COVID-19 Outpatient Therapeutics & Pre-Exposure Prophylaxis

COVID-19 Overview

Pandemic Impact. To date, SARS-CoV-2 (the virus that causes COVID-19 disease) infection has resulted in >1 million deaths nationally, including >1,800 deaths in the state of Hawaii. COVID-19 may include mild symptoms, but may result in life-threatening disease in high-risk individuals, including pregnant women, newborn infants, persons >50 years old, or those with chronic heart or lung disease, diabetes, obesity, cancer, organ transplant, or immunodeficiency.

Prevent the Spread of COVID-19. If everyone were to take all steps to prevent the spread of COVID-19. this would help to lower COVID-19 transmission in the community, among family members, friends, co-workers, students, and further limit spread at religious, social and business gatherings. Elect to wear a mask when entering healthcare or long-term care facilities to protect patients and residents.

Vaccination: Essential preventive steps include staying up-to-date with your COVID-19 vaccinations and getting an annual flu shot; both dramatically lower the risk of hospitalization and death, Being up-to-date also protects elderly and other high-risk individuals. For answers to many COVID-19 vaccine issues, click here.

New Vaccines & Variants. New bivalent COVID-19 vaccines can provide protection against the highly transmissible Omicron variants circulating. These updated vaccines are safe and effective, can lower the risk of “long” COVID, and the risk of hospitalization and death.

Outpatient Treatment of COVID-19. For adults who are at high risk of progression to severe disease, antiviral therapeutic options are available to reduce the risk of hospitalization or death. PAXLOVID (ritonavir-boosted nirmatrelvir) or REMDESIVIR are the preferred treatment options for high-risk adult patients with mild to moderate COVID-19 (see Table 2a.) . NIH treatment guidelines for children are found here.

Pre-Exposure Prophylaxis. Evusheld is no longer authorized by FDA for use as pre-exposure prophylaxis in the U.S.

Convalescent Plasma. The use of COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibody is FDA-authorized for treatment in immunocompromised patients.

Corticosteroids Contraindicated. NIH recommends against the use of corticosteroids or antibiotics for the treatment of mild-to-moderate COVID-19 (see Table 2a. and CDC or HDOH advisory).

Preferred Treatment Options for Outpatient COVID-19:

  1. Oral PAXLOVID (NIH Rx guideline, 09/2022)
    1. Fact sheet for providers
    2. Patient Eligibility Screening Checklist Tool
  2. IV REMDESIVIR (NIH Rx guideline, 12/2022)
    1. U.S. Indication and Important Safety Information

Alternative Treatments (if preferred Rx not available):

  1. Oral MOLNUPIRAVIR (NIH Rx guideline, 9/2022)
    1. HHS/ASPR Updates
    2. Molnupiravir Checklist for Providers

Note: IV Bebtelovimab is No Longer Authorized for Use (updated 02/01/2023)

Prevent all Acute Viral Respiratory Infections:

Acute viral respiratory infections (ARIs) due to COVID-19, influenza and RSV increase during winter months. Remember to get your free annual flu shot, which can be administered at the same time as the new bivalent COVID-19 booster. Everyone eligible should receive a seasonal flu shot, a bivalent COVID-19 vaccine and take steps to prevent the spread of ARIs.
If exposed to a COVID-19 patient, or develop symptoms, then: self-test, wear your mask, consult a provider about treatment, and don’t go to work until symptoms resolve.

Patients, Parents and Caregiver Resources:

If you test-positive for COVID-19, discuss possible treatment options with your healthcare provider or pharmacist.


Last updated 02/24/2023