By MATTHEW PER­RONE-As­so­ci­at­ed Press

WASH­ING­TON (AP) — Two brand-new COVID-19 pills that were sup­posed to be an im­por­tant weapon against the pan­dem­ic in the U.S. are in short sup­ply and have played lit­tle role in the fight against the omi­cron wave of in­fec­tions.

The prob­lem, in part, is that pro­duc­tion is still be­ing ramped up and the med­i­cines can take any­where from five to eight months to man­u­fac­ture.

While the sup­ply is ex­pect­ed to im­prove dra­mat­i­cal­ly in the com­ing months, doc­tors are clam­or­ing for the pills now, not just be­cause omi­cron is caus­ing an ex­plo­sion of cas­es but be­cause two an­ti­body drugs that were once the go-to treat­ments don’t work as well against the vari­ant.

“This should be a re­al­ly joy­ous time be­cause we now have high­ly ef­fec­tive an­tivi­ral pills,” said Erin Mc­Creary, a phar­ma­cist and ad­min­is­tra­tor at the Uni­ver­si­ty of Pitts­burgh Med­ical Cen­ter. “In­stead, this feels like the hard­est and most chaot­ic stretch of the pan­dem­ic.”

The pills — and oth­er COVID-19 drugs, for that mat­ter — are be­ing care­ful­ly ra­tioned, re­served for the high­est-risk pa­tients.

“Jan­u­ary is go­ing to be a ter­ri­ble month with a mil­lion cas­es a day,” said Uni­ver­si­ty of North Car­oli­na vi­rol­o­gist Dr. My­ron Co­hen. “Most peo­ple will do per­fect­ly well, but we have to se­lect out the peo­ple who won’t and give them the drugs we have avail­able.”

The Food and Drug Ad­min­is­tra­tion au­tho­rized the two pills from Pfiz­er and Mer­ck late last month based on stud­ies show­ing they cut the risk of se­vere dis­ease and death when giv­en short­ly af­ter symp­toms ap­pear. They are the first COVID-19 treat­ments pa­tients can take at home, and thus could re­duce the bur­den on hos­pi­tals.

The U.S. didn’t make the kind of mass pur­chas­es in ad­vance that it did with vac­cines.

Pfiz­er’s pill, Paxlovid, is con­sid­ered far su­pe­ri­or to Mer­ck’s, but be­cause of the six to eight months it takes to man­u­fac­ture, the com­pa­ny says it can sup­ply on­ly about 250,000 cours­es of the treat­ment by the end of this month.

The U.S. has or­dered enough Paxlovid to treat 20 mil­lion peo­ple, but the first 10 mil­lion or­ders won’t be de­liv­ered un­til June.

White House COVID-19 co­or­di­na­tor Jeff Zients said this week that the gov­ern­ment col­lab­o­rat­ed with Pfiz­er to help speed up de­vel­op­ment of the pill by sev­er­al months, and that of­fi­cials con­tin­ue to work with the com­pa­ny to look for ways to boost pro­duc­tion.

Pfiz­er said it is adding ca­pac­i­ty: “We ex­pect to use our strong man­u­fac­tur­ing ca­pa­bil­i­ties and our ex­ten­sive sup­pli­er net­work to con­tin­ue to im­prove out­put rapid­ly.”

Mer­ck’s pill, mol­nupi­ravir, was pro­duced in greater ad­vance quan­ti­ties. It takes six months to man­u­fac­ture, though the com­pa­ny says that can be com­pressed to five months if nec­es­sary.

But fi­nal test­ing showed the drug was far less ef­fec­tive than Pfiz­er’s pill and car­ried sig­nif­i­cant risks, in­clud­ing the po­ten­tial for birth de­fects when tak­en by preg­nant women. As a re­sult, it is con­sid­ered the last-choice op­tion un­der fed­er­al guide­lines.

Mer­ck said it has de­liv­ered 900,000 cours­es of the drug and is on track to ship all 3 mil­lion or­dered by the U.S. by the end of the month.

Since last month, the gov­ern­ment has sent states enough Pfiz­er pills to treat 164,000 peo­ple, al­lo­cat­ing them by pop­u­la­tion. That ap­proach is com­ing un­der fire from some states with heav­ier case­loads.

The amount al­lo­cat­ed to New York — enough to treat about 20,000 peo­ple — is in­suf­fi­cient, said Health Com­mis­sion­er Dr. Mary Bas­sett.

“We need more of these drugs in or­der to make them al­ter the course of the pan­dem­ic and re­duce hos­pi­tal­iza­tion,” she said.

State guide­lines gen­er­al­ly rec­om­mend doc­tors give pri­or­i­ty for the drugs to those at the high­est risk, in­clud­ing can­cer pa­tients, trans­plant re­cip­i­ents and peo­ple who have lung dis­ease or are preg­nant. New York’s guide­lines al­so rec­om­mend pri­or­i­tiz­ing cer­tain racial and eth­nic mi­nori­ties, giv­en their high­er rates of se­vere ill­ness and death.

States are dis­trib­ut­ing the pills dif­fer­ent­ly.

In Michi­gan, all ini­tial ship­ments went to 10 phar­ma­cies in the hard­est-hit ar­eas. Penn­syl­va­nia, Mary­land, Texas and many oth­er states have dis­trib­uted the pills more wide­ly, so that at least one phar­ma­cy in each coun­ty car­ries the drug.

De­spite the strict pre­scrib­ing guide­lines, some pa­tients have been able to get the pills through luck and per­sis­tence.

Craige Camp­bell, a web­site man­ag­er from Desert Hot Springs, Cal­i­for­nia, be­gan leav­ing mes­sages with his doc­tor im­me­di­ate­ly af­ter test­ing pos­i­tive for COVID-19 and de­vel­op­ing a 101-de­gree fever. De­spite hav­ing no un­der­ly­ing health con­di­tions, he was soon able to get a pre­scrip­tion.

The on­ly phar­ma­cy dis­pens­ing the drug was more than an hour’s dri­ve away, so Camp­bell had a friend pick it up for him.

“I felt a bit priv­i­leged in a way,” he said. “The odds that it would land in my plate in the right amount of time were pret­ty ex­tra­or­di­nary.”

At the same time, there is a short­age of an­ti­body med­ica­tions, the in­fused or in­ject­ed drugs that can head off death and hos­pi­tal­iza­tion. On­ly one of them, from Glax­o­SmithK­line, ap­pears ef­fec­tive against omi­cron, and it, too, is be­ing ra­tioned.

Fed­er­al of­fi­cials are lim­it­ing ship­ments of it to about 50,000 dos­es per week. This week, the gov­ern­ment an­nounced it is buy­ing 600,000 more dos­es, on top of 400,000 pur­chased in No­vem­ber.

At the UPMC hos­pi­tal sys­tem in Penn­syl­va­nia, the staff can treat few­er than 1,000 pa­tients per week with an­ti­bod­ies, down from as many as 4,000 ear­li­er in the pan­dem­ic.

Doc­tors and nurs­es around the U.S. have de­vel­oped com­plex means of de­cid­ing who should get the scarce med­ica­tions, based on pa­tients’ symp­toms, their un­der­ly­ing med­ical risks, where they live and whether they are healthy enough to trav­el for an in­fu­sion.

“What do we have on hand?” is the first ques­tion, said Uni­ver­si­ty of Mary­land Med­ical Cen­ter’s Dr. Greg Schrank. “Among those ther­a­pies, what’s the most ef­fec­tive and how can we di­rect it to the peo­ple that we know are of great­est risk?”

The in­creas­ing­ly com­pli­cat­ed treat­ment pic­ture comes as ex­haust­ed, frus­trat­ed hos­pi­tal work­ers try to man­age ris­ing ad­mis­sions.

As of Sun­day, near­ly 128,000 Amer­i­cans were in the hos­pi­tal with COVID-19, sur­pass­ing the all-time high of around 125,000 last Jan­u­ary. While few­er COVID-19 pa­tients now re­quire in­ten­sive care, the surge is push­ing hos­pi­tals to the break­ing point.

Con­sid­er­ing that threat, Pfiz­er’s pill ar­rived just in time, Schrank said.

“It’s not go­ing to turn the tide on the to­tal num­ber of cas­es, but it could re­al­ly help damp­en the im­pact on hos­pi­tals,” he said.

AP Writ­ers Bob­by Cal­van in New York and David Eg­gert in Lans­ing, Mich. con­tributed to this sto­ry.