COVID-19: Strategies to Protect Adult & Pediatric Patients

Recovery After COVID-19

Dr. Jonsson took care to stress that time-based criteria for clearance of COVID-19 aren’t suitable for immunosuppressed patients. Rather, home-based antigen tests to confirm viral clearance are a better strategy. Polymerase chain reaction tests aren’t recommended for this purpose because they can remain positive for weeks. “A positive home antigen tests means you have live virus in your nose that you’ll be sharing with people around you,” Dr. Jonsson said.

It’s also important to inform patients about the possibility of “rebound infection” after outpatient therapy and what to do. “If symptoms are mild, patients can just wait it out. If they have fevers or other severe symptoms, they should call for consideration of another round of treatment,” Dr. Jonsson advised.

In Sum

Dr. Jonsson concluded by stressing how important it is to discuss COVID-19 with our patients at every clinic visit. She said, “Talk about the importance of vaccines. Make sure they have home antigen tests ready to go. And tell them to call you, the prescriber of immunosuppressants, and not the primary care provider if they’re experiencing symptoms. Treat all immunosuppressed patients, and know what options are available in your area.”

Samantha C. Shapiro, MD, is the executive editor of Harrison’s Principles of Internal Medicine. As a clinician educator, she practices telerheumatology and writes for both medical and lay audiences.

References

1. Qian G, Wang X, Patel NJ, et al. Outcomes with and without outpatient SARS-CoV-2 treatment for patients with COVID-19 and systemic autoimmune rheumatic diseases: A retrospective cohort study. 2022 Oct 30:2022.10.27.22281629. Preprint.
2. Hammond J, Leister-Tebbe H, Gardner A, et al. Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19. N Engl J Med. 2022;386(15):1397–1408.
3. University of Liverpool. COVID-19 Drug Interaction Checker. https://www.covid19-druginteractions.org/checker. [cited 2022 Nov 28].
4. Centers for Disease Control and Prevention. CDC Health Advisory. COVID-19 rebound after Paxlovid treatment. 2022 May 24. https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_467.pdf.
5. National Institutes of Health. Therapeutic management of nonhospitalized children with COVID-19. Table 3b. The panel’s framework for assessing the risk of progression to severe COVID-19 based on patient conditions and COVID-19 vaccination status. Updated 2022 Aug 8. https://www.covid19treatmentguidelines.nih.gov/tables/assessing-risk.

COVID-19 Resources to Bookmark & Check Frequently

• National Institutes of Health COVID-19 Treatment Guidelines
  • Medications: https://www.covid19treatmentguidelines.nih.gov/therapies
  • Immunosuppressed people: https://www.covid19treatmentguidelines.nih.gov/special-populations/immunocompromised
  • Children: https://www.covid19treatmentguidelines.nih.gov/management/clinical-management-of-children
  • Assessing risk: https://www.covid19treatmentguidelines.nih.gov/tables/assessing-risk
• Centers for Disease Control and Prevention information for pediatric providers: https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html
• American Academy of Pediatrics COVID-19 treatment guidelines: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/outpatient-covid-19-management-strategies-in-children-and-adolescents
• ACR COVID-19 guidance: https://www.rheumatology.org/Practice-Quality/Clinical-Support/COVID-19-Guidance
• Children’s Hospital of Philadelphia COVID-19 outpatient treatment guidelines: https://www.chop.edu/clinical-pathway/covid-disease-therapies-severity-illness-non-hospitalized-children
• University of Liverpool COVID-19 Drug Interactions: https://www.covid19-druginteractions.org