Over the past two years, many new COVID-19 therapies have been designed, developed and rigorously tested. We now have a handful of safe and effective treatments — from monoclonal antibodies to antivirals — that can help people with COVID-19 avoid severe outcomes like hospitalization and death.
But when it comes to COVID-19, things change fast, and it can be hard to keep up with what treatments are available and recommended. While certain therapies might work well against the dominant variants circulating today — which is looking more and more like the BA.2 subvariant of omicron — that could all change when the next variant comes along.
On top of that, there are some nuances as to which treatments make sense for whom. Most of the therapies out there are intended for high-risk patients and some aren’t recommended for pregnant people or those taking certain medications like blood thinners or organ transplant drugs.
“It’s important to talk to your doctor and they can review your list of medications and see which therapy is the right one for you,” said Thomas Lew, a clinical assistant professor of medicine at Stanford University.
Here’s a guide to the COVID-19 treatments currently available:
What it is: Monoclonal antibodies are laboratory-produced antibodies that help block a virus from invading our cells; in the case where the virus has already invaded our cells, monoclonal antibodies kickstart the immune system’s fight against the virus. They’re administered via infusion.
Where we’re at with it: Monoclonal antibodies are targeted to a very specific virus, so they work best when they are used against the variant they are designed to treat. As the coronavirus mutates, the efficacy of our monoclonal antibodies tends to take a hit — in fact, a lot of the monoclonal antibodies we used earlier in the pandemic are no longer effective.
“The landscape of monoclonal antibodies is always changing as the virus changes,” Lew said. For example, sotrovimab worked well against the original omicron (BA.1), but isn’t as effective against BA.2, so is being shelved in areas predominantly battling BA.2. Thankfully, another monoclonal antibody called bebtelovimab still appears to work great against BA.2, Lew said.
Who qualifies: Monoclonal antibodies are typically reserved for high-risk patients who are not hospitalized and do not require oxygen but are at-risk for developing severe disease. This includes people over the age of 65, along with pregnant individuals and those with an underlying medical condition such as obesity, an organ transplant, cancer, diabetes, kidney disease, heart disease or lung disease. Patients must be older than 12 and weigh at least 88 pounds. Once a person is hospitalized or requires oxygen, they no longer qualify for monoclonal antibodies, according to Scott Roberts, a Yale Medicine infectious diseases physician.
When to start treatment: Within seven days of symptom onset. Test early, and if you qualify, start treatment immediately — even if you only have mild, cold-like symptoms.
How to get it: At an infusion center, hospital or urgent care. If you have a doctor, ask them where you can get tested and access the treatment in your region. You can find nearby locations that offer monoclonal antibodies here.
What it is: An oral antiviral pill that blocks viruses from replicating and spreading in the body. Taken two times a day for five days, Paxlovid has been found to reduce the risk of hospitalization and death by 88%. “This is the most effective treatment currently available and works for all variants,” Roberts said.
Where we’re at with it: Supply is tight in certain areas, but Paxlovid is now available at pharmacies, doctors’ offices, hospitals and urgent cares.
Who qualifies: Any high-risk patient who tests positive qualifies, even if they don’t have serious symptoms, as long as they are over 12 years of age and weigh at least 88 pounds. Paxlovid has not been tested in pregnant people, and has drug interactions so it’s not recommended for people taking certain heart rhythm medications, blood thinners, or anti-rejection medications used for organ transplant patients. If you take any medications, ask your doctor or a pharmacist if you’re a candidate for Paxlovid.
When to start treatment: Within five days of symptom onset. “Similar to Tamiflu for the flu, the earlier that Paxlovid is taken, hypothetically, the better the benefits to stop the virus from replicating,” Roberts said.
How to get it: Paxlovid is only available by prescription, so talk to your primary care physician or visit an urgent care, emergency room or health clinic. You can find nearby locations that offer Paxlovid here.
What it is: An oral antiviral pill that blocks the virus from replicating in your body. It is taken twice daily over the course of five days.
Where we’re at with it: Molnupiravir is an alternative therapy that is given to patients who don’t qualify for Paxlovid or monoclonal antibodies along with people who don’t live near an infusion site. Molnupiravir helps protect people against hospitalization and death, but it is not as effective as Paxlovid.
Who qualifies: Patients who have mild to moderate COVID-19 and are at risk for developing severe disease. It is not authorized for children younger than 18 because it may impact bone and cartilage growth. It is also not recommended for pregnant people.
When to start treatment: Within five days of symptom onset.
How to get it: Molnupiravir requires a prescription and can be picked up at a pharmacy. You can find nearby locations that offer molnupiravir here.
What it is: An antiviral medication that inhibits viral replication in the body. It is administered via an IV and, depending on the severity of illness, is given for three days or five days. According to Roberts, remdesivir has always been a backbone in treating COVID-19 patients who require oxygen. Evidence has shown that three days of IV-administered remdesivir reduces the risk of hospitalization and death by 87%.
Where we’re at with it: Recent research found that high-risk outpatients with COVID-19 are also strong candidates for remdesivir, and since then, the Food and Drug Administration authorized remdesivir for non-hospitalized at-risk people who have mild to moderate disease. Remdesivir is expected to hold up against the BA.2 variant.
Who qualifies: High-risk patients who are already hospitalized or require oxygen along with high-risk patients who aren’t hospitalized but have mild to moderate COVID-19. At-risk pediatric patients under 12 can now get remdesivir, too.
When to start treatment: Within seven days of symptom onset.
How to get it: In the hospital. Expect more doctors’ offices, urgent cares and infusion centers to start offering remdesivir soon.
The vast majority of healthy people who contract COVID-19 will be able to recover at home. “The strategy of testing, isolating and doing what’s called supportive care will be enough for those people,” Lew said.
If you have a cough, take a cough expectorant (like dextromethorphan) that can loosen up the mucus in your airways. Roberts recommended pain relievers such as acetaminophen for those with a fever. People with congestion should look to nasal sprays or decongestants (like pseudoephedrine).
People with asthma should consider using their prescription inhaler to keep their airways open, Roberts added. Gastrointestinal symptoms, like diarrhea, can be alleviated with loperamide. Lew also recommended drinking fluids to avoid becoming dehydrated.
There are a ton of COVID-19 treatments in development, including new pills, infusions and monoclonal antibodies. Several have shown promise in the early phases of their clinical trials, but it’ll take time to complete the final phases of testing (which happen to take the longest) and eventually reach the FDA’s desk for review.
Until then, keep an eye on how future variants impact the efficacy of our current treatments and look out for new therapies that will work against all variants in the months and years to come.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.