Treatments are available for those the NHS considers at highest risk of developing severe COVID-19.
The test to treatment pathway for the COVID medicine delivery unit (CMDU) service will now be based primarily on lateral flow device (LFD) tests, supplied by the UK Health Security Agency (UKHSA) to the highest-risk patients which should be used if an individual eligible for COVID treatments experiences COVID symptoms.
Digitally identifiable, eligible patients will receive a letter from NHS England to inform them of the change and remind them about treatments with an initial supply of 7 LFD tests in the post.
Patients who have not been identified digitally or captured on national datasets, may be written to separately by their consultant. The national letter below may be utilised.
Anyone who does not receive their test kit, or needs further test kits, should order them or by calling 119.
It remains essential that patients report their test results (negative or positive) or by calling 119 to assist in digital identification, timely access to treatment and wider surveillance. Results of privately bought tests cannot be registered.
Neutralising monoclonal antibodies (nMABS) are synthetic monoclonal antibodies that bind to the spike protein of the COVID virus, which prevents entry into the host cell and replication.
The nMAB which will be in use:
Antiviral medications inhibit viral replication and prevent progression of infection.
A CMDU service has been set up within Camborne and Redruth Community Hospital.
A clinical assessment team associated with the CDMU, will screen and review patients for their suitability for specialist COVID treatments. They will then refer patients to the appropriate pharmacist for further screening. Once this has been actioned, some patients will be offered the opportunity to attend a clinic at Camborne Redruth Hospital, where they can administer the nMAB via an intravenous infusion for the treatment of COVID-19 if most appropriate choice for the patient. Other patients may be offered oral medication to treat their COVID-19 diagnosis.
Patients will be identified as high risk at the point of a positive lateral flow or PCR test and be sent an email and/or SMS text to inform them of this.
If they are eligible for treatment, the admin team at the CMDU will arrange for the patient to come in for the infusion, or a course of antivirals will be sent to the patient.
Patient who are assessed as not eligible will be informed of this by the CMDU triage service and offered remote monitoring via oximetry at home.
Non-hospitalised patients are eligible if:
Patients are not eligible if they meet any of:
Determined by an independent advisory group commissioned by the Department of Health and Social Care.
This list is copied from the commissioning policy:
Further detail on interactions for nMABs or antivirals with other medication(s) can be found in the individual SPC.
Further information can also be found on the University of Liverpool COVID-19 drug interaction checker.
You may come across some high-risk patients who have slipped through the net, or if the local COVID medicines delivery unit (CMDU) has not contacted the patient within 24 hours of receipt of the result of neutralising monoclonal antibodies, they will be asked to contact either the GP practice or NHS 111 or specialist hospital clinician. You can refer to the CMDU via the routes below.
Infectious diseases CMDU-CFT. Send these referrals direct and not via the referral service.
Over the weekend period the CMDU service is not available. The service is then reinstated on a Monday morning with. Therefore, patients referred over the weekend are all screened on a Monday morning.
Advise patients that may present over the weekend to expect a phone call from a clinician on the Monday and to contact their regular GP if they have not heard from a clinician by the Monday afternoon. This is applicable to adult patients only.
In rare cases where patients lack capacity it may be necessary for the service to seek help from the patient’s GP. The time critical nature of the treatment means decisions need to be made on the day or within 24 hours for the majority of cases.
The CMDU clinician may contact the practice, initially by phone and then by sending details to the email address the practice provides, with details of the eligibility criteria and treatments available. They will ask the GP whether the patient meets the criteria and if so, on balance, whether treatment is likely to be in the patients bests interest. For example, would traveling to hospital for a day case infusion be unduly distressing, would they accept an IV cannula, would they take a large capsule twice a day.
Screeners will make every effort to make this decision independently and the patient’s GPs will be asked to support only in exceptional circumstances.
The panoramic study is looking at the use of oral anti-viral treatment for patients with recently acquired COVID infection. Read information on the panoramic study looking at oral anti-viral treatment for COVID patients for further details and how patients can sign up.
For a list of side effects please refer to individual summary of product characteristics below.
|Drug||Hospital admission rate: control||Hospital admission rate: treatment||Number needed to treat||Relative risk reduction|
A national letter has been sent to high-risk patients for preparation.
An email, SMS and text has been sent to high-risk patients following positive COVID test were sent out from Monday 20 December 2021.
It is important that any near miss or incident is reported on the relevent Trust incident system.
As these medications are MHRA black triangle drugs, all adverse reactions occurring in individuals of any age after administration should be reported to the MHRA using the specific COVID-19 yellow card scheme.