When the pandemic emerged in 2020, all COVID-19 treatments were experimental. Researchers explored existing medications like Plaquenil (hydroxychloroquine) and anti-inflammatory drugs like Ozurdex, Maxidex, or others (dexamethasone) in hopes of combatting the virus or reducing harmful inflammation. Some medical practitioners even experimented with antidepressants on patients.
Today, both researchers and regulators offer evidence-based guidelines for repurposing drugs and administering new treatments to high-risk or severely affected patients. Here’s what you need to know if you test positive:
Right After Testing Positive
As the pandemic evolved, scientists identified specific groups, such as the immunocompromised, individuals over 65, those with diabetes, hypertension, or obesity, at higher risk for severe COVID-19 outcomes. If you belong to these groups and test positive, the National Institutes of Health (NIH) recommends Paxlovid (nirmatrelvir, ritonavir) as the primary option. If it’s unavailable or unsuitable, the agency suggests Xerudy (sotrovimab), a monoclonal antibody. Other options include antiviral pills like Veklury (remdesivir) or Lagevrio (molnupiravir). Contact your healthcare provider upon testing positive to discuss potential prescriptions.
Additionally, gargling with saltwater might reduce the likelihood of hospitalization. Research presented in November 2023 showed that individuals who gargled saltwater (2.13 grams or 6 grams of salt in about 1 cup of water) four times daily for 14 days were less likely to be hospitalized. Note: This study was small and excluded individuals with high blood pressure.
Choosing the Right Antiviral
Antiviral medications like Paxlovid, remdesivir, and molnupiravir aim to halt the virus’s replication, preventing disease progression.
Remdesivir was an early contender, primarily for hospitalized patients, but evidence of its effectiveness was initially limited. Recent data suggest that administering it within seven days of symptom onset can prevent hospitalization in 87% of high-risk patients. However, as it’s intravenous, it must be administered in a hospital or clinic, once daily for three days.
Towards the end of 2021, the FDA authorized two new antivirals available as pills for at-home use.
Paxlovid stands out as the FDA’s preferred choice, reducing hospitalization chances by 89% in trials, compared to molnupiravir’s 30%. While molnupiravir is easier to take than remdesivir, it poses a potential risk of birth defects, observed in animal models but not yet in human trials.
Yet, Paxlovid interacts with numerous prescribed medications. Consult your pharmacist regarding any current drugs or supplements, including over-the-counter ones.
Synthetic antibodies, like Eli Lilly’s Bamlanivimab plus etesevimab, Regen-COV (casirivimab plus imdevimab), and Xevudy (sotrovimab), were among the first treatments for COVID-19. While initially effective, they don’t seem to work against recent Omicron variants, thus not recommended by NIH.
Potential side effects include infusion-site reactions and allergic responses.
Gradual Return to Activity
During COVID illness, prioritize rest and hydration. Over-the-counter drugs can alleviate symptoms. Gradually reintroduce physical activity, monitoring how you feel. Some experience lingering fatigue or lung/cardiovascular issues after the acute phase. Seek medical advice for persistent symptoms like shortness of breath, dizziness, chest pain, or confusion.
Hospitalization and Further Treatment
Severe cases may involve systemic inflammation. Doctors might recommend corticosteroids like Decadron or IL-6 inhibitors. Experimental drugs like the antidepressant Luvox are still under assessment. Blood thinners could be added to prevent clot formation, and critical care might necessitate various therapeutics for complications like bacterial pneumonia or renal failure.