Some COVID Survivors Ineligible for Life-Saving Treatments if Reinfected

Some people who have proven that they're susceptible to a serious COVID-19 infection aren't automatically eligible for potentially life-saving treatments if they get sick again because they may not be considered "high risk" by Food and Drug Administration (FDA) standards.

Monoclonal antibody treatments and oral antivirals have shown promise in helping to reduce the chance a person is hospitalized with COVID-19. However, they're only authorized for use in high-risk patients and prior hospitalization for COVID-19 isn't part of the eligibility criteria.

An Emergency Use Authorization for sotrovimab, the only monoclonal antibody treatment currently available in the United States, requires a person to be over 65, obese, pregnant or have certain medical conditions such as diabetes, kidney disease or have a suppressed immune system.

Similar requirements are in place for prescribing molnupiravir and paxlovid, two oral antiviral treatments, often referred to as "COVID pills."

The goal of limiting use to certain patients is to help protect those who are most vulnerable to getting seriously ill or dying of COVID-19, especially when supplies are in limited quantities. The broad strokes of the eligibility criteria means millions of Americans will be eligible for the treatments and everyone over the age of 65 are covered since they account for the bulk of hospitalizations in the United States.

Although rare, there have been cases of young, healthy people with no comorbidities being hospitalized and even intubated for COVID-19.

covid oral antiviral survivor treatment
Eligibility for life-saving COVID treatments doesn't include those who survived a previous COVID-19 severe infection, meaning some young, healthy people who battled COVID-19 in the hospital could be ineligible if they're reinfected. Above, Respiratory Therapist Nirali Patel works with a COVID-19 patient in the ICU at Rush University Medial Center on January 31, 2022, in Chicago, Illinois. Scott Olson/Reuters, Getty Images

Before being hospitalized for COVID-19, 26-year-old Fabian Granado was training to become an underwater welder. As someone who was healthy and in good shape, he told TheFlorida Times-Union that he thought he was "invincible." Granado, who was unvaccinated at the time, was admitted to the hospital on August 21. He spent two months in a coma and only walked out of the hospital on Tuesday.

While older people are still disproportionately impacted by COVID-19, the Omicron surge caused an uptick in hospitalizations among those under 29 years old, according to data from the U.S. Centers for Disease Control and Prevention (CDC). For those under the age of 65 without eligible comorbidity who become survivors of a severe COVID infection, vaccination is their only weapon against another hospitalization.

Dr. Panagis Galiatsatos, a pulmonary physician and professor at Johns Hopkins Hospital, told Newsweek that it's worth considering including survivors of severe infections as "high risk" in terms of eligibility conditions for treatments. Some patients with COVID-19 survived sepsis, putting them at a higher risk of getting COVID again because it pushes their immune system "tank" to "empty."

"If you had severe COVID and you needed critical care resources to stay alive, we should strongly consider those patients as well," Galiatsatos said.

Surviving a COVID-19 infection is known to provide people with some protection against reinfection, although the level and length of protection vary by the individual person. Vaccines are also known to provide protection against serious infection, but Galiatsatos noted that Omicron's highly infectious nature means even those who survived a severe case of COVID-19 can be infected.

However, there haven't been significant studies done on those who were previously hospitalized with COVID-19. So, Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, noted that there isn't enough data to determine that previously hospitalized patients are actually at a higher risk for subsequent severe COVID infections. Still, Schaffner called the proposed idea to include those who had a severe COVID infection a "reasonable idea." Once treatments become more widely available, Schaffner said physicians will likely have more room for individual decision-making.