With the health care system under great strain due to the convergence of rising rates of COVID-19 and record-breaking rates of influenza and RSV, the California Department of Public Health (CDPH) is urging providers to test any patient with suspected COVID-19 and influenza, as appropriate, and evaluate all symptomatic patients with a positive COVID-19 test (of any type) for treatment with one of the recommended therapeutic treatment options.

Lack of familiarity with new medications, navigating contraindications and drug-drug interactions, and the misperception of drug scarcity have contributed to low treatment rates, including reports of eligible patients seeking COVID-19 therapeutics ultimately being denied treatment.

Once an individual is diagnosed with COVID-19, early treatment with COVID-19-specific agents is the only existing strategy to markedly decrease risk of serious illness and prevent hospitalization. COVID-19 treatments reduce the risk for hospitalization and death by 50-88% among unvaccinated people and by 45-50% among vaccinated or previously infected people. There is also early, but growing, evidence that COVID-19 treatments may reduce the risk of developing long COVID.

“Hospitalizations from COVID-19 are still having marked impact on patients and communities, and preventing serious illness is core to ongoing planning and policy,” CDPH wrote in a provider health advisory. “We should optimize all of our tools to decrease the hospitalizations, deaths, and long-term impacts of COVID-19 as it still causes significant preventable morbidity and mortality.”

There is ample supply of COVID-19 therapeutic agents, but they have been underused – especially among populations disproportionately impacted by COVID-19, including communities of color, low- income communities, and residents of long-term care facilities.

According to CDPH, providers should have a low threshold to prescribe COVID-19 therapeutics given the broad range of individuals who are at higher risk for severe COVID-19 and can benefit from COVID-19 treatment. The decision to not prescribe COVID-19 treatment should be reserved for situations in which the risk of prescribing clearly outweighs the benefits of treatment in preventing hospitalization, death, and the potential for reduced risk of long COVID.

According to the advisory, the following factors should NOT be reasons to withhold COVID-19 treatment:

• Being fully or partially vaccinated.
• Having a history of prior SARS-CoV-2 infection.
• Presence of only mild disease.
• A lack of recent renal or liver function tests.

High risk patients co-infected with influenza and SARS-CoV-2 should receive treatment for both viruses, as co-infection is associated with more severe illness. There are no clinically significant drug-drug interactions between the antiviral agents or immunomodulators that are used to prevent or treat COVID-19 and the antiviral agents that are used to treat influenza.

For more information, see the CDPH advisory.