COVID Medicines Delivery Unit (CMDU)

Our COVID Medicines Delivery Unit (CMDU) offers early interventional treatment for people who are immunosuppressed and test positive for COVID-19.

We have made great progress since the early days of the COVID-19 pandemic. People who are infected with the COVID virus now are unlikely to become severely unwell and need to be in hospital for breathing support. Fewer people are affected like this now and fewer people are dying; it is important to add that this can still happen though. Great progress has been made because for the widespread availability of vaccinations in this country that are proven to be very effective in preventing severe infections requiring hospital treatment as well as treatments for the infection. We are currently seeing Omicron BA.5 as the main COVID virus causing infection. It also appears to cause less severe infections than what we have previously seen.

As a result of this progress, there is no longer an emphasis on people with a wide variety of medical conditions who were previously asked to shield and considered clinically vulnerable. Increased treatment is now focused on those people who may be immunosuppressed, which means their immune system doesn’t work as well as others. This includes a wide variety of people, for example people who have had chemotherapy for cancer. There is a cross-over with the original group of people who were told they were clinically vulnerable but this is not the same list. A range of conditions where we think the immune system may be underperforming have been drawn up by NHS England.

What happens if you have one of these conditions?

  • It is likely that you are on a central list that looks at GP registers
  • When a positive COVID-19 test is registered (PCR or lateral flow) and you are on this list of people, a message is sent to you advising to expect contact from the NHS within 24 hours as you may be eligible for treatment
  • At the same time, an automatic referral is made to the local referral centre, outlining that you have tested positive for COVID-19. Here in Devon these referrals are handled by central staff that sort and send the referral to the local CMDU service. Here at Torbay and South Devon, we provide treatment for people living in the area we serve. This part of the process can take over 24 hours to be handled which means we are later than the original text says we will be
  • We process referrals daily and contact people to assess the need for early COVID-19 treatment with them individually

Since our CMDU opened in December 2021, we have had got up to 35 referrals a day. It has been necessary to treat less than half of the people referred. This is because not everyone is actually eligible, as their immune system is strong enough to be able to work against COVID-19. For example, people with asthma or COPD who sometimes take prednisolone for an exacerbation get onto the list but if the prednisolone dose is a short course only, the person is not considered immunosuppressed. Prednisolone in high dose (e.g. 20 mg per day) for a prolonged time ( over 4 weeks) can decrease the immune response.

Our service has a good record of responding to referrals quickly. The timeframe is for treatment to start within six days of the start of symptoms also called day 5 with day 0 being the first day of symptoms. We are aware that the expectation is set very quickly that there will be a response in 24 hours with the time taken to get onto the referral system and then to make contact this is often longer than the target of 24 hours. It is reassuring to see from ours and the national results that we still get good results if treatment is started later; the latest we would start treatment would be day 7 of symptoms. We have very good results with the small number of people admitted after assessment with the CMDU (under 1 in 100 people are admitted after assessment and / or treatment).

What are some of the treatments available?

  • COVID-19 antibody treatment (Sotrovimab) – Sotrovimab is particularly for people at very high risk of not having any antibodies against COVID-19 e.g. a person who has very recently received chemotherapy
  • Paxlovid – a tablet that stops the virus from reproducing. Very effective in research trials
  • Molnupiravir – a tablet that stops the virus from reproducing. It is less strong than Paxlovid, but is an alternative if Paxlovid is not an option because of interactions with other drugs or other reasons

What do I need to do?

  • If you have had a text from NHS England expect a call, your referral is being processed. This can take up to 48 hours
  • If you have a condition that means you have contact with a specialist nurse service, you can call the helpline number for advice
  • Your GP is also able to refer to the CMDU service, with their guidance on the referral process and service provided by NHS Devon
  • The CMDU does not accept direct referrals due to the large volume of referrals we can receive on a daily basis which need to be tracked