COVID-19 Testing and Ambulatory Treatment Options at Henry Ford
Last update: May 13, 2022
Update: Outpatient Management of COVID-19
- COVID-19 case rates have sharply increased over the past week. The number of referrals for monoclonal antibody treatment is increasing which threatens to outstrip our supply.
- National guidelines recommend the oral anti-viral Paxlovid as the first choice to treat COVID-19 positive patients at high risk for severe disease. These medications are now widely available at Henry Ford Health and other retail pharmacies.
- Monoclonal antibody therapy is the second line agent. Molnupiravir is the third line treatment option as it is inferior to Paxlovid and Bebtelovimab.
- Use of more than one treatment therapy when treating outpatients is not recommended.
- We continue to provide Evusheld for pre-exposure propylaxis against COVID-19 infection in immunocompromised patients. Evusheld may not be used to treat COVID.
Please look below for more information on all these therapies, including clinical criteria and drug interactions. This web page is for providers only as a way to give you the most up to date clinical information. Please refer patients to henryford.com.
Ambulatory COVID-19 Treatment Options
MDHHS COVID-19 Outpatient Therapy Guidelines outline ambulatory treatment options for selected individuals at increased risk for hospitalization or death as defined in the latest update, which was April 6.
Oral Antiviral Agents
Paxlovid (nirmatrelvir & ritonavir) is the first line choice for ambulatory treatment and is available under Emergency Use Authorization by the FDA for treating COVID-19 in outpatients with mild to moderate disease who are at increased risk for hospitalization or death.
- Paxlovid efficacy data shows an 88% decreased risk of hospitalization and death if started within 5 days of symptom onset which is comparable to monoclonal antibody treatment. There are multiple drug interactions. These interactions are listed in the EUA.
- Paxlovid dosing is 3 tablets (150 mg nirmatrelvir x2 tablets and 100 mg ritonavir tablet) for 5 days.
- Clinical criteria:
- Paxlovid is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death (see MDHHS link above).
- No more than 5 days from symptom onset before initiation AND
- No contraindicated drug interactions
Lagevrio (molnupiravir) is the third line choice for ambulatory treatment and is available under Emergency Use Authorization by FDA for treating COVID-19 in outpatients with mild to moderate disease who are at increased risk for hospitalization or death.
- Efficacy data shows a 30% decreased risk of hospitalization and death if started within 5 days on symptom onset
- The dose is 800 mg (4 capsules) twice a day for 5 days
- This drug is contraindicated during pregnancy
- Clinical criteria:
- Lagevrio is indicated for treatment of adults with high risk of hospitalization and death (see MDHHS link above)
- Unable to use first line therapies (Paxlovid or monoclonal antibody) AND
- Positive SARS-CoV-2 test AND
- ≤ 5 days from symptom onset AND
- Age ≥18 years AND
- Not pregnant
How to order: For providers on the Henry Ford Health instance of Epic (including Community Care Connect), order “paxlovid; nirmatrelavir-ritonavir, or molnupiravir.”
Multiple MAB products are available: Bamlanovimab/Etesevimab, Casirivimab/Indevimab, Sotrovimab, Bebtelovimab. MAB treatment is the second line ambulatory treatment option for COVID-19 patients who have high risk for hospitalization and death. In March 2022, Omicron BA.2 variant became the predominant variant and is resistant to all products except Bebtelovimab, which is now the exclusive treatment option at Henry Ford Health. Variant prevalence and MAB resistance is continuously monitored by the MAB Hub team and MAB treatment protocols are adjusted accordingly.
Clinical criteria - eligible patients must have one of the following conditions:
- Immunocompromised (primary immunodeficiency, active chemo, transplant immunosuppression, biologic immunomodulators/immunosuppressive drugs, HIV with uncontrolled viral load, high dose steroids 20 mg/day at least two weeks)
- Age 65 and older
- Age < 65 AND one of the following:
- BMI 25 or greater
- Cardiovascular disease
- Chronic kidney disease
- Chronic respiratory disease
- Administer within 7 days from onset of symptoms
How to order
- Physicians on the Henry Ford Health instance of Epic (including Community Care Connect) should order “Ambulatory Referral to HF Facility for Monoclonal Antibody Infusion (mAB)” in Epic. The order will trigger MAB Hub staff to contact the patient to arrange treatment.
- Physicians not on Epic should call the Referring Physician Office at 877-434-7470. The RPO will refer patient to the MAB Hub and the patient will be contacted.
Pre-Exposure COVID-19 Prophylaxis
Evusheld (tixagevimab co-packaged with cilgavimab) is available and in adequate supply for pre-exposure prophylaxis. MDHHS has approved prophylaxis for Tier 1 and 2 criteria.
MDHHS Tier 1 Clinical Criteria
- Patients within 1 year of receiving B-cell depleting therapies (e.g., rituximab, ocrelizumab, ofatumumab, alemtuzumab)
- Patients receiving Bruton tyrosine kinase inhibitors
- Chimeric antigen receptor T cell recipients
- Post-hematopoietic cell transplant recipients who have chronic graft versus host disease or who are taking immunosuppressive medications for another indication
- Patients with hematologic malignancies who are on active therapy
- Solid-organ transplant recipients who:
- are lung transplant recipients, or
- are within 1 year of receiving a solid-organ transplant (other than lung transplant), or
- solid-organ transplant recipients with recent treatment for acute rejection with T or B cell depleting agents
- Patients with severe combined immunodeficiencies
- Patients with untreated HIV who have a CD4 T lymphocyte cell count
MDHHS Tier 2 Clinical Criteria
- Patients with active treatment for solid tumor malignancies
- Patients with moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection (CD4 cell counts of 50-200, AIDS-defining illness without immune reconstitution, or symptomatic HIV)
- Active treatment with high-dose corticosteroids ( ≥20 mg prednisone or equivalent per day for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive that are immunosuppressive or immunomodulatory (e.g., B-cell depleting agents), tumornecrosis (TNF) blockers, and other biologic agents
- For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine
How to order
- Physicians on the Henry Ford Health instance of Epic (including Community Care Connect) should order “Ambulatory referral to HF Facility for Pre-Exposure Covid Prophylaxis (Evusheld) Monoclonal Antibody Injection.” The order will trigger MAB Hub staff to contact the patient to arrange treatment.
- Physicians not on Epic should call the Referring Physician Office at 877-434-7470. The RPO will complete the referral to the MAB Hub.
COVID Testing Using Henry Ford Labs
We no longer require patients who are asymptomatic for COVID-19 to be tested prior to procedures, surgeries or hospital admission. Providers can elect to test patients for patient care or placement and should continue to test patients who have COVID-19 symptoms. All patients will continue to have a symptom screen for COVID symptoms in Epic. Employee Health continues to provide COVID testing for all Henry Ford Health team members; tests can be scheduled using MyChart.
The Testing Process
(Please note that Henry Ford Jackson Hospital follows a different process for COVID testing..)
Henry Ford Medical Group Primary Care Providers
Patients can continue to be tested at their primary care provider’s office during an in-person appointment. The clinic will send the test to Henry Ford Lab Services for processing. When a patient is not in the office, primary care providers or MyCare Advice Line nurses can place an order in Epic and arrange an appointment for the patient to visit the primary care provider’s office for specimen collection. At check in, the patient receives a test kit and instructions. They self-swab in an exam room, conference room or other location, then leave the test kit with a team member. The Primary Care team sends the test kit to the lab for processing.
Henry Ford Medical Group Specialists*
HFMG specialists may place an order in Epic for their patients to receive a COVID test at one of the lab sites below. Direct the patient to visit one of the five test sites during the designated hours for a test. No appointment is needed.
Independent providers in southeast Michigan who have Epic access through Community Connect may use Henry Ford labs for COVID PCR test specimen collection and processing. Place an order for a COVID test in Epic and direct the patient to one of the five lab sites below. The patient should visit the site during the designated hours for a test. No appointment is needed.
Pre-anesthesia and Pre-admission Testing*
Pre-surgical, pre-anesthesia and pre-admission testing are no longer required. Instruct patients to contact your office if they experience COVID-19 symptoms immediately prior to a procedure or surgery, and schedule a COVID-19 test or postpone the procedure.
If pre-surgical or pre-procedural COVID-19 testing is needed, schedule the test at one of the lab sites listed below. Because the testing locations are not open on weekends, testing for procedures and surgeries taking place on Mondays should test on the preceding Friday.
Patients receive their COVID test results in MyChart and/or through their provider’s office.
These sites are open Monday – Friday for testing Henry Ford Health patients who have been referred by their HFMG specialist or Independent Provider and have an order in Epic:
Henry Ford Hospital (Detroit) K-1 Outpatient Lab
Testing Hours: 1 – 4 p.m. weekdays
To schedule: The department is, “HFH PATHOLOGY OP LAB”
Henry Ford Wyandotte Hospital
Testing Hours: 7 a.m. – 2 p.m. weekdays
To schedule: The department is “HFWH - Pathology Outpatient Lab.”
Henry Ford Medical Center – Royal Oak
110 East 2nd Street, Royal Oak
Testing Hours: 1 – 4 p.m. weekdays
To schedule: The department is “Roy Oak Screening Clinic.”
Henry Ford Medical Center – Bloomfield Township
1961 South Telegraph Road, Bloomfield Hills
Testing Hours: 1 – 4 p.m. weekdays
To schedule: The department is “Bloom TWP Screening.”
*Scheduling Tip: When a COVID test needs to be Stat and collected by clinic staff in a scheduled visit, link the order to the appointment at the time of scheduling. It will be converted to “Clinic Collect” at check in. Once the order is linked to a visit, it will no longer appear on the Active Requests tab for the lab to Walk-In.
Henry Ford Medical Group Primary Care testing: Diane George, D.O., Chief Medical Officer, Primary Care, [email protected].
Pre-Anesthesia testing: Pat (Joe) Patton, M.D., Medical Director, Surgical Services, [email protected].
Lab testing: Lab Customer Service Center, 313-916-LABS (5227), open 24/7.