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Shasta County's Response to Local Emergencies

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Treatments and Therapeutics for Medical Professionals

Clinical Spectrum of SARS-CoV-2 Infection

Patients with SARS-CoV-2 infection can experience a range of clinical manifestations, from no symptoms to critical illness. In general, adults with SARS-CoV-2 infection can be grouped into the following severity of illness categories:

Individuals should be considered for outpatient therapy for COVID-19 if they meet the criteria below:

  • Are symptomatic with mild-moderate COVID-19 illness AND
  • Have a positive SARS-CoV-2 viral test result, AND
  • Are at high risk for progressing to severe COVID-19 and/or hospitalization.

The NIH definition of mild and moderate disease is below:

  • Mild Illness:
    Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell) but who do not have shortness of breath, dyspnea, or abnormal chest imaging.
  • Moderate Illness:
    Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation (SpO2) ≤94% on room air at sea level.

The Centers for Disease Control and Prevention (CDC) provides a list of risk factors and relative risk for severe COVID-19. Some of the most important risk factors include (listed alphabetically): age (risk increases with each decade after age 50), cancer, cardiovascular disease, chronic kidney disease, chronic lung disease, diabetes, immunocompromising conditions or receipt of immunosuppressive medications, obesity (body mass index ≥30), pregnancy, and sickle cell disease. The likelihood of developing severe COVID-19 increases when a person has multiple comorbidities.

See the Decision Tree for Treatment of Symptomatic COVID Infection and below for additional details on these treatments, availability and access in Shasta County.

*NEW* - Test to treat 

Get tested for COVID-19, receive a prescription for treatment from a health care provider (if appropriate for the patient) and have the prescription filled.

How to Make an Appointment: Schedule online

Hours of operation: 9 AM-5 PM Monday-Friday

Address: 2420 Breslauer Way, Redding 96001

Treatments and Therapeutics for COVID-19

Prioritization when supplies or access are limited (COVID-19 Treatment Guidelines Panel):

The NIH has created a prioritization framework for identifying patients at highest risk for progression to severe disease, considering age, vaccination status, immune status, and clinical risk factors. This is a helpful framework when determining which patients may be at highest risk for progression to severe disease while supply is limited.

Molnupiravir is only authorized for use if alternative COVID-19 treatment options authorized by the FDA are not accessible or are not clinically appropriate. In cases where Paxlovid or sotrovimab are not available for treatment and the patient is at high risk, consideration should be given to Remdesivir IV daily for three days or molnupiravir can be considered.  Decision Tree for Treatment of Symptomatic COVID Infection


Three of the anti-SARS-CoV-2 monoclonal antibody products that have received Emergency Use Authorizations (EUAs) from the US Food and Drug Administration (FDA), sotrovimab, bamlanivimab/etesevimab and casirivimab/imdevimab (REGEN-COV), are no longer authorized for use as a treatment or as a post-exposure prophylaxis (PEP).


While supplies of therapeutics are expected to be limited, the overall aim in distribution and use should be to achieve the greatest overall clinical benefit to patients infected with COVID-19, avoid bias, and mitigate healthcare disparities.  Clinicians are likely to find that they do not have adequate therapeutics supply for all eligible patients initially. This situation will be challenging for patients and family members, clinicians, and hospital staff.

See the NIH COVID-19 Treatment Guidelines for comprehensive information and the CDC Health Advisory (12-31-21): Using Therapeutics to Prevent and Treat COVID-19. See the latest Health Advisory by CDC (04-25-22) for updated information on treatment options for COVID-19.

Oral Medicines to Treat Mild to Moderate COVID-19

Paxlovid - (Pfizer) — nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use. If normal renal function, 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet), with all three tablets taken together twice daily for 5 days. Treatment started as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset.

Paxlovid is an oral protease inhibitor. Pfizer announced the results from a trial of 2,246 adults who received either Paxlovid or placebo. All patients had not received a COVID-19 vaccine and had not been previously infected with COVID-19. In the study, Paxlovid significantly reduced the proportion of people with COVID-19 related hospitalization or death from any cause by 88% compared to placebo among patients treated within five days of symptom onset. Paxlovid has received an EUA authorizing use for the treatment of mild to moderate COVID-19 in 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.

  • Treatment only; not approved for pre- or post-exposure prophylaxis
  • Supply is currently limited
  • Allocation to pharmacies (with a healthcare provider prescription) and clinical sites is determined by Shasta County Public Health. See Procuring medication for your patients below.
  • Use in persons 12 years of age and older weighing at least 40 kg
  • Many drug-drug interactions.
  • Paxlovid may lead to a risk of HIV-1 developing resistance to HIV protease inhibitors in individuals with uncontrolled or undiagnosed HIV-1 infection.
  • On April 14, 2022, the FDA revised the Emergency Use Authorization (EUA) for the COVID-19 oral antiviral therapeutic Paxlovid to authorize an additional dose pack presentation with appropriate dosing for patients with moderate renal impairment within the scope of the EUA. The new packaging option is in the formulation of blister cards containing 5 daily-dose blister cards with 2 nirmatrelvir tablets (150 mg each) and 2 ritonavir tablets (100 mg each). The updated provider Fact SheetLetter of Authorization, and Dear Healthcare Provider Letter are available for your reference. (From CDPH Therapeutics).

FDA: Letter of authorization | FAQs on the EUA  |  Fact sheet for health providers  |  Fact sheet for patient/caregivers

COVID-19 Drug Interactions Checker: Liverpool COVID-19 Interactions (covid19-druginteractions.org)

Molnupiravir -(Merck) — 800 mg (four 200 mg capsules) taken orally every 12 hours for 5 days. Treatment started as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset.

Molnupiravir is a nucleoside analogue that inhibits SARS-CoV-2 replication by viral mutagenesis. Merck announced results from a trial of 1,433 patients. Enrolled participants had not received a COVID-19 vaccination and had at least one risk factor associated with poor disease outcomes and symptom onset within five days prior to study enrollment. The risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (6.8%) than with placebo (9.7%), for a relative risk reduction of 30%. Molnupiravir is authorized for treatment of mild-to-moderate COVID-19 in adults with positive results of direct SARS-CoV-2 viral testing who are at high risk for progressing to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.

  • Treatment only; not approved for pre- or post-exposure prophylaxis.
  • Due to concern for side effects and decreased risk reduction compared to other available medications, Molnupiravir should only be used if other treatments are not available or not clinically appropriate (see How to prioritize patients above).
  • Supply expected to be initially more than Paxlovid.
  • Allocation to pharmacies (with a healthcare provider prescription) and clinical sites is determined by LA County DPH. See Procuring medication for your patients below.
  • Use in adults 18 and older only, not recommended in pregnancy. If the provider and patient choose to use the product during pregnancy, it is advised the patient be registered in the Merck Pregnancy Surveillance Program.
  • Females of childbearing potential should use a reliable method of contraception correctly and consistently, as applicable, for the duration of treatment and for 4 days after the last dose of molnupiravir.
  • Males of reproductive potential who are sexually active with females of childbearing potential should use a reliable method of contraception correctly and consistently during treatment and for at least 3 months after the last dose.
  • Providers should carefully review the Fact sheet for health providers before prescribing to ensure that the patient’s condition warrants treatment, that there are no drug interactions, and that there are contraindications to therapy.

FDALetter of authorization | FAQs on the EUA  | Fact sheet for health providers  |  Fact sheet for patient/caregivers

For more information, see the California Health Alerts for Paxlovid and for Molnupiravir and the Shasta County Letter to Providers. For resources to aid in selecting patient clinical populations that should be prioritized for Evusheld administration, see below.

   

Monoclonal Antibody Medicines to Treat Mild to Moderate COVID-19

Bebtelovimab (Eli-Lilly) — single 175mg IV injection administered as soon as possible after diagnosis of COVID-19 and within 7 days of symptom onset.

  • Bebtelovimab is a monoclonal antibody therapy with EUA for the treatment of mild to moderate COVID-19 in individuals with positive results of direct SARS-CoV-2 viral testing who are at high risk for progression to severe COVID-19, including hospitalization or death and for whom alternative COVID-19 treatment options approved or authorized by the FDA are not accessible or clinically appropriate.
  • Bebtelovimab is a monoclonal antibody therapy with EUA for the treatment of mild to moderate COVID-19 in individuals with positive results of direct SARS-CoV-2 viral testing who are at high risk for progression to severe COVID-19, including hospitalization or death and for whom alternative COVID-19 treatment options approved or authorized by the FDA are not accessible or clinically appropriate.
  • Use in persons 12 years of age and older weighing at least 40 kg
  • Providers should carefully review the Fact sheet for health providers before prescribing to ensure that the patient’s condition warrants treatment, that there are no drug interactions, and that there are no contraindications to therapy
  • Requests for product can be sent to laemsadutyofficer@dhs.lacounty.gov.
  • Appears to be effective against Omicron variants

FDA: EUA Letter of Authorization | Frequently Asked Questions for Bebtelovimab | Fact sheet for health care providers |  Fact sheet for parents/caregivers

Sotrovimab (GSK) — 500 mg IV as a single infusion administered as soon as possible after diagnosis of COVID-19 and within 10 days of symptom onset.

Sotrovimab is no longer authorized by the FDA for use in California due to increases of the Omicron sub-variant BA.2.  See CDPH update 3-30-22 for details

  • Sotrovimab is a monoclonal antibody therapy
  • Treatment only; not approved for pre- or post-exposure prophylaxis
  • Supply is currently unavailable
  • Allocation system to certain facilities, guided by local Medical Health Operational Area Coordinators (MHOACs).
  • Use in persons 12 years of age and older weighing at least 40 kg

FDAFact sheet for health providers  |  Fact sheet for patient/caregivers

Bamlanivimab and Etesevimab (Bam/Ete) is a monoclonal antibody-based medicine. 

Bamlanivimab and Etesevimab (Bam/Ete) are no longer authorized by the FDA for use in California due to increases of the Omicron sub-variant BA.1.  The FDA has issued an EUA* for Bam/Ete for treatment of mild-to-moderate disease and also for post-exposure prophylaxis (see below) For more information, see Fact sheet for Healthcare Providers and  Fact sheet for patient/caregivers.

Casirivimab and Imdevimab (REGEN-COV) is a monoclonal antibody-based medicine.

Casirivimab and Imdevimab (REGEN-COV) are no longer authorized by the FDA for use in California due to increases of the Omicron sub-variant BA.1 The FDA has issued an EUA* for REGEN-COV for treatment of mild-to-moderate disease and also for post-exposure prophylaxis (see below). For more information, see Fact sheet for Healthcare Providers and Fact sheet for patient/caregivers.

For more information, see the Shasta County COVID-19 Health Advisories and Updates and Coronavirus (COVID-19) Update: FDA Limits Use of Certain Monoclonal Antibodies to Treat COVID-19 Due to the Omicron Variant  COVID-19

Medicines to Prevent COVID-19

Pre-exposure prophylaxis

Evusheld (Tixagevimab/cilgavimab) (AstraZeneca) - has an EUA for pre-exposure prophylaxis against COVID-19. A combination of two long-acting anti-SARS-CoV-2 monoclonal antibodies administered via intramuscular injection, Evusheld is intended to protect individuals who are unable to mount an adequate immune response to COVID-19 vaccination or are unable to receive a COVID-19 vaccine due to severe adverse reaction.

*Update: The FDA has revised the emergency use authorization for Evusheld (tixagevimab plus cilgavimab) to increase the dose (from an initial dosing of 150 mg of tixagevimab and 150 mg of cilgavimab) to 300 mg of tixagevimab and 300 mg of cilgavimab) due to concerns about lower efficacy against certain Omicron subvariants. Health care professionals should contact patients who received the previously authorized Evusheld dose to return for an additional 150 mg tixagevimab and 150 mg cilgavimab dose as soon as possible.

The volume of each injection for the new, higher dose will be larger (3 mL instead of 1.5 mL) This means that the injections should be limited to large muscles on the body that can accommodate this volume (e.g., the gluteal muscles)

As defined in the EUA, Evusheld is authorized as a pre-exposure prophylaxis in the following:

  • Adults and pediatric individuals (12 years of age and older weighing at least 40 kg):
      • Who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2 and either:
        • Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination or
        • For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).

According to the EUA, the medical conditions or treatments that may result in moderate to severe immune compromise and an inadequate immune response to COVID-19 vaccination include but are not limited to:

  • Active treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ transplant and taking immunosuppressive therapy
  • Receipt of chimeric antigen receptor (CAR)-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection (people with HIV and CD4 cell counts <200 /mm3, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV)
  • Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory (e.g., B-cell depleting agents)

FDALetter of authorization | FAQs on the EUA  | Fact sheet for health providers  |  Fact sheet for patient/caregivers

Post-exposure prophylaxis

Bamlanivimab and Etesevimab (Bam/Ete), Casirivimab and Imdevimab (REGEN-COV) are monoclonal antibody treatments. These treatments are not effective against the Omicron variant and are not currently authorized for use.

Indications for Use(when authorized)

  • Adult or pediatric (≥12 years of age and weighing at least 40kg) patient at high risk for progressing to severe disease or death (see high-risk criteria) OR
  • Pediatric patient <40kg (including neonates- bamlanivimab/etesevimab only) at high risk for severe disease or death (see high-risk criteria) AND
  • Not fully vaccinated OR who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (individuals with immunocompromising conditions including taking immunosuppressive medications) AND
  • Have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per CDC, OR
  • Who are at high risk of exposure to an individual infected with SARS-CoV-2 because of the occurrence of COVID-19 in other individuals in the same institutional setting (for example, nursing homes, prisons) [see limitations of authorized use]
  • Post-exposure prophylaxis with monoclonal antibody therapy is not a substitute for vaccination against COVID-19
  • Bamlanivimab/etesevimab or casirivimab/imdevimab antibody therapy is not authorized for pre-exposure prophylaxis for prevention of COVID-19
  • The FDA has issued an EUA* for Bam/Ete for treatment of mild-to-moderate disease and also for post-exposure prophylaxis. For more information, see Coronavirus (COVID-19) Update: FDA Limits Use of Certain Monoclonal Antibodies to Treat COVID-19 Due to the Omicron Variant  COVID-19,  Fact sheet for Healthcare Providers and  Fact sheet for patient/caregivers

Other Medicines to Treat Mild to Moderate COVID-19

Remdesivir (Veklury – Gilead Sciences) — IV infusion for a total of 3 days initiated as soon as possible and within 7 days of symptom onset

  • Treatment only; FDA expanded EUA approval to include both inpatient and outpatient use in adults and children including those under 12 years of age and weighing at least 3.5 kg.
  • Ample supply. For additional information regarding purchasing or how to access remdesivir, please email remdesivir@amerisourcebergen.com, or call 1-800-746-6273 or reach out directly to your AmerisourceBergen representative.
  • CMS has created the Healthcare Common Procedure Coding System (HCPCS) code J0248 for reimbursement when administered in an outpatient setting. This code is available for use by all payers and is effective for dates of service on or after December 23, 2021. Additional information is available here.

FDA: EUA Letter of Authorization | Frequently Asked Questions for Veklury (remdesivir) | EUA fact sheet for health care providers | EUA fact sheet for parents/caregivers

Health care professionals may also prescribe other commonly used medications to treat COVID-19 complications (e.g., steroids). For more information see the New York Times Treatment Tracker for historical information on frequently discussed therapeutics and the COVID-19 Treatment Guidelines (nih.gov) to access the most up-to-date guideline.

 Information regarding the availability of doses and a map of locations can also be found at the federal COVID-19 Therapeutics Locator.

This information is intended for medical providers. Information for the public is available here.

Locating Medications for Your Patients

Pharmacy Address Therapeutic

Phone number

Shasta Community Health Center 21035 Placer St, Redding, CA 96001 Paxlovid & Lagevrio (molnupiravir) (530) 246-5710
CVS Store 1035 Placer Street, Suite 110, Redding, CA 96001 Paxlovid & Lagevrio (molnupiravir) (530) 999-6073
CVS Store 2025 Court Street, Suite A, Redding, CA 96001 Lagevrio (molnupiravir) (530) 999-6072
Shasta Regional Medical Center 1450 Liberty St, Redding, CA 96001 Paxlovid Inventory Reporting Status: Unknown. Inventory has not been reported in the last 2 weeks. Please contact provider to make sure product is available. (530) 244-5401
Redding Rancheria 1441 Liberty Street, Redding, CA 96001 Paxlovid Inventory Reporting Status: Unknown. Inventory has not been reported in the last 2 weeks. Please contact provider to make sure product is available. (530) 224-2700
Rite Aid 1801 Eureka Way, Redding, CA 96001 Lagevrio (molnupiravir) (530) 243-5500
CVS Store 3375 Placer St, Redding, CA 96001 Lagevrio (molnupiravir) (530) 241-7328
CVS Store 317 Lake Boulevard, Suite B, Redding, CA 96003 Lagevrio (molnupiravir) (530) 999-6099
Walgreens Store 115 Lake Blvd E, Redding, CA 96003 Paxlovid & Lagevrio (molnupiravir) (530) 229-1519
Rite Aid 975 East Cypress Avenue, Redding, CA 96002 Paxlovid & Lagevrio (molnupiravir) (530) 223-3995
CVS Store 1060 E Cypress Ave, Redding, CA 96002 Paxlovid & Lagevrio (molnupiravir) (530) 221-5575
CVS Store 1280 Dana Dr, Redding, CA 96003 Lagevrio (molnupiravir) (530) 224-1437
Omnicare of Redding 5200 Churn Creek Rd. Suite A, Redding, CA 96002 Paxlovid & Lagevrio (molnupiravir) (530) 224-3373
Rite Aid 6424 Westside Road, Redding, CA 96001 Paxlovid & Lagevrio (molnupiravir) (530) 243-3616

Pharmacy Address  Therapeutic 

Phone number

Rite Aid 3095 Mcmurray Drive, Anderson, CA 96007 Lagevrio (molnupiravir) & Paxlovid (530) 365-5753
CVS Store 2975 East Street, Anderson, CA 96007 Lagevrio (molnupiravir) (530) 744-6024
Anderson Family Health Center 2965 East Street, Anderson, CA 96007 Lagevrio (molnupiravir) & Paxlovid (530) 378-0486
AndersonRX Pharmacy 2940 East St., Anderson, CA 96007 Lagevrio (molnupiravir) & Paxlovid (530) 378-5566
Safeway Pharmacy 2601 Balls Ferry Road, Anderson, CA 96007 Lagevrio (molnupiravir) & Paxlovid (530) 365-1010

Pharmacy Address Therapeutic

Phone number

Rite Aid 5350 Shasta Dam Boulevard, Shasta Lake, CA 96019-9402 Paxlovid & Lagevrio (molnupiravir) (530) 275-1532

Pharmacy Address Therapeutic Phone number
Rite Aid 9340 Deschutes Rd, Palo Cedro, CA 96073 Paxlovid & Lagevrio (molnupiravir) (530) 547-4403

Pharmacy Address Therapeutic

Telephone

Safeway Pharmacy 37264 Main Street, Burney, CA 96013 Lagevrio (molnupiravir) (530) 335-4101
Rite Aid 37435 Main Street, Burney, CA 96013-4372 Paxlovid & Lagevrio (molnupiravir) (530) 335-4860

Pharmacy Address Therapeutic

Phone number

Mayers Memorial Hospital District 343563 Highway 299 East, Fall River Mills, CA 96028 Paxlovid & Lagevrio (molnupiravir) (530) 336-7558

 

Facilities offering Monoclonal antibody treatments are limited and services offered May Vary.

PRIMARY SITES DELIVERING MONOCLONAL ANTIBODIES FOR COVID-19 TREATMENT

  • Dr. Paul Davis -Private pay (submit to insurance for reimbursement), community access, based on availability: (530) 768-9490; Visit www.antibodyclinic.org to determine eligibility, daytime, and after-hours services, weekends, home visits

EMERGENCY DEPARTMENTS DELIVERING MONOCLONAL ANTIBODIES FOR COVID-19 TREATMENT (not recommended for non-emergencies)

  • Mercy Medical Center Redding

  • Shasta Regional Medical Center

  • Mayers Memorial Hospital

Resources

Contact Information

  • For questions related to Evusheld, Paxlovid or Molnupiravir or Sotrovimab please contact Shasta County MHOAC DOC45@co.shasta.ca.us