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COVID medication
My family's biggest fear since the onset of the pandemic was realized last week when both my parents tested positive for COVID-19. Fully vaccinated and boosted, they each experienced different symptoms. But besides their positive test results, the only commonality was the difficulty in navigating how to get them medications. My healthy 74-year-old mother was hit first with a severe sore throat that lasted about five days. It took three, at-home rapid test kits before she had a positive result (at Day 3 of her symptoms).
Meanwhile, we sent my asymptomatic father, who is 77 and diabetic, to get a PCR test. The testing site at MSP Airport returned his (positive!) results in less than 24 hours. Though he never developed symptoms beyond mild nausea, we were concerned about his risk for developing severe illness in the future.
What I learned in my personal experience is there are currently two different treatments being offered: monochlonal antibodies and oral antivirals. And while supply of the medications is constantly fluctuating, there is availability for those at greatest risk if you can navigate the complicated maze of accessing them. Dr. Mark Sannes, infectious disease physician at HealthPartners, tried to break it down for me.
Are monochlonal antibodies still being recommended?
"The previously used monoclonal antibodies are no longer effective against Omicron due to the mutations in the spike protein on the Omicron virus," says Dr. Sannes. "Only sotrovimab retained activity against this variant."
How do you choose between monochlonal antibodies and antivirals?
"Monoclonal antibodies (currently only sotrovimab) are offered for patients who are not requiring hospitalization but are at high-risk for progression to severe disease," says Dr. Sannes. "Symptom onset greater than 5 days ago would push someone toward monoclonal antibodies (sotrovimab), and they need to get treated within 7 days of symptom onset."
To see if you qualify for sotrovimab, fill out the Minnesota Resource Allocation Platform (MNRAP) Screening Form on the Minnesota Department of Health website. There are three steps in the form, so be sure to click the blue-and-green boxes at the bottom of each page until you get to the questionnaire. If you qualify after filling out the form, you'll immediately be offered a choice of clinic locations. In the case of my dad, who qualified, I was able to choose from a handful of clinic locations run by Matrix Medical, a private company contracted by the state of Minnesota. Within 24 hours, my dad received a call from Matrix, who scheduled a same-day appointment to determine if the monochlonal antibodies treatment was right for him. After reviewing his health history and medications, the provider on site determined that he was a good candidate for the treatment, and he received an infusion that took about an hour.
How do you determine if someone qualifies for one of the antivirals?
"First of all, individuals need to have a positive test to qualify for antivirals," says Dr. Sannes. "If they were tested at HealthPartners facilities and the result is positive, we use their existing medical history to determine if they are deemed high risk on a scoring model that is used statewide to see who qualifies for treatment using our limited supply of Paxlovid and molnupiravir.
"For those scoring 4 and higher—e.g. age > 65 (2 points), BMI>35 (2 points), etc.*—we offer Paxlovid twice daily for 5 days until our supply has been exhausted. When we run out of Paxlovid, we offer molnupiravir twice daily for five days to these patients until that supply is exhausted. Molnupiravir is in greater supply and is also used for patients who score 1 or higher on the same model shown below. Both of the oral antiviral therapies need to be started within five days of symptom onset, so getting tested early is important."
According to Dr. Sannes, studies have shown that Paxlovid reduces the risk of hospitalization and death by 85%, while molnupiravir decreases it by 30%.
We tried to get her a virtual appointment with her primary care physician, but that proved fruitless and frustrating. We were told that she needed to go in person (with active COVID symptoms) to her doctor's office, only to be turned away when she got there. There doesn't to be a streamlined universal process across health care systems for assessing need and prescribing Covid meds. (I reached out to the major systems and only heard back from one, HealthPartners.)
Both of my parents recovered fully. My mom's sore throat, which she compared to the worst strep she's ever had, subsided within about five days, and my dad's mild nausea was gone in 48 hours. He had no negative side effects after the monochlonal antibodies infusion.
*MASSBP score is calculated as follows with scores ≥4 bring prioritized for allocation initially:
- Age ≥65 years (2 points)
- BMI ≥35 kg/m2 (2 points)
- Diabetes mellitus (2 points)
- Chronic kidney disease (3 points)
- Cardiovascular disease in a patient ≥55 years (2 points)
- Chronic respiratory disease in a patient ≥55 years (3 points)
- Hypertension in patient ≥55 years (1 point)
- Immunocompromised status (4 points)
- Pregnancy (4 points)
