Treatments for COVID-19 are gaining new importance as they are highly transferable BA.2 Omicron variant continues to be the predominant SARS-CoV-2 strain with new BA.2 sub-variants emerging and governments and institutions relaxing or eliminating their COVID-19-related mitigation strategies such as masking in indoor public assemblies.
Centers for Disease Control and Prevention (CDC) has issued a health advice with updates on the availability and use of treatments for outpatients who have mild or moderate COVID-19 and also have a higher risk of severe outbreaks of the disease.
Physicians and healthcare organizations should do everything they can to prevent COVID-19 disease progression in patients with risk factors, according to Nancy Crum, MD, MPH, an infectious disease physician with Avita Health System, in Galion, Ohio, and alternate delegate representing the Infectious Diseases Society of America i AMA House of Delegates.
“If we can get patients tested and treated quickly, we can prevent hospitalizations and deaths and improve outcomes among both vaccinated and unvaccinated patients who are at high risk for progressive serious illness,” said Dr. Crum, an AMA member.
Physicians should refer any patient with high risk factors for treatment, even if they have mild symptoms, Dr. Crum. This includes patients with heart or lung disease, obesity, cancer, kidney disease, transplant recipients, poorly controlled HIV or people over 65.
“I’ve known hundreds of people who start with mild symptoms and the next week end up being hypoxic and in need of oxygen support,” she said. “We know the risk factors that lead to poor prognosis, and we should use that experience to administer these new COVID-19 treatments.”
Read this JAMA Patient side, “Oral antiviral medicine against COVID-19. “
Patients with respiratory symptoms, including cough or sore throat, should go and be tested. “It is true that it could be a different type of respiratory virus, but there is no specific clinical symptom that distinguishes COVID-19 from other viruses,” said Dr. Crum. “COVID-19, including mild to moderate cases, has specific therapy now available, so it’s important to differentiate.”
PCR tests are widely available in doctors’ offices and elsewhere, and it is also possible to do a quick test at home. The earlier the diagnosis is made, the earlier patients can start with these drugs, which are most effective in the first few days of illness, she said.
Testing earlier can also be a boon for public health, added Dr. Crum. “If you’re positive, you should isolate yourself to protect people out there who are not vaccinated, have an increased risk of severe COVID-19 outcomes, or are immunocompromised.”
Physicians currently have several treatments for mild to moderate COVID-19 available to them.
Paxlovid (PDF), an oral antiviral agent combined with an HIV drug, and remdesivir (marketed as Veklury) are the two best recommended by the CDC due to strong efficacy data, said Dr. Crum.
ONE New England Journal of Medicine examination showed that Paxlovid was 89% effective in preventing severe progressive disease. “It’s an oral drug, so it’s easy compared to taking a pill for five days and does not need an infusion,” said Dr. Crum. Ashish Jha, MD, White House COVID-19 Response Coordinator, has stated that people at high risk of COVID-19 complications should be a priority for Paxlovid.
The use of remdesivir goes beyond serious inpatient cases, as data show that it is effective in treating mild to moderate disease in outpatient settings and can be given as a three-day course.
Other options if Paxlovid or remdesivir are not available, feasible or clinically appropriate include a monoclonal antibody infusion known as bebtelovimab and an antiviral agent known as molnupiravir.
Bebtelovimab has shown in vitro efficacy against BA.2 variants. Although there are insufficient data on hospitalization and mortality in patients with COVID-19 patients receiving bebtelovimab, this drug has a mechanism of action similar to that of other anti-SARS-CoV-2 monoclonal antibodies that has been shown to reduce hospitalization or death in high-risk patients. .
Molnupiravir (PDF) is another five-day oral antiviral drug treatment, although its efficacy data are not as strong and mutagenicity remains a concern.
The course of treatment for all these therapies is very short, only a few days or a single infusion, noted Dr. Crum. Antiviral drugs should be given within five days of symptom onset. Belt desivir and monoclonal antibodies should be started within seven days of the onset of symptoms.
Learn what doctors would like patients to know about COVID-19 antiviral drugs.
Access to treatments has been an issue, especially with regard to Paxlovid. The Biden administration announced plans to nearly double the number of sites where antiviral drugs are available in the United States to 40,000. Locations include pharmacies, local health centers, hospitals, acute care centers, Veterans Affairs clinics and Department of Defense facilities.
Dr. Crum’s own pharmacy at Avita Health has worked with the state to obtain and distribute oral antiviral drugs, and has issued regular bulletins to providers about “what is available and how to obtain it.”
Visit AMA COVID-19 Resource Center for Physicians for clinical information, guidelines and resources and updates on advocacy and medical ethics.