Jan Browning had been dreading getting COVID-19.
The 74-year-old — who is recovering from lung cancer — was scrupulous in trying to avoid it, wearing masks and social distancing.
Then, while she was still in the middle of immunotherapy treatment, it happened.
"I got the positive result, did the online questionnaire [and] then my [healthcare provider] rang me," she said.
"They sent me an oximeter, which was delivered to my doorstep."
But it was the next element that, according to Ms Browning, made an "enormous difference".
Later on the same day, she said, a COVID-19 doctor from her local health service called her and suggested she be put on antiviral treatment because of her past medical history.
The medication was delivered to her doorstep that night. After a day of the treatment, Ms Browning said, she was "already starting to feel better".
"It was such a smooth process and, I think, for me, I would have been in strife without them," she said.
"It kept me out of the hospital. I'm playing sports again now and I feel great."
For Canberra mother Liz Pickworth, the process was the polar opposite.
The 35-year-old has advanced cancer of the thymus gland, a rare cancer affecting fewer than one in 1.5 million people.
When she was diagnosed with COVID-19 earlier this year — when she was still receiving cancer treatment — her specialists advised her to get antivirals as soon as possible.
However, despite numerous phone calls to her medical specialists and the local COVID-19 hotline, she wasn’t able to access the medications, which would have sped up her recovery.
"I felt like I was begging for my own welfare to survive COVID," she told the ABC.
"I felt alone, I didn’t know where to look for help. I just felt like I was going to be sick all the time."
Antiviral access
Two COVID-19 oral antiviral treatments, Lagevrio and Paxlovid, have been approved for use in Australia.
The treatments help stop a virus infecting healthy cells or multiplying in the body, with more than 182,000 prescriptions dispensed across the country, according to the Health Department.
Health specialists say they have become a critical element of the country's COVID-19 response, reducing pressure on the nation's hospital systems.
However, their use is restricted. Under guidelines revised last month, the only people who can access them are:
- Australians over the age of 70 who test positive to COVID-19
- Australians aged over 50 — and Aboriginal or Torres Strait Islander people aged over 30 — with two or more risk factors for severe disease
- Anyone over 18 who is severely immunocompromised or has severe physical or intellectual disabilities can also be assessed for access.
Ms Pickworth was diagnosed in January when the antivirals had only just been been approved for use in Australia.
According to the Australian Medical Association (AMA), the process has improved significantly over the past few months, with thousands gaining access to the drugs.
Yet, the two cancer patients' contrasting stories highlight what some in the health sector say is a convoluted process putting some people at unnecessary risk.
Research shows antivirals are most effective when taken in the first few days after diagnosis. However, because they need to be prescribed by a doctor, some Australians are struggling to access them within that short time frame.
The ABC spoke to a number of eligible Australians this week who said they had trouble accessing the drugs, either because they could not speak to a GP, lived in a regional area or simply because of basic administrative blunders.
Because of this, Pharmacy Guild president Trent Twomey believes patients who are eligible should be able to get them over the counter at pharmacies, a step that has been introduced in New Zealand and in parts of the US.
"Our patients are telling us they are frustrated that, by the time they can get an appointment with their doctor, [up to] four days have already lapsed,” Mr Twomey said.
"We would like people who are eligible to not have to go to their doctor to get an antiviral, but to present to their pharmacy and the antiviral would be provided."
The Pharmacy Guild has put its proposal to Health Minister Mark Butler.
A spokeswoman for the Department of Health did not address the proposal specifically.
She said that, after its COVID-19 care arrangements, states and territories were responsible for distribution of supply within their jurisdictions.
'Word getting out' about antivirals
Despite the reports of delays, doctors' groups say the current system is working well, ensuring patients who need antiviral treatments are getting them.
AMA national vice-president Danielle McMullen said there were some challenges in getting the drugs out in the early days.
However, she said, most of those had been addressed.
"We've seen a really positive increase in the number of prescriptions being dispensed over the past couple of weeks in particular," Dr McMullen said.
Dr McMullen said more messaging to the public was required but she believed "the word is getting out there" that these important medications were available.
As of July 10, when the federal government expanded access to treatments, about 73,000 scripts had been filled. As of Tuesday, more than 182,000 scripts had been filled.
Virologists such as The Doherty Institute's Tony Cunningham have have also suggested that antivirals should be used more broadly in the population to prevent ongoing symptoms.
He told the ABC that future research into who was more at risk of contracting long COVID should be considered when deliberating future changes to antiviral eligibility.
A spokeswoman for the federal Health Department said the government relied on the advice of the independent Pharmaceutical Benefits Advisory Committee when deciding its criteria for who was eligible.
It said it had "sufficient supplies" of both medicines in Australia.
Back in Canberra, Ms Pickworth said she was not angry at the health authorities who, she said, had been "very supportive" of her during cancer treatment.
“It was confusing," she said. "And being so unwell, the last thing you want to have to do is [have] to advocate for your own wellbeing.”
A spokeswoman for ACT Health said at the time of Ms Pickworth's positive case, the only antivirals available were intravenous medications.
The spokeswoman said eligibility criteria for antivirals and the mechanisms to access these treatments had "evolved significantly" throughout 2022.
