Test and Treat is a crucial strategy for people and society returning to more normal activities.
Now that the early responses to the COVID-19 pandemic have — somehow — been met (i.e. minimizing infection, spread, illness and death through masks, testing, contact tracing, social distancing and vaccines), we now face the challenge of treatment from acute COVID-19. (Treating long COVID is another major challenge.)
I had already described the further development of strategies to contain and prevent public health, from vaccines to treatment, in various presentations and discussions in the summer of 2020. Fortunately, test and treat is now possible as effective treatments for acute COVID-19 are available. More importantly, conversations I had with various people back in the fall of 2020 indicated that being able to get treatment for COVID-19 (even without a vaccine) would make people more willing to adapt to more normal ones Engaging in activities – that is, things that might put them at a higher risk of infection.
The good news is that there are now five different outpatient treatments available for people with acute COVID who are at high risk of developing serious illness. According to the NIH COVID-19 Treatment Guidelines Panelthree of these options are preferred, with two more being alternatives when the first three are not available or clinically appropriate:
Preferred therapies for non-hospitalized patients with mild to moderate COVID-19 who are at high risk of progressing to severe disease (listed in order of preference):
Paxlovid (Nirmatrelvir 300 mg with ritonavir 100 mg) orally twice daily for 5 days, initiated as soon as possible and within 5 days of symptom onset in subjects ≥ 12 years of age and weighing ≥ 40 kg
sotrovimab 500 mg as a single intravenous (IV) infusion administered as soon as possible and within 7 days of onset of symptoms in subjects ≥ 12 years of age and weighing ≥ 40 kg
remdesivir 200 mg IV on Day 1, followed by remdesivir 100 mg IV once daily on Days 2 and 3, initiated as soon as possible and within 7 days of onset of symptoms in subjects ≥ 12 years of age and body weight ≥ 40 kg
alternative therapies, when none of the preferred therapies for non-hospitalized high-risk patients are available, feasible, or clinically appropriate (listed in alphabetical order):
betelovam 175 mg as a single intravenous infusion administered as soon as possible and within 7 days of onset of symptoms in subjects ≥ 12 years of age and weighing ≥ 40 kg
molnupiravir 800 mg po twice daily for 5 days, beginning as soon as possible and within 5 days of symptom onset in subjects ≥ 18 years of age
Fortunately, the availability of such treatments is increasing – as is the availability of tests to diagnose COVID-19. To raise awareness of the availability of treatments (and tests, vaccines and masks) that COVID19.gov website was launched recently and provides information on how to do this Find COVID-19 Treatments and a Test and treat website. Hopefully the government will continue to increase its support and public commitment to the critical “test and treat” part of its response to COVID.
Some clinicians may be concerned that people who have not been vaccinated will also be resistant to treatment for COVID-19. However, I was recently told of research showing that this is not true; People who are vaccine resistant or hesitant do not appear to be any more resistant or unwilling to take a drug to treat COVID-19 than vaccinated people. (This study is being prepared for publication and I will present more information about this research as it becomes available.)
While unvaccinated individuals are significantly more likely to be “at high risk of progression to serious disease,” some of these treatments may be appropriate for vaccinated patients who become ill and are concerned about progression to more serious disease. However, as with all medical decisions, the risks and benefits must be weighed for each individual and their life situation. For example, someone I know recently did this calculation after being symptomatic (i.e. “felt like shit”) for 3 days and then testing positive. They contacted their GP and discussed treatment options. Because they had been vaccinated and were not considered to be at high risk – and were a little cautious about the side effects of Paxlovid – they decided not to take the treatment. Interesting to look at Information from WebMD about Paxlovidthe most frequently reported side effect in the few patient reviews was a very unpleasant taste. Luckily, this taste has been reported to go away after the 5 days of treatment and some of the reviews include recommendations for relief.
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About dr Michael D Miller
For more than 30 years, Michael D. Miller, MD, has worked with companies large and small, government organizations and patient advocates to improve access and affordability of treatments and innovation. His work spans many clinical, scientific, and policy areas, including autoimmune diseases, behavioral health, cancer, cell/gene therapies, diabetes, patents, reimbursement, and vaccines. A graduate of Williams College and Yale Medical School, he has served on several nonprofit boards and spoken on important health issues across the country.