11 July 2024

Although COVID-19 patients have the option of being treated at private hospitals, health authorities still insist that doctors only prescribe antiviral drugs according to Medical Services Department (MDS) guidelines.

Other than basic medication to treat fever or nasal congestion, the guidelines allow for the prescription of Favipiravir, Remdisivir, Molnupiravir, Nirmaltrevir/Ritonavir (Paxlovid) and Corticosteroids. However, most of these names don’t ring a bell as few patients have ever used them.

Now, public concern is growing that many patients may have missed out on effective treatments due to government controls.

“I did not get Favipiravir when I was treated under the social security scheme, not even when I asked for it,” a former patient complained.

Complaints from doctors

Earlier this week, the Rural Doctors Society (RDS) called on the government to stop the Government Pharmaceutical Organization (GPO) from monopolizing the procurement of Favipiravir and other antiviral drugs that can be used to treat COVID-19.

“Let private hospitals procure these medicines and then be reimbursed at the cost,” RDS said on its Facebook page. The group reckons that shortages and prices of these drugs will drop if private hospitals are given the right to order them too.

Explanation from government 

The government has responded by saying that hospitals can procure antiviral drugs that have been registered with the Food and Drug Administration (FDA). It’s just that medicines procured by private hospitals will not be given to patients for free, unlike medication from state-run medical facilities.

“The government will provide medication to those exercising their right to treatment through proper channels and whose conditions require antiviral medication based on MDS guidelines,” Health Service Support Department director-general Dr Tares Krassanairawiwong said.

On Wednesday, the FDA also gave the green light to clinics to procure these medicines, so more people can have access to affordable treatment.

Klang Hospital’s wards full of COVID-19 patients, anti-viral drugs still being provided

More about medicine choices

Favipiravir, which is also being produced locally by the GPO, has been a key antiviral treatment for COVID-19 patients since 2020. However, its usage over the past few years has also raised the chance of patients becoming resistant to the drug.

Favipiravir has also not been affordable for many patients. Private hospitals are selling a full course of 50 tablets at 2,900 baht or 3,000 baht, including a thermometer and pulse oximeter.

As per MDS guidelines, Favipiravir cannot be prescribed to asymptomatic patients. Symptomatic patients who have not developed pneumonia and have no risk factors can be prescribed the drug, provided their infection was detected early enough. However, the prescription of this drug is subject to the doctor’s judgment.

Those who want to be prescribed Molnupiravir at private hospitals must pay 5,700 baht for a course of 20 to 30 tablets.

The MDS lists Molnupiravir as the No 1 choice for symptomatic COVID-19 patients facing one risk factor, such as old age (60 and above), obesity (weighing over 90 kilos), uncontrolled diabetes, or chronic lung/liver or heart problems.

If symptomatic patients have at least two risk factors, then the recommended drugs are Remdesivir, Nirmatrelvir/ritonavir, and Molnupiravir in that order.

If patients develop hypoxia (resting oxygen saturation at 94 percent or less) and require oxygen, MDS recommends that they be prescribed Remdesivir along with a corticosteroid.

Based on these guidelines, Favipiravir and Molnupiravir have become the stars in COVID-19 treatment packages at private hospitals. Both drugs can be taken orally.

Latest MDS guidelines

MDS has updated its guideline several times over the past few years in response to the changing situation and findings. The latest update was released on July 11 after a meeting of medical lecturers, specialists, and people on the frontline of COVID-19 treatment.

As of July 21, Thailand had recorded more than 4.5 million COVID-19 infections, with 31,703 deaths. Despite the high vaccination rate in the country, and the fact that most patients developed mild symptoms, up to 2,607 COVID-19 patients were admitted to the hospital for treatment on Thursday (July 21).

By Thai PBS World’s General Desk