East Bay Getting to Zero
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Clinical Guides, COVID, Prevention

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What to do after testing positive for COVID

  1. Stay home (“isolate”), wear a mask to protect people around you, and ventilate your space, including at home, following the guidance in the graphic below. Ventilate by opening windows and doors to outside air, turn on fans to face outside, turn on exhaust fans, use humidifiers and HEPA air filters if you have them. If possible, stay in a separate space from household members who don’t have infection, especially if they are at high risk, until you test negative. For school-aged children in Alameda County, click here for return-to-school guidance.
  2. Contact your medical provider or a test-to-treat provider ASAP because you may be able to get antiviral treatment, even if you are vaccinated. The list of eligible conditions is long and includes very common conditions such as diabetes, pregnancy, depression, overweight, asthma, HIV, as well as older age and immunocompromise, so please ask your provider to check it.
    • Treatments are more effective taken as soon as possible after the start of symptoms.
    • As of May 2022, there is plenty of effective medication available, including Paxlovid oral treatment (start within 5 days of symptom onset) and second-line Bebtelovimab monoclonal antibody IV infusion treatment (within 7 days of symptom onset).
    • Contra Costa County residents can call 1-877-661-6230 if you test positive to reach a nurse and get a free same-day telehealth consult and prescription if medically appropriate. It’s best to call within 48 hours of the positive test results or symptom onset.
    • Alameda County residents at risk who cannot get Paxlovid or Remdesivir can self-refer for monoclonal antibody same or next-day treatment at Total Infusion within 7 days of symptom onset (click to make an appointment).
  3. Symptom management – what you can do to take care of yourself:
    • Rest and drink fluids regularly.
    • Use a thermometer to check your temperature. If it’s over 100.4°F, you can take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Tell your medical provider if you have a fever that won’t come down with these medicines.
    • Use a pulse oximeter to measure the oxygen level in your blood. You can purchase one for around $20 online or at many pharmacies. If your reading stays below 94%, you should tell your medical provider.
    • If needed, use other over-the-counter cold and flu medications for a runny nose, fever, headache, sore throat, muscle aches and cough (common COVID symptoms).
    • If you have shortness of breath, you may get some relief from resting on your belly (prone position) rather than on your back (supine position). 
    • Ask your provider about breathing exercises, as severe breathlessness may cause anxiety and worsen symptoms.
    • Increase walking and other forms of activity as you can tolerate. 
    • Remember that it can take different amounts of time for each person’s symptoms to resolve and make a complete recovery.
    • Keep in mind that in a small percentage of people with COVID-19, viral rebound may occur: you feel better and your antigen test becomes negative, then a few days later, the symptoms come back, and your antigen test becomes positive again. If that happens, start isolating again because you are likely infectious and let your medical provider know, as you may benefit from re/treatment.
    • Get vaccinated and/or boosted if you’re due for any doses to protect yourself against reinfection and future variants. You can get a vaccine dose as soon as you’re done with your isolation period.

Here’s a guide for movement and exercises while recovering from COVID-19: Bouncing Back from COVID-19: Your Guide to Restoring Movement from Johns Hopkins Medicine (PDF): English | Spanish | Hindi

More detailed guidance for people living with HIV can be downloaded here: GTZ-SF’s COVID FAQs after testing positive.

Note: If your symptoms are resolved on Day 5 or after and you test to get out of isolation, use a rapid antigen test, not a PCR or other molecular test. A person who has a moderate to severely immunocompromising condition (such as untreated HIV and/or CD4 <200) will need to isolate for 20 days, and if symptoms are resolved/resolving, have 2 negative rapid tests to leave isolation. Please see more details here.

A CDC study found that household transmission for Omicron was 53%. Secondary attack rates were lower for people who were boosted (43%), people had their primary vaccine series (44%), compared to people who were unvaccinated (64%). People with infection who wore masks had lower transmission rates (40%) compared to those who didn’t wear masks (69%). Those who isolated also had lower transmission rates (41%) compared to those who didn’t isolate (68%). 


Treatment options for non-hospitalized adults with mild to moderate COVID-19

If you’re a community member with COVID-19 symptoms, contact your health provider or a test-to-treat provider as soon as possible to see if you can get treatment. The list of eligible conditions for treatment is long and includes very common conditions such as diabetes, pregnancy, depression, overweight, asthma, HIV, risks due to race/ethnicity and living/working conditions, as well as older age and immunocompromise, so please check the list carefully!

A positive home antigen test result is sufficient for diagnosis of COVID-19 (take a photo of the result if you can). The sooner you start treatment for COVID-19, the more effective it is.

Click here for the national test-to-treat directory. The 2022 National COVID-19 plan includes a “test-and-treat” initiative, which is to provide COVID treatment right away, at the time and ideally at or near the place where a person tests positive for COVID. This is similar to what we aim to do with rapid ART (same-day HIV treatment).

Below is detailed information about current treatment options and ways to access them in the East Bay. This section is very “medical” and mostly a resource for health care providers. For the latest updates, check the NIH COVID Treatment Guidelines, DHHS COVID treatment guides, and download the DHHS COVID treatment algorithm decision aid (PDF). The following was adapted for the East Bay using info from Table B in the national guidelines.

Drug name in order of preferenceTime From Symptom OnsetDosing RegimenEfficacy, notes and East Bay access (added)
Paxlovid: Ritonavir-Boosted Nirmatrelvir

Oral antiviral: protease inhibitor with boosting

For ages 12+ and 40+ kg
≤5 days• eGFR ≥60 mL/min: Nirmatrelvir 300 mg with ritonavir 100 mg PO BID x 5 days  
• eGFR ≥30 to <60 mL/min: Nirmatrelvir 150 mg with ritonavir 100 mg PO BID x 5 days  
• Not recommended for eGFR <30 mL/min or severe hepatic impairment
• 88% reduction in hospitalization or death vs. placebo and 89% reduction for unvaccinated high-risk patients in pre-Omicron studies.

• Check drug interactions! www.covid19-druginteractions.org and make sure the patient’s medications EHR list is accurate.

• La Clínica, hospitals and CVS, Walgreens, Safeway, and Rite Aid pharmacies have supply. Call to ensure it’s stock and send the Rx through Epic.
• Check the National test-and-treat directory, the National COVID tx locator, pharmacy list and Alameda County for more sites.
Remdesivir

IV antiviral: polymerase inhibitor

For all ages
≤7 days• 200 mg IV on Day 1, followed by 100 mg IV once daily on Days 2 and 3
• Not recommended for eGFR <30 mL/min or severe hepatic impairment
• 87% reduction in hospitalization or death vs. placebo in pre-Omicron studies.
• In Alameda County: check for access at Highland Hospital, Sutter Hospitals, UCSF (UCSF pts), Stanford (Stanford/Santa Clara County pts), or the National COVID tx locator.
Bebtelovimab

Alternative: IV monoclonal antibody

For ages 12+ and 40+ kg
≤7 days175 mg as a single IV infusion• In lab studies and clinical trials, bebtelovimab reduced symptoms and viral loads from Omicron infections. Data for impact on hospitalization and mortality is not yet sufficient for analysis as of March 2022 and is actively being studied.
• In Alameda County: access at Total Infusion (same or next day access by self-referral or provider referral), Highland Hospital, Sutter Hospitals, UCSF (UCSF pts), Stanford (Stanford/Santa Clara County pts), or the National COVID tx locator.
Molnupiravir

Alternative oral antiviral: polymerase mutagenesis

For ages 18+
≤5 days800 mg PO BID x 5 days

Not for use if pregnant or breastfeeding due to fetal mutagenic risk.
• 30% reduction in hospitalization or death vs. placebo; better results in a study in India, but all were pre-Omicron studies.
• La Clínica, hospitals and CVS, Walgreens, Safeway, and Rite Aid pharmacies have ample supply.
• Check the National test-and-treat directory, the National COVID tx locator, pharmacy list and Alameda County for more sites.

Viral rebound after a course of Paxlovid

The CDC issued a health alert on viral rebound after Paxlovid treatment and continues to recommend Paxlovid for the treatment of mild to moderate COVID-19. Key points include:

  • Monitoring for symptoms and positive antigen tests 2-8 days after “initial recovery” (after a treatment course is completed, symptoms resolve, antigen tests become negative).
  • When rebound occurs, advise people to follow CDC’s guidance on isolation, re-isolate for at least 5 days and wear masks to prevent further transmission.
  • Most rebound cases reported as of May 24 have been mild, with a median of 3 days of symptoms, without any evidence of reinfection or viral resistance to Paxlovid.
  • The CDC alert states that “there are not reports of severe disease.” and “There is currently no evidence that additional treatment for COVID-19 is needed for COVID-19 rebound.”
  • However, the CDC also states “Consider clinical evaluation of patients who have COVID-19 rebound and symptoms that persist or worsen.” There may be cases of moderate or worsening symptoms in people at highest risk and risk for long COVID in which re-treatment may be considered with a provider. Please consider the unique situation for each patient.
  • Please report a possible case of COVID-19 rebound after Paxlovid treatment to Pfizer using the Pfizer Safety Reporting tool. Health care providers are also encouraged to submit the FDA MedWatch form.

COVID PrEP (Pre-exposure prophylaxis) with Evusheld

Including for people living with HIV and CD4 <200. Evusheld provides additional protection and is not a substitute for vaccination for people who can safely get vaccinated.

  • Evusheld (tixagevimab 300 mg plus cilgavimab 300 mg): 3 mL IM injections x2, given as two separate consecutive intramuscular injections.
  • On February 24, 2022, the FDA revised the dosing to be double the original 150 mg dose to 300 mg since the higher dose is more likely to prevent infections by the Omicron variant. Protection against Omicron may also last less than 6 months, so look out for updates on re-dosing intervals. People who received the smaller 150 mg dose should receive additional doses for a total of 300 mg as soon as possible.
  • In pre-Omicron clinical trials, people who received Evusheld (in addition to any baseline vaccinations) had a 77% reduced risk for developing COVID-19 compared to placebo, and the protection lasted about 6 months.
  • For people who:
    • Are moderately to severely immunocompromised and may have inadequate immune response to COVID-19 vaccination (BIIa). This includes people living with HIV and CD4<200 or not on ART (highest priority for PLWH with CD4 <50), inadequate immune reconstitution on ART or symptomatic HIV; on cancer treatment; within 2 years of stem cell transplant; on high-dose steroids (e.g. ≥20 mg prednisone daily x 2+ weeks) or other moderate-to-severely immunosuppressive treatments.  
    • Or are not able to be fully vaccinated with any available COVID-19 vaccines due to a documented history of severe adverse reaction to a COVID-19 vaccine or any of its components (AIIa).
  • Evusheld should be deferred for at least 2 weeks after COVID vaccination.
  • In Alameda County: access Evusheld at Total Infusion (provider referral required; appointments available within 1-2 days), Highland Hospital, Sutter Hospitals, UCSF (UCSF patients only), Stanford (Stanford or Santa Clara County patients only), or check the National COVID tx locator.
  • Check the National COVID therapeutics locator for locations.

Adapted from NIH COVID prevention guidelines


Long COVID resources

Treatment and rehabilitation

Long COVID studies

Long COVID policies and advocacy