What you should know about COVID treatments

Free and effective treatments for COVID-19 are readily available to Massachusetts patients at increased risk of severe illness, according to clinicians and public health officials, who urge patients to talk to their doctors if they get infected. 

“Fortunately, there is now a strong supply of these treatments available in our state for at-risk patients,” said Dr. Ashley Yeats, vice president of medical operations at Blue Cross Blue Shield of Massachusetts. “If you test positive, even if you have mild symptoms like a runny nose or sore throat, please talk to your doctor about whether treatment may be appropriate to help prevent hospitalization.”
 

Who should consider treatment?

“If you’ve tested positive for COVID, are in a high risk group and have any symptoms, these treatments may help keep you from getting very sick,” said Dr. Estavan Garcia, chief medical officer of the Massachusetts Department of Public Health, in an informational video. 

People who are considered at high risk for severe disease include those who are older than 55 or have an underlying condition such as heart, lung, liver or kidney disease or diabetes, are overweight, have a substance use or mental health disorder, or whose immune system is suppressed by illness or medication. This group includes nearly 40% of all Massachusetts residents.

What kinds of treatments are available?

The FDA has authorized two kinds of COVID treatments for people who are at higher risk for moderate-to-severe COVID-19 illness: monoclonal antibodies and antiviral therapies. 

Antivirals

Antivirals work to keep the virus from replicating, which reduces your viral load and can help reduce the severity of your symptoms. These must be taken within 5 days of your first COVID-19 symptoms and include new pills as well as Remdesivir, taken via IV.

• Paxlovid is currently recommended as the first-line treatment. This antiviral, available to people 12 and up, interferes with key proteins the virus needs to replicate. Patients take three tablets twice daily for five days. In clinical trials, Paxlovid reduced COVID-19-related hospitalizations by almost 90%, and was generally tolerated well, without serious side effects. A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the virus that causes COVID-19) infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status. Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease. There is currently no evidence that additional treatment is needed with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected. Talk to your doctor about whether Paxlovid is appropriate for you, or could interfere with other regular medications you have been prescribed. Paxlovid also is available through some telehealth services, including a prescription and delivery service that is free to Massachusetts adults. 
• Molnupiravir introduces errors into the virus' genetic code, preventing it from making copies of itself. Patients take four tablets every 12 hours for five days. Because Molnupiravir is not recommended during pregnancy and is less effective at reducing COVID-19-related hospitalizations than other treatments (30% in clinical trials), it is authorized only for people 18 and older when other treatments are not accessible or clinically appropriate.
• Remdesivir is administered as a series of three daily intravenous infusions. Because of this, it may be less convenient than taking oral pills or a single dose of an intravenous monoclonal antibody treatment. In clinical trials Remdesivir decreased the risk of severe COVID-19 by 87%. It has also been studied in pregnancy and has very few interactions with other medications. It is authorized for people 12 and up who are high-risk, and for high-risk, hospitalized children who are 28 days or older.

Monoclonal antibodies

Antibodies are protective proteins that your body makes to fight viruses, for example, by blocking them from attaching to human cells, making it more difficult for the virus to reproduce. Monoclonal antibodies are made in a laboratory and act a lot like natural antibodies. 

• If antivirals are not an option for you, a clinician may recommend Bebtelovimab, a newer antibody treatment which is given by IV within 7 days of your first COVID symptom and is authorized for people 12 and up. Laboratory data has shown Bebtelovimab helps fight a broad range of COVID variants, including the latest Omicron subvariant, which is now dominant in Massachusetts.

Guidance may change as new variants develops. And like all medications, antivirals and monoclonal antibodies have side effects, and are not appropriate for everyone.

Note that after recovering, some people may experience a brief return of symptoms and again test positive, regardless of whether they received COVID treatment. Such "rebounds" are generally mild and no additional treatment is needed.

How to get access to treatment

The FDA has authorized pharmacists to prescribe Paxlovid and you can find a site here or by checking with your local pharmacy.

In Massachusetts, you also can contact Massachusetts’ Paxlovid treatment and delivery hotline, or call the COVID-19 Self-Referral Treatment Line, Monday-Saturday, 8 a.m.-6 p.m. at (508) 213-1380 to learn about monoclonal antibody treatment. See nationwide availability for both antiviral and monoclonal antibody treatments here and Massachusetts sites here.  

“If you have any kind of risk factor such as diabetes or high blood pressure or asthma, we encourage you to call your provider or the Gothams phone number immediately to see if treatment could be right for you,” said Public Health Commissioner Margret Cooke. “Do not wait to see if your symptoms worsen.”

Oral antivirals also are available at select CVS and Walgreens retail pharmacies. 

An interactive map shows all locations in the state with available antiviral pills and monoclonal antibody treatment. 

Vaccination is still the best protection

These treatments cannot be used before you are exposed or before you test positive.

“Free, safe vaccines and boosters remain the most effective way to lower your risk of developing COVID-19, avoid spreading the infection to anyone else, and stay out of the hospital,” Yeats said. 

^{PHOTO OF Dr. ASHLEY YEATS BY MICHAEL GRIMMETT}