Though we’re now more than two years into COVID-19 taking over our lives, every new development and piece of advice from medical professionals, the government and even well-meaning loved ones can still get our heads spinning. One of the latest sources of confusion? COVID-19 therapeutics. The information around these therapeutics can be a tad mystifying, but we’re here to help clear up your questions.
What exactly are COVID-19 therapeutics?
An excellent place to start is a quick lesson in what COVID-19 therapeutics are. Essentially, these are treatments that can be taken once someone who is high-risk has contracted COVID-19, and they are used to prevent severe disease, hospitalization and death. The options are administered differently — some are given orally, some are given via shot and some are given by intravenous (IV) infusion.
You’ll also see that only the drug remdesivir is officially approved by the Food and Drug Administration (FDA) for treating COVID-19, meaning that it was able to show its benefits in clinical trials. The other therapeutic options are also safe, but they were granted emergency use authorization (EUA), which is slightly different. EUA is given when an emergency has been declared (the pandemic), and there isn’t time to go through all the extensive steps (that can take years) for full approval. If the evidence they have strongly suggests patients would benefit from the treatment during the emergency, then the FDA can fast-track the medication’s release.
So, what are the treatment options for COVID-19?
The one you’ve probably heard the most about is Paxlovid, a pill that is taken by mouth and specifically targets the COVID-19 virus in your body.
“In the study that led to its authorization, Paxlovid led to an 88% reduction in the progression of disease to more severe disease, hospitalization and death,” explains Dr. Shireesha Dhanireddy, infectious disease specialist at UW Medicine. “These were all unvaccinated individuals that were in this study, and all had at least one risk factor for progression.” She says that Paxlovid also works for people who are vaccinated, but that they don’t have as much data about the additional benefits (yet).
It’s also worth noting that recently The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network Health Advisory about Paxlovid, focusing on the potential for recurrence of COVID-19 or “COVID-19 rebound” after its use.
Though Paxlovid is considered the “go-to” when it comes to COVID-19 therapeutics because of its accessibility and effectiveness, remdesivir is another treatment option. As mentioned, remdesivir is the only FDA-approved therapeutic for treating COVID-19. The others are under emergency use authorization. Though it was initially used just for hospital-based treatment for those with severe COVID-19, one recent study shows that it can also be highly effective when given in your doctor’s office or clinic to reduce hospitalization and death. But the fact that remdesivir is administered via IV does make it less convenient because it takes more time to administer.
This brings us to our third therapeutic option, Molnupiravir, another pill that is taken orally like Paxlovid. Though it is far less effective, it’s a useful alternative if Paxlovid is not available or there's concern about Paxlovid interacting with another medication you’re taking (since it has few issues with that).
Then there’s bebtelovimab, a monoclonal antibody given by injection or IV that provides antibodies to destroy the virus. There isn’t as much data about bebtelovimab and omicron, but it does seem to reduce progression to more severe disease (which is always good news). This therapeutic is also helpful for transplant patients who are on medications that don’t play well with Paxlovid.
Lastly is the one prophylactic therapeutic, Evusheld, which is given by injection and provides people who are immunocompromised with antibodies that basically float around their system, just in case. If and when they contract COVID-19, the antibodies attack and destroy the virus.
Who is eligible for therapeutics (and why)
Surprisingly, the answer isn’t all that complicated.
“If you don’t have any risk factors, and you’ve been vaccinated and boosted, you likely don’t need this medication,” says Dhanireddy. “However, if you have any chronic disease like diabetes, heart disease, lung disease — those are risk factors for more severe disease, particularly in unvaccinated folks.”
And in that case, therapeutics might be the right step for you. The CDC has this helpful list of underlying medical conditions that might make you more susceptible to severe COVID-19. If you have one (or more) risk factors, you’ll likely be eligible for these meds.
There are also a few other things to consider for COVID-19 therapeutics. For them to be effective:
- You should have symptoms of COVID-19. You don’t need medication if you don’t have any symptoms.
- Your symptoms should be mild to moderate, and not severe.
- You should be within five days of showing symptoms. That is the period studied, so if you wait until beyond that point, the benefits are unclear.
Who doesn’t need COVID-19 therapeutics?
It is also helpful to understand who really doesn’t need therapeutics. Doctors’ offices have recently been swamped with calls about therapeutics, with people wondering if repeated positive antigen tests or their super stuffy nose means they need them. The answer is: probably no. As Dhanireddy noted above, if you don’t have any risk factors and have been vaccinated and boosted, you’ll likely be just fine without them.
What are the side effects?
Also, important to note: there have been some side effects associated with some of the treatments, including a bad taste in your mouth, diarrhea, nausea and dizziness — which is why treatment might not be the best option for people with very mild COVID-19 symptoms. However, if you do fall into one of those high-risk categories and contract COVID-19, you should contact your doctor immediately to discuss therapeutics (since you have limited time to start taking them).
According to Dhanireddy, “We have seen a dramatic increase in doctors prescribing therapeutics, I think because there has been a lot more awareness of these meds and increasing comfort in using them.”
She also says that supply has not been an issue in the Seattle area, and doctors should easily be able to prescribe therapeutics from a local pharmacy if you end up needing them.
The most important thing to remember about therapeutics
The most important thing to remember about therapeutics is that they exist! These therapeutics are here for one reason: to prevent hospitalization and death in people who are at a higher risk of bad outcomes from contracting COVID-19.
Dhanireddy wants anyone with risk factors to understand that getting help quickly is paramount, as is spreading the word about therapeutics to high-risk communities who could really benefit from these meds, but who experience issues with access. Of particular concern? People with limited English proficiency who may not be aware of therapeutics, and communities of color who have been disproportionately impacted by the disease.
As Dhanireddy says, “These therapies exist for everyone who is in need, not just for people with the means and the health literacy to easily get them.”