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Treatment for people at the highest risk from COVID-19

Medicines are available to treat people with COVID-19 (coronavirus) who are at the highest risk of becoming seriously ill.

These include:

  • Paxlovid - an oral medicine taken as tablets
  • Sotrovimab - given through a drip in your arm (infusion)

You'll be told by your doctor or consultant if these medicines are for you.

Most people will not need or benefit from these medicines. Most people can treat the symptoms of COVID-19 at home.

The best way for most people to protect themselves from COVID-19 is to get vaccinated and get a booster dose, when they are due.

Who these COVID-19 medicines are for

Treatment for COVID-19 may be recommended for people who meet all of the following:

  • You are at the highest risk of becoming seriously ill from COVID-19.
  • You have symptoms of COVID-19 that started within the last 5 days.
  • You have had a positive PCR or antigen COVID-19 test within the last 5 days.
  • You are aged 12 or over and weigh at least 40kg (6.3 stone).
  • You have been prescribed the treatment by a doctor.

Some medicines must be given in a hospital and need a prescription from a hospital specialist. Some medicines can be prescribed by GPs and other doctors.

Most people will not need these medicines.

People at the highest risk from COVID-19

You are at high risk of serious illness or death from COVID-19 if you:

  • are immunocompromised and have a weak immune system
  • have not been fully vaccinated and are aged 65 or over
  • have not been fully vaccinated and have additional risk factors

You may also be considered for Paxlovid if you are:

  • vaccinated and aged 75 or over
  • vaccinated and aged 65 or over with additional risk factors

Additional risk factors

Additional risk factors include:

  • obesity (BMI over 35)
  • diabetes mellitus
  • high blood pressure (hypertension)
  • cardiovascular disease
  • chronic lung disease
  • conditions that weaken your immune system

You are also at the highest risk of serious illness or death from COVID-19 if:

  • you have been treated with rituximab within the past 12 months
  • you have been treated with B-cell or T-cell depleting therapies
  • you have been taking more than 40mg a day of prednisolone (steroids) for more than a week
  • have been taking more than 20mg a day of prednisolone (or more than 2mg/kg/day for a child under 10kg) for 2 weeks or longer
  • you are pregnant and have other risk factors - your consultant will advise you
  • you have one of the following listed conditions or treatments that make COVID-19 vaccines less effective for you:
Primary immunodeficiency conditions

People with any of the following:

  • Severe combined immunodeficiency (SCID).
  • Combined immunodeficiency (CID).
  • Common variable immunodeficiency (CVID).
  • Hypogammaglobulinaemia with recurrent infections and immunoglobulin replacement or prophylactic antibiotics.
  • Good syndrome (thymoma and B-cell deficiency).
  • Hyper IgM syndrome.
  • Autoimmune polyglandular syndromes.
  • Type 1 interferons (IFN) pathway defects or autoantibodies.
Secondary immunodeficiency conditions

People with any of the following:

  • Lung transplant at any time in the past.
  • Heart transplant at any time in the past.
  • Kidney, liver, intestines or pancreas transplant in the past year.
  • HIV and not receiving treatment (high viral load) and CD4 count of less than 50.
  • HIV and receiving treatment and CD4 count of less than 200.
  • AIDS.
Immune-Mediated Inflammatory Disorders (IMID)

Examples of an immune-mediated inflammatory disease include: rheumatoid arthritis, inflammatory bowel disease and systemic lupus erythematosus.

You are at the highest risk if you have an IMID and are having the following treatments:

  • B-cell depleting therapy (for example: Rituximab) within the past 12 months or where B-cells have not recovered.
  • Systemic Tacrolimus - but not if you are being treated with topical tacrolimus or other topical calcineurin inhibitors.
  • Corticosteroids for long term use of more than 5mg a day of prednisolone or a high dose from time-to-time.
  • Cyclophosphamide within the last 6 months.
  • Cyclosporin.
  • Mycophenolate Mofetil.
  • Mycophenolic acid.
  • Biologic monotherapy with agents known to make COVID-19 vaccines less effective.
  • Biological agents and Azathioprine.
  • Biological agents and Methotrexate (MTX).
  • Abatacept.
Blood disorders

You have one of the following conditions:

  • Haematopoietic stem cell transplantation (HSCT) in the last 12 months or where B-cells have not recovered.
  • Graft-versus-host disease (GVHD) that is active.
  • Chronic B-cell lymphoproliferative disease. 
  • Myeloma - but not monoclonal gammopathy of undetermined significance (MGUS).
  • MGUS with weakened immune function but that is not myeloma.
  • Myelodysplastic syndrome.
  • Sickle cell disease.
  • Haematology disorders and have received B-cell or T-cell depletion therapy in the last 12 months (anti-CD20, alemtuzumab, ATG).

You have had of the following treatments:

  • CAR-T therapy (Chimeric Receptor T-cell therapy) in the last 2 years.
  • B-cell depletion therapy (anti-CD20, daratumumab) in the last 12 months, or where B-cells have not recovered.
  • T-cell depleting therapies (alemtuzumab, ATG) in the last 12 months.
  • Radiotherapy in the last 6 months.
  • Systemic anti-cancer therapy in the last 12 months (excluding tyrosine kinase inhibitors) for haematology malignancy - but not stable CML.
Cancer

You have:

  • active solid cancer
  • metastatic cancer
  • had radiotherapy in the last 6 months
  • had chemotherapy in the last 3 months
  • haematological (blood) cancer

People who have certain types of haematological (blood) cancers - please see 'blood disorders' section above for more detailed information.

Kidney conditions

You have:  

  • had a kidney transplant
  • stage 4 chronic kidney disease (CKD)
  • stage 5 chronic kidney disease (CKD)
  • had B-cell depleting therapy (for example: Rituximab) within the past 12 months or where B-cells have not recovered.
Liver conditions

You have:  

  • cirrhosis
  • had a liver transplant
  • been treated with any immunosuppression for liver disease - this does not include low-dose corticosteroids
Brain and nervous system conditions

You have:  

  • Huntington’s disease
  • motor neurone disease (MND) and are on immune-based therapies
  • multiple sclerosis (MS) and are on immune-based therapies
  • myasthenia gravis and are on immune-based therapies
How was this list decided?

The list of health conditions and clinical risk factors has been agreed by the Therapeutics Advisory Group (TAG).

This independent advisory group of health experts was established by the HSE.

People at the very highest risk from COVID-19 will be considered for treatment first. As availability increases, other people at high risk from COVID-19 may be considered for treatment.

How to get COVID-19 medicine if you are at the highest risk

Contact your GP or doctor urgently if you are at high risk from COVID-19 and:

  • you have COVID-19 symptoms, or
  • you have a positive PCR or antigen COVID-19 test

If you are at the highest risk of serious illness or death and have COVID-19, your GP or hospital consultant and their team may recommend this treatment for you.

If they decide the treatment is right for you, you’ll start it as soon as you can. Your doctor and their team will give you more information and answer any questions you have. They may ask what other medicines you take, including any herbal remedies, vitamins or supplements.

Some medications are tablets. Others are given in hospital, through a drip in your arm (infusion).

If this COVID-19 treatment is not recommended for you, your doctor will provide you with the care that is right for your condition and symptoms.

Children

Children are at low risk of getting seriously ill from COVID-19. 

They are very unlikely to need hospital treatment for COVID-19, even if they have conditions such as asthma, diabetes, obesity or cystic fibrosis.

The best way to protect your child from severe illness from COVID-19 is to get them a COVID-19 vaccine if they are aged 5 or older.

Only a small number of children aged 12 or older who are at the highest risk from COVID-19 might need treatment with medication. COVID-19 medications are not suitable for children under 12 years old.

Children who may benefit from treatment

Children aged 12 or older may benefit from treatment if they:

  • have an extremely weak immune system, such as around the time of transplants or if having CAR-T therapy (chimeric receptor T-cell therapy)
  • have had specific immune disorders from birth, such as autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) or interferon pathway disorders

Children aged 12 or older may also  benefit from treatment if they are not fully vaccinated and need ongoing hospital treatment for:

  • a severe and complex neurodisability that may include frequent pneumonias and multiple medical needs
  • multiple illnesses and have complex medical needs, such as needing the use of machines, a tracheostomy or home ventilation to help them breathe

Treatment for COVID-19 is free

Treatment for COVID-19 is free of charge through the HSE if it is recommended for you.

The HSE will never ask for your bank account or card details, or ask you to pay for treatment.

Page last reviewed: 13 July 2022