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So you’ve just tested positive for COVID – what now? If you are immunocompromised, older or otherwise vulnerable, you may feel overwhelmed or scared about seeking care in a moment when U.S. case counts remain sky-high and hospitals are at their breaking point.
Omicron’s ability to infect others with rapid speed means that more people in general are more vulnerable to infection, including those whose age or medical conditions make them more at risk for serious outcomes. While omicron appears to cause less severe illness compared to prior variants, models project the country will still see between 50,000 and 300,000 additional COVID-19 deaths by early spring. So the talk about “mild infection” may offer little reassurance to individuals and families in those circumstances.
READ MORE: A doctor’s advice about testing and masks right now
Several of the outpatient COVID-19 therapeutics are only available to those who are eligible — in many cases, people who are over the age of 65, have relevant underlying medical conditions or who are immunocompromised — and must be administered within a few days after symptom onset, once their infection is confirmed by a positive test. Qualifying conditions may include diabetes, chronic lung diseases, heart conditions, sickle cell disease and others. Therapeutics are no substitute for vaccination, doctors emphasize. Generally, if you are unvaccinated, otherwise healthy and experiencing severe symptoms, your main option is to seek emergency care.
In a dream world, every COVID-positive person who is potentially eligible for life-saving treatments would have immediate and easy access to the care that they need, said Dr. Lindsay Petty, an infectious disease physician at Michigan Medicine, part of the University of Michigan.
Right now, that’s not the world we live in. But you’ll never know what options are available until you make a call to a physician and get the ball rolling.
Here’s a look at treatment options for medically vulnerable people and why swift home-testing is so important.
If you or a loved one tests positive for COVID-19, the first thing you should do is call a health care provider, whether that’s your family doctor or your local community health center. If you’re not sure where to start, you can also call your local health department for advice.
Time is of the essence when making that call, because if a COVID-positive person is eligible for treatments like monoclonal antibodies, antiviral pills or other outpatient therapeutics, there’s a time limit on when those can be administered.
Graphic by Megan McGrew/PBS NewsHour
Antivirals work to thwart the coronavirus’ replication inside your body. One antiviral pill called Paxlovid — which has been shown to reduce the risk of hospitalization and death by 88 percent — must be taken within five days of symptom onset to work effectively. But Petty warns that this therapeutic has multiple drug interactions that should be discussed ahead of time, especially between physicians and patients who take multiple pharmaceuticals regularly, which is often the case for those who are older or who have underlying conditions.
The same time frame goes for another antiviral called molnupiravir, which has a much lower risk reduction for hospitalization and death — 30 percent — but at the time of reporting was in comparatively larger supply, and does not carry the same risks in terms of potential drug interactions.
A handful of different monoclonal antibody treatments – which give your immune system a boost by helping it recognize and fight the coronavirus — have been available beginning toward the end of 2020 to help patients beat COVID. But just one, named sotrovimab, has proven to be effective against omicron.
READ MORE: As omicron rages, COVID-19 pill stymied by shortages
Given the heightened demand and limited access, supply is a major issue for both the antiviral pills and this monoclonal antibody treatment. In some places, there may not be enough to go around, and providers will have to prioritize those most at risk for severe illness on the list of eligible patients.
It’s not a distribution problem as much as a manufacturing problem. “There’s just not enough drug being made,” Dr. Steve Stites, chief medical officer at The University of Kansas Health System, said.
In cases where a patient cannot access Paxlovid or sotrovimab, the National Institutes of Health’s COVID treatment guidelines recommend a three-day infusion of the antiviral remdesivir. Molnupiravir should only be given if those other three options aren’t available or can’t be administered, the guidelines say.
These therapeutics help save lives and make it less likely that medically vulnerable COVID patients will need hospital care. But you should seek emergency medical care if you or a loved one with COVID begins to experience symptoms like shortness of breath when active or at rest, or chest pain. Stites said that the in-patient COVID treatments found at any given hospital haven’t changed much, and they’re generally still in good supply. The goal, he emphasized, is to keep as many patients out of the hospital as possible.
Hospitals across the nation are struggling with severe staffing shortages as swaths of employees are infected with omicron and forced to stay home. But no matter what, do not hesitate to seek medical care if you need it, Petty emphasized, whether it’s for COVID or another medical condition. She noted in some cases, especially in places where a massive amount of COVID patients are seeking outpatient therapeutics or even hospital care, there may be a longer wait than normal.
Medical staff treat a COVID-19 patient in the Intensive Care Unit (ICU) at the Providence Mission Hospital in Mission Viejo, California, U.S., January 25, 2022. Shannon Stapleton/Reuters
“Just realize that the help you receive may be slower to come, and have some patience with the medical providers you encounter,” Petty said.
Tests are important not just for providing an extra level of security before socializing with other people, but also for making sure those who do test positive get the treatment they need as soon as possible.
At-home rapid tests have largely been in short supply since omicron first hit the United States. Although the Biden administration has made an effort to get more of those tests in people’s hands, most recently by rolling out a webpage where each household can request four rapid tests to be shipped to them for free, it will take time for that effort to be carried out.
READ MORE: Website for free virus tests is here. How does it work?
While you’re waiting on those tests, you can try to buy those sold online or at your local pharmacy, if that’s an option for you.
Petty said that anyone who is presenting symptoms of COVID-19, such as a headache, fever, sore throat, congestion or other respiratory symptoms, should get tested as soon as possible.
Although rapid tests aren’t necessarily as precise as the gold-standard PCR test, experts agree they’re quite effective at catching active, contagious infections in those who take them. Dr. Gerald Harmon, a family medicine specialist and president of the American Medical Association, emphasized the importance of following the manufacturer’s recommendations on any at-home tests. He acknowledged recent social media chatter in which some users have recommended that people swab their throats as opposed to just their nostrils when taking those tests, but he said it’s always better to do what the instructions say.
“If they tell you to swab the front part of your nose with a certain type of applicator, [for] goodness sake, do that,” Harmon said. He also recommends taking a rapid test if you want to exit isolation before the traditional seven to 10 day mark to ensure you’re no longer infectious before you interact with other people.
Before you get that positive test result, there are measures all of us can take in hopes of protecting ourselves, our loved ones and our communities.
At this point, it goes without saying: getting vaccinated, or boosted if you’re already fully vaccinated, is one of the best ways anyone can protect themselves against the possibility of severe disease. Those whose immune systems are moderately to severely immunocompromised or who cannot get vaccinated due to the risk for severe allergic reaction have an additional option in Evusheld, an antibody therapy designed to proactively boost protection before they are exposed to the virus.
Stepping up your approach to masking is another key step to staying safe in public. The Centers for Disease Control and Prevention has a list of KN95 and N95 masks — the highest quality option out there, because they do the best job preventing any virus from entering your airways. That guidance can help you figure out which mask options are authentic, and which you should avoid because they are counterfeit.
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If it’s not possible to get your hands on those types of masks, you could choose to layer a surgical mask under a cloth one, or use a fitter that eliminates any gaps between your mask and your face. A close fit is the most important aspect of mask wearing — it must sit as close to your face as possible so any air you breathe is filtered first.
Taking those preventative steps has the added benefit of helping to ease the additional strain that this surge has put on health care workers.
Stites emphasized that “we know how to bend the curve” of COVID-19 infections, and that making every effort to do so buys time – both for more therapeutics to be manufactured, and for reducing the strain on health systems by keeping health care providers healthy.
“As long as the numbers [of COVID-positive people] in the community continue to exponentially rise, the number of our staff affected by that may exponentially rise as well,” Stites said.
Isabella Isaacs-Thomas is a digital reporter on the PBS NewsHour's science desk.
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