Category: Health Alert Network

This message is to alert Idaho medical providers about the availability of oral antiviral medications to treat COVID-19. Two oral antiviral medications are now available. In late December, the U.S. Food and Drug Administration (FDA) issued emergency use authorizations for two oral antivirals for the treatment of COVID-19. These two antivirals are Pfizer’s Paxlovid (nirmatrelvir and ritonavir, co-packaged) and Merck’s molnupiravir.

There has been a rapidly changing situation with the arrival of the Omicron variant into Idaho, new information about lack of effectiveness of some currently utilized therapeutics against the Omicron variant, and the availability of new therapeutics. The local public health districts and Idaho Division of Public Health are coordinating with federal partners to ensure Idaho patients will have access to newly available therapeutics as they become available.

The Centers for Disease Control and Prevention (CDC) is anticipating an increase in influenza illness this winter, and both influenza A(H3N2) and B viruses are cocirculating in some parts of the country. While influenza activity is still low in Idaho and overall nationally, a recent increase of influenza A(H3N2) viruses has been detected primarily in young adults in outbreaks at colleges and universities in several states. As SARS-CoV-2 continues to circulate in the United States, illnesses associated with both viruses might stress healthcare systems.

Treatment with monoclonal antibody therapies continues to be recommended for certain patients with COVID-19 who are at high-risk of progression to severe disease. Monoclonal antibodies that target the spike protein have been shown to have a clinical benefit in treating SARS-CoV-2 infection. Three anti-SARS-CoV-2 monoclonal antibody products currently have Emergency Use Authorizations (EUAs) from the Food and Drug Administration (FDA) for the treatment of mild to moderate COVID-19 in non-hospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and/or hospitalization.

Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting MIS-C criteria should report suspected cases to Central District Health (Phone: 208-327-8625 or FAX: 208-327-7100) or to the Bureau of Communicable Disease Prevention Epidemiology Section (208-334-5939).

Ivermectin is not authorized or approved by Food and Drug Administration (FDA) for prevention or treatment of COVID-19. FDA has cautioned about the potential risks of use for prevention or treatment of COVID-19. Ivermectin-related calls to poison control centers across the U.S. have increased five-fold from pre-pandemic baseline. Our regional poison center is experiencing a small but increasing trend of ivermectin-related calls from Idaho.

Healthcare providers should be aware that on July 30, 2021, the FDA revised the emergency use authorization (EUA) for casirivimab/imdevimab (REGEN-COV) to include authorization for post-exposure prophylaxis for COVID-19. REGEN-COV also remains authorized for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death.

COVID-19 cases in Idaho have increased 70% since July 1, 2021. In Central District Health’s (CDH) counties, COVID-19 cases increased over 158% from June to July 2021. Nationally, cases have increased over 300% from June 19 to July 23, 2021. Increases in cases, hospitalizations, and deaths are driven by the highly transmissible B.1.617.2 (Delta) variant combined with relatively low vaccination rates.

Treatment with monoclonal antibody therapies continues to be recommended for certain patients with COVID-19 who are at high-risk of progression to severe disease. However, there are some recent changes of which healthcare providers should be aware.

Myocarditis with or without pericarditis has been reported in three Idaho patients after they had recently received COVID-19 vaccine. All three patients received the second dose of Pfizer vaccine 2-10 days before being evaluated at a hospital. The Centers for Disease Control and Prevention (CDC) and other state public health agencies are also aware of reports of myocarditis following COVID-19 vaccination; the CDC’s Advisory Committee on Immunization Practices’ Vaccine Safety Technical Work Group has recently reported a statement on the issue, at https://www.cdc.gov/vaccines/acip/work-groups-vast/technical-report-2021-05-17.html. Consider a diagnosis of myocarditis or pericarditis in any evaluation of chest pain following COVID-19 vaccination.