Some recipients for free antivirals at a ‘test-to-treat’ site in a Gulf area

BERKELE, California – After avoiding movie theaters, restaurants and gyms for more than two years, Helen Ho decided to take her first big risk since the epidemic began to end her graduation.

In late May, Ho, 32, flew to Cambridge, Massachusetts to collect his PhD. In public policy from Harvard University. A few days after returning home to the Bay Area, he tested positive for Covid-19. At first, the Ivy League-educated researcher was at a loss for what he had to do.

“The protocols on how you would respond after a positive test are extremely confusing,” Ho said.

But a few days later, after talking to a consulting nurse, he found himself in the backyard of an extinct senior center in West Berkeley that had been transformed into one of the state’s new “test-to-treatment” sites.

The Senior Center is one of 138 free Covid test sites that have expanded to California one-stop treatment sites to improve access to antiviral drugs. The state initiative is modeled after the Biden administration’s “test-to-treat” program announced in March, which aims to provide high-risk patients who test positive with immediate access to antiviral drugs. To do this, California OptumServe, a Minnesota-based managed care company, will spend $ 18.2 million a year on the effort.

With a month of initiative on sites from Eureka to San Diego, state health workers are slow to get Pfizer’s Paxlovid and Mark’s feces into the hands of patients who need to take them in the first few days of symptoms to avoid serious illness. Officials say less than 800 people across the state have received prescriptions on OptumServe sites, despite new covid infections reaching an average of about 14,000 a day in early June in California.

And although the goal of the initiative is to serve the insured, about two-thirds of those screened already have insurance. For those who have health coverage, OptumServe bills the insurer and then pays the state.

The state’s public health officer, Dr. Thomas Aragon, said the goal of the test-to-medical campaign was to “ensure access to treatment for high-risk patients who may be out of the hospital.”

The state says its priority is to make the pills accessible to millions of elderly, chronically ill and disabled Americans, especially the poor and uninsured – even though very few people have heard of the drug.

Liliya Sekreta is seen working on the West Berkeley OptumServe site.
Liliya Sekreta is the head nurse at the West Berkeley OptumServe “test-to-treat” site.(Rachel Shearer for KHN)

Lilia Secreta, head nurse at the West Berkeley Optamserv site, said there was a demand for testing and treatment. During the winter covid growth associated with the Omicron and Delta variants, the line for testing extends to the corners of the senior center.

“We had the National Guard and extra staff here to make sure people weren’t angry or upset,” the secretary recalled. At that time, rapid tests were not widely available.

Nowadays, the site is managed by a skeletal staff of two young nurses, a few medical assistants and a Spanish-language translator. Located a few blocks from University Avenue, the main drag in Berkeley, it is located in a pre-working-class neighborhood of stucco bungalows.

On a foggy morning in early June, medical assistants stuck with their phones in patients who do tricks for covid tests at a rate every five minutes.

Ho is one of them. He is at risk of becoming seriously ill from the virus among millions of Californians – in his case, because he is taking immunosuppressive drugs for chronic arthritis. Ho has health insurance, but a nurse who answered the advice number at the bottom of the text message and informed him of the results of a positive Covid test suggested that it might be easier to return to the OptumServe site in West Berkeley where he received his test. Find out if he is suitable for antivirals.

Although she was feeling well, Ho knew she needed immediate medical attention. The Centers for Disease Control and Prevention says Paxlovid and Malnupiravi are about 90% effective in reducing hospitalization and death from covid if taken within the first five days of symptoms.

The FDA approved the pills for emergency use in December, but supplies were initially scarce. By April, production had increased but, by then, a handful of physicians were prescribing the drug, with pharmacists across the country reporting piles of unused antivirals on their shelves.

“I’ve read reports of people taking these drugs,” Ho said “But they didn’t know about them.”

She is also worried about infecting her elderly mother, with whom she lives in Albany with her husband and 14-month-old son.

Ho sat down at a folding table and answered questions from a nurse to determine his eligibility for the yellow plastic cover and pill. Later, Ho spoke to a doctor via iPad who concluded that Ho would be eligible for a prescription. Those who are eligible can go home with the medicine without a trip to the pharmacy.

“I’m glad to be able to go somewhere that was accessible,” Ho said “But to be honest, it wasn’t very well publicized. Not everyone has the time to call and ask like me, ‘What do I do next?’

Screening for treatment can take up to an hour and a half. Staff must ensure that patients are not taking any medications that may interact with antivirals, including cholesterol-lowering drugs and some birth control pills. The secretary, head nurse, said patients who could qualify were those 65 years of age or older, those with chronic disease and those who were obese or immunized. People should not take pills if they are very sick, or if they are not sick at all.

Dr. Kirsten Bibins-Domingo, an epidemiologist at the University of California-San Francisco, says such personal screening makes the test-to-treat model confusing and inefficient.

“It should be easy – if the doctor says yes – to get these pills by telehealth,” he said.

So far, workers say demand for the drug has been so low that no one has had to wait long. Officials said that as of mid-June, 1,219 people across the state had been screened at OptumServe sites for drugs and 768 of them had left with Paxlovid pills.

“I think it’s a new concept that people are still getting used to,” said Catherine Sullivan, a Berkeley City employee who oversees the West Berkeley site, which has served as a community testing site since the epidemic began.

Mary White is seen posing for a photo with her bike.
Mary White has been frequenting West Berkeley Center for Covid-19 testing since the first month of the epidemic.(Rachel Shearer for KHN)

Some residents prefer peace of mind to talking to a nurse or doctor rather than taking tests at home.

Mary White, an art teacher and 53-year-old Berkeley resident, came down with a cold symptom in late May, got on her collapsible bike and went to West Berkeley Center for PCR testing, where she had been testing since the first month. Shutdown’s White has health insurance, but he says he thinks it’s more convenient than the hassle of trying to schedule an appointment at neighboring Auckland’s Kaiser Permanente, which could be a day of convenience.

For the first time, his test came back positive.

“I was just like, ‘Oh no! What can I do? I have to do something!'” Said White, 64.

He returned to the center and underwent antiviral screening. After seeing a doctor from afar in Chicago, he left with a full five-day course of Paxlovid, which he had only taken for two days before stopping because the drugs made him feel nauseous.

Returning a few days later for a follow-up test, White said he felt much better after the age-old remedy of rest and fluid intake. He added that since there was no end to the epidemic, he was grateful for the benefits of a community where locals could simply walk and talk to a health worker.

“For people like me,” he said, “it’s very comforting.”

The story was produced by KHN, which publishes the California Healthline, the editorially independent service of the California Health Care Foundation.

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