Action plans for treating COVID, and improving your heart health

Dr Trish Batchelor
Deputy Chief Health Officer
Department of Veterans’ Affairs

COVID medications: Paxlovid and Lagevrio

I was hoping by the time I sat down to write this column that the impacts of COVID might be behind us. And while life is returning to some degree of normality and high rates of vaccination have had a huge impact on the rates of severe disease and hospitalisation, we are certainly not out of the woods yet. With the more transmissible Omicron variant dominant we are now in a phase of continued transmission in Australia. A fourth vaccine dose is now available via general practitioners (GPs) for those at high risk of severe disease, which includes anyone aged over 65 or with a wide range of pre-existing conditions. If you think you may be eligible, please have a chat with your GP.

You are probably aware that two antiviral medications to treat mild to moderate

COVID are now available. They are Paxlovid and Lagevrio. Both can be prescribed by your GP on the Pharmaceutical Benefits Scheme if you are eligible.

The initial trials of these medications were undertaken against the Delta variant in an unvaccinated population. They demonstrated that Paxlovid was around 80% and Lagevrio around 40% effective in reducing hospitalisations in higher risk individuals. Real world data in vaccinated people during the time of Omicron is just starting to be released. Studies from Israel and Hong Kong have showed very similar levels of protection against severe disease.  This is exciting news and adds to our arsenal of treatments for COVID for people at higher risk of severe disease.

However, critical to the success of these medications is that they be taken within the first five days of symptoms, and the earlier the better. I would urge any of you who meet the eligible criteria (see below) to proactively meet with your GP and develop an action plan. This way you can quickly access treatment should you test positive. There is currently no shortage of either medication in Australia.

This is particularly important as Paxlovid, while more effective and our preferred choice, has many drug interactions. In other words, it is more likely to cause side effects by interacting with other drugs you may be taking. Your GP will need to check that it is safe for you to take, or give guidance on any changes in your regular medications that may be needed if there are interactions with Paxlovid.

Heart health checks

Like many of you, I was shocked to hear of the untimely death of Shane Warne from heart disease. This sad event has raised awareness of the importance of proactive heart health checks. Since 2019 there has been a Medicare item number for a heart health check, meaning it can be bulk-billed. Anyone over the age of 45, or over the age of 30 if you are of Aboriginal or Torres Strait Islander heritage, can access this.  

Heart disease still causes one in four deaths in Australia and more than 1,600 hospitalisations daily. Risk factors that we can personally modify account for 90% of the risk for a heart attack, meaning that we can each do a lot to reduce our own risk.

The Australian Heart Foundation notes that two out of every three Australians have at least three risk factors for heart disease. However, one in three people who are eligible for a heart health check have not had their cholesterol or blood pressure measured within the recommended time frames.

The main lifestyle behaviours you can modify to reduce your risk of heart disease include quitting smoking, eating a heart-healthy diet, getting enough physical activity, keeping your weight in a healthy range and avoiding binge or consistently heavy drinking of alcohol. There are some medical conditions that if not well managed can also increase your risk, including high cholesterol, high blood pressure, diabetes and some mental health conditions, such as depression. As part of a heart health check, your GP should check all of these risk factors (which may require you to have a blood test) before using a risk calculator to assess your personal risk. Then, together you can develop an action plan to address those risk factors that are most relevant to you.

There is a tendency to think of heart disease as more of a male problem, yet heart disease is the second most common cause of death in Australian women, after dementia. There are some specifically female risk factors including polycystic ovarian syndrome, premature menopause, some autoimmune diseases (while not specific to women they are much more common in women) and breast cancer treatments including radiotherapy and chemotherapy. Additionally younger women tend to be more likely to present with ‘atypical’ symptoms of heart disease such as indigestion, jaw, shoulder or back pain, shortness of breath, or dizziness.

If, after having a heart health check, you find you need to address some personal risk factors, the Heart Foundation website (heartfoundation.org.au) has some fantastic resources. DVA runs a 12-month heart health program that you may be eligible for depending on your service history. The eligibility checker can be found on the DVA website.

Until next time stay well.

Eligibility for Paxlovid or Lagevrio

• Aged over 65 with two other risk factors for severe disease*
• Aged over 75 with one other risk factor for severe disease
• Aged over 50, of Aboriginal or Torres Strait Islander origin with two other risk factors for severe disease
• Moderate to severe immunocompromise, aged over 18

*Risk factors for severe disease include obesity, diabetes, kidney failure, heart failure, chronic respiratory disease, dementia, stroke or cirrhosis.