update on covid-19 guideline for adults
We are now farther along in the pandemic and on to the third major variant, omicron, which is now dominant. This variant presents a totally different disease pattern than the others.
Here are updated management recommendations.
If a person requires hospitalization for Covid-19, Sotrovimab plus dexamethasone are commonly used.
Here are updated management recommendations.
- We encourage patients to take advantage of the available vaccines and completes the course
- two doses of Pfizer plus a booster, or
- two doses of Moderna plus a booster, or
- one dose of J&J plus an mRNA booster.
- If a breakthrough case of the omicron variant occurs, the symptoms will usually be minor if the individual has had the full set of vaccines. Most people have a sore throat and stuffy nose and can stay home (even if they have adrenal insufficiency) if they have no symptoms of pneumonia or high fever.
- However, if acute Covid-19 occurs in an unvaccinated or partially vaccinated person, the disease may be more severe. If significant symptoms do occur, we now have two potential treatments that can provide improvement and potentially reduce the need for hospital treatment. They are Sotrovimab, a monoclonal antibody infusion that works for omicron and Paxlovid, an oral medication from Pfizer.
- Each of these treatments must be started within 5 days of the onset of symptoms, but preferable within 3 days.
- The personal physician treating the patient must have proof of a positive PCR and refer the patient to a regional hospital or health system that has access to these drugs. The final determination and prescription will be made by that facility based on availability, severity of disease, and guidelines that are used to stratify the risk of severe complications with the person's medical history.
- Those with a severe illness of any kind that necessitates Emergency Department treatment will require stress doses of glucocorticoids using our usual guidelines.
- Steroid dosing guidelines for illness are found here https://www.nadf.us/uploads/1/3/0/1/130191972/nadf_stress-dosing_guidelines.pdf
If a person requires hospitalization for Covid-19, Sotrovimab plus dexamethasone are commonly used.
FDA approves antiviral pills to treat covid-19 at home
The Food and Drug Administration announced an emergency use authorization (EUA) of antiviral treatments for mild-to-moderate coronavirus disease (Covid-19) on December 22 and 23rd. This wonderful news provides a useful new course of action for covid-19 infections, including breakthrough cases of omicron as well as the other variants.
These antiviral treatments will eventually be for everyone, but initially will be indicated especially for those who are at high risk of complications, including those with adrenal insufficiency. The remedies will be very similar to the use of Tamiflu which is used for acute cases of influenza.
A provider will need to verify a positive PCR, symptoms of covid, and then start the treatments within 5 days of onset. However, currently these therapies are not available but are expected to be distributed gradually in the next month, with supplies increasing over the next few months.
In the meantime, those who do have breakthrough symptomatic illness should try to get the one monoclonal antibody infusion that works for omicron, though it is difficult to get because of shortages. Regeneron and Eli Lilly both announced their antibody treatments didn’t work as effectively in diffusing omicron.
Before any treatments, patients must review their current condition with their physician, including the list of medications they are currently taking. Some drugs cannot be taken with these new antiviral treatments.
More information can be found in FDA’s announcements:
Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19 | FDA
Coronavirus (COVID-19) Update: FDA Authorizes Additional Oral Antiviral for Treatment of COVID-19 in Certain Adults | FDA
These antiviral treatments will eventually be for everyone, but initially will be indicated especially for those who are at high risk of complications, including those with adrenal insufficiency. The remedies will be very similar to the use of Tamiflu which is used for acute cases of influenza.
A provider will need to verify a positive PCR, symptoms of covid, and then start the treatments within 5 days of onset. However, currently these therapies are not available but are expected to be distributed gradually in the next month, with supplies increasing over the next few months.
In the meantime, those who do have breakthrough symptomatic illness should try to get the one monoclonal antibody infusion that works for omicron, though it is difficult to get because of shortages. Regeneron and Eli Lilly both announced their antibody treatments didn’t work as effectively in diffusing omicron.
Before any treatments, patients must review their current condition with their physician, including the list of medications they are currently taking. Some drugs cannot be taken with these new antiviral treatments.
More information can be found in FDA’s announcements:
Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19 | FDA
Coronavirus (COVID-19) Update: FDA Authorizes Additional Oral Antiviral for Treatment of COVID-19 in Certain Adults | FDA
COVID-19 FOR EMERGENCY AND HOSPITAL PERSONNEL FOR CHILDREN WITH ADRENAL INSUFFICIENCY
Please refer here for information regarding ER treatment for children. The adult section is currently being updated.
https://www.nadf.us/covid19-er-hospital-children.html
https://www.nadf.us/covid19-er-hospital-children.html
