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Last updated October 19, 2020. 6 minute read

COVID-19 treatments: what has been proven to help?

Remdesivir, an antiviral drug, is being used in hospitalized patients with severe COVID-19 symptoms who are not on high-flow oxygen. Convalescent plasma has been used for other diseases and is being considered as a possible treatment for people with SARS-CoV-2.

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

COVID-19 overview

Since the new coronavirus disease 2019 (COVID-19) began in Wuhan, China, it has become a global pandemic affecting over 8.1 million people in the United States and over 40 million people worldwide (as of October 19, 2020) (ArcGis, 2020). Contributing to this spread is the fact that it’s possible to transmit the virus to others even if you don’t have any (or only have mild) symptoms. According to the Centers for Disease Control and Prevention (CDC), when symptoms of COVID-19 do occur, they usually appear 2–14 days after exposure to the virus and may include (CDC, 2020):

Vitals

  • There is no definitive treatment for the novel coronavirus at this time, but researchers are doing clinical trials to find an effective COVID-19 treatment.
  • Remdesivir, an antiviral drug, is being used in hospitalized patients with severe COVID-19 symptoms who are not on high-flow oxygen.
  • Favipiravir is another antiviral treatment that has just started clinical trials.
  • Convalescent plasma has been used for other diseases and is being considered as a possible treatment for people with SARS-CoV-2.
  • Other treatments being tested are immunomodulators, including dexamethasone, monoclonal antibodies (LY COV555, Actemra/RoActemra, Olumiant), and antibody cocktails like REGN-COV2.
  • Cough
  • Fever or chills
  • Muscle pain (myalgias)
  • Headache
  • Shortness of breath (dyspnea)
  • Coughing up mucus
  • Sore throat
  • Diarrhea
  • Nausea/vomiting
  • Loss of smell (anosmia)
  • Change in the sense of taste (dysgeusia)
  • Stomach pain
  • Runny nose

However, people over the age of 65 and those with chronic medical conditions like heart disease, diabetes, obesity, lung disease, liver problems, kidney disease, weak immune systems, or cancer may be at higher risk of developing severe symptoms, like acute respiratory distress syndrome (ARDS). These symptoms may require hospitalization, admission to the intensive care unit (ICU), intubation (mechanical ventilation), and can lead to death in some people.

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Current COVID-19 treatments being tested

Unfortunately, there is no definitive treatment or vaccine for COVID-19 at this time. Scientists all over the world are looking for a way to treat this disease effectively.

In March and April 2020, the antimalarial drugs hydroxychloroquine and chloroquine were considered potential options for treatment. Early studies suggested that these medications may have antiviral action against SARS-CoV-2, the virus that causes COVID-19 (IDSA, 2020).

However, investigations later showed that there is an increased risk of heart rhythm problems and death in people given hydroxychloroquine and chloroquine. For this reason, the U.S. Food and Drug Administration (FDA) recommends that anyone given these medications for COVID-19 be kept under close medical supervision (e.g., part of a clinical trial) due to safety concerns and potential toxicity (IDSA, 2020).

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Antivirals

Antiviral drugs are medications that attack a virus after it has gotten into your body. Creating a new antiviral therapy to work against SARS-CoV-2 would take years. Instead, scientists have turned to existing antiviral medications to see if any of them can help against COVID-19.

One such possibility is the antiviral medication, remdesivir. Remdesivir, an intravenous (IV) medication, was initially developed to help with other viruses, like the Ebola virus. This drug prevents virus particles from reproducing—if it can’t copy itself, then it can’t spread to other cells in the body. A National Institutes of Health (NIH) clinical trial showed that COVID-19 patients who took remdesivir recovered faster than those taking a placebo (NIH, 2020). The FDA has granted an “emergency use authorization” (EUA) to use remdesivir as a COVID-19 treatment. An EUA allows physicians to use remdesivir before it has gone through the entire FDA approval process. Given that supplies are limited, the recommendation is that remdesivir be given to hospitalized COVID-19 patients, due to the severity of their symptoms, but who are NOT on high-flow oxygen or mechanical ventilation (NIH, 2020). However, there is not enough evidence to recommend for or against using remdesivir in people with mild to moderate symptoms.

Another medication being tested is favipiravir, an oral antiviral drug used to treat influenza (flu) in Japan. Recently, clinical trials have begun to see if favipiravir can be used to treat COVID-19 patients who are not hospitalized and have mild to moderate disease (Stanford, 2020). It is too early to tell if this drug will become part of the treatment arsenal.

Convalescent plasma

Convalescent plasma is blood plasma taken from people who have recovered from SARS-CoV-2 infection. This plasma may contain antibodies against the virus. A plasma transfusion into a patient with a severe COVID-19 infection could help them fight off the disease quicker and more effectively, especially if done early. While convalescent plasma has been used in the past to treat other conditions (like the 2003 SARS-CoV epidemic, the 2009–2010 H1N1 influenza virus pandemic, and the 2012 MERS-CoV epidemic), its use for SARS-CoV-2 is still considered experimental. The National Institutes of Health state that there is not enough information to recommend for or against the use of convalescent plasma (NIH, 2020).

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Immunomodulators

Immunomodulators are medicines used to normalize the immune system. COVID-19 can cause your body to react with an increased immune system response that leads to severe symptoms and can damage your lungs and other organs. Scientists investigating whether drugs that help regulate the immune response may protect against severe COVID-19 symptoms. 

Dexamethasone is a corticosteroid with potent anti-inflammatory properties. A large clinical trial (over 6,000 participants) found that dexamethasone decreased mortality in hospitalized patients who were on mechanical ventilation (NIH, 2020). The current recommendation is that dexamethasone should be reserved for people who are intubated or who require supplemental oxygen during their hospitalization for COVID-19 (NIH, 2020). Corticosteroids are not benign medications—they should be used with caution and only under the supervision of your healthcare provider. With some viruses, corticosteroids can worsen the outcome. Dexamethasone should not be given to people who do not need oxygen support (NIH, 2020)

Monoclonal antibodies are drugs that attack a pathogen or target a specific step in the inflammation pathway. LY Cov555 is one monoclonal antibody medication being tested in people with early COVID-19 as well as in COVID-19 patients who require hospitalization. Trials are also looking at other monoclonal antibodies like tocilizumab (brand name Actemra/RoActemra), sarilumab, and siltuximab (interleukin-6 inhibitors) (UpToDate, 2020). At the moment, not enough evidence exists to recommend for or against the use of these drugs for COVID-19 treatment. Baricitinib (brand name Olumiant), an immunomodulator that works against Janus kinase (another part of the inflammation pathway), is currently not recommended for use against COVID-19 unless it is part of a clinical trial (NIH, 2020).

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Lastly, Regeneron has an antibody “cocktail” REGN-COV2: a mixture of two human antibodies that are derived from the blood of people who recovered from a COVID-19 infection. By combining antibodies, the hope is that REGN-COV2 will be more effective at targeting and neutralizing the virus than single antibody therapies. The trial is expected to last through June 2021.

Supplements

Most people have heard of using vitamin C and zinc supplements to fight the common cold, so it is no surprise that people are trying to use them against COVID-19. Vitamin C has antioxidant and anti-inflammatory properties. Zinc negatively affects the ability of some viruses to copy themselves. Unfortunately, there is not enough data to recommend for or against using vitamin C or zinc supplements for COVID-19 treatment (NIH, 2020). You should not use higher than recommended doses of zinc unless you are being monitored as part of a clinical trial (NIH, 2020). Vitamin D is another supplement of interest—given that immune system cells express it, vitamin D may play a role in regulating the immune response. The research is ongoing, but at the moment, there is not enough evidence to support or recommend against using vitamin D for COVID-19 treatment (NIH, 2020).

What does this all mean?

We still do not have a definitive treatment for COVID-19, but scientists are learning more about the disease every day, and researchers are actively trying to develop and test medications and vaccines. In the meantime, there are some steps you can take to help keep yourself and your loved ones safe. Whenever possible, avoid contact with others. When you are out, remember to practice social distancing—avoid large groups of people and stay at least six feet away from others. Wear a face mask in public and wash your hands frequently—especially before eating and touching your face.