Treatment of patients with COVID-19
Drugs and biologics are available to treat patients with COVID-19, including antivirals
Antiviral treatment options for adults with COVID-19
According to Ontario Health guidance, antiviral COVID-19 treatments in Ontario should be strongly considered for individuals with COVID-19 symptoms and a positive SARS-CoV-2 test (PCR, rapid molecular or rapid antigen) who are at high risk for severe outcomes from COVID-19.
High-risk individuals who are recommended to receive antiviral therapy are:
- Aged 65+
- Aged 18+ who are immunocompromised
Antiviral therapy may be considered for high-risk individuals who are:
- Aged 18+ with one or more medical condition(s) or health-related social need(s) that puts them at higher risk of disease progression
- Refer to Ontario Health’s antiviral therapy recommendations to help identify patients at higher risk for disease progression based on the number of conditions they are experiencing and how well these are controlled
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Individuals with solid organ transplants who test positive for COVID-19 should contact their transplant care team for COVID-19 treatment and follow-up care
- Aged 18+ who never received a COVID-19 vaccine
Individuals who are at a higher risk of poor outcomes from COVID-19 based on social determinants of health should also be considered priority populations for access to COVID-19 antiviral therapies. These include individuals aged 18+ who:
- Are members of First Nations, Inuit, Métis and urban Indigenous communities, Black communities or other racialized communities
- Have an intellectual, developmental or cognitive disability
- Use substances regularly (e.g. alcohol)
- Live with mental health conditions
- Are underhoused
Treatment planning for high-risk patients
Discuss treatment options with high-risk patients and care partners to determine eligibility for COVID-19 therapies and to help develop a treatment plan before any potential infection, so patients can access treatment as quickly as possible when needed.
Treatment plans should include:
- Patient goals for care
- Where patients can get tested, including rapid antigen tests for patients to use at home which you can access through the Provincial Antigen Screen Program
- Signs and symptoms of COVID-19 and when testing and medical care are needed
- Healthcare provider contacts for evaluation and treatment following a positive test
- Up-to-date renal function tests and other relevant workups (e.g. eGFR, ALT)
- Up-to-date medication history, including vitamins, minerals and supplements
- Proactive assessment of drug-drug interactions to determine mitigation strategies or alternate therapies that may be needed
- How to access COVID-19 therapies locally, including drug funding options
You may choose to contact high-risk patients proactively to provide them with information on antiviral therapies so that they are prepared if they develop COVID-19 symptoms. You can do so during appointments, via email or phone, on your practice’s website or online portal, through community partners or through broader electronic communications to all patients where feasible.
You can also proactively put a COVID-19 antiviral prescription on file for your patient at their local pharmacy. Patients will require a positive test to fill the prescription.
Therapeutic Support Line
Physicians can get evidence-based information about COVID-19 therapeutics, including eligibility, access, managing potential drug interactions and navigating specific clinical scenarios, through the Ontario Pharmacists Association’s COVID-19 Therapeutics Support Line. This free service, available by phone at 1-888-519-6069, is staffed by registered pharmacists from 10 a.m. to 8 p.m. ET daily and has a chatbot to answer questions after hours. The service is funded by an unrestricted quality improvement grant from Pfizer.
Treatment options that are no longer available
Sotrovimab
Sotrovimab, a monoclonal antibody, is no longer recommended for the treatment of COVID-19.
Evusheld
Ontario Health released a memo on Dec. 12 no longer recommending for the routine use of Evusheld for pre-exposure prophylaxis and for treatment of COVID-19, due to recent evidence showing that it is likely ineffective against new circulating variants. Health Canada also advises that Evusheld may not be effective against certain SARS-CoV-2 Omicron subvariants when used as a prophylaxis or treatment for COVID-19.