Recommendation 16: In persons exposed to COVID-19 who are at high risk of progression to severe COVID-19, the IDSA guideline panel suggests post-exposure casirivimab/imdevimab rather than no casirivimab/imdevimab. (Conditional recommendation, low certainty of evidence)
Remark: Dosing for casirivimab/imdevimab is casirivimab 600 mg & imdevimab 600 mg IV or SC once.
Recommendation 17: Among ambulatory patients with mild to moderate COVID-19 at high risk for progression to severe disease, the IDSA guideline panel suggests bamlanivimab/etesevimab, casirivimab/imdevimab, or sotrovimab rather than no neutralizing antibody treatment. (Conditional recommendation, Moderate certainty of evidence)
Remarks:
Dosing for casirivimab/imdevimab is casirivimab 600 mg and imdevimab 600 mg IV. Subcutaneous injection is a reasonable alternative in patients for whom it cannot be given intravenously.
Dosing for sotrovimab is sotrovimab 500 IV once.
Dosing for bamlanivimab/etesevimab is bamlanivimab 700 mg and etesevimab 1400 mg IV or SC once.
Patients with mild to moderate COVID-19 who are at high risk of progression to severe disease admitted to the hospital for reasons other than COVID-19 may also receive bamlanivimab/etesevimab, casirivimab/imdevimab, or sotrovimab.
Local variant susceptibility should be considered in the choice of the most appropriate neutralizing antibody therapy. Local availability of different monoclonal antibody combinations may be affected by predominance of local variants.
Recommendation 18: Among hospitalized patients with severe COVID-19, the IDSA guideline panel recommends against bamlanivimab monotherapy. (Strong recommendation, Moderate certainty of evidence)
Recommendation 19: Among hospitalized adults with severe* COVID-19 having elevated inflammatory markers but not on invasive mechanical ventilation, the IDSA panel suggests baricitinib rather than no baricitinib. (Conditional recommendation, Moderate certainty of evidence)
Remarks:
Baricitinib 4 mg per day up to 14 days or until discharge from hospital.
Baricitinib appears to demonstrate the most benefit in those with severe COVID-19 on high-flow oxygen/non-invasive ventilation at baseline.
Patients who receive baricitinib for treatment of COVID-19 should not receive tocilizumab or other IL-6 inhibitors.
*Severe illness is defined as patients with SpO2 ≤94% on room air, including patients on supplemental oxygen, oxygen through a high-flow device, or non-invasive ventilation.
Recommendation 20: Among hospitalized patients with severe* COVID-19 who cannot receive a corticosteroid (which is standard of care) because of a contraindication, the IDSA guideline panel suggests use of baricitinib with remdesivir rather than remdesivir alone. (Conditional recommendation, Low certainty of evidence)
Remark: Baricitinib 4 mg daily dose for 14 days or until hospital discharge. The benefits of baricitinib plus remdesivir for persons on mechanical ventilation are uncertain.
*Severe illness is defined as patients with SpO2 ≤94% on room air, including patients on supplemental oxygen, oxygen through a high-flow device, or non-invasive ventilation.
Recommendation 21: Among hospitalized adults with severe* COVID-19, but not on non-invasive or invasive mechanical ventilation, the IDSA panel suggests tofacitinib rather than no tofacitinib. (Conditional recommendation, Low certainty of evidence)
Remarks:
Tofacitinib appears to demonstrate the most benefit in those with severe COVID-19 on supplemental or high-flow oxygen.
Patients treated with tofacitinib should be on at least prophylactic dose anticoagulant.
Patients who receive tofacitinib should not receive tocilizumab or other IL-6 inhibitor for treatment of COVID-19.
The STOP-COVID Trial did not include immunocompromised patients.
*Severe illness is defined as patients with SpO22 ≤94% on room air, including patients on supplemental oxygen or oxygen through a high-flow device.
Recommendation 22: In hospitalized patients with COVID-19, the IDSA panel suggests against ivermectin outside of the context of a clinical trial. (Conditional recommendation, very low certainty of evidence)
Recommendation 23: In ambulatory persons with COVID-19, the IDSA panel suggests against ivermectin outside of the context of a clinical trial. (Conditional recommendation, very low certainty of evidence)
Nurses and Doctors all over the USA (and the world) are killing themselves trying to save those in their care with Covid-19. It didn't and doesn't have to be this way, but with most of their serious patients being the unvaccinated, it may be months before cases drop significantly and meanwhile, our families are being devastated needlessly.
Yes, do your research, but when a vaccine is this effective and costs taxpayers only 10 to 37 dollars per dose vs hospital bills that can be from $17,000 to $200,000 and up, what do you think is easier/better?
Wearing your damn mask and getting your vaccine could end this quickly, but some people can't see it through their need to rebel. Be a patriot and help make this thing go away.
P.S. Danil54grl, thank you for your civil and thoughtful response.