Treatment for patients with COVID-19 depends on the severity of the illness and the patient’s symptoms. Care for patients is primarily supportive to help relieve symptoms and manage respiratory and other organ failures. Most patients with COVID-19 can recover at home with adequate rest, staying hydrated, and taking medications to relieve fever, aches, and pains. Hospitalization may be required for COVID-19 patients who are critically ill and have more severe symptoms.
The following is a brief summary of the various treatments that were or are currently used for individuals who are hospitalized with COVID-19 or not hospitalized but at risk of developing severe illness:
- Remdesivir: On October 22, 2020, the FDA approved the antiviral drug remdesivir (Veklury) to treat COVID-19. The drug is approved to treat adults and children ages 12 and older, weighing at least 88 pounds. Clinical trials suggest that remdesivir may modestly speed up recovery time. The antiviral drug is given intravenously and should be administered in a hospital or in a healthcare setting capable of providing acute care. Remdesivir acts to inhibit the RNA-dependent RNA polymerase (RdRp) of the coronavirus to stall RNA synthesis, eventually making the virus inactive. Currently, the NIH recommends the use of remdesivir in hospitalized and non-hospitalized patients.
(For the most updated recommendation, please consult the following NIH link). Dexamethasone: Many physicians in the U.S. treat very ill COVID-19 patients with dexamethasone or other corticosteroids because these patients typically develop a hyper-immune response (called cytokine storm) to the viral infection. In these cases, it is the immune system's overreaction that is damaging the lungs and other organs and often can lead to death. Dexamethasone and other corticosteroids (prednisone, methylprednisolone) are potent anti-inflammatory drugs. They are readily available and inexpensive.
The NIH COVID-19 treatment guidelines recommend the use of dexamethasone or corticosteroids in certain people hospitalized with severe COVID-19. This recommendation was based on studies that showed patients who required supplemental oxygen or ventilators and who received dexamethasone were less likely to die within 28 days than those who received standard care. However, dexamethasone did not have a benefit in patients who did not need respiratory support. Currently, NIH recommends the use of dexamethasone or other corticosteroids for hospitalized patients on oxygen, but it is not recommended for those patients not on oxygen.
- Monoclonal Antibodies: In November 2020, February 2021, May 2021, and June 2021, the FDA granted emergency use authorization (EUA) to several monoclonal antibody treatments for mild to moderate COVID-19 in adults and pediatric patients when the patient has a positive COVID-19 test and the patient is at high risk for progressing to severe COVID-19, hospitalization, or both. Treatments include infusions of Sotrovimab or Tocilizumab or combination use of Casirivimab/imdevimab, or Bamlanivimab/Etesevimab. . In these patients, the approved treatments can reduce the risk of hospitalization and emergency room visits. These therapies must be given intravenously soon after developing symptoms. The FDA-approved monoclonal antibodies work by attacking the spike protein (S) of the COVID-19 virus making it more difficult for the virus to attach to and enter human cells.
NIH guidelines currently recommend against the use of monoclonal antibodies for the prevention and treatment of COVID-19. Additionally, monoclonal antibodies no longer have FDA emergency use authorization for the treatment of COVID-19. This is due to the ineffectiveness of monoclonal antibodies against new variants, particularly dominant Omicron subvariants.4
