neca-COVID-Update-October-2020.pptx

File 1 of 1 from October 2020 COVID-19 Update

10/20 COVID-10 Update

Details

COVID-19 Update October 2020
1

Disclosures
This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $3,879,101 with zero percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

2

Disclosures
John J. Faragon, PharmD discloses the following:
Speakers Bureau
Gilead
Janssen
Merck
Advisory
ViiV

3

Learning Objectives
Discuss recent updates to COVID-19 Epidemiology and testing recommendations
Using recently updated NIH guidelines, describe the transmission, signs/symptoms and therapeutic options for COVID-19
Describe effect of COVID-19 on patients with HIV infection
Review recent recommendations from DHHS regarding patients with HIV during the COVID-19 epidemic

COVID-19 EPIDEMIOLOGY AND TESTING

https://coronavirus.jhu.edu/ - Accessed 10.11.20
John Hopkins COVID-19 Trends, October 11, 2020

https://coronavirus.jhu.edu/ - Accessed 10.11.20
John Hopkins COVID-19 Trends, October 11, 2020

Who should get tested, CDC
People who have symptoms of COVID-19
People who have had close contact (within 6 feet of an infected person for at least 15 minutes) with someone with confirmed COVID-19
People who have been asked or referred to get testing by their healthcare provider, or state health department
Not everyone needs to be tested
If you do get tested, you should self-quarantine/isolate at home pending test results and follow the advice of your health care provider or a public health professional.

www.cdc.gov August 24, 2020.

Types of Tests for COVID-19
https://www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics.
Accessed September 17, 2020.

CDC
www.cdc.gov August 24, 2020.

NIH Guidelines, Testing for SARS-CoV-2 Infection
Summary Recommendations
The COVID-19 Treatment Guidelines Panel (the Panel) recommends that a molecular or antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should be used to diagnose acute SARS-CoV-2 infection(AIII).
The Panelrecommends againstthe use of serologic testing as the sole basis for diagnosis of acute SARS-CoV-2 infection(AIII).
The Panelrecommends againstthe use of serologic testing to determine whether a person is immune to SARS-CoV-2 infection(AIII).

Rating of Recommendations:A = Strong; B = Moderate; C = OptionalRating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies; III = Expert opinion
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

www.cdc.gov/coronavirus

CDC Clinical Tips for HCP
CDC. Available athttps://www.cdc.gov/coronavirus. Accessed 8/18/20

COVID-19 EPIDEMIOLOGY AND TESTING

Transmission, Symptoms and Complications COVID-19
Wiersinga, WJ, et al. JAMA, doi:10.1001/jama.2020.12839
Transmission
Primarily via respiratory droplets from face-to-face contact
Aerosol spread may occur, but remains unclear
48% to 62% of transmission via pre-symptomatic carriers
Common symptoms, hospitalized patients
Fever (70%-90%), Dry cough (60%-86%), Shortness of breath (53%- 80%)
Fatigue (38%)Myalgias (15%-44%)
Nausea/vomiting or diarrhea (15%-39%)
Headache, Weakness (25%), and rhinorrhea (7%)
Anosmia or ageusia may be the sole presenting symptom in approximately 3% of individuals with COVID-19
Common laboratory abnormalities, hospitalized patients
Lymphopenia (83%), elevated inflammatory markers (eg, erythrocyte sedimentation rate, C-reactive protein, ferritin, tumor necrosis factor-, IL-1, IL-6)
Abnormal coagulation parameters (eg, prolonged prothrombin time, thrombocytopenia, elevated D-dimer [46% of patients], low fibrinogen)

Transmission, Symptoms and Complications COVID-19
Wiersinga, WJ, et al. JAMA, doi:10.1001/jama.2020.12839
Common radiographic findings
Bilateral, lower-lobe predominate infiltrates on chest radiographic imaging and bilateral, peripheral, lower-lobe ground-glass opacities and/or consolidation on CT imaging
Common complications among hospitalized patients
pneumonia (75%); acute respiratory distress syndrome (15%)
acute liver injury (19%)
cardiac injury (7%-17%)
VTE (10%-25%)
AKI (9%)
Neurologic manifestations, impaired consciousness (8%)
Shock (6%)
Cerebrovascular disease (3%)
Rare complications among critically ill patients
cytokine storm and macrophage activation syndrome

NIH Guidelines, Prevention and Prophylaxis of SARS-CoV-2 Infection
Summary Recommendation
The COVID-19 Treatment Guidelines Panel (the Panel)recommends againstthe use of any agents for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pre-exposure prophylaxis (PrEP), except in a clinical trial(AIII).
The Panelrecommends againstthe use of any agents for SARS-CoV-2 post-exposure prophylaxis (PEP), except in a clinical trial(AIII).
Rating of Recommendations:A = Strong; B = Moderate; C = OptionalRating of Evidence:I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies; III = Expert opinion
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

COVID-19 Illness categories
AsymptomaticorPresymptomaticInfection: Individuals who test positive for SARS-CoV-2 by virologic testing using a molecular diagnostic (e.g., polymerase chain reaction) or antigen test, but have no symptoms.
Mild Illness: Individuals who have any of the various signs and symptoms of COVID 19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.
Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment or imaging and a saturation of oxygen (SpO2) 94% on room air at sea level.
Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2<94% on room air at sea level, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%
Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Not hospitalized OR hospitalized, but not requiring supplemental oxygen
Hospitalized and requiring
supplemental oxygen
Hospitalized and requiring oxygen through high-flow or noninvasive ventilation
Hospitalized and requiring invasive mechanical ventilation or ECMO
NIH COVID-19 Treatment Guidelines
Dexamethasone*** plus remdesivir** (AIII) OR
Dexamethasone*** (AI)
No specific antiviral or immunomodulatory therapy recommended, panel recommends against the use of dexamethasone (AI)
See the remdesivir disclaimer below on using this drug in hospitalized patients with moderate COVID-19*
Remdesivir IV for 5 days** (A1) +/- dexamethasone IV or PO for up to 10 days ***(BIII) or until hospital discharge, whichever comes first
If remdesivir can not be used, dexamethasone may be used instead*** (BIII)
Dexamethasone*** (AI) OR
Dexamethasone*** plus remdesivir** for patients who have recently been intubated (CIII)

** 200mg IV for one day, followed by remdesivir 100mg IV once daily for 4 days
*** Dexamethasone dose is 6mg
* Insufficient data to recommend for or against routine treatment with remdesivir for all hospitalized patients with moderate COVID-19. Panel recognizes there may be situations in which a clinician judges that remdesivir is an appropriate treatment for a hospitalized patient with moderate disease.

Remdesivir
Mild or Moderate COVID-19
There are insufficient data for the Panel to recommend either for or against the usein patients with mild or moderate COVID-19.
Patients with COVID-19 Who Are on Supplemental Oxygen but Who Do Not Require High-Flow Oxygen, Noninvasive or Invasive Mechanical Ventilation, or ECMO
The Panel recommends usingremdesivirfor 5 days or until hospital discharge, whichever comes first(AI)
Patients with COVID-19 Who Require High-Flow Oxygen, Noninvasive Ventilation, Mechanical Ventilation, or ECMO
Because there is uncertainty regarding whether starting remdesivir confers clinical benefit in these groups of patients, the Panel cannot make a recommendation either for or against starting remdesivir.
Duration of Therapy
There are insufficient data on the optimal duration ofremdesivirtherapy for patients with COVID-19 who have not shown clinical improvement after 5 days of therapy, some experts extend the duration to up to 10 days(CIII)

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Adaptive Covid-19 Treatment Trial (ACTT-1)
Remdesivir IV versus placebo
Enrollment started February 21, 2020, ended on April 19, 2020.
60 trial sites in US, Denmark, UK, Greece, Germany, Korea, Mexico, Spain, Japan, Singapore
Randomized 1:1 to get remdesivir or placebo
Preliminary results from 1059 patients with data available after randomization
Serious AEs: 21.1% (114/541) with remdesivir and 27.0% (141/522) with placebo

Beigel. NEJM. 2020;[Epub]. NCT04280705.
Outcome
Remdesivir
(n = 538)
Placebo
(n = 521)
HR (95% CI)
P Value
Median recovery time, days
11
15
1.32 (1.12-1.55)
< .001
Mortality by 14 days, %
7.1
11.9
0.70 (0.47-1.04)
NS

Characteristic
All
Remdesivir (538)
Placebo (521)
Age
58.9 +/- 15
58.6 +/- 14.6
59.2 +/- 15.4
Male Sex
684 (64.3)
352 (65.1)
332 (63.6)
American Indian
7 (0.7)
4 (0.7)
3 (0.6)
Asian
134 (12.6)
77 (14.2)
57 (10.9)
Black, AA
219 (20.6)
108 (20)
111 (21.3)
White
565 (23.4)
279 (51.6)
286 (54.8)
Hispanic/Latino
249 (23.4)
132 (24.4)
117 (22.4)
Median time, Symptoms to randomization
9 (6-12)
9 (6-12)
9 (7-13)
Zero comorbid conditions
193/920 (21)
91/467 (19.5)
102/453 (22.5)
One comorbid conditions
248/920 (27)
131/467 (28.1)
117/453 (25.8)
Two or more comorbid conditions
479/920 (52.1)
245/467 (52.5)
234/453 (51.7)
Cancer
71 (7.7)
39 (8.3)
32 (7.0)
Immunodeficiency (innate or acquired)
64 (6.9)
28 (6.0)
36 (7.9)
HTN
460/928 (49.6)
231/469 (49.3)
229/459 (49.9)
Obesity
342/925 (37)
177/469 (37.7)
165/456 (36.2)
Type 2 DM
275/927 (29.7)
144/470 (30.6)
131/457 (28.7)
Hospitalized, no O2
127 (11.9)
67 (12.4)
60 (11.5)
Hospitalized, on O2
421 (39.6)
222 (41.0)
199 (38.1)
Hospitalized, non-invasive ventilation, High-Flow
197 (18.5)
98 (18.1)
99 (19.0)
Hospitalized, mechanical ventilation or ECMO
272 (25.6)
125 (23.1)
147 (28.2)
Baseline Score Missing
46 (4.3)
29 (5.4)
17 (3.3)

Beigel. NEJM. 2020;[Epub].

Remdesivir.com/us/ - EUA

What is an EUA?
NOT an FDA Approval
Still requires normal FDA approval process
Still requires adverse event reporting

Remdesivir Key Points

200mg IV load, then 100mg IV for 4 days, 5 days total
Infuse over 30 minutes
CrCl<30ml/min safety not established
LFTs >5XULN safety not established
Adverse events Hypotension, N/V, increased LFTs, increased Scr
Fact Sheet has to be given to patient or family

Immunomodulators for COVID-19
Dexamethasone
Based on preliminary report from the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial, the Panel recommends usingdexamethasone6 mg per day for up to 10 days for the treatment of COVID-19 in patients who are mechanically ventilated(AI)and in patients who require supplemental oxygen but who are not mechanically ventilated(BI).
The Panelrecommends againstusingdexamethasonefor the treatment of COVID-19 in patients who do not require supplemental oxygen(AI)
If dexamethasone is not available, the Panel recommends using alternative glucocorticoids, ie: prednisone,methylprednisolone, orhydrocortisone (AIII)
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Dexamethasone 28 day mortality
RECOVERY Collaborative Group. NEJM. DOI:10.1056/NEJMoa2021436

Other Drugs
Recommends againstthe use of chloroquine orhydroxychloroquinefor the treatment of COVID-19, except in a clinical trial(AII)
Also recommends againsthigh-dose chloroquine(600 mg twice daily for 10 days) for the treatment of COVID-19(AI)
Recommends againstusing the following drugs to treat COVID-19, except in a clinical trial:
The combination ofhydroxychloroquine plus azithromycin (AIII), because of the potential for toxicities.
Lopinavir/ritonavir (AI)orother HIV protease inhibitors (AIII), because of unfavorable pharmacodynamics and because clinical trials have not demonstrated a clinical benefit in patients with COVID-19.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Immunomodulators for COVID-19
Insufficient data to recommend either for or against the use of the following immunomodulators for the treatment of COVID-19:
Interleukin-1 inhibitors(e.g.,anakinra)
Interleukin-6 inhibitors(e.g.,sarilumab, siltuximab, tocilizumab)
Interferon-betafor the treatment of early (i.e., <7 days from symptom onset) mild and moderate COVID-19.
Recommends againstthe use of the following immunomodulators for the treatment of COVID-19, except in a clinical trial:
Interferons (alfa or beta)(AIII)
Bruton's tyrosine kinase inhibitors(e.g.,acalabrutinib, ibrutinib, zanubrutinib) andJanus kinase inhibitors(e.g.,baricitinib, ruxolitinib, tofacitinib)(AIII)
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Convalescent Plasma
The Food and Drug Administration issued an Emergency Use Authorization for COVID-19 convalescent plasma for the treatment of hospitalized patients with COVID-19.
Based on the available evidence, the Panel has determined the following:
There are insufficient data to recommend either for or against the use of convalescent plasma for the treatment of COVID-19.
Convalescent plasma should not be considered the standard of care for the treatment of patients with COVID-19.
Prospective, well-controlled, adequately powered randomized trials are needed to determine whether convalescent plasma is effective and safe for the treatment of COVID-19. Members of the public and health care providers are encouraged to participate in these prospective clinical trials.
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Anticoagulation
Venous Thromboembolism Prophylaxis and Screening:
Hospitalized adults with COVID-19 should receive VTE prophylaxis per the standard of care for other hospitalized adults(AIII)
Treatment:
Patients with COVID-19 who experience an incident thromboembolic event or who are highly suspected to have thromboembolic disease at a time when imaging is not possible should be managed with therapeutic doses of anticoagulant therapy as per the standard of care for patients without COVID-19(AIII)
Patients with COVID-19 who require extracorporeal membrane oxygenation or continuous renal replacement therapy or who have thrombosis of catheters or extracorporeal filters should be treated with antithrombotic therapy per the standard institutional protocols for those without COVID-19(AIII)
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

Miscellaneous Medications
Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs)
Persons with COVID-19 who are prescribed ACE inhibitors or ARBs for cardiovascular disease (or other indications) should continue these medications(AIII).
The COVID-19 Treatment Guidelines Panel (the Panel)recommends againstthe use of ACE inhibitors or ARBs for the treatment of COVID-19, except in a clinical trial(AIII).
HMG-CoA Reductase Inhibitors (Statins)
Persons with COVID-19 who are prescribed statin therapy for the treatment or prevention of cardiovascular disease should continue these medications(AIII).
The Panelrecommends againstthe use of statins for the treatment of COVID-19, except in a clinical trial(AIII).
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Persons with COVID-19 who are taking NSAIDs for a comorbid condition should continue therapy as previously directed by their physician(AIII).
The Panel recommends that there be no difference in the use of antipyretic strategies (e.g., with acetaminophen or NSAIDs) between patients with or without COVID-19(AIII).

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
National Institutes of Health. Available athttps://www.covid19treatmentguidelines.nih.gov/. Accessed 10/6/20

COVID-19 HIV SPECIFIC INFORMATION

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Individuals aged >60 years and those with diabetes, hypertension, cardiovascular disease, pulmonary disease, or obesity are at highest risk of life-threatening COVID-19
The limited data do not indicate that the disease course of COVID-19 in persons with HIV differs from that in persons without HIV
Before the advent of effective combination antiretroviral therapy (ART), advanced HIV infection (i.e., CD4 cell count <200/mm3) was a risk factor for complications of other respiratory infections. Whether this is also true for COVID-19 is yet unknown
Some people with HIV have other comorbidities (e.g., cardiovascular disease, lung disease) that increase the risk for a more severe course of COVID-19 illness. Chronic smokers are also at risk of more severe disease
Additional caution for all persons with HIV, especially those with advanced HIV or poorly controlled HIV
DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Every effort should be made to help persons with HIV maintain an adequate supply of ART and all other concomitant medications
Influenza and pneumococcal vaccinations should be kept up to date
Persons with HIV should follow applicable recommendations of the U.S. Centers for Disease Control and Prevention (CDC) to prevent COVID-19, such as social distancing and proper hand hygiene. These recommendations are regularly updated
Information on COVID-19 prevention in children with HIV forpediatric health care providersand thegeneral publicis available from CDC
DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Persons with HIV Should:
Maintain on-hand at least a 30-day supplyand ideally a 90-day supplyof antiretroviral (ARV) drugs and other medications
Talk to their pharmacists and/or health care providers about changing to mail order delivery of medications when possible
Persons for whom a regimen switch is planned should consider delaying the switch until close follow-up and monitoring are possible
Persons with HIV should not switch their ARV regimens or add ARV drugs to their regimens for the purpose of preventing or treating SARS-CoV-2 infection

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Clinic or Laboratory Monitoring Visits Related to HIV Care:
Together with their health care providers, weigh the risks and benefits of attending, versus not attending in-person, HIV-related clinic appointments at this time
Factors to consider include the extent of local COVID-19 transmission, the health needs that will be addressed during the appointment, and the person's HIV status (e.g., CD4 cell count, HIV viral load) and overall health.
Telephone or virtual visits for routine or non-urgent care and adherence counseling may replace face-to-face encounters. For persons who have a suppressed HIV viral load and are in stable health, routine medical and laboratory visits should be postponed to the extent possible.
Persons with HIV and in Opioid Treatment Programs:
Clinicians caring for persons with HIV who are enrolled in opioid treatment programs (OTPs) should refer to theSubstance Abuse and Mental Health Service Administration (SAMHSA) websitefor updated guidance on avoiding treatment interruptions. State methadone agencies are also responsible for regulating OTPs in their jurisdictions and may provide additional guidance.

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Guidance for Persons with HIV in Self-Isolation or Quarantine Due to SARS-CoV-2 Exposure
Health Care Workers Should:
Verify that patients have adequate supplies of all medications and expedite additional drug refills as needed.
Devise a plan to evaluate patients if they develop COVID-19-related symptoms, including for possible transfer to a health care facility for COVID-19-related care.
Persons with HIV Should:
Contact their health care provider to report that they are self-isolating or in quarantine.
Specifically, inform their health care provider how much ARV medications and other essential medications they have on hand.

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Guidance for Persons with HIV who have Fever or Respiratory Symptoms and are Seeking Evaluation and Care
Health Care Workers Should:
FollowCDC recommendations, as well as state and local health department guidance on infection control, triage, diagnosis, and management.

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Guidance for Persons with HIV who have Fever or Respiratory Symptoms and are Seeking Evaluation and Care
Persons with HIV Should:
FollowCDC recommendations regarding symptoms.
If they develop a fever and symptoms (e.g., cough, difficulty breathing), they should call their health care provider for medical advice.
Call the clinic in advance before presenting to the care providers.
Use respiratory and hand hygiene and cough etiquette when presenting to the health care facility and request a face mask as soon as they arrive.
If they present to a clinic or an emergency facility without calling in advance, they should alert registration staff immediately upon arrival of their symptoms so that measures can be taken to prevent COVID-19 transmission in the health care setting. Specific actions include placing a mask on the patient and rapidly putting the patient in a room or other space separated from other people.

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
When Hospitalization is Not Necessary, the Person with HIV Should:
Manage symptoms at home with supportive care for symptomatic relief.
Maintain close communication with their health care provider and report if symptoms progress (e.g., sustained fever for >2 days, new shortness of breath).
Continue their ARV therapy and other medications, as prescribed.

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
When the Person with HIV is Hospitalized:
ART should be continued. If the ARV drugs are not on the hospital's formulary, administer medications from the patients' home supplies.
ARV drug substitutionsshould be avoided. If necessary, clinicians may refer torecommendations on ARV drugs that can be switchedin the U.S. Department of Health and Human Services (HHS) guidelines for caring for persons with HIV in disaster areas.

DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
When the Person with HIV is Hospitalized:
For patients who receive ibalizumab (IBA) intravenous (IV) infusion every 2 weeks as part of their ARV regimen, clinicians should arrange with the patient's hospital provider to continue administer of this medication without interruption.
For patients who are taking an investigational ARV medication as part of their regimen, arrangements should be made with the investigational study team to continue the medication if possible.
For critically ill patients who require tube feeding, some ARV medications are available in liquid formulations and some, but not all, pills may be crushed. Clinicians should consult an HIV specialist and/or pharmacist to assess the best way for a patient with a feeding tube to continue an effective ARV regimen.
DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
When Receiving Investigational or Off-Label Treatment for COVID-19:
There is currently no approved treatment for COVID-19. Several investigational and marketed drugs are being evaluated in clinical trials to treat COVID-19 or may also be available via compassionate use or off-label use.
For patients receiving COVID-19 treatment, clinicians must assess the potential for drug interactions between the COVID-19 treatment and the patient's ARV therapy and other medications.
Information on potential drug interactions may be found in product labels, drug interaction resources, clinical trial protocols, or investigator brochures.
Persons with HIV should not be excluded from COVID-19 clinical trials.ClinicalTrials.govis a useful resource to find studies investigating potential treatments for COVID-19.
DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Additional Guidance for HIV Clinicians
Some Medicaid and Medicare programs, commercial health insurers, and AIDS Drug Assistance Programs (ADAPs) have restrictions that prevent patients from obtaining a 90-day supply of ARV drugs and other medications. During the COVID-19 outbreak, clinicians should ask providers to waive drug-supply quantity restrictions. ADAPs should also provide patients with a 90-day supply of medications.
Persons with HIV may need additional assistance with food, housing, transportation, and childcare during times of crisis and economic fragility.
DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

DHHS Interim Guidance, COVID-19 for Persons with HIV June 19, 2020
Additional Guidance for HIV Clinicians
During this crisis, social distancing and isolation may exacerbate mental health and substance use issues for some persons with HIV.
Telehealth options, including phone calls, should be considered for routine visits and to triage visits for patients who are ill.
There are reports that measures designed to control the spread of COVID-19 may increase the risk of gender-based violence against women and girls, as well as limit their ability to distance themselves from abusers or to access external support.
During the COVD-19 outbreak, reproductive desires and pregnancy planning should be discussed with all women of childbearing potential.
DHHS. Interim Guidance on HIV and COVID-19. June 19, 2020.

COVID-19 RESOURCES

Select National and International Resources for COVID-19
CDC Cases and Latest Updates
www.cdc.gov/coronavirus/2019-ncov/cases-updates/index.html
CDC Situation Summary
www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html
CDC Healthcare Professionals Information
www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
CDC Interim Guidelines for Clinical Specimens
www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
CDC Emergency Preparedness and Response, Clinician Outreach and Community Activity (COCA)
www.emergency.cdc.gov/coca/
WHO Coronavirus Website
www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-h...
HRSA COVID-19 FAQs
www.bphc.hrsa.gov/emergency-response/coronavirus-frequently-asked-questi...

Local Resources for COVID-19 NY, NJ, PR, USVI
NYSDOH Coronavirus Website
www.health.ny.gov/diseases/communicable/coronavirus/
NYSDOH Coronavirus Website Information for Providers
www.health.ny.gov/diseases/communicable/coronavirus/providers.htm
NJDOH Coronavirus Website
www.nj.gov/health/cd/topics/ncov.shtml
Puerto Rico Coronavirus Website
www.salud.gov.pr/Pages/coronavirus.aspx
USVI Coronavirus Website
www.doh.vi.gov/covid19usvi

www.aidsetc.org

www.necaaetc.org

National HIV Curriculum hiv.uw.edu