Expert Q&A: Why COVID-19 Post-Exposure Prophylaxis Is a Pharmacist's New Tool

In an interview with Pharmacy Times, Jerry P. Abraham, MD, MPH, CMQ, a prominent family medicine physician, public health advocate, and leader in mobile street medicine connected with Charles R. Drew University of Medicine and Science (CDU) and Kedren Community Health Center in Los Angeles, discussed the continued burden of COVID-19 on immunocompromised patients, seniors, and multigenerational households, where prevention remains challenging. He highlighted a newly approved oral antiviral for post-exposure prophylaxis, shown to reduce symptomatic infection risk by 67% when started within 72 hours of exposure, and emphasized pharmacists' central role in delivering this new prevention option to patients.

By all of us taking it upon ourselves to be safe and healthy... when we're exposed to COVID-19, if we can get you ensitrelvir, then you're able to prevent COVID-19, and the data is very strong and supports it.
— Jerry P. Abraham, MD, MPH, CMQ

Pharmacy Times: Can you please introduce yourself?

Jerry Abraham, MD, MPH, CMQ: I'm Dr. Jerry Abraham. I'm the director of public health integration, street medicine, and workforce development here at Kedron Community Health Center, which is a historically Black institution and federally qualified health center, and the acute psychiatric hospital here in South Los Angeles. I also teach psychiatry and family medicine at Charles Drew University, which is our nation's fourth historically Black medical school.

Pharmacy Times: We're seeing a summer surge in COVID-19 cases even six years into the pandemic. What's driving continued transmission at this point?

Abraham: Yes, we see, just like during the height of the pandemic, COVID-19 was coming in waves, and that had geographic variability and a temporal component. People often just think of cough, cold, flu, pneumonia, COVID season as just that fall or winter period, but there often is this other peak that comes up at the end of spring during the middle of summer, and we do see an increase in infections, especially as people are traveling, as people are gathering indoors, as there's more extreme heat, and then people are getting ready to go back to school. Then you start seeing cross-pollination of people and pathogens, including bacteria and viruses. Another thing to keep in mind is that the bugs themselves are evolving, and the next part of it is that different variants might have different virulence, or their ability to infect people can change as well.

So we really can't afford to let our guard down, especially for folks that are living with cancer or who are immunocompromised or immunosuppressed. Just like we do with several other public health strategies, being able to cocoon and protect the most at-risk individuals is really important, and that's really what ensitrelvir is able to offer us.

Estimates from the Centers for Disease Control and Prevention show that COVID-19 infections are continuing to rise across the country in 41 states, and so this is perfect timing to make sure that we're protected and safe as we continue our travels, go back to school, and try to keep going on with our best and healthiest lives. That will also help us have a better fall and winter as those respiratory illnesses increase again.

Pharmacy Times: CDC estimates put new US cases between October 2025 and July 2026 as high as 4.2 to 12.7 million, with hundreds of thousands of hospitalizations and thousands of deaths. What does that tell us about how severe COVID-19 still is today?

Abraham: First and foremost, it's a reminder that COVID-19 is still around, that it still affects millions of people here in the United States, and that it continues to have these lasting impacts on communities and individual patients. I still have patients that are struggling with long COVID, still deal with things like not being able to smell or taste, and still haven't quite been able to get back to their baseline before they had a COVID-19 infection. So it is really important that, if we are able to, we prevent COVID-19 every way we can.

It reminds me a lot of our strategies around HIV PrEP, for example, where we're able to take medicines to make sure, or even after I am exposed to HIV, that I'm able to take medicines, post-exposure prophylaxis, in order to ensure that I don't get infected. So here we have tools like ensitrelvir that can help us.

But why risk suffering these severe consequences, especially if you've already got serious health conditions? We know that there are certain groups that this means a lot more for: grandma living in the nursing home or long-term acute care facility. We know that there are people that suffer complications from COVID, whether it's neurologic, cardiovascular, respiratory, or renal. So imagine if you already have conditions that are putting you at risk, or you already have a condition that impacts those organ systems. You definitely want to make sure that we prevent COVID-19 infection in those individuals at all costs.

And it's just a reminder, as we always think about our vaccination strategies for the fall, that seniors, because their bodies don't respond the same to bacteria and viruses and other respiratory illnesses, have an increased risk of serious illness, hospitalization, and death. So it's really important that we protect our elders at this time. And again, this is another intervention that's very helpful.

Pharmacy Times: Nearly half of individuals living with an infected household member go on to develop COVID-19 themselves. Why has prevention within households remained such a persistent challenge?

Abraham: Yes, I'll just start by saying that here, where I work in South LA, folks are living in multi-generational homes. People may be living with their grandkids. Grandma and Grandpa may be living in the house. There may be lots of folks that are coming in and out and going to work, for example, your parents, or maybe their aunts and uncles or cousins, in addition to children coming in and out of schools and daycares and interacting with other folks outside of the household.

Imagine you're someone who's living there who doesn't have the luxury to come and go, who may not always have access to all of the tools that we have in healthcare. Imagine being left very vulnerable and exposed to whatever all of us are bringing in and out of our homes: that individual, let's say Grandma, who is homebound and cannot leave, is now exposed to COVID-19 and can be infected.

So, as I mentioned with cocooning, being able to make sure that everyone in that multi-generational house is protected and that we prevent COVID-19 amongst those individuals helps Grandma not get infected as well. That's really at the heart of a lot of our public health strategies when we center the health of populations, communities, and people. It's very important that we build herd immunity with vaccines, but also, once folks are exposed or at risk of being infected by COVID-19, we take necessary steps. These are strategies that we've long used for things like the flu and HIV and other illnesses.

Really, preventing COVID-19 and, once exposed, post-exposure prophylaxis to COVID-19 are essential strategies that are part of helping us make sure that we don't see the most dire of the consequences that we remember from the days of the pandemic. These are strategies that we used even during COVID-19 when there were therapeutics available; our team delivered tens of thousands of therapeutics to patients, and we were able to see people not get hospitalized, not have a serious infection, and really be able to get back to work or back to life sooner. So I'm really excited to see that there's now a strategy very similar that we can bring to patients once again.

Pharmacy Times: Ensitrelvir is now the first and only oral antiviral approved for post-exposure prophylaxis of COVID-19, reducing symptomatic infection risk by 67% in trials following exposure. How does having a PEP option change the prevention toolkit for clinicians?

Abraham: I think it's so exciting to now have this option, post-exposure prophylaxis, also known as PEP, among clinicians, and maybe even patients have heard of it as another tool to help prevent COVID-19 illness in people. It's been great that folks have been able to get access to the vaccines. There are folks who may not be able to get vaccinated for various reasons; it may even be contraindicated for some. So there are folks that are really exposed, sitting ducks, if you will.

With this new strategy with ensitrelvir, and the FDA approving it for this indication of post-exposure prophylaxis in individuals 12 and older to prevent them from getting sick from COVID-19, we ultimately also help others not get infected, help not spread COVID-19, and ultimately reduce severe illness, hospitalization, deaths, and healthcare utilization, which results in costs. So we just see win, win, win across the board, and we're really excited to be able to offer this.

And lastly, these strategies have been employed around the world, so it's really exciting that we're able to bring those here. With this approval by the Food and Drug Administration, we're ready to make sure that we can help again bend the curve of COVID-19 illnesses this summer.

Pharmacy Times: For pharmacists advising patients this summer, what's the key message about recognizing exposure risk early and knowing when an option like ensitrelvir PEP might be appropriate?

Abraham: Well, I'm really excited that you're asking me this question because, as a primary care physician and as someone on the front lines in exam rooms and out on the streets with patients, we see how critical pharmacies are in helping keep our patients healthy. Especially where we're at, we see a lot of community mom-and-pop pharmacies that really are able to hold our patients' hands, help them get their vaccines and their medications, and now they'll be able to help our patients get ensitrelvir to really help prevent COVID-19 infection, especially after they've been exposed.

So imagine folks going to school and coming back and realizing, okay, that whole lecture hall was exposed to COVID and I live with Grandma. I'm now able to go to my doctor, go to the pharmacy, and pick up ensitrelvir, and start taking it within three days, within 72 hours of that exposure, and now I'm able to prevent COVID-19 illness in myself, and that also helps prevent spreading it to others. And again, this is a great intervention that helps people 12 years of age and older if they meet this criteria that the Food and Drug Administration has now allowed for this new indication as post-exposure prophylaxis for COVID-19. Really, if we can catch it in this critical window—that’s that first 72 hours—then we're really able to make sure that you don't experience or suffer from infection, especially the most severe symptoms that COVID-19 can have.

And it's again a reminder that COVID-19, while today we take it for granted, for some it can have serious consequences like cardiomyopathy. It can impact people's renal function. We see how it really hurts people with respiratory illnesses or conditions already. It's so challenging to get sick when you're already in cancer treatment, or you've received an organ transplant, or you're immunosuppressed or immunocompromised because you have an autoimmune or rheumatological condition and are receiving certain treatments, where you really can't afford to get sick, or maybe you won't be able to get some of the other interventions that we have.

So by all of us taking it upon ourselves to be safe and healthy — all the things that we do: washing our hands, wearing masks when appropriate, staying home or covering our mouths when we're sick, but also when exposed, making sure that we take medicines, just like we would if we had the flu or if we were exposed to HIV — when we're exposed to COVID-19, if we can get you ensitrelvir, then you're able to prevent COVID-19, and the data is very strong and supports it. That's why the Food and Drug Administration has moved forward with this approval.

It's really exciting that pharmacists know that this is now a new tool that you'll be seeing in your pharmacies, that patients may be asking about, or that you might see clinicians now sending prescriptions for. I'm really excited to be able to talk to clinical and retail pharmacists and to all sorts of folks in the pharmacy space who are interacting with our patients so that they can be well equipped with the knowledge and now with this tool in order to continue to help keep us safe and healthy. It's just a reminder how important pharmacists and people working at pharmacies are in all of our public health strategies, including the approach and prevention of COVID-19.