If you’re experiencing symptoms of COVID-19 and a COVID-19 test confirms you have the virus, you may wonder what treatment options are available to help you feel better and avoid getting seriously ill.
Here’s the good news: Most people who get sick with COVID-19 will be able to recover at home, especially if they’ve been vaccinated and boosted. Some of the same things you do to feel better if you have the flu or a bad cold also help with COVID-19 symptoms. These include getting enough rest, staying hydrated, and taking over-the-counter medications such as Tylenol or Advil to relieve fever and aches and pains. The Centers for Disease Control and Prevention (CDC) has guidance for at-home treatment of COVID-19.
However, people who are at high risk for developing severe illness may benefit from medications and treatments to limit the progression of COVID-19. Studies show that those 65 and older and those who have a chronic health problem that puts them at risk for severe COVID-19 (obesity, diabetes, lung disease and heart disease, among others) are at higher risk, especially if they are not fully vaccinated and boosted. This heightened risk of hospitalization can be reduced when treated with certain COVID-19 medications.
“The FDA has authorized, under emergency use authorization, treatments for this population based on studies that show they are effective at keeping people from requiring hospitalization,” says UNC Health infectious diseases specialist David Wohl, MD. “Some of these are predicted to be effective against the omicron variant of COVID-19.”
These medications are also most likely to be effective if begun soon after symptoms start.
Monoclonal Antibody Treatment
Our bodies produce antibodies as part of our natural defense against viruses such as COVID-19. Monoclonal antibodies are antibodies produced in a lab that are given as a one-time infusion through an IV to patients who have COVID-19.
“We know that some people naturally produce incredibly good antibodies to fight the virus, and copies of these antibodies can be used to treat others,” Dr. Wohl says. “The antibodies aren’t taken from one person and put in another, like a transfusion. They’re produced in a lab and then infused through an IV into patients.”
For people with COVID-19, monoclonal antibodies can get into circulation before the body can begin making its own antibodies, providing a kick-start in fighting the virus.
A monoclonal antibody called sotrovimab is the only monoclonal antibody available that is predicted to be effective against omicron. In a large clinical trial, sotrovimab reduced the risk of hospitalization or death in at-risk people by about 85 percent.
Paxlovid is an antiviral pill for adults and children ages 12 and older who weigh at least 88 pounds and who are at high risk of severe disease and hospitalization.
“Monoclonal antibody treatments are logistically complicated to deliver and not universally available. Oral therapies such as Paxlovid allow people to be treated without needing a place to go for infusion,” Dr. Wohl says. “Paxlovid works against COVID-19 by interfering with the virus’ ability to replicate. It looks to be as effective as an infusion of a monoclonal antibody.”
Typically, the virus makes copies of itself, which is how it spreads in the body to make you sick. Paxlovid blocks the production of a viral enzyme the virus needs to multiply. Paxlovid consists of two medications taken together, nirmatrelvir and ritonavir. In total, three pills are taken twice a day for five days.
“Paxlovid has been found in a large clinical trial to be highly effective in reducing the risk of hospitalization of the high-risk population by about 89 percent,” Dr. Wohl says.
Paxlovid can have serious interactions with widely used medications, including statins, blood thinners and some antidepressants.
“Your provider will be able to help you determine if any current medication you are on needs to be adjusted before you can take Paxlovid or if you are not able to take it because of the risk of side effects based on your other medications,” Dr. Wohl says.
The FDA does not recommend Paxlovid for people with severe kidney or liver disease.
Remdesivir is an antiviral drug that has been approved by the FDA for adults and certain pediatric patients with COVID-19 who are sick enough to need hospitalization. It is now also approved to give to outpatients. Remdesivir requires infusion through an IV over three consecutive days.
A clinical research study found that a three-day course of this antiviral was effective at preventing the need for hospitalization in outpatients with COVID-19. Rates of hospitalization or death were about 87 percent lower in study participants treated with remdesivir.
Healthcare facilities, including UNC Health, administer remdesivir at infusion clinics when there are insufficient supplies of sotrovimab or Paxlovid.
Molnupiravir is an antiviral pill that works by introducing mistakes into the virus’s genetic code, preventing the virus from replicating as usual.
It is authorized for use only when other therapies are not readily available, and it is not recommended for individuals who are pregnant, breastfeeding or under the age of 18.
“In a clinical trial, the results for molnupiravir were not as good as we saw with Paxlovid, the monoclonal antibodies, or remdesivir,” Dr. Wohl says. “There was only about a 30 percent reduction in hospitalization. Thus, this is a treatment that’s used when nothing else is basically available.”
Patients take four pills twice a day for five days.
COVID-19 Treatments in Limited Supply
The supply of all of these medications is very limited and those at greatest risk are prioritized for treatment.
“These medications are for people who have symptoms and some degree of higher risk of getting very sick from COVID-19. They are not treatments for people without symptoms or who are healthy and don’t have risk factors for progression to more severe disease,” Dr. Wohl says. “At this point, we do not have medications that we know can reduce symptoms, get people to return to work faster or prevent long COVID. But we are working on it.”
If you are concerned you may have been exposed to or have symptoms of COVID-19, call your primary care physician. Your provider can help you determine if you are eligible for these treatments.
Think you may have COVID-19? Talk to your doctor. Don’t have one? Find a doctor near you.