COVID-19 Treatments

Some new medications have received emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) to treat mild-to-moderate COVID-19. These therapies are for use in individuals at high risk of developing severe illness if infected with COVID-19. Most individuals with COVID-19 have mild illness and can recover at home without medical care. Read more from Dartmouth Hitchcock Medical Center and Clinics about common symptoms and recovering at home.

Cheshire Medical Center has two new treatments for COVID-19—Paxlovid and Bebtelovimab—on an outpatient basis for eligible patients. These treatments remain active against all known COVID-19 variants circulating in the region at this time.

Over the past few weeks, Omicron BA.2 has overtaken BA.1 as the predominant COVID-19 variant in certain parts of the country. While Sotrovimab has been utilized as the COVID-19 monoclonal antibody of choice throughout Dartmouth Health over the past few months due to retention of activity against Omicron BA.1, it has been found to have decreased neutralizing activity against Omicron BA.2. As such, on March 25, 2022, the emergency use authorization for Sotrovimab was revoked in New England due to an estimate that >50% of circulating cases of COVID-19 were from Omicron BA.2.

Note: These treatments are endorsed for use for pregnant women by the Society for Maternal Medicine and by the American College of Obstetrics and Gynecology.

Neither of these treatments is an alternative to getting vaccinated and boosted or wearing a mask.

Paxlovid (nirmatrelvir/ritonavir)

Paxlovid (nirmatrelvir/ritonavir) is an antiviral pill used to treat mild-to-moderate COVID-19 in patients ages 12 and older who have tested positive for COVID-19 and who are at an increased risk of severe illness or hospitalization. This medication requires a prescription and should be taken within five days after the start of symptoms.

Results of a clinical study showed an 88% decrease in the risk of hospitalization or death at 28 days as compared with a placebo. Laboratory studies also showed that Paxlovid was effective against the Omicron variant. Paxlovid is not meant to be used to prevent infection or to prevent illness after being exposed to COVID-19. Learn more about Paxlovid (PDF).

Bebtelovimab

It is a new anti-SARS-CoV-2 monoclonal antibody that received emergency use authorization by the FDA on February 11, 2022. Unlike Sotrovimab, it retains neutralizing activity against all known COVID-19 variants, including both Omicron BA.1 and BA.2. There has been Phase 2 trial data demonstrating more rapid viral decay in patients with COVID-19 following receipt of Bebtelovimab, compared to placebo. While there are insufficient data on hospitalization and mortality outcomes in patients who have received Bebtelovimab, this agent has a mechanism of action similar to other anti-SARS-CoV-2 monoclonal antibodies that have demonstrated a reduction in hospitalization or death in high-risk patients in Phase 3 trials.

 

Supplies are limited

We will be receiving a very limited supply of these medications from the state of New Hampshire. However, the State has distributed Paxlovid and another oral agent (Molnupiravir) to local pharmacies for distribution.

Getting your COVID-19 treatments at Cheshire

Currently, there are several steps involved in getting one of the above COVID-19 treatments. In order to be eligible to receive one of these medications, you need to test positive for COVID-19 and be at increased risk for severe illness or hospitalization. This is bound to change, so please keep checking this page for updated information.

  1. Your primary care provider or specialist will need to submit a referral for treatment with Paxlovid or Bebtelovimab.
  2. Next, the Cheshire therapeutics team will review the referral and other factors, including when you first experienced your symptoms, your other health conditions, and your other medications. Based on this, the team will determine if you are eligible to receive a COVID-19 treatment and which one is best for you.
  3. Once you are approved to receive the COVID-19 treatment, we will set up a virtual visit with you so that we can explain the risks and benefits of treatment. We will also discuss any adjustments that might need to be made to your other medications.
    • Please make sure that you have set up a myDH account and are familiar with video visits in preparation for this virtual visit. If you don’t have a myDH account, you can set one up.
    • View directions for setting up your virtual visit.
    • We will need to obtain your informed consent to receive one of the medications at the virtual visit.
    • Your treatment plan will be shared with your referring provider.
    • If you are referred for Paxlovid, you will be able to pick up your medication at Cheshire Medical Center’s Retail Pharmacy curbside.
    • If you are referred for Bebtelovimab, you will be scheduled for an infusion at the KARES Unit at Cheshire Medical Center in Keene.

If you have any questions about side effects or your COVID-19 symptoms after your treatment, please follow up with your primary care provider.

Information for provider referrals

For providers at Cheshire Medical Center, or elsewhere within the Dartmouth Health system, who are directly contacted by their patient after a positive COVID-19 antigen or PCR test, there will be an ambulatory referral order containing questions to determine primary eligibility.

We will be managing referrals for those 18 years and older. Patients between the ages of 12 and 17 should be referred to the Dartmouth Hitchcock Medical Center in Lebanon/Alice Peck Day clinic.

Once a patient’s eligibility is determined, they will be set up for a virtual visit with a provider to review risks and benefits and obtain informed consent for their recommended treatment, as well as discuss temporary adjustments to their usual medications (if applicable).

A note from the centralized COVID-19 Therapeutics Clinic will be sent to the referring provider documenting the care plan.