Keeping yourself safe from infectious diseases like COVID-19 is a practice in both offense and defense.
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There are proactive steps you should be taking to keep yourself from getting sick in the first place. That’s the offense. And it includes things like getting vaccinated and keeping up with booster shots. And, of course, good hand hygiene and staying away from people who are sick.
And then, there’s the other side of it. The defense. The treatments that can help keep your illness more manageable if your best attempts at keeping the virus at bay don’t work out.
Because it happens.
Despite our best efforts, COVID-19 is a tough competitor. Even after taking precautions, you can still get infected with COVID-19 and be forced to go on the defense.
Getting vaccinated can reduce your risk for becoming infected with COVID-19 or from becoming seriously ill. But if you do still become infected, layering on certain medications can also help limit the severity of your illness.
“COVID-19 medications shouldn’t be looked at as alternatives to vaccination,” clarifies critical care physician Abhijit Duggal, MD. “But they can be effective as adjuncts to vaccination if you do become ill.”
So, if you do get COVID-19, what pills may be prescribed to you? And how do they work? Dr. Duggal explains.
If you become infected with COVID-19, your healthcare provider may recommend specific medications that can help.
Some COVID-19 medications can be used for people who have severe infections and are being treated in the hospital. That includes things like IV medications to decrease inflammation and immunomodulators, which work to change your body’s immune response.
“Both of these medications are antivirals and are being used to prevent the severity of disease,” Dr. Duggal explains. “They’ve been associated with decreasing the symptoms of COVID-19 and decreasing the risk of being hospitalized as a result of COVID-19.”
A virus consists of genetic material surrounded by a capsid, or a protective covering made of proteins.
To reproduce, viruses worm their way into your body’s cells, and use them as incubators to make copies of themselves. The more they copy, the more likely they are to cause severe infection.
But if that copy-and-paste process gets interrupted, the virus will stop replicating. And you won’t get as sick.
That’s the goal of antiviral pills. To stop the copy machine.
“Antiviral pills act directly on the virus itself, and either disrupt the reproduction cycle of the virus — meaning the virus can’t replicate — or cause direct damage to the virus, so you decrease how dangerous it is,” Dr. Duggal further explains. “When we can stop the virus from replicating, the virus can’t sustain itself. When its replication stops, you basically drop the overall number of virus cells in your body.”
Antiviral pills aren’t new and aren’t limited to COVID-19 treatment. Antivirals are also used to treat infectious diseases like HIV, hepatitis B and hepatitis C. Tamiflu®, which you may have taken after catching the flu, is also an antiviral.
And they’re not one-size-fits-all medications.
“You need to figure out which chemical is going to disrupt the exact protein associated with the specific virus itself,” notes Dr. Duggal. For example, drugs used to treat HIV are calibrated specifically for those virus proteins. Similarly, Paxlovid and Lagevrio are used exclusively to treat COVID-19.
Some COVID-19 infections may be quite mild and managed well with over-the-counter medication or simple home remedies, like using a humidifier, getting lots of rest and drinking plenty of fluids.
For people whose symptoms don’t improve on their own, COVID-19 antiviral medications may be a consideration. But they’re not for everyone.
The U.S. Department of Health and Human Services says Paxlovid is approved for use in adults ages 18 and older “with a current diagnosis of mild to moderate COVID-19 and who are at high risk for progression to severe COVID-19.” Paxlovid also has received Emergency Use Authorization (EUA) for treating children who are at least 12 and weigh 40 kilograms (88 pounds) who are at high risk for severe COVID-19 infection.
Lagevrio has only been approved for adults and for use in cases where alternative COVID-19 treatment (that is, Paxlovid) isn’t accessible or appropriate for them. Like Paxlovid, it’s approved for people who are at higher risk for severe infection.
“The way to think about these medications is that if you have tested positive for COVID-19 and are at risk for developing complications from the infection, they significantly decrease your risk for becoming seriously ill,” says Dr. Duggal.
Both Paxlovid and Lagevrio are best when started as soon as possible after you start developing symptoms — best when started within five days. They’re available only by prescription.
It’s important to recognize that Paxlovid and Lagevrio should only be used in people who have tested positive for COVID-19. Not as a “just in case” measure to try to prevent illness.
That’s because overuse of these medications can cause the virus to become drug resistant.
“Resistance against medications is always a problem,” Dr. Duggal emphasizes. “Even in other diseases, when you’re using antivirals, you want to be very mindful of how you use them so you don’t develop resistance against those medications. You want to save these medications for people who really need them. If people just start taking pills in hopes it’ll decrease their risk, the risk of the virus developing resistance against the pill is going to go up very, very quickly, which would be a big problem.”
Dr. Duggal reiterates that antiviral pills to treat COVID-19 aren’t a substitute for vaccination.
“Antiviral medications are post-exposure medications to make sure that you don’t develop viral concentration levels high enough to cause you to have a very bad infection,” he stresses. “Your primary prevention is vaccination because your risk for severe disease is going to definitely be much, much lower if you are vaccinated.”
Getting vaccinated against COVID-19 is the most crucial step you can take to keep yourself safe and healthy. But rest assured that if you do catch COVID-19, vaccination coupled with antiviral medication may help keep you from becoming seriously ill. Talk with your healthcare provider about your risk and your options.