Updated April 13, 2022

Remdesivir. Convalescent plasma. Monoclonal antibodies. Antiviral pills. Over the course of two years, we’ve heard of several treatments for COVID-19.  But what options are currently available? 

Here, VCU Health infectious disease expert Dr. Megan Morales updates us on what treatments are currently available for COVID-19, how effective they are and what’s on the horizon.

Let’s start with the most recent — the COVID pills.

We now have two COVID pills — Molnupiravir and Paxlovid. Both are authorized for emergency use by the FDA (Food and Drug Administration). When Paxlovid is taken early, within five days of the start of symptoms, it is highly effective — 88% in studies — at preventing mild to moderate COVID symptoms from becoming severe. Molnupiravir is less effective — around 30% — so is used when other options are not available.

Not only are the pills remarkably effective — Paxlovid, in particular — this is the first time we have an oral therapy instead of an intravenous therapy for COVID-19. You can get the pills at your local pharmacy and take them from home, rather than traveling to an infusion center or hospital for treatment.

The downside?  Paxlovid can have potentially serious interactions with other medications, including birth control pills, blood thinners, blood pressure and cholesterol pills, HIV medication, cancer treatments, transplant anti-rejection medications, steroids and even over-the-counter herbal supplements. It is important to review your complete list of medications with your pharmacist or physician before taking Paxlovid.

Molnupiravir is less effective than other COVID treatments, so we only use it when other options are not available. It cannot be used in pregnant women, or in men or women planning to conceive in coming months.

And remdesivir?

Remdesivir was approved by the FDA in October 2020 as the nation’s first treatment for COVID-19. VCU faculty participated in remdesivir research and played a key role in determining the drug’s effectiveness.

Until recently, remdesivir had been used as a treatment only for patients who were sick enough to be hospitalized and had low oxygen levels. In this setting, it helps patients recover faster. In January 2022, the FDA expanded authorization of remdesivir to the outpatient setting. It can be given to high risk patients to prevent worsening of COVID infection and the need for hospitalization.

Of the current COVID-19 treatments, remdesivir is the only one that can be used for very sick, hospitalized patients. It  is the only authorized antiviral treatment for children at high risk of severe COVID infection.

The drawbacks? Remdesivir is an infusion therapy, given daily for 3-10 days, and involves routine lab monitoring.

Monoclonal antibody therapy?

Antibodies are the proteins your immune system makes to fight off infection. Monoclonal antibodies are man-made antibodies — antibodies made in the lab. They are designed to fight off a virus, mimicking what a healthy immune system would do.

Monoclonal antibody therapy is an especially important treatment for people whose immune system is unable to produce a sufficient antibody response on its own.

Downside? Because monoclonal antibodies are designed to fight off a specific virus, they don’t always work when the virus mutates. That’s what’s happening with COVID-19. We have only one monoclonal antibody still available for use against the prevalent strain, omicron BA.2. That is bebtelovimab.

Convalescent plasma?

Convalescent plasma is an IV treatment in which patients receive anti-COVID antibodies donated by people who have recovered from COVID-19 infection. This treatment has had mixed results in studies, but it likely has a helpful role when given early in the course of infection — especially for people with reduced immune systems due to chronic conditions or medications. It is no longer widely available.  

What about other medications, like ivermectin and hydroxychloroquine?

Studies have shown that drugs such as azithromycin, ivermectin and hydroxychloroquine are not effective against COVID-19. Off-label use of these medications to treat COVID-19 is not recommended by the Infectious Disease Society of America or VCU Health.

Vaccination?

Vaccination is still our best approach to preventing severe COVID-19 infection. Though we have treatments available for our most vulnerable patients, being vaccinated before getting exposed to COVID-19 will help make it a milder case. 

What is our best hope for containing COVID-19?

We will never eradicate COVID-19. Smallpox is the only disease eradicated to date. But we can get to the point where COVID-19 becomes “endemic”; that is, there are enough people in the community who are immune to the disease that we no longer experience large-scale hospitalizations and deaths.

We’re headed in that direction by way of vaccines, boosters and natural immunity, which you get to some degree once infected. Ongoing mutation of the virus, though, makes this more of a challenge than some other infections

Meanwhile, scientists will continue to improve our vaccines and treatments so they remain effective against future COVID-19 variants or even against additional coronaviruses  I hope to see a return of convalescent plasma until we have a stable monoclonal antibody against all COVID-19 variants.

Other things we need to do? We need quick and easy access to medications as well as testing. We need early diagnosis so people can get the medications when they are most effective, and so that they know to isolate at home to keep from spreading the virus. We can do this by ramping up the supply of home diagnostic tests and rapid tests, and making them available at pharmacies, schools and places of employment. 

Sign Up for E-Newsletter