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COVID-19 Outpatient Treatment

Outpatient Treatment and therapies for COVID-19 can greatly reduce the risk of developing severe COVID-19.

Treatment for COVID-19 when symptoms are still quite mild can greatly reduce risk of developing severe COVID-19. These treatments help you get better faster and avoid needing to be hospitalized. These therapies are available at Mass General Brigham and at Massachusetts Department of Public Health treatment sites.

Patients at increased risk of severe COVID-19 are eligible. About 40% of all Mass General Brigham patients have increased risk conditions and are eligible.

Please see below for additional details regarding outpatient treatment options for COVID-19.

Oral antiviral treatments for COVID-19 - Paxlovid

Oral antiviral treatments are taken by mouth to treat mild to moderate symptoms of COVID-19. The Food and Drug Administration (FDA) has issued an emergency use authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets). This medication slows down COVID-19’s ability to replicate.

It is used for patients who are symptomatic from COVID-19. It is not available for patients who have been exposed to COVID-19, but have not contracted the virus.

Paxlovid is an oral pill. It is available by prescription only.

Paxlovid must be given with 5 days of the start of symptoms.

Yes. The oral antiviral treatment is available for vaccinated and not-yet-vaccinated patients.

Yes. The antiviral treatment could help you, too.

Researchers at Mass General Brigham have found that Paxlovid reduces chances of being hospitalized or dying from COVID-19 by 45%.

Paxlovid therapy is available for patients age 12 years and older who:

  • Weigh at least 40 kilograms (a little over 88 pounds) AND
  • Have COVID-19 confirmed by either antigen or PCR testing AND
  • Have symptomatic COVID-19 AND
  • Are within 5 days of the start of symptoms AND
  • Have a health condition that makes them more likely to experience severe COVID-19 infection.

Paxlovid can interact with other medications. Please let your care team know all the medications and supplements you are taking.

Paxlovid should not be used without specific discussion with your care team if you:

  • Have had a transplant and must take tacrolimus, cyclosporine, everolimus, or sirolimus
  • Have severe kidney or liver disease
  • Require certain anticoagulant medications (clopidogrel, rivaroxaban, or others)
  • Take many chemotherapy medications
  • Take St. John’s wort

There are other equally effective options for patients who have COVID-19 who cannot take Paxlovid. Contact your care team to understand what your best option might be.

No. Paxlovid has been provided free by the US Government and you can receive it no cost.

If you think you might be eligible for treatment, please contact your primary care or specialty care team. They can refer you for treatment.

For Massachusetts residents, there is also a free telehealth program to get oral Paxlovid treatment. This is offered through the Department of Public Health. You can get started on their website. Hours are 8 a.m. to 10 p.m. daily. Their services are available in English, Spanish, Haitian Creole, and Portuguese. Find out more information about program eligibility and Paxlovid on the mass.gov website.

Monoclonal antibodies (mAb) - Bebtelovimab

The Federal Drug Administration (FDA) has issued emergency use authorization (EUA) for several investigational monoclonal antibodies. These antibodies can help the immune system respond to fight the virus. The NIH COVID-19 Treatment Guidelines provide information about these drugs.

Bebtelovimab is the only monoclonal antibody effective against the COVID-19 BA.2 Omicron sub-variant. It is used for patients who have symptomatic COVID-19. Bebtelovimab is not available for patients who have been exposed to COVID-19 but have not contracted the virus.

Monoclonal antibody therapy is best when given within the first few days of symptoms. If your symptoms are already improving, treatment is probably not necessary.

Monoclonal antibody therapy is best when given within the first few days of symptoms. If your symptoms are already improving, treatment is probably not necessary.

You may be able to get monoclonal antibody therapy if you have been vaccinated for COVID-19. You must meet eligibility criteria.

Monoclonal antibody therapy has been shown to decrease the risk of hospitalization in patients who are at high risk for severe COVID-19 when given early in symptomatic COVID-19 infection. Trials have found a reduction in the risk of hospitalization of up to 70% to 90% with other monoclonal therapies compared with no therapy. There is no data available yet on the impact of Bebtelovimab on risk of hospitalization or death. However, laboratory testing showed that Bebtelovimab is effective against both the omicron variant and the BA.2 omicron subvariant.

Bebtelovimab therapy is available for patients who are ages 12 years and older and:

  • Weigh at least 40 kilograms (a little over 88 pounds) AND
  • Have COVID-19 confirmed by either antigen or PCR testing AND
  • Have symptomatic COVID-19 AND 
  • Are within 7 days of the start of symptoms AND
  • Have a health condition that makes them more likely to experience severe COVID-19 infection.
  • Generally used for only patients who cannot take Paxlovid

It depends. Bebtelovimab was previously provided for free by the US Government but is now billed to your insurance. Massachusetts residents will not need to pay for co-payments, deductibles, or out-of-network costs. Costs for residents of other states may depend on your insurance.

These therapies are available at Mass General Brigham and at treatment sites at other hospitals. If you think you might be eligible for treatment, please contact your primary care provider or specialist. They can refer you for treatment.

Do not go to urgent care or the emergency room for any of these therapies. They are not available at those locations. There are specific clinics designed to give this therapy.

If you are able to get the therapy, we will contact you with information and instructions. For patients who are on Patient Gateway, we will send a Patient Gateway message if we determine that we cannot offer treatment. If you are not enrolled in Patient Gateway, you can sign up here.

If your provider has referred you to Department of Public Health treatment sites, you will receive a call if you can be accommodated. They do not currently contact patients or Mass General Brigham if you cannot be treated.

Evusheld 

Tixagevimab/Cilgavimab (Evusheld) is an antibody cocktail used to prevent COVID-19 in people who cannot be adequately protected by vaccination. The Federal Drug Administration (FDA) has issued emergency use authorization (EUA) for Evusheld. 

This medication contains monoclonal antibodies that can help the immune system respond to fight the virus. It is used to reduce the risk of COVID-19 infection in patients who have a weakened immune system. It is not a substitute for vaccination. It is also not used to treat COVID-19 infection. The NIH COVID-19 Treatment Guidelines provide information about this drug.

Evusheld is given as an injection. It is not a pill.

Evusheld is available for patients ages 12 years and older who:

  • Weigh at least 40kg (a little over 88 pounds) AND
  • Do not have an active COVID-19 infection or a recent exposure AND
  • Are up to date on COVID-19 vaccines (unless there is a medical reason against vaccination, such as severe allergies) AND 
  • Have a weakened immune system and therefore, may have an inadequate immune response to COVID-19 vaccination

Evusheld should be given every six months or until your immune system can sufficiently protect you.

Yes. You must be fully vaccinated prior to receiving Evusheld. Of note, Evusheld should be administered at least 2 weeks after vaccination.

No. Evusheld is not a substitute for COVID-19 vaccination. It will not be used in unvaccinated people who are expected to have an adequate immune response to vaccination. The only exception is if there is a medical reason against vaccination (for example: history of severe allergic reaction to the COVID-19 vaccine).

Evusheld has been shown to reduce the chance of infection by 77% in one study in people with normal immune systems. Mass General Brigham researchers found that Evusheld reduced risk of COVID-19 by 60% in immunocompromised organ transplant recipients.

Yes, you will need to receive a dose every 6 months if ongoing protection is needed.

If you think you might be eligible, please contact your primary care provider or specialist. They can provide or refer you to receive Evusheld.

Please note that Evusheld is not used for COVID-19 treatment. It is used to reduce the risk of COVID-19 infection in patients with a weakened immune system.

Do not go to urgent care or the emergency room or urgent care for Evusheld therapy; It is not available at those locations. There are specific clinics designed to give this therapy.

If you can get the therapy, we will contact you with information and instructions. For patients who are on Patient Gateway, we will send a Patient Gateway message if we determine that we cannot offer treatment.

Who is eligible for these treatments?

To receive outpatient treatments for COVID-19, you must have COVID-19 confirmed by either antigen or PCR testing. You must also have a health condition that makes you more likely to experience severe COVID-19 infection. Patients are prioritized for the available treatments based on their risk of severe COVID-19.

High-risk conditions for severe COVID-19 include undergoing treatment for cancer, currently taking medications for transplant, or immunosuppressant medications for other conditions. Other high-risk conditions, including having chronic lung, kidney, or liver disease; diabetes; HIV; obesity; and age 65 years or older, may predispose you to worse symptoms from COVID-19 or influenza.

Learn more about predisposing health conditions from the CDC

 
Updated 9/20/2022