Can You Get Covid after Following All the Guidelines?
Let's say you're vaccinated and masked, and despite your best efforts, you become ill with Covid. Known as a breakthrough infection, this occurs because the guidelines are difficult to follow, especially with the people you live with. From the moment you realize you might be coming down with something, is there anything you can do to prevent hospitalization?
Disclaimer: The following information is correct as of this date, which changes on a nearly daily basis as we learn more about Coronavirus.
Before discussing what to do after exposure to Coronavirus, the virus that causes Covid-19 illness, discussing the preventive strategies that can be implemented to prevent an infection is critical. These are important because when closely followed, they lead to less disease.
Promoting optimal health by adopting daily exercise, adequate sleep, and taking supplements in addition to the ideal diet all help keep us stay strong and healthy, but for many people with certain medical conditions, these measures are not enough to prevent hospitalization and death due to Coronavirus. In the case of Covid-19, having certain medical conditions increases the risk of hospitalization with severe Covid illness.
The preventive measures that are considered effective are:
1. Controlling the virus by facial covering (wearing a face mask), frequent hand sanitizing and washing, with careful attention to door knobs, phones, and other devices that are touched often. Maintaining a 6 feet distance from others while being social, and adequate ventilation and open spaces.
2. Reducing disease severity by staying up-to-date with vaccination requirements, and treatments that are initiated after exposure to Coronavirus.
Hand Washing
Just one word on hand washing. How well are you washing? Would you wash differently if you had paint on your fingers? What about a virus?
Face Masks and Six Feet
Achuu. A person infected with Covid without a face covering will infect those within reach of a droplet or a sneeze or a cough, which is roughly 6 feet. In other words, someone can produce saliva drops that fall on you when they talk, sneeze or cough, if you are within 6 feet, because that's how far the droplets fly. When you think about drops sprinkled on your face, you might think we should all want this distance and masks even in the absence of a pandemic.
Vaccination
The vaccination prevents severe Covid, and death from Covid. Severe Covid means you have trouble breathing, need oxygen, or require a tube to breath (mechanical ventilator).
As with many vaccines, this vaccine does not prevent infection from Covid. So yes, you can become infected with Covid after vaccination, and this is the rationale for the face covering recommendation. Vaccination against Covid is recommended to prevent death, and it is highly successful at doing this.
In addition to preventing death effectively, the Covid-19 vaccine also reduces the need for intensive care. That means your risk of requiring a ventilator is reduced to nearly zero. So it is worth getting vaccinated? Absolutely.
A person can be infected with Covid before they develop symptoms, and even a vaccinated person who becomes ill with Covid can spread the infection as well.
Can You Get Covid after Following All the Guidelines?
Let's say you wear a mask, and are vaccinated, and you become ill with Covid. Known as a breakthrough infection, this occurs because the guidelines are difficult to follow, especially with the people you live with. Assuming a person removes a mask while in the comfort of home, one of the most common ways parents and grandparents are becoming infected is because the kids are bringing home Coronavirus. Is there anything you can do to prevent hospitalization?
Covid-19 Infusion Treatment Outside the Hospital?
With the approval of Regen-Cov, it's now common to receive outpatient Covid treatment. This treatment was FDA-approved to prevent hospitalization from Covid, and to be given in the early stages of disease, even before symptoms develop (post-exposure prophylaxis). Once you suspect you may have contracted Covid, or begin experiencing symptoms, please contact your physician to decide if you are considered high risk or low risk for hospitalization for Covid-19 illness, and to discuss your treatment plan.
If you are considered "low risk" after a discussion with your physician, and you are unlikely to become severely ill, then you do not qualify for this treatment. If you are considered "high risk" for hospitalization from Covid after a discussion with your physician, then this is for you. The FDA-approved medication for treatment of Covid outside the hospital is an option if you are:
not severely ill
not yet hospitalized
not having trouble breathing
The Regen-Cov treatment is given at an infusion center. It is intravenous, but may be given subcutaneously if it cannot be given intravenously. Please contact us if you need advice about what to do.
Why Outpatient Treatment for Covid?
When hospitals were inundated with people who had Covid, doctors were forced to make the difficult decision to care for the sickest patients only. Because typically a person infected with Covid will worsen after seven days of being sick, it was not surprising that the "high risk" person who was not too ill to be hospitalized initially, and sent home, would return to the hospital a few days later in critical condition and require the intensive care unit. Prior to vaccination, about 1 in 4 patients require a ventilator once hospitalized.
Along with learning that Covid worsens after the first week, it was also discovered that some people wouldn't become as ill and could safely recover at home. Risk factors were identified which predicted who would die from Covid, and who could possibly stay home to recover. These risk factors included lab tests, need for oxygen, and others that your physician will evaluate and discuss with you.
The next question became: Could anything be done to help those who were not sick enough to be hospitalized initially, but not healthy enough to be considered low risk? Could they be safely treated at home to prevent hospitalization? These questions led to research that prompted approval of Regen-Cov for this indication, used for those who are not too sick to be hospitalized yet, but who are at risk for returning a few days later with advanced illness.
The other reason this treatment is available is for a person who has not had the chance to be fully vaccinated. This individual is considered high risk for hospitalization and death, especially as they are considered unprotected against the emerging variants.
How to Qualify for Regen-Cov
The U.S. Food and Drug Administration today revised the emergency use authorization (EUA) for REGEN-COV (casirivimab and imdevimab, administered together) authorizing REGEN-COV for emergency use as post-exposure prophylaxis (prevention) for COVID-19 in adults and pediatric individuals (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. REGEN-COV is not authorized for pre-exposure prophylaxis to prevent COVID-19 before being exposed to the SARS-CoV-2 virus -- only after exposure to the virus. Health care providers should review the Fact Sheet for detailed information about the use of REGEN-COV for post-exposure prophylaxis.
In other words, in order to receive this treatment, you:
Must be exposed to someone who has been diagnosed with Covid-19.
Preferably you receive this treatment after exposure to Covid-infected person, and before symptoms, in order to prevent severe illness leading to hospitalization.
Must be at least 12 years old
Must be at high risk for being hospitalized or dying from Covid-19 related illness
REGEN-COV also remains 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) 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.
In other words, in order to receive this treatment, you:
Must have a positive result for a Covid-19 test
Must have mild to moderate symptoms
Must be at least 12 years old
Must be at high risk for being hospitalized or dying from Covid-19 related illness
Can Regen-Cov Replace Vaccination?
Prophylaxis with REGEN-COV is not a substitute for vaccination against COVID-19. FDA has authorized three vaccines to prevent COVID-19 and serious clinical outcomes caused by COVID-19, including hospitalization and death. FDA urges you to get vaccinated, if you are eligible. Learn more about FDA-authorized COVID-19 vaccines.
REGEN-COV may only be used as post-exposure prophylaxis for adults and pediatric individuals (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, and
not fully vaccinated or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (for example, people with immunocompromising conditions, including those taking immunosuppressive medications), and
have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC), or
who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes or prisons)
Frequently Asked Questions
What is "fully" vaccinated?
In general, people are considered fully vaccinated two weeks after their second dose in a two-dose series (the Pfizer or Moderna vaccines) or two weeks after a single-dose vaccine (the Janssen vaccine).
What counts as "exposure" to Covid?
You need to be "exposed to Covid" in order to receive this treatment. The CDC defines close contact as someone who has been within six feet of an infected person (laboratory-confirmed or a clinically compatible illness) for a cumulative total of 15 minutes or more over a 24-hour period.
People should talk to their health care provider about whether the use of REGEN-COV for post-exposure prophylaxis is appropriate for them.
Can Regen-Cov replace vaccination?
FDA authorized REGEN-COV monoclonal antibody therapy for post-exposure prophylaxis (prevention) for COVID-19. Prophylaxis with REGEN-COV is not a substitute for vaccination against COVID-19.
Where's the Data in Support of This Approach?
The primary data supporting the EUA reissuance for post-exposure prophylaxis of COVID-19 are from a Phase 3 trial. The trial was a randomized, double-blind, placebo-controlled clinical trial studying a single dose of REGEN-COV for prevention of COVID-19 in household contacts of individuals infected with SARS-CoV-2. Cases were confirmed using real-time reverse transcription–polymerase chain reaction (RT-PCR), one of the most accurate laboratory methods for detecting, tracking, and studying COVID-19. An 81% reduction in confirmed symptomatic COVID-19 cases was observed with REGEN-COV compared to placebo at day 29 in cases who were RT-PCR negative and seronegative at baseline (the primary analysis population). In the overall trial population, there was a 62% reduction in RT-PCR confirmed symptomatic COVID-19 cases in the REGEN-COV group compared to placebo at day 29.
What are the Side Effects?
The most common side effects were injection site reactions. The signs and symptoms of injection site reactions which occurred in at least 1% of subjects in the REGEN-COV group were skin redness (erythema), an uncomfortable, irritating sensation that creates an urge to scratch (pruritus), and ecchymosis (discoloration of the skin resulting from bleeding underneath, caused by bruising). There were no cases of severe hypersensitivity reactions, or potentially life-threatening allergic reactions (such as anaphylaxis). People who had a previous severe allergic reaction to REGEN-COV should not use it again.
How Long is the Infusion?
The infusion is a 30 minute infusion of medication by way of a vein into your body. From the moment you park your car, check-in, provide consent to treatment, have a nurse set up your IV, and begin medication, until you can walk back to your car, it will take a total of approximately two hours of your time.
For Physicians:
Other important information for these trials including other outcomes and side effect information is available in the health care provider fact sheet.
REGEN-COV consists of the monoclonal antibodies casirivimab and imdevimab, administered together. Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens, such as viruses like SARS-CoV-2. The authorized dose for REGEN-COV for both treatment and as post-exposure prophylaxis is 600 mg of casirivimab and 600 mg of imdevimab administered together.
For treatment, intravenous infusion is strongly recommended; subcutaneous (under the skin) injection is authorized as an alternative route of administration when intravenous infusion is not feasible and would lead to delay in treatment.
For post-exposure prophylaxis, either intravenous infusion or subcutaneous injection is appropriate. For individuals who remain at high risk of exposure to another individual with SARS-CoV-2 for longer than 4 weeks, and who are not expected to mount an adequate immune response to full SARS-CoV-2 vaccination, following an initial dose of 600 mg of casirivimab and 600 mg of imdevimab, repeat doses of 300 mg of casirivimab and 300 mg of imdevimab once every 4 weeks are appropriate for the duration of ongoing exposure.
What about Off-Label Remedies and Alternative Treatments?
You may have heard about Ivermectin, Hydroxychloroquine, or Zinc lozenges for use during early Covid infection. Dexamethasone, azithromycin, doxycycline, favipiravir, aspirin and colchicine have also been used after exposure, and before severe illness develops. These are all FDA approved medications, used off-label for Covid, that have an established record and well known safety profile for many other indications. There is an outpouring of studies looking at the role of these medications in treating Covid-19. As with all pharmaceuticals, they also have side effects and need to be used judiciously. Acupuncture has also been studied in Covid-19. If you become ill with Covid-19, we're here to help.
How to Get Covid Infusion and Covid Care
At Marta Long MD, we are ready to care for you during your illness with Covid-19, and to help you stay out of the hospital. We want our care to keep you healthy, and we want you to call us for any concerns.
To learn more about Marta Long MD, a Concierge at-home Primary Care Practice based in Irvine, California and serving Orange County, please visit www.MartaLongMD.com