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Treatment Updates: Paxlovid vs. Monoclonal Antibody Therapy for acute Covid-19 Infection

What You Need to know

Covid-19 cases are again rising nationally and locally. The true number of cases is likely much higher than what is being reported due to many cases being diagnosed with at home antigen testing. Most cases are being caused by Omicron BA.2 sub-variants. Disease severity is much milder than prior iterations of the virus such as Delta or the original Alpha strain. Most importantly we are seeing much less pneumonia with the latest variants. This is important because pneumonia is the leading cause of hospitalization and death from a Covid -19 infection. When you combine this with the fact that most people are either previously vaccinated, previously infected, or both; the disease is not nearly as dangerous as what we were seeing previously.

Therapeutics are also more widely available than ever before and now include oral Anti-Viral Medication (i.e Paxlovid) as well as IV Monoclonal Antibody Therapy. There are pro's and con's to each therapy and I am getting a lot of questions about which therapy is best.

Both treatments are effective in preventing hospitalization and death and work best when started as soon as possible after symptom onset. Both are indicated for high risk patients, with mild to moderate illness not requiring hospitalization, within 5 days of symptom onset.


Rebound After Paxlovid Treatment


Unfortunately, I have seen several cases of rebound after Paxlovid treatment and the FDA recently issued a health advisory regarding this phenomenon. What this means is patients who were treated with Paxlovid initially experience resolution of symptoms, test negative, and then experience either a rebound of symptoms or a subsequent positive viral test. Covid-19 rebound typically occurs 2-8 days after initial recovery. This can be aggravating as patients who experience rebound after treatment may experience a longer duration of illness and also are capable of transmitting Covid-19 during this rebound period. This also means they should again isolate during this infectious period. Fortunately we do not see this with Monoclonal Antibody Therapy which is something to consider when choosing therapy for a Covid-19 infection. Also there are several drug interactions to consider before starting to take Paxlovid so please consult with your doctor before initiating therapy. Monoclonal Antibody Therapy does not have these interactions. As always if you are sick reach out to your physician about which therapy is best for you. I just wanted to share my experience from what I have seen clinically in the Emergency Department and hopefully help you make the best and most informed decision possible if you should require therapy for an acute Covid-19 infection. We currently offer At Home Monoclonal Antibody Therapy as well as Telehealth appointments for Paxlovid Prescriptions if you need help coordinating treatment. Stay Safe. - Dr. Q



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