COVID-19 continues to twist and turn as new variants become more predominant. The BQ1 and BQ1.1 variants have become the dominant strains in the US as of mid-November. These variants will likely crowd out the BA.4 and BA.5 variants that have been most prevalent in the previous six months. This will potentially affect protection with presently-available vaccines and therapies such as Evusheld.
In addition, the rise of influenza and respiratory syncytia virus (RSV), especially in children, has put an incredible strain on hospital beds once again, including an emergency order in Colorado by Governor Polis allowing pediatric patients to be treated at adult hospitals
It’s important to take reasonable steps to protect ourselves and our loved ones especially as we head into the holiday season and Winter months.
First and foremost, if you haven’t already received your initial COVID-19 vaccination, please get vaccinated as soon as possible. The MS Center’s medical team continues to strongly recommend all individuals receive the COVID-19 vaccination unless they have a known allergy to a component of the vaccine.
The COVID-19 vaccines and boosters remain our best defense against COVID-19. The updated bivalent booster is designed specifically to target the omicron subvariants — BA.4 and BA.5 — and the original coronavirus strain. Early studies suggest, however, that both the Moderna and the Pfizer bivalent vaccines have significant protection against the new strains as well.
The CDC recommends that people ages 5 years and older receive one updated (bivalent) booster if it’s been at least two months since their last COVID-19 vaccine dose, whether that was their final primary series dose, or an original (monovalent) booster. People who have gotten more than one original (monovalent) booster are also recommended to get an updated (bivalent) booster.
Even if you’re vaccinated, reasonable precautions in high-risk situations are still good advice. You may not need to wear a mask everywhere you go, but you should keep one handy in case you find yourself in a crowded, poorly-ventilated place. You may not need to sanitize your hands every time you touch a doorknob, but washing your hands thoroughly and regularly throughout the day is important.
And of course, if you’re feeling sick, stay home — and if possible, take a COVID self-test. If you know you’ve been exposed to someone who has COVID, take extra precautions to avoid close contact with others until you’re reasonably sure you’re in the clear.
We develop antibodies against many viruses after being infected, or by taking a vaccine. Both offer varying levels of protection against future infection with the same virus. Many MS disease-modifying therapies, however, can impact how your immune system works by reducing production of antibodies that neutralize SARS-CoV-2 after vaccination or natural infection. Prior to November, one way to get additional antibodies against COVID was to take them as a drug cocktail called Evusheld.
Evusheld is a combination of two monoclonal antibodies that work against the spike protein of SARS-CoV-2, and is given as two intramuscular injections at the same visit. Evusheld is a drug for moderately to severely immunosuppressed patients who have been vaccinated, but haven’t developed adequate levels of those protective antibodies. It’s likely useful for up to six months, and present guidance is to repeat those shots every six months.
Evusheld was a helpful tool against the BA.4 and BA.5 variants and patients who received it added a layer of self-protection while those variants were dominant. However, as of mid-November, the BQ.1 and BQ.1.1 variants have become the dominant strains of COVID-19 in the US, which appear to be resistant to the antibody cocktail in Evusheld. Because of this, Evusheld is being phased out and UCHealth will stop offering it. The doctors at the Rocky Mountain MS Center continue to monitor the situation and we will keep you up to date on current recommendations as COVID continues to change over time. This does not mean that previous recommendations were incorrect, simply that the dominant virus variants have changed and therefore we have new recommendations.
Evusheld is not a replacement for the COVID vaccination or boosters.
If you do contract COVID-19, there are treatments available that can reduce your risk of being hospitalized or dying from COVID-19. These medications must be prescribed by a healthcare provider. You must start these medications as soon as possible after testing positive to be effective.
You may be eligible for these treatments regardless of the MS DMT you are using, but if you are taking MS DMTs that suppress parts of your immune system — including Rituxan, Ocrevus, Kesimpta, Gilenya and its generics, Mayzent, Zeposia, Ponvory, Lemtrada, Mavenclad, and any chemotherapy drugs — you may be at slightly higher risk of a severe COVID infection. Thus, use of these medications may be more important in this context.
Discuss these options with your healthcare provider as soon as possible if you test positive for COVID-19. You will need a prescription for these treatments.
Below is the summary of current COVID-19 treatment options from the CDC and the U.S. Department of Health & Human Services:
If you’re not hospitalized and have had symptoms for 5 days or less, here are the treatment options that your healthcare provider could recommend:
- Paxlovid: This is an oral medication (pill) to treat mild to moderate symptoms of COVID-19. It must be given within 5 days after the first symptoms of COVID-19 appear. Paxlovid is for adults and children who are 12 years of age and older, weighing at least 88 pounds and is generally well-tolerated. Treatment is two pills three times daily for five days. In order to qualify for a prescription, you must also have had a positive COVID-19 test result and be at high risk for developing severe COVID-19. That means you must either have certain underlying conditions (including cancer, diabetes, obesity, or take medicines that place you at high risk of severe COVID) or be 65 or older. An unknown percentage of individuals using Paxlovid have had a rebound, ie, they may test negative after treatment and then positive a few days later. This may, or may not, be associated with return of symptoms. The significance of this remains unclear, but patients may be able to transmit COVID to others if they have a rebound, so usual precautions should be taken until it is clear a negative test is persistent.
- Veklury (remdesivir): This antiviral treatment is for people staying in the hospital and people who are not in the hospital. People who are not in the hospital must go to an IV infusion center to receive this treatment. Veklury must be given within 7 days after first symptoms of COVID-19 appear. It is given as a daily IV infusion for 5-10 days depending on response.
- Lagevrio (molnupiravir): This is an oral medication (pill) to treat mild to moderate symptoms of COVID-19. It must be given within 5 days after the first symptoms of COVID-19 appear. Lagevrio is for adults 18 years and older, and is four capsules twice daily for five days. It is generally well-tolerated, but should not be taken if breastfeeding or pregnant.
If you’ve had symptoms for 7 days or less, here are the treatment options that your healthcare provider could recommend:
- Bebtelovimab: This is a monoclonal antibody for adults and children 12 years or older (weighing at least 88 pounds) who have tested positive for COVID-19. However, this monoclonal antibody appears to be losing its effectiveness against the new strains of COVID-19 and is also being phased out.
These treatments are all very similar, with the exception of molnupiravir which is a bit weaker.
Please note that as strains and variants of COVID change, treatments could also change, especially the monoclonals as described above. Convalescent IVIG or antibodies made from patients who have recovered from COVID-19 have been used in the past and may become available again as more people get infected and recover from the new strains. New monoclonals may become available. However, the loss of these treatments add to the suggestion of getting boosted (and treated if needed) with the bivalent vaccine as this appears to be still be effective at providing good protection.
You must start these medications as soon as possible after testing positive to be effective. The most expeditious way to get treatment is to schedule a telehealth appointment through urgent care facility. For more information and resources to get COVID-19 treatment here is a helpful link for Colorado residents: https://covid19.colorado.gov/getting-covid-19-treatment.
Here is a link with more information about Telehealth appointment options: https://covid19.colorado.gov/telehealth-treatment
Again, it is important to reinforce: The COVID-19 vaccines and boosters remain the best defense against COVID-19. It is critical to receive your vaccine and boosters as soon as possible. Please see our current chart of vaccine and booster guidance and our frequently asked questions page.
For the MS Center’s latest COVID-19 updates — including a detailed chart of vaccine and booster guidance for those on MS DMTs, frequently asked questions, and a lists of COVID myths and facts – please visit MSCenter.org/covid.