New treatments are available for the treatment of COVID-19 in patients who are immune compromised or have other medical conditions increasing their likelihood of developing progressive COVID-19 related disease.
Island Health has established an Outpatient COVID Therapeutics Clinic for the evaluation and treatment of vulnerable patients who have mild to moderate COVID-19 infection in the community. To receive treatment you will need to be evaluated to determine which therapy is best for you.
If you are a solid organ transplant patient, a cancer patient on active chemotherapy, a patient with severe kidney dysfunction, or an otherwise vulnerable patient who cannot take Paxlovid due to drug interaction or other contraindications, you may be a candidate for Remdesivir therapy at an Island health infusion clinic. These patients may contact the clinic directly to undergo evaluation regarding potential treatment options. These patients may only be referred to the Outpatient COVID Therapeutics Clinic by their family doctor, nurse practitioner, or specialist to undergo evaluation regarding potential treatment options. Patients are not able to call the clinic directly to refer themselves.
- Who is eligible for therapy?
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Patients who test positive for COVID-19 via a Polymerase Chain Reaction (PCR) or Rapid Antigen Test (RAT) test AND have been identified as being at increased risk for needing to go to the hospital for COVID-19. Below is the eligibility criteria.
- Individuals who are immunocompromised or have high-risk conditions identified as Clinically Extremely Vulnerable (CEV) regardless of vaccine status or previous infection
- Not all children ages 12-17 who are CEV will benefit from treatment. Paxlovid is not recommended below the age of 18 at this time. Those with multiple co-morbidities would have the highest potential benefit and are eligible only for sotrovimab
- Unvaccinated individuals without previous infection who are EITHER:
- ≥50 years OR
- ≥18 and have three or more chronic conditions/co-morbidities
- Individuals ≥ 50 years with 1-2 vaccine doses or previous infection alone, with three or more chronic conditions/co-morbidities
- Individuals aged ≥70 years with 1-2 vaccine doses or previous infection alone, with one or more chronic condition/co-morbidity
- Individuals ≥ 70 years with three or more chronic conditions/co-morbidities regardless of vaccine status or previous infection
- Indigenous individuals (if not captured above) who are EITHER:
- ≥18 and unvaccinated without previous infection OR
- ≥ 50 years with 1-2 vaccine doses or with previous infection alone OR
- ≥ 70 years regardless of vaccine status or previous infection
- What are chronic conditions and co-morbidities?
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You may benefit from treatment if you have one or more chronic conditions. Treatment availability also depends on your age and whether you are vaccinated. Chronic conditions or co-morbidities associated with increased risk include the following:
- congestive heart failure, other chronic heart conditions,
- chronic kidney disease (GFR<60)
- chronic respiratory disease (moderate to severe asthma, COPD)
- obesity (BMI>30), diabetes (taking oral medications)
- cerebrovascular disease and stroke
- dementia and other cognitive disorders
- substance abuse
- smoking
- neurological conditions
- What treatment is right for me?
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Paxlovid and Remdesivir are highly effective antiviral agents which reduce the risk of COVID-19 disease progression to more serious illness. Paxlovid is generally preferred as it can be given orally, but many patients are unable to take it due to underlying medical conditions or due to drug interactions with existing medicines. Patients are screened and undergo thorough review by a clinical team before determining which drug is most appropriate.
If you meet criteria for treatment, are assessed within the five day symptom window, and are eligible, you will be offered Paxlovid. If you meet criteria for COVID-19 treatment but are not eligible for Paxlovid, you may be offered Remdesivir therapy. However, you will need to receive treatment at one of the Island Health infusion clinics for three daily infusions.
In rare circumstances, Sotrovimab may be the only treatment which is reasonable. It is reserved for high risk patients who are unable to take Paxlovid or Remdesivir. This may be due to underlying medical conditions, drug interactions, or inability to attend an outpatient infusion clinic for three consecutive days.
- Who is eligible for Paxlovid?
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Paxlovid (nirmatrelvir/ritonavir) is an oral antiviral medicine, recently approved by Health Canada, which needs to be taken twice a day for five days. Patients must have a positive test for COVID-19 (either a rapid antigen test or a PCR test) and the drug must be started within five days of symptom onset. Many patients are eligible for this medicine but there are a number of contra-indications and drug interactions which prevent some patients from taking it. You will need to be evaluated to determine your eligibility for treatment with Paxlovid.
If you are interested in therapy with Paxlovid or remdesivir, click on the “Who is eligible for therapy” tab and review the treatment criteria.
- What does Paxlovid treatment look like?
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Paxlovid is an oral antiviral effective against the virus that causes COVID-19. It is a combination of two drugs and patients take two or three pills twice a day for five days. Some patients may experience gastrointestinal upset or taste disturbance. If the medication causes stomach upset, take it with food. If necessary use an anti-nausea medication like Gravol. Drink plenty of fluids and stay well-hydrated.
If your symptoms of COVID-19 worsen, or you have any questions or concerns, you can either contact the OCTC nurse during clinic hours or call your primary care provider or prescriber. If neither are available, you can call 811, go to an urgent care clinic, emergency department, or call 911 if you have difficulty breathing, have chest pain, can’t drink, feel very sick, feel confused, or experience any loss of consciousness.
- How to obtain a Paxlovid prescription
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Paxlovid can be prescribed by any physician or nurse practitioner in BC. Please contact your primary care provider or specialist physician involved in your care to discuss potential therapy. Alternatively, you can contact Service BC: 1-888-COVID-19. Interested patients should first check the BC COVID-19 Treatment Self-Assessment website and complete the self-assessment to see if they are eligible for treatment. If you meet criteria you will be invited to contact the clinic for further review regarding a potential Paxlovid prescription.
Some patients may also be referred to the local Island Health Outpatient COVID-19 Therapeutics Clinic for evaluation. Patients will be reviewed by a nurse and some will be referred for a virtual physician assessment regarding potential treatment with either Paxlovid or Remdesivir.
Not every pharmacy in BC stocks Paxlovid, but those that do are listed here. Your prescriber will send a prescription to a pharmacy near you. They will either arrange for someone to pick up the drug or deliver it to you directly.
- What is Remdesivir?
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Remdesivir is an intravenous antiviral drug shown to be highly effective in reducing the risk of COVID-19 disease progression. It is given by intravenous infusion daily for three consecutive days. This drug is generally safe and very well-tolerated.
Antiviral drugs are generally effective against all variants of concern and there is little risk of mutations or emergence of new coronavirus strains becoming resistant. It may be contraindicated in some patients with severe liver disease. For patients with chronic kidney disease the dosage may be adjusted.
- What does Remdesivir treatment look like?
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Patients who are unable to take Paxlovid may be eligible for treatment with Remdesivir. At present, there are 7 infusion sites in Island Health - located at the Royal Jubilee Hospital, Nanaimo Regional General Hospital, West Coast General Hospital, Campbell River Hospital, Comox Valley Hospital, Oceanside Health Centre, and Ladysmith Health Centre. There are plans to open more infusion sites in the near future.
Remdesivir is administered by intravenous infusion over 30 minutes, for three consecutive days, by a qualified healthcare. For those with poor kidney function, the treatment is often adjusted to be given only twice, with 48-72 hours between doses. After the first dose, patients go home with the IV infuser in place for the next two visits. The IV will be removed after the last dose. Most patients tolerate the treatment extremely well. It is important that clinicians have recent lab work for review of kidney function and liver function. We may need to draw blood for testing if there has not been lab work done recently. If the blood tests are out-of-range, the treatment may be adjusted.
- What is Sotrovimab?
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Sotrovimab is a monoclonal antibody treatment, which received Health Canada approval under an interim order for use in patients with COVID-19 in December, 2021. It was previously shown to be highly effective at reducing progression to more serious disease.
However, the new omicron BA.2 variant, which is now predominant in British Columbia, appears to show some resistance to this drug. We do not yet know the magnitude of this effect and await further study data to more clearly define the role of Sotrovimab in COVID-19 therapy. In the meantime, it may still be used in certain circumstances when there are no other treatment options available and we feel there could be potential benefit.
Sotrovimab can be administered intravenously at one of the Island Health infusion clinics. At present there are 7 infusion sites in Island Health - located at the Royal Jubilee Hospital, Nanaimo Regional General Hospital, West Coast General Hospital, Campbell River Hospital, Comox Valley Hospital, Oceanside Health Centre, and Ladysmith Health Centre. There are plans to open more infusion sites in the near future.
If you are interested in therapy with one of these drugs please click on the “Who is eligible for therapy?” tab and review the treatment criteria.
- What does Sotrovimab treatment look like?
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Sotrovimab is administered by intravenous infusion by a qualified healthcare professional and takes approximately 60 minutes. After the infusion a patient is monitored for another 60 minutes for any potential side effects or transfusion reactions. Most patients tolerate the treatment extremely well.
Sotrovimab clinical practice guide.
- What to expect after the treatment is complete
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- A follow-up telephone appointment will be scheduled for two days post final infusion to review your status.
- Some patients may have home oxygen monitoring arranged at the time of discharge.
- Most patients with mild illness do not progress to severe disease. However, many patients may still have symptoms due to their COVID-19 illness.
- If your symptoms worsen or you have any questions or concerns you can either contact the OCTC nurse during clinic hours or call your primary care provider. If neither are available, you can call 8-1-1.
- Go to an urgent care clinic, emergency department, or call 9-1-1 if you: have difficulty breathing, have chest pain, can’t drink, feel very sick, feel confused, or experience any loss of consciousness.
- How to book an appointment?
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Some patients are unable to take Paxlovid due to drug interactions, contraindications, or other medical conditions.
If you are not a candidate for Paxlovid, a referral to the Outpatient COVID Therapeutics Clinic can be made your family doctor, nurse practitioner or specialist. To refer a patient for assessment for Remdesivir or Sotrovimab, doctors or nurse practitioners can contact the Outpatient COVID Therapeutics Clinic at 250-737-2030, ext 44685. Patients are not able to call the clinic directly to refer themselves.
Patients will then be contacted by the Outpatient COVID Therapeutics Clinic and undergo an initial screening process. If eligible, patients are then referred for a virtual telehealth appointment with a healthcare provider. Some patients may then be prescribed Paxlovid or scheduled for Remdesivir infusions or a Sotrovimab infusion, at the infusion clinic nearest to you in Island Health - located at the Royal Jubilee Hospital in Victoria, Nanaimo Regional General Hospital, West Coast General Hospital, Campbell River Hospital, Comox Valley Hospital, Oceanside Health Centre, and Ladysmith Health Centre. Some patient may not receive treatment and may be followed-up with in one to two days to see how their COVID symptoms are progressing before determining if treatment is necessary.
**Please note that contact from the Outpatient COVID Therapeutics Clinic may take 24-48 hours, depending on the availability of clinic nurses and doctors. Our goal is to assess patients as soon as possible, but at the latest within 5-7 days after COVID symptoms begin.
