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Outpatient COVID-19 Treatments

There are now oral and intravenous outpatient treatment options available for COVID-19 patients at Yale New Haven Health, particularly those who may be at risk for developing more severe illness, but are not sick enough to require hospitalization. The available oral therapies prevent the COVID-19 virus from reproducing which helps to decrease the amount of virus present. Monoclonal antibody therapy is given intravenously and just like antibodies that develop naturally in the body, monoclonal antibodies help the body fight off viruses like COVID-19. However, monoclonal antibodies are manufactured in a lab and are not derived from human blood products.

Currently, there are two oral treatments, nirmatrelvir/ritonavir (Paxlovid™) and molnupiravir, which received an Emergency Use Authorization by the FDA. The FDA also has authorized the emergency use of these monoclonal antibody treatments: bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab, and bebtelovimab. Currently, only bebtelovimab is being used at Yale New Haven Health to best target the current COVID-19 strain in the community.

If you or a loved one has been diagnosed with COVID-19, your primary care physician may refer you to receive one of these oral or intravenous treatments. At this time, oral therapy prescriptions for patients are available at many retail pharmacies throughout the community. Intravenous monoclonal antibody therapy has to be given at a Yale New Haven Health outpatient facility. (Available at Bridgeport Hospital, Greenwich Hospital, Lawrence + Memorial Hospital, Westerly Hospital and Yale New Haven Hospital.) During your appointment, you will receive one dose of the medication through a vein (intravenous or IV infusion) and can return home after a brief monitoring period.

Researchers have found these medicines reduce the need for hospitalization in outpatients with mild to moderate COVID-19, compared to patients who received a placebo. These treatments are only available for outpatients who meet specific criteria and your provider has to prescribe them.

To learn more about how these treatments work and for a full list of requirements, read more below. For additional questions or help referring a patient for treatment contact the COVID call center at 833-275-9644 (833-ASK-YNHH).

How are these medicines administered?

Nirmatrelvir/ritonavir (Paxlovid™) and molnupiravir are available as tablets which are taken by mouth twice a day for five days. The monoclonal antibody therapy (bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab, or bebtelovimab) are given to outpatients at Yale New Haven Health System locations. Patients receive one dose of bamlanivimab/etesevimab, casirivimab/imdevimab sotrovimab, or bebtelovimab through a vein (intravenous or IV infusion). Afterwards, you will be monitored by our care team for possible side effects for another hour after the infusion has ended. Patients who receive this treatment should have someone drop them off and pick them up.

This treatment is administered at Yale New Haven Hospital, Greenwich Hospital, Bridgeport Hospital, Lawrence + Memorial Hospital and Westerly Hospital. Before getting this treatment, patients must obtain a referral from a physician.

Who is eligible?

The clinical criteria for these oral and intravenous therapies are based on current FDA and NIH guidance and are updated to reflect the currently available supply of medications. Your provider will assess your risk of severe complications from COVID-19 based on these criteria and decide if any of these therapies are appropriate for you.

Of the medicines, which one will patients receive?

All of these medicines work to prevent hospitalizations from COVID-19. There are many considerations for your health care provider when prescribing these medications including certain pre-existing health conditions and/or interactions with medications that you are currently taking. It is important to make sure your provider is aware of all of your health conditions as well as all medications you are taking including over the counter medications. In addition, the supply of each medicine changes over time, so which one you will receive will depend on which is most appropriate for you as determined by your health care provider as well as based on the availability of the medications.

What are the possible side effects?

Possible side effects from nirmatrelvir/ritonavir (Paxlovid™) include altered sense of taste, diarrhea, elevated blood pressure and muscle aches. Molnupiravir’s possible side effects include diarrhea, nausea, and dizziness. Possible side effects of bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab, or bebtelovimab can include allergic reactions, which can happen during and after the infusion. Such reactions are rare but can include fever, chills, nausea, headache, shortness of breath, low blood pressure, wheezing, swelling of your lips, face, or throat, rash including hives, itching, muscle aches, and dizziness.

The side effects of getting any medicine by vein may include brief pain, bleeding, bruising of the skin, soreness, swelling, and possible infection at the infusion site. These are not all the possible side effects. Serious and unexpected side effects may happen. Nirmatrelvir/ritonavir (Paxlovid™), molnupiravir, and the monoclonal antibodies (bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab, and bebtelovimab) are all still being studied so it is possible that all of the risks are not known at this time.

What if I’m pregnant or breastfeeding?

There is limited experience treating pregnant people or breastfeeding mothers with nirmatrelvir/ritonavir (Paxlovid™), molnupiravir, bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab and bebtelovimab. Molnupiravir is not currently recommended at Yale New Haven Health for patients who are pregnant and/or breastfeeding. For a mother and unborn baby, the benefit of receiving nirmatrelvir/ritonavir (Paxlovid™), or one of the monoclonal antibody therapies may be greater than the possible risk from treatment. We advise our patients to discuss any possible treatment with their obstetrician or midwife.

What are the recommendations for receiving these medicines and the COVID-19 vaccine?

The COVID-19 vaccine can be given at any time following receipt of oral or monoclonal antibody therapies. CDC guidelines state you can get vaccinated once you your symptoms are resolved and you are and out of quarantine. We strongly recommend COVID-19 vaccination even after treatment because it can help to protect against future infection.

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The Recovery Program at the Winchester Chest Clinic

Some COVID-19 patients are continuing to experience respiratory symptoms long after their initial recovery from this illness. The Recovery Program at the Winchester Chest Clinic is open to those patients who have persistent respiratory symptoms. For patients who fit specific criteria, they should consult their primary care physician for a referral to the program.

Learn more about the program