Got Questions On COVID-19 Treatments? PA Experts Have Answers

PENNSYLVANIA — The Pennsylvania Department of Health delivered an online panel Tuesday on the COVID-19 treatment options available for commonwealth residents.

Physician General Dr. Denise Johnson hosted the conversation, with guests Dr. J. Ryan Bariola of the University of Pittsburgh and Dr. Pablo Tebas of the University of Pennsylvania weighing in.

Multiple prevention or treatment options are currently available in the commonwealth, the experts outlined. The types currently available are pre-exposure prevention methods and post-exposure prophylaxis methods, as well as oral antiviral medications and monoclonal antibodies.

Bariola and Tebas focused primarily on oral antiviral medications and monoclonal antibodies, both of which should be administered within five days of illness in order to be effective. They work best in outpatient settings for patients with mild illness; those already sick enough to be admitted to the hospital are not eligible.

There are three monoclonal antibody products with emergency use authorization from the Food and Drug Administration:

• Regeneron's REGEN-COV (casirivimab plus imdevimab)
• Eli Lilly's bamlanivimab plus etesevimab (bam/ete)
• GSK's sotrovimab

Two oral antiviral medications have emergency use authorization, too:

• Merck's molnupiravir
• Pfizer's Paxlovid

The primary difference between these is that monoclonal antibodies target the spike protein of a virus, while oral antivirals kill the virus by targeting different stages of its life cycle once its inside cells, the scientists explained.

Some monoclonal antibodies are approved for both treatment and prevention, but Tebas said given the high demand relative to the amount available that treatment should be prioritized.

The experts reiterated that, though the treatments are tested and effective, from both a public health and supply perspective vaccines and boosters are still far more effective at protecting people from severe complications of COVID-19.

"These are not meant to be first line," Johnson said. "We have great protection against COVID-19 with the vaccine."

Bariola agreed, saying, "It’s the basics of medicine: Prevention beats treatment every single day."

Because monoclonal antibodies directly attack the virus, afterwards cells won’t have the training, memory, or early warning system to recognize it again. Scientists think the antibodies stick around at an effective level for only around 30 days, such that by the time you recover you could be susceptible again.

Two main groups are top priority for receiving treatments: unvaccinated high-risk people and immunosuppressed people. Within those groups, Tebas said healthcare providers should then look at age, vaccination status, immune status, and the presence of clinical risk factors (such as obesity, hypertension, and diabetes) when determining whether to prescribe treatments.

"Age is the most powerful predictor of complications of COVID," Tebas said.

Ultimately, it is up to local jurisdictions to equitably prioritize allocating treatments, the experts said.

Johnson said that the health department has made a concerted effort to distribute treatments across the commonwealth fairly, with special attention given to allocating to rural or high risk areas. A map of dispensing sites is available on the health department website.

Given the high demand for treatments, Bariola said — with the exceptions of the Merck pill being unsafe for pregnant people and the Paxlovid pill having many drug interactions to be aware of —the best treatment for you is the one your healthcare provider is able to prescribe and has in stock.

"What you have access to is what you need to take," he said.

All of these drugs are currently free of cost, with the exception of possible insurance copays or deductibles for the infusion of monoclonal antibodies. But even these fees can be waived by insurance, or covered by government funding for those who are uninsured.

“You have already paid for it," Tebas said. "You paid your taxes, and this is your government working for you.”

In response to questions around the omicron variant and the possibility to still become infected with COVID-19 even after vaccination, Bariola reiterated that the goal is to reduce severe infection.

“Very few vaccines are 100 percent effective," he said. "A vaccine’s job is to prevent you from getting critically ill.”

Tebas also said treatments, while valuable, are a last resort.

"We shouldn’t change our approach to COVID in terms of prevention," he said.

Learn more about COVID-19 treatment in Pennsylvania.

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