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title: "How do you get access to antivirals on the NHS CDMU system and does it work?"
layout: post
image: 
    feature: header_evusheld.png
---
So, after three years of shielding, I got Covid. I contracted it at hospital (or on my way there). How do I know? Because I don't go anywhere else. I thought, though, that it might be useful to document my experience of getting antiviral treatments for Covid as an extremely clinically vulnerable individual.

I developed a sore throat on Saturday evening (17th December 2022) but tested negative. This mutated into a cough and runny nose and I retook the lateral flow test on Monday (19th December 2022) at 9am, where it went positive. I reported this to the government site which said that I would receive a call within 24 hours.

I then emailed my immunology department who called me back within 45 minutes. They instigated a referral to my local CMDU (Covid Medicines Delivery Unit).

About 30 minutes after this I got a call from the CMDU triage system, where a nice woman asked me about my eligibility. (And, humorously, whether I "wanted" the treatments. Me: "no thanks, happy to die instead").

So far up to this point, things had been going quite well. I didn't feel too bad, it looked like the system was rolling. But then the operative told me that the CMDU was "quite busy" (wonder why on Earth that could be!) and that I shouldn't expect a call from a clinician until... the next morning. There was nothing to do but say "OK" but... this is supposed to be urgent and time sensitive. Meanwhile, my main complaint was that the headache got much worse over the course of the day.

In the end, the call came at 17.37 on the same day and I was prescribed molnupiravir and told it would be delivered the next day. This was remarkably simple as I clearly fulfill 3 or more of the categories of eligible people. Due to nurses strikes and efficacy concerns, I wasn't offered sotrovimab, which I understand is what most people with kidney failure have been getting.

Alarmingly, the doctor I spoke with said that today was the worst day for covid that he had seen in nine months and that he had spent all day prescribing antivirals to vulnerable individuals. He said it is now far worse than flu in terms of prevalence and hospitalisation. But I digress...

The doctor also gave me a phone number for the pharmacy that, apparently, is due to deliver my antivirals tomorrow. I was given instructions to phone them if I hadn't heard back by 10am the next day.

Unsurprisingly, by 10am, I had not heard anything and so tried the number I was given. This turned out to be the incorrect number and I had to look up the pharmacy phone number. So a tip here: find out to which hospital they have sent the prescription. Anyway, they said the drugs would be with me by midday. At 12.30 I phoned them again and they said they were about to be sent. They called me back at 12.37 saying they were en route and would be with me in 30 to 60 minutes. At 2.30pm the drugs still had not arrived. My wife phoned them (she's the fierce one) and they said they had been collected and were out for delivery. Finally, at 2.45pm, they arrived and I took the first dose.

So, from positive test to antivirals arriving took 30 hours. Not bad, but also not great when the drugs _must_ be used within the first 5 days of symptoms. I made this, but others might not.

It is surprising to me that vulnerable people haven't been supplied with these antivirals, ready to take the second they become ill. This is what immunology have done for me with antibiotics. I am on permanent prophylactic antibiotics and I have a set of "breakout" antibiotics at home that I am supposed to take whenever I get an infection, even if viral, to ensure that no secondary bacterial infections take hold. Really, if the government expects vulnerable people to get covid and then seek help, it would make more sense to ensure that vulnerable people have immediate access to antiviral therapies, at home, ready to go.

As for my covid infection: thus far it has been relatively mild, although I feel lousy (it's nowhere near as bad as I have felt in the past 2 months with my kidney problems). This might be due to the Evusheld helping. It might be due to the 6 vaccine shots that I have had giving some t-cell response (it certainly wasn't an antibody response). I hope, also, though, with the antivirals that I will recover relatively quickly and well. The slight worry/risk is that my wife seems also to have symptoms, but is testing negative. The thing I must avoid is just recovering myself, thanks to the antivirals rather than any immunity, and then becoming immediately re-infected from her. So that's going to make for a jolly and sociable Christmas...