March 12, 2020

Emerging Policy Positions on COVID-19 and Some Policy Implications

According to the Institute for Tropical Medicine in Antwerp, we do not yet know whether the new coronavirus (SARS-CoV-2 or COVID-19) has any effect on HIV or vice versa.  To date, the Institute reports that people whose HIV infection is stable will be least affected if exposed to the virus and those with low CD4 levels (or other underlying diseases) may be more severely impacted by any influenza infection, including coronavirus. Finally, they note that “some antiviral agents used to treat an HIV infection appear to have an effect on SARS-CoV-2 under laboratory conditions. However, we do not yet know what the impact of this finding will be on patients.”

The Guardian noted today that, “of the three people leading the US response to coronavirus, only one, Dr Deborah Birx, has previously been on the frontline against a mysterious virus which scientists couldn’t stop.”  The other two are Vice-President Mike Pence and Department of Health and Human Services (DHHS) Secretary Alex Azar, who has said that he hired Dr. Birx as his “right arm.” In 2014, President Obama appointed Birx as the U.S. Global AIDS Coordinator, putting her in charge of PEPFAR.

VP Pence has said, according to Politico, that “therapeutics to treat the virus could be available as early as this summer, while a vaccine may not be ready until next year.” Pence also met with members of Congress to discuss COVID-19 funding, resulting in an emergency bill for $8.3 billion for the response.  Meanwhile Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, advised the House Oversight and Reform Committee that the outbreak in the U.S. is escalating.  “I can say we will see more cases, and things will get worse than they are right now,” Dr. Fauci said, before being rushed, together with other high-level officials, back to the White House for meetings.

Among many HIV-focused organizations, providers and people with HIV, concern is focused on how to ensure uninterrupted access to HIV medications while also minimizing the need for people with HIV to go to clinics, pharmacies and other venues where they might be exposed to coronavirus. Advocates are reviewing previous emergencies in which people with Part D Medicare were able to get larger-than-usual supplies of antiretroviral drugs to sustain them for the duration. Doing so, however, also requires stretching the supplies out in order to maintain access to pills for longer timespan than expected. The only public information provided by the Center for Medicare and Medicaid Services to date has been a press release on March 9 and a re-issue and expansion of a guidance for long-term care providers entitled Hospice and Nursing Home Staff on COVID-19.

Medicaid access may be less difficult to ensure in some areas since Governors (rather than federal officials) authorize Medicaid rules and have the power to declare a “state of emergency,” which enables them to access extraordinary resources. Doing so, however, also requires having to stretch the resources out in order to maintain the supply for longer time-spans that expected.

National Association of State and Territorial AIDS Directors (NASTAD) is gathering information on this, citing precedents in New York and California where, at times of crisis, uninterrupted HIV medication has been provided for patients for up to 60 and 90 days. After the 9-11 attack in New York and Hurricane Katrina in New Orleans, for example, arrangements were made in some areas to extend prescriptions to reduce the hardship and risk (of exposure to other infections when leaving home) to people living with HIV.

We remain proud of and thankful for our Academy members and all healthcare providers that are on the frontlines combatting the spread of the coronavirus. The Academy will continue to keep you updated on the federal response to this pandemic. More information to come. Stay tuned!