On the first day of his COVID-19 infection, Brad Cox experienced mild symptoms.
By the following day, the 57-year-old had trouble breathing and started coughing up blood and phlegm.
Alarmed by how swiftly his infection was progressing, he pushed for a treatment he heard about from a nurse who was helping him manage an ongoing medical issue.
"If it wasn't for the nurse that told me about it, I would have spent some time in hospital," he said.
"Whether I would have survived or not, who knows?"
Australia now has a range of treatments available for people at high risk of severe COVID-19.
But doctors are concerned they are not getting to everyone who needs them.
Chris Moy, vice-president of the Australian Medical Association, said people who should have received the drugs had ended up in ICU because they had gone without.
Sometimes, the outcome has been worse.
"People are dying because they haven't got antivirals," he said.
'It's lifesaving': Struggle to access treatment
Mr Cox had never heard of sotrovimab before his nurse mentioned it.
But even after he was armed with the drug's name, it was not easy for him to get hold of it.
At first, he followed the standard guidance and reported his severe symptoms to his local health service in Victoria.
When a doctor called to find out more about his condition and medical history, Mr Cox said he asked whether he was eligible for a sotrovimab infusion.
Despite living with type 1 diabetes and impaired kidney function, and having previously had a pulmonary embolism, Mr Cox was told by the doctor he did not qualify for the drug.
Worried his symptoms would get even worse, he called his local hospital.
This time he was told he was eligible.
He had the infusion within an hour.
"You just instantly feel the fact that you're recovering," he said.
"It's lifesaving."
Confusion over criteria to receive treatments
There are several COVID-19 treatments available, each used in different circumstances.
Monoclonal antibodies, such as sotrovimab and Evusheld, help stave off an infection by stopping the virus from entering cells.
Antivirals, such as Paxlovid and molnupiravir, deal with an infection by preventing the virus from multiplying.
The Commonwealth government has been building up Australia's stockpiles of monoclonal antibodies and antivirals since last year.
The Therapeutic Goods Administration approved the drugs and the National COVID-19 Clinical Evidence Taskforce provided guidelines for doctors on when they should be prescribed.
But it is the states' and territories' health services that give them to patients.
Dr Moy said not all health services were using the same criteria.
"The one thing that has been a problem has been the inconsistency of the various systems and the criteria across the country," he said.
GPs in particular have struggled to know when to recommend these treatments to patients and how their patients can access them.
HealthDirect, the national medical information service, is now working with various states to make the process more consistent across the country.
Adding to the confusion is concern that use of sotrovimab should be wound back.
Research has shown it might not be as effective at treating the Omicron BA.2 variant and may cause resistance in some patients, so health authorities are considering pulling it off the market.
Bob Pickard, 59, contracted COVID-19 in NSW just weeks after being hospitalised with fluid in his lungs.
The tooling coordinator at a local airport lives with atrial fibrillation, a heart condition that resulted in him spending more than a fortnight in ICU.
Concerned he was at high risk of severe disease, his GP referred him to the local hospital which managed COVID-19 patients in the community.
The GP told Mr Pickard he was eligible for treatment to help prevent a severe infection.
He never received it, despite telling the doctors who called about his recent stay in ICU that he was overweight.
"I know it's all new, the COVID, but if there is medication here that they know works, why not give it to us?" he said.
Lack of public awareness
A doctor from Mr Pickard's local hospital called every day to check on his symptoms which luckily never became more severe than body aches and fatigue.
Had his condition deteriorated, it might have been too late.
To be most effective, antivirals and monoclonal antibodies must be given within five days of the start of the infection.
"I didn't probably realise the severity of it until actually being told I could have gone back into ICU," Mr Pickard said.
Haematologist Nada Hamad treats blood cancer patients, many of whom have had their immune system wiped out as part of their treatment.
They are among the most vulnerable to suffering a severe COVID-19 infection.
But Dr Hamad said even they did not know there was treatment available if they contracted COVID-19.
She works at St Vincent's Hospital in Sydney and tells all her patients to get in touch if they test positive.
She said many relied on public messaging about the latest viral strains being mild, so when they got infected they did not think to ask about antivirals.
"I have a number of patients who were eligible and didn't get it and were sick after," she said.
Dr Moy said vaccination remained the best way to prevent severe infections and agreed that too few high-risk patients knew treatments were available.
"There is a very little understanding in the community of the need to get in and get your antivirals fast," he said.
He said in some cases, health services would try to contact high-risk patients who had tested positive for COVID-19, but they would not pick up their phone or would not follow through on the advice they were given.
"If you've got a positive [result] and you get told to get treatment, go and get treatment," Dr Moy said.
