at one year and a very devastating report from the VA administration, Washington University. So, this is unlike the pathogens that you mentioned, the other coronavirus cold, common cold or the flu. This is entirely different.
Q: Let's turn to vaccine news. According to a study out this week, the lower dose of the Pfizer vaccine doesn't protect 5 to 11-year-olds from infection, as well as the full dose. What are the details from the study that you're paying attention to and how should parents of young children be thinking about this new information?
A: Well, this is an important CDC report that actually counters New York state that came out the day before, at least as it was reported. So, the CDC report is about omicron and it spanned the age groups of 5-to-11 and then also the 12-to-17. And what it showed is that there was really excellent protection against hospitalizations for the young children. But we knew with omicron our vaccines have not held up well for transmission and infection and, of course, that was what was seen. So, it shouldn't be a surprise to anyone that children, particularly in the omicron phase, were not protected well by vaccines. But the good part is that there was very strong protection against hospitalization and that's what we are after right now because omicron, unlike any version of the virus previously, was a workaround with respect to its remarkable ability to evade our immune system and cause infections. So here, we had to change what we expect from vaccines, which is protect from those infections getting severe, leading for children, or any person, to wind up in the hospital. And they work well for that.
