M e d i c a l R e c o r d F e at u r e
COVID-19 Update:
New Developments, New Opportunities and Challenges in 2022 by Debra Powell, MD Chief, Division of Infectious Diseases Medical Director, Infection Prevention Tower Health WHERE ARE WE NOW? We have now passed the second anniversary of the start of the COVID-19 pandemic. The SARS-CoV-2 virus has affected us all. Many have been infected, suffered the loss of family members, incurred financial hardships, and were not able to participate in significant in-person life events. The good news is that the community case numbers have greatly improved from the peak of the Omicron variant in mid-January 2022 and the requirements for mask use have decreased or been eliminated. Our community is very relieved to be getting back to normal interactions.
WHAT HAVE WE LEARNED AND WHAT TREATMENTS ARE AVAILABLE? We have learned a great deal about treating and preventing this infection and are very fortunate that we have effective oral and intravenous medications for treating COVID-19 infection plus highly effective vaccines to prevent severe infection requiring hospitalization and contributing to decreasing deaths. Our antiviral medications include two oral medications: ritonavir-boosted nirmatrelvir (Paxlovid) and molnupiravir; plus, IV remdesivir. Both ritonavir-boosted nirmatrelvir and molnupiravir medications received Emergency Use Authorization (EUA) by the FDA for treating COVID-19 in an outpatient setting for those with mild-to-moderate disease who are at high risk of progressing to severe disease and/or hospitalization. Both medications have significant precautions that must be considered prior to prescribing. Remdesivir is being used for high-risk hospitalized patients. All antiviral medications are most effective when used in the first 5- 7 days of the disease course. Ritonavir-booster nirmatrelvir, due to the ritonavir component, has severe drug-drug interactions with many medications that must be cross referenced prior to prescribing. The dose must be adjusted for renal insufficiency and cannot be prescribed for patients with severe renal or liver dysfunction.
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