Usage and awareness of antiviral medications for COVID-19

COVID-19; SARS-CoV-2; Antiviral 9 10 11 12 13 14 15 16 17 18 19 20 Corresponding Author Contact Information: 21 Department of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 22 90095. Email: [email protected] 23 24 . CC-BY-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 26, 2022. ; https://doi.org/10.1101/2022.04.21.22274155doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 2

25 We surveyed people that recently tested positive for SARS-CoV-2 to assess the 26 frequency and correlates of early treatment seeking behavior. Among high risk 27 respondents, 66.0% were aware of treatment for COVID-19 and 36.3% had sought 28 treatment, however only 1.7% reported use of an antiviral for SARS-CoV-2 infection. 29 More public outreach is needed to raise awareness of the benefits of treatment for 30 COVID-19. 31 32 . CC-BY-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 26, 2022. ; https://doi.org/10.1101/2022.04.21.22274155doi: medRxiv preprint 3 Main Text 33 Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome 34 coronavirus 2 (SARS-CoV-2), continues to cause severe disease, hospitalization, and 35 death. There are effective means to treat SARS-CoV-2 infection [1-4], however is it not 36 clear how often those who would benefit most use monoclonal antibodies, molnupiavir, 37 and nirmatrelvir. We surveyed users of a national SARS-CoV-2 testing company to 38 assess treatment awareness, treatment seeking behavior, and use of antiviral 39 medications for those with a positive test result. 40 41 We recruited adults (18 years or older) who had tested positive for SARS-CoV-2 by a 42 reverse transcriptase polymerase chain reaction (RT-PCR) assay at a large clinical 43 laboratory (Curative, San Dimas, CA). To be eligible, individuals had to have a positive 44 RT-PCR test result within 7 days of enrollment. All surveys were anonymous and 45 voluntary. We collected data on age, assess treatment awareness, treatment seeking 46 behavior, and use of antiviral medications for COVID-19. Descriptive statistics were 47 calculated on StataSE (StataCorp, College Station, TX). Advarra deemed the study IRB 48 exempt (Pro00059961). 49 50 There were 1,159 respondents during March 2022. Among individuals aged 65 years 51 and older, 66.0% were aware of treatment for COVID-19 and 36.3% had sought 52 treatment, however only 1.7% reported use of an antiviral for SARS-CoV-2 infection 53 (Figure). Rates were similar among younger individuals. 54 55 . CC-BY-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 26, 2022. ; https://doi.org/10.1101/2022.04.21.22274155doi: medRxiv preprint 4 Due to the timing of the survey, infections were most likely caused by either the 56 Omicron variant of SARS-CoV-2 or a sublineage of the Omicron variant, which might be 57 less severe in those with prior immunity [5]. Our findings demonstrate that increased 58 awareness and use of antivirals among those at risk for severe disease due to COVID-59 19 are urgently needed among individuals that test positive for SARS-CoV-2. 60 61 Declarations 62 Declaration of competing interests 63 NK is a consultant for Curative. JDK is an independent consultant and serves as the 64 Medical Director of Curative. 65 66 Funding 67 Curative Inc. and by a gift to the Keck School of Medicine of the University of Southern 68 California by the W.M. Keck Foundation. 69 70

71 To the participants that donated their time. 72 73 . CC-BY-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 26, 2022. ; https://doi.org/10.1101/2022.04.21.22274155doi: medRxiv preprint 5

74 1. O'Brien MP, Forleo-Neto E, Musser BJ, et al. Subcutaneous REGEN-COV 75 Antibody Combination to Prevent Covid-19. N Engl J Med 2021; 385(13): 1184-76 95. 77 2. Gupta A, Gonzalez-Rojas Y, Juarez E, et al. Early Treatment for Covid-19 with 78 SARS-CoV-2 Neutralizing Antibody Sotrovimab. N Engl J Med 2021; 385(21): 79 1941-50. 80 3. Whitley R. Molnupiravir - A Step toward Orally Bioavailable Therapies for Covid-81 19. N Engl J Med 2021. 82 4. Reis G, Dos Santos Moreira-Silva EA, Silva DCM, et al. Effect of early treatment 83 with fluvoxamine on risk of emergency care and hospitalisation among patients 84 with COVID-19: the TOGETHER randomised, platform clinical trial. Lancet Glob 85 Health 2022; 10(1): e42-e51. 86 5. Christie B. Covid-19: Early studies give hope omicron is milder than other 87 variants. BMJ 2021; 375: n3144. 88 6. Mahase E. Covid-19: Pfizer's paxlovid is 89% effective in patients at risk of 89 serious illness, company reports. BMJ 2021; 375: n2713. 90 91 . CC-BY-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 26, 2022. ; https://doi.org/10.1101/2022.04.21.22274155doi: medRxiv preprint 1 Figure. Treatment awareness, treatment seeking behavior, and use of antiviral medications among individuals 65 years 92 and older versus individuals younger than 65 years that tested positive for SARS-CoV-2 infection in 37 States in the 93 United States from 1 March 2022 to 30 March 2022 94 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Those aware of treatment Those seeking treatment Use of antivirals Monoclonal antibodies Molnupiavir Nirmatrelvir Less than 65 years (N=918) Age 65 years or greater (N=241) 95 96 . CC-BY-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 26, 2022. ; https://doi.org/10.1101/2022.04.21.22274155doi: medRxiv preprint