11 July 2024

With the number of COVID-19 patients surging to more than 20,000 daily, Thai authorities are busy taking steps to ensure an adequate supply of medicines.

Even though most COVID-19 patients only need basic medicines for fever and nasal decongestion, Thai medical authorities have been dispensing up to 2 million anti-viral Favipiravir tablets daily to minimize casualties.

Over the past three months, more than 3,000 patients have succumbed to the virus in Thailand and the rising daily death toll is nearing 100 on some days.

Latest treatment guideline  

The Medical Services Department’s latest guideline for COVID-19 treatment, however, states that anti-viral medications should not be dispensed to asymptomatic cases as patients in this group can recover on their own. Doctors may consider prescribing the herbal medication Fah Talai Jone (Andrographis Paniculata), as it has proved to be useful in the treatment of COVID-19.

Symptomatic patients may be prescribed Favipiravir if their infection is detected early enough, to prevent their condition from worsening. However, if their infection is confirmed five or more days after they first develop symptoms, then prescribing Favipiravir is unnecessary. The anti-viral drug will also not be prescribed to people with mild symptoms.

However, anti-viral medication is strongly recommended for COVID-19 patients who fall under the vulnerable group, regardless of how mild their symptoms may be. The vulnerable group covers people aged 60 and above, those who have chronic kidney disease, chronic obstructive pulmonary disease, any chronic lung problem, have had a stroke, uncontrollable diabetes, obesity (weighing over 90 kilos or BMI above 30), congenital heart disease, cirrhosis or low immunity.

These patients will be eligible for any of the following anti-viral medications: Nirmatrelvir/ritonavir (five-day regime); Molnupiravir (five-day regime); Remdesivir (three-day regime); and Favipiravir (five-to-10-day regime).

These anti-viral medicines are also recommended for patients with comorbidity (presence of one or more additional conditions) and/or mild pneumonia.

In more serious cases, Remdesivir may be prescribed for five to 10 days.

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Stocking up

Last week, the Government Pharmaceutical Organisation (GPO) said that it plans to deliver 30 million more tablets of Favipiravir to the Public Health Ministry by the middle of this month.

The week-long Songkran holiday starts on April 13, raising the risk of a wider outbreak. Thais usually take trips or head back to their homes for family gatherings at Songkran, making it difficult to ensure social distancing, which has proved to be the best way of curbing the spread of COVID-19.

“The Public Health Ministry has requested 75 million tablets of Favipiravir and Molnupiravir for the Songkran period,” GPO deputy managing director Sirikul Matevelungsun said.

Dr. Thongchai Keeratihattayakorn, the ministry’s deputy permanent secretary, however, has been downplaying concerns about the shortage of COVID-19 medication.

“We have enough medicines in stock. Shortages may be reported in some areas because some hospitals do not update their stocks on a daily basis,” Thongchai explained. “But once it’s reported, we can quickly fill their stocks with help from other hospitals nearby.”

Use with caution

Medical experts have said that though medicines like Favipiravir have proved to be useful in many cases, they can have an effect on the liver. Hence, if such medicines are not necessary, patients should not take them.

Dr. Manus Potaporn, deputy director-general of the Medical Services Department, said pregnant women and people with liver problems, in particular, should think twice before taking this anti-viral.

Thongchai, meanwhile, pointed out that people who have already taken a booster shot are unlikely to develop serious symptoms if they catch COVID-19. After five days of infection, their immune response will be strengthened just as it would be by taking Favipiravir.

New stocks arriving

Late last month, Thailand signed a contract to buy 50,000 Paxlovid courses from Pfizer. This new medicine, a combination of nirmatrelvir and ritonavir tablets, will be delivered to Thai authorities ahead of the Songkran break.

Dubbed the most effective tablet for COVID-19 treatment to date, Paxlovid has been found to curb hospitalization and death rates by 88 percent if prescribed within five days of the start of symptoms.

“We will only prescribe Paxlovid to patients at risk or those who are not fully vaccinated,” Medical Services Department’s director-general Dr. Somsak Akksilp said.

By Thai PBS World’s General Desk