Since March 2020, the medical world has made some pretty amazing advances in treatments for COVID-19. The right one for you will usually depend on the severity of your symptoms and how long it's been since you tested positive. But the dynamics of the pandemic also matter — especially the emergence of new coronavirus variants.
"We are in such a better position now than we were at the beginning of the pandemic, both because we have better prevention — primarily vaccines and boosters — but also because we have better treatments," Dr. Megan Ranney, emergency medicine physician and associate dean for strategy and innovation at the Brown School of Public Health, told TODAY.
The main options we have right now fall into two camps: antiviral medications and antibody treatments, Dr. Taison Bell, assistant professor of medicine in the divisions of infectious diseases and international health and pulmonary and critical care medicine at the University of Virginia, told TODAY. Antivirals help keep the virus from replicating inside your body while antibody therapies supplement your immune system's natural defenses against the virus.
For many people, especially those who are fully vaccinated, a bout of COVID-19 does not require extensive treatment or a trip to the hospital. But if you have risk factors for severe symptoms, you're likely eligible to receive some of these treatments that can help prevent you from needing to be hospitalized — including some options you can take at home.
Home COVID-19 treatments and remedies
At-home antiviral medications
There are two options for antiviral pills you can take at home: There's a combination of nirmatrelvir and ritonavir (Paxlovid) there's molnupiravir (Lagevrio), both of which received authorization from the Food and Drug Administration in December 2021. To be eligible for a prescription for these medications, you need to have a positive COVID-19 test and at least one risk factor for severe COVID-19.
Compared to IV medications, the pills are generally "less complicated from an administrative standpoint," Bell said.
The catch is that they need to be taken within three to five days of being diagnosed with COVID-19, Ranney said.
That's why quick access to COVID-19 testing and a provider who can prescribe the medication within the proper timeframe are so essential. The government's Test to Treat program was designed to help address this issue. Check the website to find locations near you where you can get both a COVID-19 test and, if the test is positive, a prescription for Paxlovid.
The other issue with these medications, though, is potential drug interactions. "There are some big categories of people that can't take Paxlovid," Ranney explained. That's because "there are some medications that can go into either dangerously high levels or dangerously low levels because of the way Paxlovid works."
That can be especially dangerous for solid organ transplant patients, Dr. Robin Avery, an infectious diseases physician at the Johns Hopkins School of Medicine, told TODAY. The ritonavir part of Paxlovid can elevate the level of drugs like tacrolimus — a "mainstay of immunosuppression" — in the body, she said, to the point where patients can experience tremors, kidney failure and even strokes.
On the other hand, people who are pregnant or breastfeeding should not take molnupiravir, Ranney added. So, if possible, they should take Paxlovid instead.
Bell recommended that patients and their providers who are concerned about potential interactions check the University of Liverpool's COVID-19 drug interactions checker. Avery also recommended perusing the interaction information in the National Institutes of Health COVID-19 treatment guidelines and those from the Infectious Diseases Society of America.
What is the Paxlovid "rebound"?
There have been reports of people taking Paxlovid, feeling better and testing negative for a few days before symptoms return and sometimes testing positive again, usually two to eight days after initial recovery. This phenomenon, nicknamed a Paxlovid rebound, seems to be "uncommon, but ... I wouldn't call it rare," Bell said.
The Centers for Disease Control and Prevention recently warned that Paxlovid rebound is a possibility.
"First of all, it does look like this subvariant does tend to cause some rebound in and of itself," Bell explained. So, as the CDC noted, some people who have COVID-19 caused by the omicron subvariants circulating now may experience a rebound of their symptoms with or without taking Paxlovid.
Another theory, Bell explained, is that a relatively short course of treatment with Paxlovid isn't enough for your body to successfully mount its own defenses. "What you're doing is buying time with this; you're keeping the virus at bay (while your body builds up its immune response)," he said. But, for some people, one course of Paxlovid might not give their body enough time to do that.
The CDC recommends that people experiencing Paxlovid rebound start their isolation over, as it's unclear how likely they are to spread the virus.
Other home remedies for COVID-19
If you have a relatively mild bout of COVID-19, there are things you can do at home to feel better, depending on your symptoms.
- Use over-the-counter medications like acetaminophen and ibuprofen to reduce body aches and fevers, according to the CDC.
- Stay hydrated and be sure to get plenty of rest, the Mayo Clinic advised.
- For a cough or sore throat, try soothing remedies you might use for a seasonal cold or flu, like cough drops or tea with honey.
- Recognize when you need medical attention. If you're having trouble breathing, notice a persistent pressure in your throat or chest, are finding it hard to stay awake at all or show any of the CDC's other major warning signs, get help immediately.
Other treatments you can take as an outpatient
“The first-line treatment for someone who gets diagnosed with COVID and has a relatively high risk is to prescribe them (Paxlovid) pills,” Ranney said. But if someone can't get the pills, or they’re outside of the window where the pills might be effective, "the next treatment is monoclonal antibodies, which are an infusion." You receive it in a designated medical facility and can leave afterward.
Among immunocompromised patients, this type of therapy "has made the most difference in early treatment," Avery said. It's kept people from developing severe symptoms and needing to come to the hospital, she added.
But the effectiveness of monoclonal antibody treatments depends on the coronavirus variants that are circulating at any given time. Experts now understand that these antibody therapies, like the antibodies your body makes naturally in response to an infection, work by binding to a small part of the coronavirus' spike protein. If the spike protein is different from variant to variant, these treatments may not work as well.
That's why some treatments, like bamlanivimab, that were used early on are now no longer effective. Instead, the NIH recommended using sotrovimab during the winter omicron wave and now recommends using bebtelovimab against BA.2.
IV antiviral treatments
Remdesivir (Veklury), is an antiviral treatment that you can receive at certain medical centers and health care locations.
It's given through an IV and requires three consecutive days of treatment, the NIH explained. So although there's evidence remdesivir can be effective at keeping people out of the hospital, "it's logistically tricky," Avery said. "A lot of centers don't necessarily have an area where they can do these outpatient fusions three days in a row."
One major benefit of remdesivir? Its helpfulness isn't likely to be affected by changes in dominant variants. "It works on the level of the RNA polymerase, not the spike protein," Avery explained. "So mutations in the spike protein wouldn't be expected to affect its efficacy."
Treatments you might receive in the hospital
Patients in the hospital will also receive a standard set of supportive treatments, like those that help fight and prevent blood clots, Ranney said. But there aren't many options to treat COVID-19 specifically.
“If you’re sick enough to get hospitalized, we have many fewer choices,” Ranney said. “By that point, COVID has already started to cause damage to a large extent.” Here's what you might get:
Alongside remdesivir, patients who are hospitalized and require oxygen may receive the corticosteroid dexamethasone. Medications like this can be used to halt the "upswing of the inflammatory phase, which causes the respiratory failure so forth in inpatients," Avery said.
Bell reiterated that this is not something that people should take outside of a doctor's supervision. "There's a risk-benefit to steroids because in addition to calming down inflammation, which could be a benefit, it also suppresses your immune system," he explained. "So you're always walking that line."
If dexamethasone isn't available, the NIH recommended looking into other corticosteroids, such as prednisone.
Baricitinib and tocilizumab
These are both drugs that are normally used to treat rheumatoid arthritis. For hospitalized COVID-19 patients, either one may be given along with dexamethasone or another corticosteroid, the NIH said.
Plasma from donors who've recovered from COVID-19 can be given to hospitalized patients to help them heal. In the early days of the pandemic, it seemed like convalescent plasma could be helpful. But today, the NIH recommends against using any plasma collected before the emergence of omicron and recommends only using it in people who are immunocompromised.
But this is one therapy option where "the pendulum may swing back," Avery said, pointing to the work of her colleague Dr. Arturo Casadevall. In a recent study published in the New England Journal of Medicine, a team of researchers including Casadevall found there could be benefits to using convalescent plasma among unvaccinated people within nine days of symptom onset.
"We've actually used a lot of convalescent plasma throughout the pandemic in our immunocompromised patients because we feel that they often don't mount enough antibody response (to the vaccine or infection)," she explained.
What experts want you to know:
As much progress as we've made in developing COVID-19 treatments, there is still work to do — especially when it comes to making those options actually accessible.
“We have a situation now where these (treatments) are widely available physically,” Bell said. “But, functionally, there are still barriers to getting them.” Not everyone has a primary care provider who can easily prescribe them Paxlovid, for instance.
Ranney agreed: "Unfortunately, there are groups across the country that continue to be unaware of the ability to get these treatments or simply don't have access to them," she said, noting recent research showing that Black, Asian and Hispanic people were less likely than white people to be prescribed monoclonal antibody treatment.
Also, it pays to know what risk factors you have for severe COVID-19 and, maybe, to have a conversation about that with your doctor before you get infected, Avery said. Those risk factors can include having a high BMI, being over 60 years old, being a former smoker, and having diabetes or heart disease.
"If people have one or more of these risk factors, they should consult with their providers and actually make a plan in advance," Avery said. "At the very least, that person and their provider should have a discussion" about whether they're eligible for therapies like Paxlovid and whether there are potential drug interactions to be aware of.
And the experts also underscored that treatment is not a replacement for prevention measures. "The therapeutics are always the second line," Bell said. Getting vaccinated, getting boosted and wearing a high-quality mask are still the best way to prevent getting COVID-19.