What can one do to treat Covid once a person is positive? We have talked much about strategies to prevent the infection, primarily focused on vaccination. That still is the very best strategy. However, a few medical interventions are available which have been shown to reduce the severity of the disease. Unfortunately, none of these are as effective as we would like.
Before getting into the details, a comment on drug evaluation. This is a far more complex operation than most people realize.
A general assumption is that all one would have to do to establish effectiveness would be to give the drug to some folks and see if they get better. Years ago it was presumed that if one had a bad cold you should get a shot of penicillin. In fact most of the people that got a shot did in fact improve. They assumed that the shot did the trick. However, when legitimate studies were done comparing outcomes of folks with similar symptoms who got different treatments it was found that those who did not get the shot got well just as soon as those who got the shot. The improvement seen was the natural history of the disease and had nothing to do with the penicillin.
To make all this even more complex, response to medication is affected by a number of factors including age, gender, underlying health conditions, etc. It is not always possible to evaluate each of these groups separately. In some situations, when there seems to be an urgent need for the product and when preliminary data are positive, the FDA can issue an “emergency use authorization (EUA)”. The product is released for use and the FDA monitors the outcomes to collect data necessary for full approval.
So……what medications are available for Covid.
Remdesivir. The only drug fully approved for Covid treatment. It is an IV medication approved only for hospitalized patients at high risk.
Monoclonal antibodies. An IV preparation which can be given to outpatients who are positive for Covid but who do not require immediate hospitalization. This product has been shown to reduce hospitalization and has been released under an EUA.
Dexamethasone. A steroid drug which has been in use for many years to treat inflammatory conditions. It does not have a specific authorization for Covid but has been shown to reduce lung inflammation in advanced cases of Covid, especially those requiring ventilator treatment.
Paxlovid. A new oral drug released to treat Covid under an EUA. It is approved to treat outpatients who have tested positive for the infection but who do not require hospitalization. If given soon after the positive test it has been shown to reduce the risk of disease progression. At this time it is not available in our area – but hopefully soon.
Molnupiraivir. A very recently approved EUA drug similar to Paxlovid
We are making progress but still do not have treatments that are as effective as we would like.
Finally, a word about ivermectin which has gotten much attention. Ivermectin has been shown to be active in tissue culture against Covid virus. However, it required concentrations of the drug more than 10 fold higher than what can be tolerated in humans. The situation is similar to the penicillin story I cited above. Some people have taken the drug and improved but wellstructured comparative studies have never shown actual benefit from ivermectin.