Know Your Treatment Options for COVID-19

From antiviral meds to preventative therapy, the options are greater than ever
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We’re heading into our third winter with COVID-19 and, at this point, “there are very few Americans who have not been exposed,” says infectious disease expert Steven Gordon, MD. Most of us have encountered COVID-19 by now, whether from an infection or being around someone who was sick.

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The virus that went global in 2020 is still very much with us. But we’re in a much better place to fight it now than when it started. We have vaccines and boosters. Plus, there are now several treatment options that can prevent serious infections.

These treatments represent a new era in the fight against COVID-19. You can use many of them at home — they’re available for certain people who aren’t ill enough for hospitalization.

Dr. Gordon shares the latest updates on COVID-19 treatments. But he emphasizes that even with these additional medications for COVID-19, prevention (looking at you, vaccines and boosters) is still our best weapon in this pandemic.

How to treat COVID-19 at home

About 80% of people who get sick with COVID-19 have a mild illness and can recover on their own. But even if your illness is “mild,” you can still feel pretty miserable. If this is you, here’s what to do for COVID-19 treatment at home.

Rest and hydrate

Stay home while you’re having symptoms, take it easy and drink plenty of fluids. Water is always the top choice for staying hydrated.

Treat your aches and pains

You may be wondering what medicine you can take for COVID-19. Start with your regular over-the-counter medicines like ibuprofen (Advil® and Motrin®) or acetaminophen (Tylenol®) to ease headaches and body pain. These meds can also help lower a fever.

Watch for more serious symptoms

If you’re not improving or you’re getting worse, Dr. Gordon advises keeping a close watch on symptoms. While rare, other illnesses can develop even with a mild case of COVID-19.

Some people with COVID-19 can end up with pneumonia, a lung infection. It may start mild or look similar to other illnesses, with symptoms like cough, fever and shortness of breath.

If you have serious symptoms like chest pain and trouble breathing, get those checked out right away.

COVID-19 treatments used in the hospital

Most of us are all too aware by now that some COVID-19 infections can turn severe and require hospitalization. Hospital interventions aim to control the virus, help you breathe and prevent runaway inflammation, particularly in your lungs.

When inflammation gets out of control, your immune system goes into overdrive and can damage lung tissues. This type of severe infection can also lead to several other serious complications throughout your body.

Treatments in the hospital include therapy for maintaining oxygen levels and medications to reduce the severity of the illness. According to Dr. Gordon, healthcare providers may give you a combination of treatments. Even though “there is no magic bullet for COVID-19,” he says, there are treatments known to save lives.

Oxygen therapy and ventilators

One of the dangers of a serious COVID-19 infection is low oxygen levels in your blood. This causes low oxygen in your body’s tissues (hypoxia) and can quickly damage your brain and other organs.

Hospital treatment may include oxygen through a breathing tube. People with severe cases may need a ventilator to help them breathe. This is a serious intervention requiring sedation. Being on a ventilator means an extended hospital stay and can lead to long recovery times.

Remdesivir

This antiviral drug for COVID-19 was approved by the U.S. Food and Drug Administration (FDA) in October 2020 to treat people who are hospitalized with COVID-19. Remdesivir works by disrupting the coronavirus replication process in your body and easing the load on your immune system.

You get remdesivir through an IV infusion. Dr. Gordon says most people tolerate this drug well, and it has very few interactions with other medications.

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Baricitinib

This anti-inflammatory drug was the first of its kind to be granted full FDA approval for treating certain people in the hospital for COVID-19. Baricitinib is known as a Janus kinase inhibitor.

Baricitinib works by blocking certain enzymes in your body that cause inflammation. This is important because when inflammation gets out of control in COVID-19, it can lead to respiratory failure and death. Baricitinib is available in pill form and taken orally.

Tocilizumab

Another anti-inflammatory, tocilizumab, is a monoclonal antibody treatment. This type of drug blocks certain steps in virus replication in the body, which helps the immune system work better to fight the illness.

Tocilizumab received emergency use authorization (EUA) approval from the FDA in June 2021. It targets interleukin-6 receptors to reduce inflammation. You receive tocilizumab as an IV infusion.

Steroids

Steroid drugs such as dexamethasone or prednisone also target the potentially dangerous lung inflammation that can happen with COVID-19. These drugs are typically used only in severe cases. You receive steroid treatments as injections.

Evusheld: A new option for preventing COVID-19

In December 2021, Evusheld™ received EUA as a preventive therapy. Besides vaccines, Evusheld is the first drug approved for COVID-19 prevention.

Evusheld is a combination of two monoclonal antibodies (tixagevimab and cilgavimab). You may be a candidate for Evusheld if you aren’t currently sick with COVID-19 and haven’t been recently exposed to the virus. You also must meet at least one of these criteria:

  • Have a compromised immune system due to a health condition or treatment.
  • Are taking medications that prevent the COVID-19 vaccine from working properly, such as those used after a transplant.
  • Have a known allergy to the available COVID-19 vaccines.

Evusheld is given as a pair of injections. The dose may be repeated every six months. Talk to your healthcare provider if you think Evusheld might be a good option for you.

What to do if you have COVID-19: New treatment options to keep you out of the hospital

Early in the pandemic, treatments focused on people who were the sickest and in the hospital for severe COVID-19. Now, there are new treatments for people who aren’t sick enough to be hospitalized but may still be at risk of progressing to serious illness.

These therapies are for people who:

  • Have a positive COVID-19 test result.
  • Have mild-to-moderate symptoms.
  • Are in the first few days of the illness.
  • Are considered high risk for developing severe COVID-19.

The definition of high risk in this situation is very broad, according to Dr. Gordon.

High-risk groups eligible for these treatments include people with underlying medical conditions or other risk factors. You may be at high risk if you have:

  • Asthma.
  • Cancer.
  • Chronic diseases.
  • Diabetes.
  • Obesity.

And these are just a few examples of high-risk groups. You may also be considered high risk if you’re pregnant, over 65, have an impaired immune system or take immunosuppressant medications, says Dr. Gordon.

He explains that these home treatments have all been shown to reduce the chance of being hospitalized with severe COVID-19.

But what if you’re not considered high risk and still want one of these treatments? Your healthcare provider can make that decision, says Dr. Gordon. So, even if you’re not high risk, your provider may still be willing to give you one of these treatments. Talk to your provider if you test positive.

Here’s a rundown of the options.

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Paxlovid

This antiviral treatment is a combination of two drugs, nirmatrelvir and ritonavir. Paxlovid™ was granted EUA by the FDA in December 2021 to treat people who:

  • Tested positive for COVID-19.
  • Have mild-to-moderate symptoms.
  • Are in a high-risk group.

How to take Paxlovid

You must be within five days of the start of symptoms to take Paxlovid. This treatment is a series of 30 pills taken orally over five days.

One drawback of this treatment, says Dr. Gordon, is that you may need to stop your current medications while taking Paxlovid due to drug interactions.

What about Paxlovid rebound?

Paxlovid rebound occurs when someone finishes their course of Paxlovid pills, tests negative for COVID-19, but then tests positive. Don’t take an additional course of treatment at that point, says the CDC (Centers for Disease Control and Prevention).

Even though high-profile cases of Paxlovid rebound have been in the news, Dr. Gordon states that Paxlovid rebound is rare.

Remdesivir

Remdesivir is another antiviral drug used to prevent severe COVID-19 in high-risk people who aren’t sick enough to be hospitalized. In January 2022, the FDA approved this treatment for nonhospital use.

How to take remdesivir

You get remdesivir as an IV infusion, with one infusion on each of three consecutive days. You must get the first infusion within seven days of experiencing symptoms.

Lagevrio

Another antiviral, Lagevrio™ (molnupiravir), was granted EUA in December 2021. People who are pregnant or trying to become pregnant shouldn’t use this medication.

How to take Lagevrio

Treatment with Lagevrio must begin within five days of when symptoms start. It’s available in capsules and should be taken every 12 hours for five days.

Bebtelovimab

Bebtelovimab is a monoclonal antibody treatment with EUA authorization granted in February 2022. It’s approved for nonhospital use in high-risk people with mild-to-moderate COVID-19. It blocks certain steps in the process of virus replication in your body, making it easier for your immune system to fight off the virus.

How to take bebtelovimab

This drug is given as a single shot, and you must get it within seven days of symptom onset.

Protecting yourself against COVID-19

COVID-19 isn’t going to disappear anytime soon, as much as we’d like that to happen. It may never go away completely, which means that COVID-19 vaccines will continue to be part of our lives.

Dr. Gordon stresses that vaccination is and will continue to be the go-to for avoiding severe COVID-19. “This is a vaccine-preventable illness,” he says. “And vaccines have prevented millions of deaths worldwide since they became available.”

These days, the best way to protect yourself is by staying up to date with vaccinations. That means getting the original series of shots plus all applicable booster doses recommended by the CDC.

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