COVID therapies important step on pathway out of pandemic

MASSACHUSETTS IS THANKFULLY seeing sustained decreases in COVID-19 cases, hospitalizations, and deaths. In the early days of the COVID-19 pandemic, there was limited testing capability, no specific therapies, and no vaccines. Today, we have a plethora of tools at our disposal to manage COVID-19 and, because of this, students are learning in person and businesses are welcoming workers back to offices. While all of this is great progress, it is important to remember that we will be living with COVID-19 for some time.

But there are many reasons to be hopeful and we are optimistic that an array of effective and accessible therapies will help us transition to an endemic phase of COVID-19.

With an overwhelming majority of residents vaccinated, others with immunity from infection, readily available effective oral treatments for early disease and potent treatments for severe disease, we are entering a period of less severe disease, decreased transmission, and likely decreased symptoms.  A continued multipronged approach using all of the tools in our toolbox is critical to ensuring that spread will be limited, vulnerable persons will be protected, and the healthcare system will not be overwhelmed.

As we look forward, we are well-positioned to manage COVID-19, with vaccines and boosters critically important and the single most impactful tools in that toolbox.

The wide availability of convenient at-home testing kits provides help in detecting individual cases and decreasing community spread by providing real time results of infectious periods of COVID-19.  Making these kits available at low or no-cost has been a game changer; it is vital that our federal government and private industry work together to ensure an ongoing supply of tests.  Mitigation measures including good general hygiene, masking for individuals at higher risk of severe COVID-19, and proper isolation and quarantine protocols provide additional protection.

As we emerge from the Omicron surge, our focus has turned to how we learn to live with COVID-19 and how we transition from the pandemic to endemic state.  The new available therapies play an important role in this progress.

There are a number of treatments for patients at high risk of complications of COVID-19 and those who may not respond fully to vaccination.

These medications are available to patients infected with COVID-19.  Remdesivir, dexamethasone, tocilizumab, and barcitinib have proven effective in treating hospitalized patients.  Their use is recommended by experts and supported by guidelines from the National Institutes of Health (and Infectious Diseases Society of America.  They are being widely prescribed in hospitals across the Commonwealth and have proven to be life saving for many patients.

Monoclonal antibodies, remdesivir, and most recently two oral antiviral therapies, molnupirivir and nirmatrelvir + ritonavir (Paxlovid), have been authorized for treatment of early disease in patients at high risk for complications of COVID-19 outside the hospital. These are all effective in preventing severe illness.

The antibody sotrovimab is effective against omicron, requires intravenous infusion and one hour observation, and is available at infusion centers and emergency rooms across Massachusetts.  Bebtelovimab should be infused within 7 days of diagnosis and will be provided at infusion centers across Massachusetts. Molnupiravir is authorized for outpatient treatment of adults with mild to moderate COVID-19 within 5 days of symptom onset. These last two treatments are for use when other options are not accessible or clinically appropriate.

While the initial availability of these therapies was limited and early uptake was slow, supplies have vastly improved. They are widely available across the Commonwealth and can help prevent hospitalization and reduce the chance for severe disease. As medical providers, it is our collective responsibility to speak with our patients about these therapies and ensure that they have access to these treatments if clinically appropriate.

Residents of the Commonwealth should know that they live in a state that is well prepared and at the ready to provide the necessary therapies if the need arises. If you test positive for COVID-19, speak with your doctor about treatment options available to you. These treatments are free, effective, and could keep you from becoming severely ill from COVID-19.

Thankfully we now have such tools, in addition to vaccines, to help us continue moving into a better future, one in which COVID is a manageable part of our everyday lives.

Dr. Helen Boucher is the interim dean of Tufts University School of Medicine, chief academic officer at Tufts Medicine, and an infectious disease physician at Tufts Medical Center. Dr. Larry Madoff is an infectious disease physician and medical director in the Bureau of Infectious Disease and Laboratory Sciences at the Massachusetts Department of Public Health.