OPINION: Adapting to the changing reality of the COVID-19 pandemic

Good news, bad news. We have new therapeutics under emergency use authorization by the FDA for treating non-hospitalized people with the omicron variant of COVID-19, but they are not readily available. These medications are used in non-hospitalized patients, early in the illness, when they work best against viral replication to prevent hospitalizations or death.

As most folks know by now, there are monoclonal antibody treatments used to treat COVID-19. There are three different ones that have been widely used up until now. Bamlanivimab/etesevimab and casirivamab/imdevmab are not working against omicron. Sotrovimab is the only one that is, and it is in short supply. It is being used to treat high-risk, non-hospitalized patients with mild to moderate omicron infections. The National Institutes of Health has published risk group prioritizations based on four key elements: age, vaccination status, immune status and clinical risk factors. If you are having difficulty getting monoclonal antibody treatment, this is the reason. It is not lack of planning by the State of Alaska or Municipality of Anchorage.

Other treatment options include the antiviral medications Paxlovid and Molnupiravir, also under FDA emergency use authorization. These are also not readily available. Paxlovid has many drug-to-drug interactions that may limit its use, but when used judiciously, it has shown 88% reduction in hospitalizations or deaths. Remdesivir has been used in the hospital setting, given intravenously. NIH and Infectious Diseases Society guidelines have suggested its use for non-hospitalized patients. Molnupiravir, another oral antiviral medication, has shown a 30% reduction in hospitalization or deaths. The FDA emergency use authorization is only if other authorized treatment options are not available or clinically appropriate, due to concerns that it may cause human DNA mutations.

We expect to see more supplies of these medications become available in the next few weeks and months.

It is important to remember that vaccinations, while not 100% effective, are still important to prevent severe illness and death. Even with so many breakthough cases, unvaccinated patients and those with no prior COVID-19 infection remain the most vulnerable.

The CDC has modified its guidelines on isolation and quarantine. Non-pharmaceutical mitigation measures are still being recommended. New information on mask usage has changed as well. The most effective facial barrier is the N95 mask, followed by the KN95. Cloth masks provide very little if any protection. Surgical and medical masks are not much better. Hand-washing for 20 seconds or more, physical distancing now recommended at three to six feet, and adequate room ventilation with room air turnover at least two times or more per hour to prevent accumulation of aerosolized viral particles. These four measures must all be used together to be effective.

Keep in mind that omicron, though extremely contagious and spreading rapidly, is still less virulent than previous COVID-19 variants. We have more therapeutic tools at our disposal than ever before, with more being developed.

Michael B. Savitt, M.D., F.A.A.P., serves as chief medical officer for the Anchorage Health Department.

Correction: The initial version of this column stated that people should distance at three feet to help avoid COVID-19 infection. It has been updated to align with CDC guidance of three feet in schools with required masking and low to moderate transmission, and six feet in other circumstances.

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