Grandparents & great aunt exposed to someone who tested positive for COVID. Next steps?
December 23, 2021 5:58 PM   Subscribe

So I’m freaking out. I just found out my grandparents and great aunt (all around 85) have been exposed by a visiting relative. Is there any intervention besides monoclonal antibodies available? We’re in the US.

Grandmother & great aunt are both pretty healthy and boosted (Pfizer). Grandfather has diabetes and would not get boosted (Fox News convinced him that it wasn’t worthwhile. I’m seething but there was nothing I could do to convince him). I’m reading that monoclonal antibodies are not being offered for omicron. Is there anything else that can reduce their chances of being hospitalized? I want to do whatever I can for them. This was likely an omicron exposure because the person they were exposed to tested positive 24hrs after being exposed and I understand omicron likely works very quickly. Thanks in advance.
posted by microscopiclifeform to Health & Fitness (16 answers total) 2 users marked this as a favorite
 
Response by poster: I just realized I mistitled this. They haven’t tested positive, they were exposed to someone who tested +. Can mods edit it?
posted by microscopiclifeform at 6:01 PM on December 23, 2021


There is one of the monoclonal antibodies that does still work against Omicron. It's may be slightly too early for Paxlovid since it's not expected to be available until next week (in very limited supply, though) and needs to be taken within five days of infection.

I'd suggest testing tomorrow and Sunday and if it comes up positive, they should be able to work with their doctor to get whatever is available. If they're in Florida they don't have a high chance of being able to get the treatments, but in other states that aren't being hammered as hard just yet they may have better luck.
posted by wierdo at 6:12 PM on December 23, 2021 [1 favorite]


Mod note: fixed!
posted by Eyebrows McGee (staff) at 6:21 PM on December 23, 2021 [2 favorites]


I would also advocate for testing Grandfather asap and again 2 days later and maybe again at day 7 (depending on the date of exposure). See if you can make a plan for separating Grandfather from Grandma and great aunt - if not now then as soon as he shows any symptoms. You don't want them to have the very extensive exposure that comes from living with someone who has COVID - much greater than the risk of the visitor.
posted by metahawk at 6:22 PM on December 23, 2021 [4 favorites]


You need to find their city's resources for monoclonal antibodies. Surely at least one of them is actively under the care of a physician, I would start by having them contact their doctor's office. I know there's still some question marks about whether mAb works for Omicron.

Really all of them should be isolated, but your grandfather in particular is far more likely to get sick and will carry a higher viral load than a properly-vaccinated person would if he does, so he is now the primary threat.

If any of them start showing any symptoms, I would have them sleep sitting up in a recliner from that point on. The more fragile someone is, the faster the pneumonia pipeline is.

While there's some data that omicron is faster to test positive, I'm still hearing stories of people with symptoms testing negative upward of five days before the first positive test, so make no assumptions until you've cleared at least 10 if not 14 days to be safe.
posted by Lyn Never at 6:28 PM on December 23, 2021


Best answer: Neither of the treatments weirdo recommends are offered to people who have not tested positive, so you'd need to wait to test them, and their tests would need to be positive to be eligible for treatment. The only prophylaxis now is vaccination.

The interval recommended for testing is 3-5 days after exposure, so you'd need to take this into account when deciding when to have them tested. I see that you have heard that Omicron will turn tests positive sooner, but I am not aware that that is the case. I'm a nurse who spent the entire day performing Covid antigen and PCR tests, (interspersed with boosters and one 1st shot!) and we advise people who were testing because of a known exposure that testing before 3 days was too soon to catch positive test results. Testing within 24 hours will probably produce a negative result even if they have actually been infected, and may create a false sense that they don't need testing two days later. I don't know where they live, but here in PA there is a real shortage of tests available in pharmacies (we ran out after doing about 150 tests), but with their age and co-morbid conditions they can probably call their physicians for hospital-lab testing.

As an aside, though rapid antigen take-home tests are very accurate, it takes an established infection (again 3-5 days) to become positive if someone is infected. They are absolutely not obtainable here, totally sold out, but I hear from a friend who lives in a red state that her CVS has them in a display stacked to the ceiling.
posted by citygirl at 6:38 PM on December 23, 2021 [11 favorites]


If your relatives end up testing positive, along with monoclonal antibodies, this Vox article suggests asking into fluvoxamine and budesonide. It says they're not well-proven, but with long-established tolerability and safety profiles, what evidence there is could be considered sufficient for giving them a try. Some key excerpts:

"Symptom-based treatment options like fluvoxamine and budesonide aren’t sure things... But they are safe, they have been FDA-approved for other use cases for decades, and there’s strong published evidence supporting them as options. Despite that, many patients have likely never heard of them — and some doctors have felt unsure if it’s acceptable to prescribe them...

While these medications may be worth trying because of their known safety profile despite limited evidence... it could absolutely turn out that the real-world effects are much smaller than hoped for, or even fail to materialize altogether.

But despite that, some researchers and doctors say, prescribing them is reasonable... [Says] Eric Lenze, a professor of psychiatry at the Washington University School of Medicine in St. Louis...: 'We have decades of knowledge about these treatments. These treatments are well tolerated...'"

Best of luck.
posted by daisyace at 7:05 PM on December 23, 2021 [4 favorites]


Is there any intervention besides monoclonal antibodies available? We’re in the US.

If you look online for early / outpatient covid treatment you are going to find a "lot of stuff." You can probably guess some of the names. There are a lot of rabbit holes you could go down. Anecdotally, there appear to be a lot of challenges there if ask your doctor for an off-label prescription for this or that.

As mentioned by daisyace above, fluvoxamine looks very promising as an emerging repurposed/off-label treatment. One non-medical advantage is that it doesn't seem to carry the baggage and controversy associated with some of the other off-label drugs.

If I caught covid I would probably look into getting high-dose vitamin D treatment. However, this might face some of the same challenges associated with the more controversial off-label repurposed drugs. (Extreme use of vitamins tends to raise the spidey-sense of most normal MDs.)

In general, unless a treatment is considered standard of care, it may be hard to pitch your doctor (or your relatives' doctors) on it unless they are already on board and open-minded about it.
posted by theorique at 7:51 PM on December 23, 2021 [2 favorites]


Best answer: Step 1 is frequent testing and try to stay calm. This is super scary but the odds are in their favor due to vaccination test.

Step 2 is call a doctor. All the approved antivirals--not just the antivirals--should do and seem to do much better if given very early. If I were exposed as soon I tested positive I'd be asking for any Covid antiviral treatment they have available (though with Merck at the bottom of the list.)
posted by mark k at 9:23 PM on December 23, 2021 [3 favorites]


Get a few hepa air filters to their home and leave them running in shared spaces (dining room, living room, the couple’s bedroom, etc). In the case that only one person has caught it, scrubbing the air may help the others to not catch it from that person.
posted by nouvelle-personne at 3:06 AM on December 24, 2021 [1 favorite]


Even with the ages we're talking about, your family are much more likely to be fine - either not get it or have very mild symptoms - with Omicron and transmission is not a sure thing by any means. I absolutely panicked when my dad got Delta, but my mother never did. My husband tested positive for Omicron two weeks after I got boosted and while we sleep in different bedrooms, our house is tiny and I didn't get it. It's absolutely rampant in the UK and Ireland and we've simultaneously the most new cases per day and the lowest ICU occupancy we've had in ages. The stats are really on your side here, particularly the family members who are boosted.
posted by DarlingBri at 5:51 AM on December 24, 2021 [2 favorites]


It's known that several of the existing MAB cocktail does not work on omicron, or have vastly reduced effect.

To ELI5, MAB works by flooding the blood with antibodies so they bind to the virus, preventing the virus from infiltrating your cells to make copies of itself and make you sick. However, omicron has developed differences that the original MABs that worked on original COVID works rather poorly against it. If the MAB doesn't bind to the virus (the jigsaw doesn't quite fit) then virus can still infect cells.

Data as of a few days ago shows that boosted vaccine has 70+% resistance to omicron, i.e. won't get sick at all. And even if a "breakthrough infection" occurs, symptoms tend to be mild, much milder than without vaccines or boosters.

WITHOUT boosters, on the other hand, and the resistance falls into the 10's and 20's, IIRC. I don't have the exact number handy at this time.

Fluvoxamine is an antidepressant, and while initial tests, backed by Steve Hirsch, shows some promise, NIH asked for a larger trial to confirm the findings. Hirsch pushed his panel for endorsement (no more trials), and the panel refused and most resigned. So fluvoxamine never went to large scale trial. And Hirsch went full antivax after the rejection.

Given that FDA have already approved two separate treatments for COVID-19, I would NOT be so quick to reach for off-label use meds.
posted by kschang at 8:06 AM on December 24, 2021


Data as of a few days ago shows that boosted vaccine has 70+% resistance to omicron

70% of what?
posted by mskyle at 9:36 AM on December 24, 2021


Best answer: My dad was admitted to the hospital Wednesday with covid (double vaxxed with Pfizer, but not yet boosted, guess what we had scheduled for Wednesday). Talked to the ID doc yesterday and they're not doing the monoclonals. I guess everyone is assuming it's Omicron since it's the dominant strain.

Both of the antivirals are approved now. Get at home tests if you can. Here in Cleveland, they're impossible to find. ERs aren't testing anyone unless they're going to be admitted. Urgent care are testing asymptomatic people with exposure, but only after 5 days (I think, my covid brain is fuzzy). If you can get a pulse ox, that would be helpful too.
posted by kathrynm at 12:32 PM on December 24, 2021 [1 favorite]




Response by poster: Thanks all for the answers. I really appreciate it. It looks like our options are limited unless they test positive. Grandmother got tested today, was negative. All 3 are getting PCR tested Sunday. I have some rapid tests to take to them if they develop symptoms. I am going to make sure they get retested (PCR) Tuesday as well since that will be the 5-day mark.
posted by microscopiclifeform at 3:56 PM on December 24, 2021


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