As COVID-19 cases are on the rise in many parts of the world, now seems like a good time to review treatment options.
Treatment options depend on how sick someone is. For this post, we are going to give the run down treatments for adults across the clinical spectrum of disease (from no symptoms at all to critical illness).
Group 1: Adults with COVID-19 at low risk of progressing to severe disease who do not require hospitalization or supplemental oxygen
➡ Symptomatic treatment. This can include any number of things to reduce symptoms, ranging from Grandma’s chicken soup to medicines to tamp down fever, cough, runny nose, aches or pains.
➡ It’s important to watch and alert your primary care clinician or go to the emergency department if symptoms are getting worse.
Group 2: Adults with COVID-19 at high risk of progressing to severe disease who do not require hospitalization or supplemental oxygen
➡ Still symptomatic treatment. Bring on the soup!
➡ Ritonavir-boosted nirmatrelvir (Paxlovid): This is the preferred treatment option for most people. Paxlovid is an antiviral pill that reduces the risk of hospitalization by about 89%. It should be started within 5 days of the first symptom. Paxlovid has lots of interactions with other medications, so it is important to talk with your primary care clinician or pharmacist before starting this medicine.
➡ Remdesivir: This is an antiviral medication given through an IV over 3 days. It reduces the risk of hospitalization by about 87%. It should be started within 7 days of having symptoms.
➡ If someone can’t get Paxlovid or Remdesivir, the next best choice is bebtelovimab. This is a monoclonal antibody treatment that targets the SARS-CoV-2 spike protein. It should be started within 7 days of symptom onset. Previously used monoclonal antibody treatments (like sotrovimab) are not as effective against the Omicron BA.2 subvariant, but bebtelovimab still is!
➡ Last, and definitely least, is molnupiravir. This is the last option and only used if none of the others are available. Molnupiravir should be started within 5 days of symptoms. It is only about 30% effective at reducing hospitalization or death. There are also risks in pregnancy and theoretical concerns that it could help produce anti-viral resistant viruses.
➡ In the US, you can find locations that have COVID-19 treatments here.
Group 3: Adults with COVID-19 who require hospitalization and supplemental oxygen
➡ Still symptomatic treatment. Everyone needs some TLC. Having COVID feels awful.
➡ Remdesivir if only a little bit of extra oxygen is needed. Remdesivir lowers the risk of needing tubes placed to help someone breathe.
➡ If more than just a tiny bit of oxygen is needed, then the treatment is dexamethasone AND remdesivir. Dexamethasone is a steroid medication that reduces inflammation. A whole bunch of studies have shown that dexamethasone reduces the risk of death for people who are hospitalized and need supplemental oxygen.
➡ If people are rapidly getting worse and need more oxygen over a short period of time, a second immunomodulating drug (like baricitinib or tocilizumab) are added. These are medications that reduce inflammation and lower an overactive immune response.
Group 4: Adults with COVID-19 who require hospitalization and mechanical ventilation or ECMO
➡ These folks are really sick and get admitted to the Intensive Care Unit (ICU).
➡ They may be treated with mechanical ventilation (tubes placed in the throat to help them breathe) or even extracorporeal membrane oxygenation (ECMO). ECMO is used when both the heart and lungs are damaged and need time to heal. Blood is pumped outside of the body to a heart-lung machine to remove carbon dioxide and add oxygen. It is then rewarmed and returned back to the body.
➡ Dexamethasone is the cornerstone of treatment here.
Of course, the best treatment is one that is never needed. This is why prevention matters most! Vaccines, ventilation, staying home when sick, testing, and masking indoors when communities have more cases remains super important!
As always, this is not medical advice. If you get sick, call your PCP to talk about what treatment might be best for you.
Stay safe. Stay well.
Those Nerdy Girls
Links with more info:
NIH COVID Treatment Guidelines
Infectious Disease Society of America Guidelines on the Treatment of Patients with COVID
World Health Organization Therapeutics and COVID-19 Guideline
Dear Pandemic Post on Paxlovid
Paxlovid Drug Interactions Tables
Dear Pandemic Post on Molnupiravir
