Respiratory Illness: Information for Health Professionals

COVID-19 Antiviral treatments

· Recommendations on outpatient use of intravenous remdesivir (Veklury) in adults (developed with the support of the Ontario Health Infectious Diseases Advisory Committee)

·  Guidance on how to access antiviral treatments for COVID-19 (nirmatrelvir/ritonavir [Paxlovid] and remdesivir) in the community

Additional resources are available on Ontario Health’s COVID-19 Treatment website.

To be considered for antiviral treatment, individuals must have symptoms and test positive for COVID‑19 (by molecular or rapid antigen test). They also need to be assessed by a health care provider to determine if treatment is right for them, which includes whether or not they are at higher risk of developing severe symptoms.

Individuals may be at higher risk if they are:

• 60 years of age or older
• 18 years of age or older and are immunocompromised
• 18-59 years old and at a higher risk of severe COVID-19, including having:
  • chronic medical conditions (such as diabetes, heart, or lung disease)
  • inadequate immunity against COVID-19 from:
    • not receiving a full primary series of the COVID-19 vaccine
    • having received a full primary series but no COVID-19 vaccine or COVID-19 infection within the past six months

Based on an individual's circumstances, a health care provider may determine that treatment is right for them even if they do not belong to one of the groups above.

The use of antivirals in children under the age of 18 is not routinely recommended. Exceptions may be made on a case-by-case basis, such as for children who are severely immunocompromised and/or have multiple risk factors.

Available treatments

Paxlovid

• Oral antiviral treatment for COVID-19, available for free by prescription to individuals with COVID-19 who are at higher risk of severe illness and hospitalization. Treatment must begin within five days of the start of symptoms.
• Can be prescribed by any physician, nurse practitioner, or pharmacist and is available through clinical assessment centres, hospitals, and participating pharmacies.

Remdesivir

• Antiviral medication that must be given intravenously at designated clinics. Treatment must begin within seven days of the start of symptoms.

Individuals can access Ontario’s antiviral treatment screener to help determine if they are at higher risk and should be assessed for treatment. A positive rapid antigen test, PCR or rapid molecular test is required as part of the assessment for antiviral treatment. Anyone who is eligible for an assessment is also eligible for a PCR test at any testing centre in Ontario. 

A list of pharmacies that are dispensing Paxlovid can be found at COVID-19 testing and treatment.

COVID-19 Preventive treatments (pre-exposure prophylaxis)

Evusheld

• Single dose of antibodies (two injections at the same time) that provides protection for immunocompromised individuals from COVID‑19 for at least six months.
• Evusheld requires a prescription and is only authorized for patients who:
  • are not positive for COVID‑19 at the time of treatment
  • are 12 and older
  • have certain health conditions that make them higher risk and need additional protection, including:
    • solid organ transplant recipients
    • stem cell transplant recipients
    • CAR-T therapy recipients
    • other hematologic cancer patients undergoing treatment
    • people receiving anti-B-cell therapy (such as rituximab)
    • people with significant primary immunodeficiency

Influenza Antiviral Treatments

• Antiviral Medications for the 2023-24 Seasonal Influenza: Public Health Considerations | Public Health Ontario
  • This document briefly describes key considerations for the use of antiviral medications as a public health measure for reducing the spread and severity of seasonal influenza, including outbreak prevention and control. It also provides additional resources for health care providers who may be prescribing influenza antivirals for their patient population(s).