Updated March 21, 2022
[Note: For patients who enter the hospital with severe COVID-19, a number of other treatment options may be considered by and discussed with your health care providers. For more information on those in-patient treatment options, click here]
FDA Warning: FDA has not approved ivermectin for use in treating or preventing COVID-19 in humans. Taking large doses of this drug is dangerous and can cause serious harm. Never use medications intended for animals on yourself. Ivermectin preparations for animals are very different from those approved for humans. For more information, click here.
I tested positive for COVID-19 what should I do now?
- First, isolate yourself – stay home, separating yourself from any other household members.
- If you have symptoms, remain in isolation for at least 10 days after symptoms first appear and continue through a full day (24 hours) after symptoms have disappeared.
- If you do not have symptoms, remain in isolation for at least 10 days have passed since the date of the first positive test.
- Follow the NH DHHS isolation guide.
- Second, let your primary care provider know.
- Importantly, ask your healthcare provider about treatments. If you do not have a healthcare provider, NH DHHS suggests you contact ConvenientMD to ask about treatment. If you need emergency care, do not delay, go to your nearest Emergency Room.
Is there a treatment that can reduce my risk of severe illness and hospitalization for COVID-19?
Yes. Two oral antiviral medications have received Emergency Use Authorization from the FDA and are available in NH by prescription and -- in limited amounts -- through the Federal "Test to Treat" program.
- Molnupiravir can be prescribed through certain Walgreens, CVS and RiteAid pharmacies
- Paxlovid will be available at Walgreens pharmacy locations
- The federal COVID-19 “Test to Treat” program is allocating Paxlovid and Molnupiravir to certain CVS “Minute Clinics.”
To find the pharmacies with supplies of antivirals, healthcare providers and advocates can use this COVID-19 Therapeutics Locator.
In addition, three monoclonal antibody products have received Emergency Use Authorizations (EUAs) from the FDA for treatment of mild to moderate COVID-19 in nonhospitalized patients with laboratory-confirmed COVID-19 infection who are at high risk for progressing to severe disease and/or hospitalization. These treatments may reduce the risk of severe illness, hospitalization and death and have been found not to be as effective against the Omicron variant. These treatments are only appropriate for patients meeting the FDA’s definition of high risk and must be administered promptly.
The treatments include:
1) Bamlanivimab and etesevimab (Lilly) administered together are authorized for use in adults and pediatric patients who are at high risk for progression to severe coronavirus disease 2019 (COVID-19), including hospitalization or death for:
- the treatment of mild to moderate COVID-19, or
- post-exposure prophylaxis of COVID-19 in individuals who have not been fully vaccinated against COVID-19 (Individuals are considered to be fully vaccinated 2 weeks after their second vaccine dose in a 2-dose series or 2 weeks after a single-dose vaccine) or are not expected to mount an adequate immune response to complete vaccination, and
- have been exposed to someone infected with COVID-19 or
- who are at high risk of exposure in an institutional setting, including a nursing home or prison
2) casirivimab and imdevimab (Regeneron) is authorized for use by adults and adolescents (12 years of age and older who weigh at least 88 pounds (40kg)) who are at high risk for severe COVID-19, including hospitalization or death for:
- treatment of mild to moderate symptoms of COVID-19
- post-exposure prophylaxis of COVID-19 in persons who are:
- not fully vaccinated against COVID-19 (Individuals are considered to be fully vaccinated 2 weeks after their second vaccine dose in a 2-dose series or 2 weeks after a single-dose vaccine) or,
- are not expected to build up enough of an immune response to the complete COVID-19 vaccination (for example, someone with immunocompromising conditions), and
- have been exposed to someone with COVID-19 or
- is at high risk of being exposed to someone who is infected with COVID-19 (for example, nursing homes, prisons)
- 3) Sotrovimab is 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) who are at high risk for progression to severe COVID-19, including hospitalization or death. Sotrovimab is not authorized for use in patients:
- who are hospitalized due to COVID-19, OR
- who require oxygen therapy due to COVID-19, OR
- who require an increase in baseline oxygen flow rate due to COVID-19 (in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity).
Benefit of treatment with sotrovimab has not been observed in patients hospitalized due to COVID‑19.
These treatments must be administered promptly, so if you or your child have tested positive for COVID-19, contact your primary health care provider immediately to discuss if you or a child are candidates for this treatment. If you do not have a health care provider, NH DHHS suggests you contact ConvenientMD about treatment options.
These 3 monoclonal antibody treatments are not authorized for pre-exposure prevention purposes and are not substitutes for vaccination against COVID-19. The exception, in limited circumstances, is Evusheld, as described below.
What are monoclonal antibodies?
Monoclonal antibodies are laboratory-produced molecules that act as substitute antibodies that can restore, enhance or mimic your immune system's ability to attack the COVID-19 virus. Research suggests that these monoclonal antibodies block the virus that causes COVID-19 from attaching to human cells, making it more difficult for the virus to reproduce and cause harm. Monoclonal antibodies may also neutralize or destroy the virus.
What do you mean by “they must be administered promptly”?
To be effective, monoclonal antibody treatments must be given as quickly as possible to those at high risk when they test positive, and are either still without symptoms or have mild to moderate symptoms, such as fever, cough, and difficulty breathing. Patients who are hospitalized for COVID-19 or being treated with oxygen because of COVID-19 are not eligible.
Who are considered “high risk patients”?
High risk individuals include:
- all persons 65 years of age and older
- persons 55-64 with high blood pressure, heart disease, chronic obstructive pulmonary disease, obesity, diabetes and those who are immunosuppressed.
- persons aged 12 to 17 years who weigh at least 88 pounds and have one these additional factors:
- a Body Mass Index in the 85th percentile or above, for their age and gender based on Centers for Disease Control and Prevention growth charts,
- Sickle cell disease
- Congenital or acquired heart disease
- Neurodevelopmental disorders such as cerebral palsy
- A medical-related technological dependence, for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19),
- Asthma, reactive airway or other chronic respiratory disease that requires daily medication for control.
All high-risk individuals who test positive for COVID-19 should contact their healthcare provider immediately upon receiving that result to determine if they are eligible for monoclonal antibody treatment and where they can receive it.
How is the treatment administered?
Monoclonal antibodies are administered through an infusion (an intravenous ‘drip’) or for some products as an injection. The treatment “attacks” the virus in the same way as antibodies produced from either a prior COVID-19 infection or vaccination and accelerates the natural production of antibodies against the COVID-19 virus in both those who are unvaccinated and those whose post-vaccination “memory cells” need boosting.
What does it cost?
The monoclonal antibody serum is provided free from the federal government.
Where can I get this treatment?
These treatments are available at various locations throughout New Hampshire.
- 15 hospitals and 9 ConvenientMD centers (including Portsmouth, Exeter/Stratham, Dover). Note: ConvenientMD is not able to provide therapy to those 12-18 years old, but hospitals may be able.
If your healthcare provider determines you are eligible, they will schedule an appointment at one of these locations. Then that Monoclonal Antibody Infusion Site will contact you. If it is determined you meet clinical criteria, the site will provide specific instructions on your appointment.
Do I still need to get a vaccination after receiving monoclonal antibodies?
Yes. You will still need to receive a COVID-19 vaccination for long-term protection. NH DHHS currently recommends that the COVID-19 vaccine should NOT be given for at least 90 days after a person receives passive antibody therapy as treatment for COVID-19 (i.e., convalescent plasma or monoclonal antibodies).
Is there a pill (oral treatment) for COVID-19?
On December 22, 2021, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms or about 88 pounds) with positive results of direct SARS-CoV-2 testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. US Government has purchased 10 million doses for distribution to the states.
Source: FDA Authorizes first oral antiviral treatment Paxlovid
On December 23, 2021, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for Merck’s molnupiravir for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults 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, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate. Molnupiravir is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset.
Source: FDA Authorizes additional oral antiviral treatment Molupiravir
What is the “Evusheld” treatment and how does it work?
Evusheld is a pre-COVID protection option developed by AstraZeneca that combines two monoclonal antibodies (tixagevimab and cilgavimab) in one injection. In a study of persons who were at high risk of severe illness, hospitalization, or death from COVID-19 because they were immunocompromised or ineligible to receive a COVID-19 vaccination, Evusheld was shown to reduce the risk of developing COVID-19 compared to those who received a placebo.
This drug combination can help to prevent COVID-19 by providing antibodies directly to a person through an injection. These antibodies work similarly to the antibodies developed after a COVID-19 illness or vaccination but instead of your own body producing the antibodies, these antibodies are already formed, ready for action, and are long-acting.
Tixagevimab and cilgavimab , the two long-acting monoclonal antibodies in Evusheld, target the spike protein of SARS-CoV-2, blocking the viruses’ attachment and entry into human cells.
Who is eligible to receive Evusheld?
The FDA has given an Emergency Use Authorization [EUA] for the use of this drug in persons aged 12 and older weighing at least weigh at least 40 kg [88 pounds] who, even though they have been vaccinated, have an immune disorder that may prevent them from developing an adequate supply of their own antibodies. It has also been approved for use in persons who have had an allergic response to a COVID-19 vaccine or are allergic to a vaccine component.
Some of the conditions that impair immune responses and would make persons eligible for this product include: primary immunodeficiency disorders, active treatment of cancer, rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, advanced or untreated HIV infection. Those who are receiving certain medications such as a TNF inhibitor or immunosuppressive drugs designed to prevent the rejection of organ transplants are also eligible. If you have a weakened immune system and think your situation qualifies for treatment with Evusheld, contact your PCP to discuss your eligibility.
To qualify you cannot have been currently exposed to or infected with COVID-19.
This drug is not authorized for persons who have chosen not to be vaccinated, for treatment of a COVID-19 exposure, or for treatment of a COVID-19 infection. Those persons who develop early symptoms of COVID-19 and are diagnosed with the infection by their health care provider are reminded to seek treatment using a different monoclonal antibody product. For more information see the COVID-19 Treatment FAQ document.
Why did the FDA give Evusheld an EUA?
Evusheld’s emergency use approval followed the findings of a Phase 3 study in a trial called PROVENT. This drug trial enrolled over 5,000 people who were unvaccinated, had never had COVID-19, and were either 60+ years of age, had a pre-specified co-morbidity (obesity, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, immunocompromised state, or previous history of severe or serious adverse event after receiving any approved vaccine), or were at increased risk of SARS-CoV-2 infection due to their living situation or occupation.
How is Evusheld given?
Evusheld is administered by a health care provider as two consecutive intramuscular injections: 150 mg of tixagevimab and 150 mg of cilgavimab. The preferred injection site is the gluteal muscle.
The manufacturer recommends the patients be observed for approximately one hour after injection to make sure they do not experience any adverse effects.
What are the side effects of Evusheld?
In the clinical trials using Evusheld the most common side effects were headache, fatigue and cough.
Serious adverse events were rare in the PROVENT drug trial. The most serious adverse effects were heart-related (including heart attack). Persons with underlying heart disease who are also immunocompromised or allergic to the COVID-19 vaccine should discuss the benefit and risk of getting Evusheld with their health care provider.
What if I qualify but have been vaccinated?
The current recommendation is to wait for a minimum of 2 weeks after vaccination to receive an Evusheld injection.
How long does Evusheld protect a person from severe COVID-19?
Current evidence is the drug provides protection for approximately 6 months. Eligible persons can receive the injections every 6 months. However, AstraZeneca has not yet provided any safety or efficacy data on repeat injections except what is being observed in clinical trial data.
FDA Authorizes New Long-Acting Monoclonal Antibodies for Pre-exposure Prevention of COVID-19 in Certain Individuals
FDA Fact Sheet for Healthcare Providers on Evusheld
For more information on COVID-19 treatments, click here.