MEDICAL ADVISORY: Patient Access to Outpatient Therapies for COVID-19  

Issued by:  Azim Kasmani, MD, FRCPC, Associate Medical Officer of Health

Primary care providers play a critical role in supporting patients who are at high risk for severe disease in accessing COVID-19 therapies. Antivirals (e.g. Paxlovid and Remdesivir) help treat people with mild symptoms early in the course of illness to help prevent severe outcomes, hospitalization and death. The Niagara Health Clinical Assessment Centre (CAC) is available to support community members with mild to moderate symptoms of COVID-19. The centre is accessible by referral only.

Niagara Region Public Health encourages all family physicians to communicate proactively with patients at higher risk for severe disease regarding how to seek treatment should they become infected with COVID-19, and to refer to the CAC any eligible patients who have developed symptoms of COVID-19 within 24 hours of the patient seeking support.

Who can receive COVID-19 antiviral treatment?

In order for COVID-19 antivirals to be effective, they must be administered early in the course of illness. Out patients are currently eligible for Paxlovid within 5 days of symptom onset, and Remdesivir within 7 days of symptom onset.

Please refer to the Ontario Science Table Recommended Drugs in Adult Patients with COVID-19 guide or the CAC Referral Form for complete eligibility criteria and a list of individual risk factors.

In general, patients ages 18+ at risk of progression to severe COVID-19 should be referred to the CAC within 5-7 days of symptom onset. Eligible patients include those who are:

• Immunocompromised (any age regardless of vaccine status)
• Unvaccinated and pregnant
• Unvaccinated and 70+

Patients may also be eligible based on a combination of vaccination status and individual risk factors

• Ages 18-39 who are unvaccinated with three or more risk factors
• Ages  20-39 who are partially vaccinated (one or two doses of COVID-19 vaccine) with three or more risk factors
• Ages 40-69 who are unvaccinated with one or more risk factors
• Ages 40-69 who are partially vaccinated (one or two doses of COVID-19 vaccine) and three or more risk factors
• Ages 70+ who are partially vaccinated (one or two doses of COVID-19 vaccine) with one or more risk factors
• Ages 70+ with three doses of COVID-19 vaccine with three or more risk factors

Children and adolescents under the age of 18 with risk factors for severe disease should contact their pediatrician to determine if treatments are available.

What is the process for referring someone for antiviral treatment?

Please refer to the Recommended Drugs in Adult Patients with COVID-19 guide for how to properly assess disease progress and recommend treatment.

If a patient contacts you with COVID-19 symptoms, consider their eligibility for antiviral treatment using the CAC Referral Form. Patients who are mildly to moderately ill and who have had symptoms for less than 5-7 days should be assessed.

Please complete the CAC Referral Form to refer the patient to the CAC at Niagara Health where the patient will be assessed, tested, and prescribed treatment if eligible.

• Patients will still be accepted without recent bloodwork. Please do not delay referral, as bloodwork can be completed at the clinical assessment centre.
• Provide patients with an up to date list of their medications (including prescription and over-the-counter medicines, vitamins, and herbal supplements) and medical conditions for their appointment
• Patients who are eligible for treatment are always eligible for PCR testing. They do not need referral to seek PCR testing.
• Referrals will be reviewed with the infectious diseases team. Some patients may not receive treatment, despite referral. Both medications include a number of contraindications.
• Paxlovid is an oral antiviral with a five day course, while Remdesivir is an IV antiviral with a three day course
• COVID-19 vaccination remains the best way to protect against progression to severe illness, and all patients should be encouraged to ensure their vaccine series is up to date

Completed referral forms can be sent to:

• Niagara Health – COVID-19 Clinical Assessment Centre (CAC)
  • Phone: 905-378-4647 Ext. 41985
  • Fax: 905-397-1904
• Hours of Operation: Monday to Friday 8:00 a.m. to 4:00 p.m. except for statutory holidays
  • NO WALK-INS - APPOINTMENTS ONLY

More information

• Guidance for primary care providers – Access to outpatient therapies for COVID-19
• COVID-19 antiviral treatment  
• Ontario Science Table: Recommended Drugs in Adult Patients with COVID-19 guide
• Staying Up to Date with COVID-19 Vaccines: Recommended Doses
• Niagara Health – COVID-19 Clinical Assessment Centre (CAC)