Know the COVID-19 Vaccine, Treatment Options

With fall having arrived, it is important for pharmacists to be sure they are up-to-date with information on COVID-19 vaccines and options for treatment. Because of their role as a resource in keeping patients healthy, pharmacists have a special responsibility in shar-ing the latest information and statistics surrounding the pandemic.

Approximately 96 million individuals in the United States have had some version of the COVID-19 virus; of that number, 1.05 million have died, according to the CDC.¹ Most individuals who experience severe illness from COVID-19 are older than 50 years (though not always) and have underlying medical conditions such as chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart disease, or obesity.¹

Control Efforts

Due to the rising number of COVID-19 cases and lack of knowledge about the disease at the beginning of 2020, efforts to prevent spread of the virus were extreme. These included banning large gatherings, closing public places and schools, and encouraging work from home. Many individuals were required to wear masks outside their homes.

These measures slowed the spread of COVID-19 but also hurt the economy, forcing many small businesses to close. Many individuals were scared, creating a defensive, tense environment. Children forced to stay home from school often fell behind in their studies and developed anxiety disorders.

In hindsight, perhaps these efforts were too extreme for individuals not at high risk for developing severe disease, but because little was known about COVID-19 at the time, it was a decision based on protecting the population.

Vaccination

Operation Warp Speed (OWS), a partnership between the US Departments of Defense and Health & Human Services, was designed to speed development of a COVID-19 vaccine. The US Government Accountability Office determined that vac-cine makers and OWS adopted strategies for quickly developing vaccines while mitigating risk.²

The 3 vaccines resulting from OWS were from Johnson & Johnson, Moderna, and Pfizer/BioNTech. These fast-tracked vaccines started to be available in January 2021. Since then, more than 262 million individuals or 79% of the US population have received at least 1 dose. Overall, more than 224 million individuals or 68% of the population are considered fully vaccinated. Additionally, more than 108 million individuals or 33% of the population have received a booster dose.³

On August 31, 2022, the FDA authorized using bivalent formulations of the vaccines as single booster doses at least 2 months after primary or booster vaccination. These bivalent vaccines consist of 2 messenger RNA (mRNA) com-ponents of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to an FDA news release. The first component is from the original strain of SARS-CoV-2, for broad protection against COVID-19. The other is a com-ponent in common between the Omicron variant’s BA.4 and BA.5. lineages, which are causing most US cases of COVID-19 and are expected to circulate from now through the winter, according to the FDA release.⁴ In June 2022, the FDA’s Vaccines and Related Biological Products Advisory Committee voted to include an Omicron component in COVID-19 booster vaccines.⁴

For each bivalent COVID-19 vaccine, the FDA considered available evidence. According to the FDA news release, this included effectiveness and safety data for each monovalent mRNA COVID-19 vaccine; immunogenicity and safety data from a study of a bivalent COVID-19 vaccine containing mRNA from Omicron variant BA.1 lineage that is similar to each vaccine being authorized; and nonclinical data obtained using a bivalent COVID-19 vaccine with mRNA of the original strain and mRNA in common between Omicron’s BA.4 and BA.5 lineages.⁴ Based on data supporting these authorizations, the bivalent COVID-1 vaccines should provide increased protec-tion against Omicron, accor ing to the FDA news release. Individuals getting a bivalent COVID-19 vaccine may experience adverse effects (AEs) common among those getting monovalent mRNA COVID-19 vaccines.⁴ The monovalent mRNA COVID-19 vaccines are no longer authorized as booster doses for individuals 12 years and older, according to the FDA, which said it will evaluate data and submissions to support authorization of bivalent COVID-19 boosters for more age groups.³ The bivalent Moderna COVID-19 vaccine is authorized for use as a single booster dose in individuals 18 years and older, provided it has been at least 2 months since they completed primary vaccination or got their most recent booster dose of any authorized monovalent COVID-19 vaccine. Similarly, the bivalent Pfizer-BioNTech COVID-19 vaccine is authorized for use as a single booster dose in individuals 12 years and older, according to the FDA release.⁴

COVID-19 Treatment

The FDA has authorized certain antiviral medications and monoclonal antibodies to treat mild to moderate COVID-19 in individuals more likely to experience severe illness, according to the CDC. Antiviral treatments target specific parts of the virus to stop it from multiplying in the body, helping prevent severe illness and death. Monoclonal antibodies help the immune system recognize the virus and do a better job of fighting it. According to the CDC, these treatments include the following⁵:

Bebtelovimab. This monoclonal antibody is indicated in adults and children 12 years and older. Given as a single intravenous (IV) injection, it should be started within 7 days of symptom onset.

Nirmatrelvir with ritonavir (Paxlovid; Pfizer).This antiviral treatment is indicated in adults and children 12 years and older. This is an oral dosage taken at home that should be started within 5 days of symptom onset.⁵

Remdesivir (Veklury; Gilead). This antiviral treatment is indicated in children and adults. This is an IV infusion given at a health care facility for 3 consecutive days and should begin within 7 days of symptom onset.⁵

Patient Pearls

Some treatments might have AEs or interact with other medications, according to the CDC. Patients should ask physicians about the medications; those without health care providers can visit Test to Treat locations or contact a local community health center or health department.⁵

Hospitalized patients might receive other types of treatments, depending on the extent of illness. These could include medications to treat the virus, reduce an overactive immune response, or treat COVID-19 complications, according to the CDC.⁵ Many individuals with COVID-19 experience mild illness and can recover at home by using OTC medicines such as acetaminophen or ibuprofen, the CDC said.

Pharmacists who counsel patients this fall and winter should understand that COVID-19 presents a constantly changing landscape. Patients may look to pharmacists as an important community resource and as a way of keeping informed about the latest developments regarding the coronavirus. It is crucial that pharmacists stay informed about COVID-19.

References

1. COVID data tracker. CDC. Updated September 22, 2022. Accessed September 14, 2022. https://covid.cdc.gov/covid-da-ta-tracker/#datatracker-home

2. Operation Warp Speed. US Government Accountability Office. February 11, 2021. Accessed September 14, 2022. https://www.gao.gov/products/gao-21-319

3. US coronavirus vaccine tracker. USA Facts. Updated August 31, 2022. Accessed September 14, 2022. https://usafacts.org/visualizations/covid-vaccine-tracker-states/

4. Coronavirus (COVID-19) update: FDA authorizes Moderna, Pfizer-BioNTech bivalent COVID-19 vaccines for use as a booster dose. News release. FDA. August 31, 2022. Accessed September 14, 2022. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-au-thorizes-moderna-pfizer-biontech-bivalent-covid-19-vac-cines-use

5. COVID-19 treatments and medications. CDC. Updated August 5, 2022. Accessed September 14, 2022. https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-se-vere-illness.html

About the Author

Kathleen Kenny, PharmD, Rph,has more than 25 years’ experience as a community pharmacist. She is a freelance clinical medical writer based in Homosassa, Florida.