The number of COVID cases in Massachusetts is trending down, but it’s still higher than at any time before omicron. That means there are still a lot of people getting sick with COVID.
Several treatments are available that promise to help keep patients out of hospital, but they are rare. We spoke to doctors about COVID treatment options, who gets them, and when the supply will improve:
What treatments are there for people with COVID?
In an outpatient setting, four drugs are used to help people with omicron infections.
Two are given intravenously: a monoclonal antibody treatment called sotrovimab and an antiviral drug called remdesivir. They have both been shown to be very effective in preventing serious illnesses. However, there are challenges. The supply of sotrovimab is limited. In addition, administering drugs intravenously adds logistical complications, especially since there are staffing shortages throughout the health system.
The other two drugs are antivirals taken by mouth. These two drugs were approved just over a month ago and are the first home treatments available.
Pfizer’s treatment – called paxlovid – is nearly 90% effective in preventing hospitalization and death. But it is very rare and has only recently become available to patients in Massachusetts. Merck’s pill, molnupiravir, is closer to 30% effective and is considered a backup option. Both of these treatments should be taken soon after the first signs of infection appear.
Despite the challenges, these treatments are helping, doctors say.
“It’s hard to overestimate the impact of these drugs, if given to the highest priority group – the most vulnerable people,” said Scott Dryden-Peterson, infectious disease physician and medical director of outpatient therapy. Mass General Brigham’s COVID. “If you get three doses, you avoid about one hospitalization.”
This is essential, he said, given that the hospitals are very, very full.
Who receives these treatments?
Currently, there are not enough of these drugs for everyone who catches the coronavirus. And, to really work, these drugs need to be given to patients quickly, without knowing who will become seriously ill. (Most drugs should be given within five days of the onset of symptoms. Monoclonal antibody therapy can be given up to 10 days after the onset of symptoms.)
That means doctors need to prioritize people they think are most likely to end up in hospital with severe COVID.
There are state guidelines that help doctors determine who should be eligible. They are based on four factors: age, vaccination status, immune status and other clinical risk factors.
The most-at-risk population – called Level 1 – includes moderately to severely immunocompromised people, people who are not fully vaccinated and over the age of 75, and people who are not fully vaccinated, over the age of 65 and have another factor. risk such as heart failure. or lung disease.
Until very recently, there were insufficient staff and supplies to treat all Massachusetts Level 1 patients. This meant that many hospitals turned to lottery systems to determine who received the limited doses.
Now things are looking up. That’s because Pfizer’s oral antiviral drugs have started reaching patients, and the number of highly vulnerable patients has started to decline as the total number of cases in the state declines.
Sandeep Jubbal, infectious disease physician and medical director of UMass Memorial Health’s COVID Treatment Center, said as of last week his center was able to provide treatment to all Level 1 patients and people of the next priority group, level 2. The staff is even considering opening levels 3 and 4.
“This is great news,” Jubbal said.
What should I do if I have COVID and think I might benefit from treatment?
The reality on the ground can be messy. Some patients go from doctor to doctor, or from emergency department to emergency department, trying to find someone who can provide them with authorized treatment.
But that’s not how the system is supposed to work. In Massachusetts, as soon as you test positive, healthcare professionals advise you to contact your primary care physician or specialist. Your doctor will help you determine if you might be eligible for treatment and check your medical records – for example, people with severe kidney problems should not take paxlovid. Then, if you qualify, your doctor can list you at a treatment center.
Some states rely on commercial pharmacies to dispense treatments, but Massachusetts has focused on medical centers and mobile sites. Many of these treatment sites are now accepting rapid home test results and not waiting for PCR tests, as it can sometimes take a while for PCR test results to come back.
Jubbal says there are discussions about creating a system where patients can call a treatment center themselves and not go through their doctor. But, he said, that won’t happen anytime soon.
Have there been negative reactions regarding the distribution of treatments to unvaccinated people?
Yes, there was frustration about that. However, experts say, it’s important to remember that the goal is to keep as many people alive and out of hospital as possible. This is partly so that hospitals are not overwhelmed and can treat patients with COVID as well as non-COVID conditions.
Jubbal said he had heard a lot about this concern. “The reason is that given the current influx of unvaccinated patients, they have the highest risk of being hospitalized. And patients who are vaccinated, they usually don’t get to the point or fall enough sick to be admitted to hospital,” he said.
As the UMass Treatment Center begins offering COVID drugs to Tier 3 and Tier 4 patients, Jubbal said he will prioritize those who are vaccinated but not boosted. This is because vaccination and booster already do a very good job of preventing hospitalization and death.
Is the limited supply distributed fairly?
Unfortunately, there are signs nationwide that the treatment available is not necessarily reaching everyone equally. A recent report from the CDC found that early in the pandemic, black, Hispanic, and Asian individuals were less likely to receive monoclonal antibody treatments.
When will the offer improve?
Although the release of paxlovid and declining cases have improved the situation in Massachusetts, Dryden-Peterson expects the supply of COVID therapies to be very tight until at least February.
The hope is that eventually treating COVID will be more like treating the flu. If you catch the flu and your doctor thinks you’re at risk for serious illness, you can go to your local pharmacy and get some antiviral medicine. But Dryden-Peterson says that reality is still “far in the future.”
