Question

I’m looking for some guidance on possible treatments for Covid. I care for my partner who is bedbound with severe ME/CFS. He hasn’t been able to get vaccinated due to also having multiple allergies and the possible anaphylaxis risk. Vaccination would therefore have do be done in hospital and he isn’t well enough to go to hospital.

We are still shielding as a household – although the rest of us are triple-jabbed – to avoid the risk of bringing in Covid and infecting him. However I’m becoming increasingly concerned that this virus isn’t going to go away and that it’s going to be harder to be able to protect him. So I’d like to have a possible treatment plan agreed in advance with the GP, in case he catches Covid-19. However, the NHS list for those available for antiviral drug treatment doesn’t specify ME/CFS. Any thoughts or advice welcomed!

Answer

The information on the NHS website summarises the current situation regarding two possible immediate treatment options for people who are at increased risk of developing serious complications if they catch COVID-19 and are being managed at home.  The aim is to provide immediate treatment for the infection and prevent admission to hospital.

The two treatments being made available are an antiviral drug called molnupiravir and an immunological treatment known as a neutralising monoclonal antibody (sotrovimab). At the moment the intention is to provide these drugs to people who meet the fairly strict and narrow eligibility criteria as listed on the NHS website and have Covid-19 symptoms that are confirmed by a positive PCR test.

The list of eligible conditions includes people who have a weakened immune system (i.e., are immunosuppressed) due to either a medical condition like cancer that causes immunosuppression or are taking a drug (such as a steroid) which depresses immune system function.

The NHS: Treatments for Coronavirus

The NHS offers treatments to people with coronavirus (Covid-19) who are at the highest risk of becoming seriously ill. The treatments available are:

• • nirmatrelvir and ritonavir (Paxlovid).
  • sotrovimab (Xevudy).
  • remdesivir (Veklury).
  • molnupiravir (Lagevrio).

Nirmatrelvir, ritonavir, remdesivir and molnupiravir are antiviral medicines. Sotrovimab is a biological medicine. It is also known as a neutralising monoclonal antibody (nMAb). These treatments can help some people manage their Covid-19 symptoms and reduce the risk of becoming seriously ill.

Who can have a COVID-19 treatment?

You're eligible for these Covid-19 treatments if you have not been admitted to hospital and all of the following apply:

• • you're aged 12 or over.
  • you're at highest risk of getting seriously ill from Covid-19.
  • you have symptoms of Covid-19, which are not getting better.
  • you have tested positive for Covid-19.

People at highest risk

You may be at highest risk of getting seriously ill from COVID-19 if you have:

• • Down's syndrome, or another chromosomal disorder that affects your immune system
  • certain types of cancer or have received treatment for certain types of cancer
  • sickle cell disease
  • certain conditions affecting your blood
  • chronic kidney disease (CKD) stage 4 or 5
  • severe liver disease
  • had an organ transplant
  • certain autoimmune or inflammatory conditions (such as rheumatoid arthritis or inflammatory bowel disease)
  • HIV or AIDS and have a weakened immune system
  • a condition affecting your immune system
  • a rare condition affecting the brain or nerves (multiple sclerosis, motor neurone disease, Huntington’s disease or myasthenia gravis)

A doctor or specialist can confirm if you are eligible for treatment.

The NHS: Treatments for Covid-19 | March 2023

ME/CFS is not currently on this list as the abnormalities in immune system function in ME/CFS are not normally those found in significant immunosuppression. However, we do know that people who have ME/CFS and catch Covid-19 are likely to have a significant exacerbation of their ME/CFS symptoms, or a more prolonged relapse. And anyone with ME/CFS who has not been vaccinated, or failed to complete a course, is clearly at increased risk of catching Covid-19

We believe that people with ME/CFS particularly those who are severely or very severely affected can make a case to be considered for these treatments if they were to catch Covid-19. This is something that needs to be discussed with your GP – as it would require the support of a doctor who is actively involved in your clinical care.

Apart from doing all you can to reduce the risk of catching the infection from a human contact, there is not a great deal more that people can do when it comes to prevention.  However, if someone with ME/CFS is housebound then they should probably be taking a vitamin D3 supplement – especially as vitamin D deficiency may decrease resistance to Covid-19.

• We would also suggest having a pulse oximeter in the house (these devices can be purchased from chemists) so that oxygen levels can be monitored if someone with ME/CFS does get Covid-19 and that you are aware of the NHS information on how to manage the infection at home.

See also: Long Covid: Vaccinations.

More information

• Vitamin D & Deficiency
  We explain what vitamin D is and why it is so important, how it occurs naturally, the supplements that are available, whether deficiency is likely in ME/CFS, and how it can be treated.
• Covid-19: Long Covid & ME/CFS
  An extensive free booklet that reviews the overlaps between Long Covid and ME/CFS, and explains how people with Long Covid can safely learn to manage their symptoms and any continuing disability.
• Covid-19: Vaccines & ME/CFS
  In this free leaflet, we tell you all you need to know about the Covid vaccines if you have ME/CFS. It will help should you be struggling to reach a decision about whether to have the vaccinations or not.
• Long Covid and ME/CFS – Are they the same?
  An extensive free booklet that reviews the overlaps between Long Covid and ME/CFS, and explains how people with Long Covid can safely learn to manage their symptoms and any continuing disability.
• Template: Covid-19 ME/CFS Clinically Vulnerable Status 
  This free template letter explains why people with ME/CFS are more vulnerable and should receive extra help in relation to COVID-19.