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Lesotho Transforms COVID-19 Treatment with Oral Antiviral Medicine

21 February 2024 by Limpho Sello

 Est Read Time: 6 min(s) 43 sec(s)

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Baroane Phenethi, Head of Health Education at Lesotho’s Ministry of Health, speaks to media practitioners about Covid-19 oral medication. Credit: Provided Picture.

A sharp chill slices through Selemeng Matsoso’s back, prompting a shiver she attributes to her prolonged exposure to the night air.

She finds herself at a party with friends in Masite, Quthing, September 2023. Reflecting on that chilly night, Matsoso confides to Uncensored News, “At the time I was wearing lighter clothes, and being outside until dawn made matters worse.”

The next day sees Matsoso’s back devoid of the cold’s lingering touch. With her partner by her side, they breeze through Sunday, engaging in their usual activities without concern for her health.

However, just two days later, Matsoso’s well-being takes an unexpected turn as she suddenly experiences a blocked nose seemingly out of nowhere.

Initially brushing it off as a consequence of the cold she endured on Saturday, Matsoso recalls, “It is just a common cold from the cold I experienced on Saturday” and ignored it.

However, by Wednesday, her condition worsens dramatically. She recounts, “I had lost my appetite, my sense of smell was gone, and I had a fever. I was sweating non-stop and was fatigued. The following day, Thursday, I started coughing.”

Reflecting on her deteriorating health, Matsoso adds, “Then, I felt very sick and could sense that this was not a normal common cold. I have suffered from the flu several times, but this was different.”

Although Matsoso desperately needs to see a doctor, she is forced to postpone her visit because Quthing Hospital does not see patients on Thursdays. The day is set aside for patients with scheduled check-up appointments.

Grappling with an unusual sense of cold, she resolves to get tested for Covid-19 the following day when she reaches the hospital.

Covid-19 remains public health emergency.

While many countries have transitioned from COVID-19-specific reporting to integrating it into respiratory disease surveillance, the World Health Organisation (WHO) emphasises that COVID-19 remains a significant public health emergency.

This United Nations body urges member states to maintain, rather than dismantle, their established COVID-19 infrastructure.

“It is crucial to sustain early warning, surveillance and reporting, variant tracking, early clinical care provision, administration of vaccine to high-risk groups, improvements in ventilation, and regular communication,” reads WHO’s COVID-19 Epidemiological Update published on 16 February 2024.

As of 7 January 2024, WHO reports over 774 million confirmed COVID-19 cases and more than seven million deaths globally. In Lesotho, Jhpiego’s overview presentation of the Test to Treat indicates 35,963 confirmed cases by 14 October 2024, with 709 people succumbing to COVID-19-related complications during the same period.

Presenting this report on behalf of Ministry of Health on 8 February 2024, Baroane Phenethi, Head of Health Education at Lesotho’s Ministry of Health, stressed that these numbers reflect an increase in COVID-19 cases and a rising death toll among Lesotho’s population.

Against this backdrop, the United States Agency for International Development (USAID) has prioritised Lesotho as one of the ten countries for the introduction of the Test to Treat (T2T) initiative, aimed at populations at high risk of severe illness from COVID-19.

This initiative is supported by the Promoting the Quality of Medicines Plus (PQM+) program, which facilitates the product registration of COVID-19 therapeutics in countries identified by USAID. These countries include Lesotho, Bangladesh, Botswana, Cote D’Ivoire, El Salvador, Ghana, Malawi, Mozambique, Rwanda, and Senegal.

The treatment aspect of T2T involves the introduction of the COVID-19 antiviral, Molnupiravir 800mg (4x200mg) capsules (co-packed with nirmatrelvir and ritonavir), administered exclusively to individuals with mild to moderate COVID-19.

What exactly is a COVID-19 antiviral?

According to Mayo Clinic, a globally reputable research institution, Molnupiravir is a medicine used to treat people who have mild to moderate COVID-19 symptoms and are at higher risk of getting seriously ill.

The medication is taken by mouth as a pill. Mayo indicates that America’s Food and Drug Administration (FDA) authorised for emergency use a drug called Molnupiravir.

The clinic highly advises people against trying Molnupiravir without a prescription and approval by a doctor, “even if you’ve heard that they may have promise.”

Baroane Phenethi. Credit: Provided Picture.

In Lesotho, the introduction of this oral COVID-19 treatment is being enrolled under the Test to Treat initiative officially launched on 7 December 2023 by the Ministry of Health. The launch was supported by Jhpiego and the USAID.

Phenethi said 33 patients tested positive with COVID-19 in September 2023. 18 of these COVID-19 patients were put on treatment, with Molnupiravir prescription. Additionally, 53 out of the 78 confirmed cases in November received this oral treatment. Furthermore, six of 13 confirmed cases in December 2023 were put on treatment.

At the beginning of this year, in January, Phenethi said 35 patients tested positive with Covid-19 and 22 were given the treatment.

“Most if not all of these cases came after an outbreak in Maseru schools, that is Morija Girls High School, Thabeng High School and the Lesotho College of Education (LEC),” explained Phenethi.

However, he quickly added that not everyone tested positive for COVID-19, like asymptomatic patients, are eligible for this treatment. Only patients with mild to moderate symptoms are eligible for the COVID-19 antiviral treatment.

“The oral antivirals assist to prevent further spread of the virus in the body. People who have a risk of getting severe disease such as the elderly who are than 60 years, Infants less than one year qualify for this treatment. Others who are eligible are people with immunocompromised conditions, such as cancer patients. Those with chronic diseases such as diabetes, HIV, hypertension, anything that might put them at risk of getting severe disease are eligible.

“Test to Treat is an approach designed for health facilities to provide a one-stop early detection of symptomatic Covid-19 infection by rapid antigen testing and treatment with approved oral antiviral medications,” Phenethi said.

He however stressed that the introduction of the T2T does not mean that critically ill COVID-19 patients will be neglected.

“But I must indicate that patients who are severe to critical are not neglected just because they are not eligible for this treatment. They are put to their right care which includes admissions and support by ventilators,” explained Phenethi.

Reaction Check: Follow-up on Medication Response

Back in Masite, Quthing, 38-year-old Selemeng Matsoso arrived at Quthing Hospital, determined to undergo a COVID-19 test before consulting a clinician.

“I got to the hospital, and they checked my temperature,” Matsoso recounted, noting, “despite the excessive heat I felt and the rate at which I was sweating, my temperature was surprisingly normal.”

Despite her normal temperature reading, Matsoso tested positive for Covid-19 and was promptly prescribed Molnupiravir treatment on October 6, 2023.

“I had taken it for five days,” she explained. “I was told by the health professionals that I might have side effects and that should I experience anything unusual, I must return back to the hospital.”

During a presentation, Phenethi elaborated on potential side effects of the capsules, emphasizing their variation from person to person.

“As for any side effects of the antivirals, a doctor is best equipped to explain to a patient about any side effects that may occur and give out further instructions in any case,” he said.

Matsoso’s recovery progressed without encountering any medical hurdles. “They told me to return should I feel any pain or unusual feeling. They even called to check on me three days after they gave me treatment, and I told them I was fine,” she recalled.

Reflecting on her experience, Matsoso expressed confidence in the effectiveness of the medication, stating, “based on my experience, they (the medication) were very effective, and I did not get any side effects.”

Encouraging others who test positive to take the treatment if prescribed, Matsoso revealed her initial reluctance towards Covid-19 vaccines.

“At the time I was working at the same hospital in the maternity ward, issuing birth certificates to newborns. I knew I had to vaccinate to protect them. But it is not something I did willingly as I did with testing for COVID-19 and welcoming the treatment.”

Nonetheless, she emphasised her lack of regret in taking the vaccine, attributing her milder illness to vaccination.

T2T implementation in ten hospitals

Phenethi announced that the Test to Treat (T2T) program is currently being piloted across the country. Participating hospitals include Machabeng in Qacha’s Nek, Berea, Paray in Thaba-Tseka, Quthing, Mafeteng, Mokhotlong, Ntsekhe, Motebang in Leribe, Botha-Bothe, and Queen Elizabeth II in Maseru.

“We are currently in the pilot phase, with plans for nationwide expansion, reaching communities, health centres, through Village Health Workers, and outreach programs. However, for this to succeed, we need to ensure access to diagnostics and create awareness about the importance of testing and treatment,” Phenethi explained.

He emphasized the necessity for people to be informed about this initiative, warning that without awareness, individuals may resort to home remedies, such as herbal concoctions, and only seek medical help when their condition becomes critical.

Tlali Mpo, a 78-year-old resident of Ha-Koali, Quthing, recently opted for home remedies to treat COVID-19, despite being prescribed Molnupiravir treatment by clinicians at Quthing Hospital.

Mpo, who had been transferred from St. Mathews Health Centre in the same district, expressed his apprehension: “I was given the tablets and instructions on how to use them at home. I was afraid to use them as I thought something worse might happen to me. I kept them with me until my next visit, which was on 22 October 2023.”

Upon returning to the hospital, Mpo was retested for COVID-19. “They told me I no longer had COVID-19.”

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