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Last updated September 13, 2021. 7 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 Chimene Richa, MD
Reviewed by 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 hundreds of millions of people worldwide (ArcGis, 2021). 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 2–10 days after exposure to the virus and may include (CDC, 2021a):

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

Vitals

  • There is no cure for the novel coronavirus at this time, but vaccines are available for the prevention of COVID-19. Remdesivir is an antiviral drug that is approved by the FDA for the treatment of hospitalized patients with severe COVID-19 symptoms. Convalescent plasma has been used for other diseases in the past and is currently being investigated as a treatment for people with SARS-CoV-2. Other treatments being tested include immunomodulators and monoclonal antibodies.

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 are 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), and intubation (mechanical ventilation), and can lead to death in some people.

Current COVID-19 treatments

Unfortunately, there is no cure for COVID-19 at this time. Several vaccines, however, received emergency use authorization from the FDA for the prevention of coronavirus infection. The first vaccine to get full FDA approval for the prevention of coronavirus infection was the Pfizer-BioNTech vaccine. The vaccines are currently available at medical offices, health care facilities, and national pharmacy chains.

In October 2020, the US Food and Drug Administration (FDA) approved an antiviral drug called remdesivir for the treatment of patients hospitalized with coronavirus (FDA, 2020). 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 have taken years, so scientists turned to existing antiviral medications to see if any of them can help against COVID-19.

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.

One study showed that it might shorten hospital stays and improve symptoms in patients that required hospitalization (Beigel, 2020). Two other small studies showed the drug offers some benefits when used for five days in patients hospitalized with coronavirus. At this time, remdesivir is the only medication to have received FDA approval for the treatment of COVID-19. Still, this treatment is not for everyone and is currently only recommended for adults and children over the age of 12 who require hospitalization (FDA, 2020).

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. However, investigations later showed that there is an increased risk of heart rhythm problems and death in people given hydroxychloroquine and chloroquine (IDSA, 2020).

For this reason, the U.S. Food and Drug Administration (FDA) does not recommend hydroxychloroquine or chloroquine for the treatment of COVID-19 (IDSA, 2020).

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Other antivirals

Another medication being tested is favipiravir, an oral antiviral drug used to treat influenza (flu) in Japan. Some research shows that favipiravir might be beneficial in people with mild to moderate COVID-19, but other studies show very little benefit in people with advanced disease (Hassanipour 2021, Joshi 2021). 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 SARS-CoV in 2003, H1N1 influenza in 2009-2010, and MERS-CoV in 2012), its use in treating 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, 2021a).

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Immunomodulators

Immunomodulators are medicines used to regulate 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, 2021b). 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. 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, 2021b)

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 (Clinicaltrials.gov, 2020). 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, 2021c).

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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. In the early stages of its clinical trial, researchers found that REGN-COV2 decreased the amount of virus in the body (Weinreich, 2021). It is still being investigated to determine its use in the treatment of COVID-19.

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, 2021d). You should not use higher than recommended doses of zinc unless you are being monitored as part of a clinical trial (NIH, 2021e). 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).

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What does this all mean?

There is still no cure for COVID-19, but scientists are learning more about the disease every day. Researchers are actively trying to develop and test medications and vaccines. Antiviral medications such as remdesivir are available for treatment and vaccines for prevention are currently being distributed both in the United States and abroad.

There are also steps you can take to help keep yourself and your loved ones safe. 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.

If you are exposed to a person who has been diagnosed with coronavirus, it’s important to self-quarantine for 10 days. You can also speak to a healthcare provider about getting tested. If you yourself test positive for COVID-19, the CDC guidelines recommend self-isolating, including from members of your own household if possible. Ten days after the appearance of your first symptoms, if you have been fever-free without fever-lowering medication for at least 24 hours, it becomes unlikely that you might infect another person (CDC, 2021b).

References

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    Centers for Disease Control and Prevention (CDC) – Symptoms of Coronavirus (22 February 2021a). Retrieved on September 13, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

    Centers for Disease Control and Prevention (CDC) – Quarantine and Isolation (29 July 2021b). Retrieved on September 13, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
  3. ClinicalTrials.gov – A Study of LY3819253 (LY-CoV555) in Participants With Mild to Moderate COVID-19 Illness (BLAZE-1) (2020). Retrieved September 13, 2021, from https://clinicaltrials.gov/ct2/show/NCT04427501
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    Infectious Diseases Society of America (IDSA) Guidelines on the Treatment and Management of Patients with COVID-19. (2020). Retrieved 31 July 2020, from https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
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    National Institutes of Health (NIH) – COVID-19 Treatment Guidelines: Convalescent Plasma (2021a). Retrieved September 13, 2021, from https://www.covid19treatmentguidelines.nih.gov/therapies/anti-sars-cov-2-antibody-products/convalescent-plasma/
  7. National Institutes of Health (NIH) – COVID-19 Treatment Guidelines: Corticosteroids (2021b). Retrieved September 13, 2021, from https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/

    National Institutes of Health (NIH) – COVID-19 Treatment Guidelines: Corticosteroids (2021c). Retrieved September 13, 2021, from https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/vitamin-c/

    National Institutes of Health (NIH) – COVID-19 Treatment Guidelines: Vitamin C (2021d). Retrieved September 13, 2021, from https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/

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