Over the past two years, many new COVID-19 therapies have been designed, developed, and rigorously tested. We now have a handful of safe and effective treatments – from monoclonal antibodies to antivirals – that can help people with COVID-19 avoid serious consequences such as hospitalization and death.
But when it comes to COVID-19, things change quickly, and it can be difficult to keep up with available and recommended treatments. While some therapies might work well against the dominant variants circulating today – which increasingly resemble omicron’s BA.2 subvariant – that could change everything when the next variant arrives.
On top of that, there are some nuances as to which treatments make sense for whom. Most available therapies are for high-risk patients and some are not recommended for pregnant women or those taking certain medications such as blood thinners or organ transplant medications.
“It’s important to talk to your doctor and they can review your list of medications and see which treatment is right for you,” said Thomas LevClinical Assistant Professor of Medicine at Stanford University.
Here is a guide to currently available COVID-19 treatments:
What it is: Monoclonal antibodies are antibodies produced in the laboratory that help prevent a virus from invading our cells; in the event that the virus has already invaded our cells, monoclonal antibodies relaunch the fight of the immune system against the virus. They are administered by infusion.
Where are we : Monoclonal antibodies are targeted to a very specific virus, so they work best when used against the variant they are designed to treat. As the coronavirus mutates, the effectiveness of our monoclonal antibodies tends to suffer – in fact, many of the monoclonal antibodies we used earlier in the pandemic are no longer effective.
“The monoclonal antibody landscape is constantly changing as the virus changes,” Lew said. For example, sotrovimab worked well against the original omicron (BA.1), but is not as effective against BA.2, so it is set aside in areas that primarily fight BA.2. Fortunately, another monoclonal antibody called bebtelovimab still seems to work very well against BA.2, Lew said.
Who is eligible: Monoclonal antibodies are generally reserved for high-risk patients who are not hospitalized and do not need oxygen, but who are at risk of developing serious illness. This includes people over the age of 65, as well as pregnant women and those with an underlying medical condition such as obesity, organ transplant, cancer, diabetes, kidney disease, heart disease, or lung disease. Patients must be over 12 years old and weigh at least 88 pounds. Once a person is hospitalized or needs oxygen, they are no longer eligible for monoclonal antibodies, according to scott robertan infectious disease specialist from Yale Medicine.
When to start treatment: Within seven days of onset of symptoms. Test early and, if eligible, begin treatment immediately, even if you only have mild, cold-like symptoms.
How to get it: In an infusion center, hospital or emergency care department. If you have a doctor, ask where you can get tested and access treatment in your area. You can find nearby places that offer monoclonal antibodies here.
What it is: An oral antiviral pill that prevents viruses from replicating and spreading in the body. Taken twice a day for five days, Paxlovid has been found to reduce the risk of hospitalization and death from 88%. “It’s the most effective treatment currently available and it works for all variants,” Roberts said.
Where are we : Supply is limited in some areas, but Paxlovid is now available in pharmacies, doctor’s offices, hospitals and emergency care.
Who is eligible: Any high-risk patient who tests positive is eligible, even if they do not have severe symptoms, as long as they are over 12 years old and weigh at least 88 pounds. Paxlovid has not been tested in pregnant women and has drug interactions, so it is not recommended for people taking certain heart rhythm medications, blood thinners, or anti-rejection medications used for transplant patients. If you are taking medication, ask your doctor or pharmacist if you are a candidate for Paxlovid.
When to start treatment: Within five days of onset of symptoms. “Similar to Tamiflu for the flu, the earlier Paxlovid is taken, hypothetically, the better the benefit in preventing the virus from replicating,” Roberts said.
How to get it: Paxlovid is only available with a prescription, so talk to your GP or go to an urgent care department, emergency room or health clinic. You can find nearby locations that offer Paxlovid here.
What it is: An oral antviral pill that stops the virus from replicating in your body. It is taken twice a day for five days.
Where are we : Molnupiravir is an alternative therapy that is given to patients who are not eligible for Paxlovid or monoclonal antibodies and to people who do not live near an infusion site. Molnupiravir helps protect people from hospitalization and death, but it is not as effective as Paxlovid.
Who is eligible: Patients with mild to moderate COVID-19 and at risk of developing severe disease. It is not permitted for children under 18 as it may impact bone and cartilage growth. It is also not recommended for pregnant women.
When to start treatment: Within five days of onset of symptoms.
How to get it: Molnupiravir requires a prescription and can be picked up at pharmacies. You can find nearby places that offer molnupiravir here.
What it is: An antiviral drug that inhibits viral replication in the body. It is administered intravenously and, depending on the severity of the disease, is administered for three or five days. According to Roberts, remdesivir has always been a backbone in treating COVID-19 patients who need oxygen. Evidence has shown that three days of remdesivir given intravenously reduces the risk of hospitalization and death by 87%.
Where are we : Recent search found that high-risk outpatients with COVID-19 are also good candidates for remdesivir, and since then, the Food and Drug Administration has authorized remdesivir for non-hospitalized at-risk individuals with mild to moderate illness. Remdesivir should resist the BA.2 variant.
Who is eligible: High-risk patients who are already hospitalized or require oxygen with high-risk patients who are not hospitalized but have mild to moderate COVID-19. At risk pediatric patients those under 12 can now also get remdesivir.
When to start treatment: Within seven days of onset of symptoms.
How to get it: To the hospital. Expect more doctor’s offices, urgent care and infusion centers to start offering remdesivir soon.
Medicine available without a prescription
The vast majority of healthy people who contract COVID-19 will be able to recover at home. “The strategy of testing, isolating and doing what’s called supportive care will be enough for these people,” Lew said.
If you cough, take an expectorant (like dextromethorphan) which can loosen mucus from your airways. Roberts recommended pain relievers such as acetaminophen for those with a fever. People with congestion should turn to nasal sprays or decongestants (like pseudoephedrine).
People with asthma should consider using their prescription inhaler to keep their airways open, Roberts added. Gastrointestinal symptoms, such as diarrhea, may be relieved by loperamide. Lew also recommended drinking fluids to avoid becoming dehydrated.
There are a ton of COVID-19 treatments in development, including new pills, infusions, and monoclonal antibodies. Several have shown promise in the early stages of their clinical trials, but it will take time to complete the final stages of testing (which take the most time) and eventually reach the FDA office for review.
Until then, keep an eye out for the impact of future variants on the effectiveness of our current treatments, and research new therapies that will work against all variants in the months and years to come.
Experts are still learning about COVID-19. The information in this story is what was known or available at the time of publication, but advice may change as scientists discover more about the virus. Please consult the Centers for Disease Control and Prevention for the most current recommendations.