Although vaccination is the most powerful method to prevent the viral spread and severe disease, it is also important to develop treatments for those already infected by SARS-CoV-2. In this post, we will briefly review some COVID-19 treatments [1]. The use of each one depends on the medical history of the patients and their characteristics (e.g., age, symptom severity, among other criteria). Thus, it is best to follow the doctor’s guidelines, especially since these medications require a doctor’s prescription. If you want to know why antivirals are needed instead of antibiotics, you can read the posts “Viruses and bacteria: almost invisible but nothing alike” and “Antibiotics vs Antivirals: two weapons, two targets“.
Paxlovid is an antiviral containing two combined medications (nirmatrelvir and ritonavir). Paxlovid inhibits one of the main steps required before SARS-CoV-2 replication [2]. The drug is given to people who have tested positive for COVID-19 and have moderate or mild symptoms but are at risk for severe disease. The treatment should start in the first five days after the symptoms appear, and the medication would help reduce the risk of death or hospitalization [1].
Remdesivir [3] is another antiviral drug that is used against SARS-CoV-2. It inhibits the enzyme in charge of replicating the viral RNA. Studies have shown that remdesivir can be helpful as a COVID-19 treatment, and it is approved for hospitalized people that weigh at least 40 kg and are at least 12 years old [4].
Molnupiravir [6] recently received emergency use authorization. This antiviral is authorized for adults with moderate or mild COVID-19 symptoms, who tested positive for the virus and are at risk for developing severe disease. It is meant to be used when other FDA-approved treatment options are not appropriate or available.
Besides antivirals, another alternative is the use of antibodies*. We should remember that one of the mechanisms through which vaccination protects us is that it induces the natural production of antibodies. Therefore, injecting pre-made antibodies can help us fight the virus (see here for more information). Antibodies like bamlanivimab/etesevimab, casirivimab/imdevimab, and sotrovimab react against the spike protein that covers SARS-CoV-2 [1]. These medications are typically used for non-hospitalized people (they must weigh at least 40 kg and be at least 12 years old) who present moderate or mild symptoms but have a risk of severe disease [5].
There is another line of treatment that is similar to antibody injections: the convalescent plasma transfusion. When people recover from COVID-19, their blood carries antibodies against SARS-CoV-2. By receiving a plasma transfusion, the recipient can benefit from the donor’s antibodies. Since plasma is contained in the blood, it is important to note that a compatible blood type is needed for the transfusion. If interested, please note that some of the requirements for convalescent plasma transfusion are: the donor must have recovered from COVID-19 (past but no current COVID-19 infection) and must have high antibody levels [1]. Stay tuned for another post where we delve more into blood transfusions and COVID-19.
It should be mentioned that certain patients with COVID-19 may develop the so-called “cytokine storm.” This refers to an excessive overreaction of the immune response, which can lead to organ damage. In those cases, the doctor may prescribe anti-inflammatory medications like dexamethasone and antibodies like tocilizumab [1].
Even though medications are being developed and reviewed to help fight the pandemic, they do not replace vaccines. Vaccinations continue to be an excellent mechanism to prevent COVID-19 and its complications.
*Antibody - a molecule produced by immune cells that recognizes and binds to another molecule that is foreign to the organism, the antigen. By binding to the antigen, the antibody can tag the foreign molecule for destruction or directly neutralizes it.
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Written by: Nicole
Edited by: María and Natasha
BioDecoded is a volunteer group committed to sharing accurate scientific information. For more information about vaccines and their safety profile, please see previous posts or consult with your personal physician. If you have any questions about this topic, please comment or send them to our email.
References:
Treatments for COVID-19. Harvard Health (2020). Available at: https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19 (Accessed: 9 January 2022).
Pfizer’s Novel COVID-19 Oral Antiviral Treatment Candidate Reduced Risk of Hospitalization or Death by 89% in Interim Analysis of Phase 2/3 EPIC-HR Study. Pfizer (2022). Available at: https://www.pfizer.com/news/press-release/press-release-detail/pfizers-novel-covid-19-oral-antiviral-treatment-candidate (Accessed: 9 January 2022).
Beigel, J., et al. (2020). “Remdesivir for the Treatment of Covid-19 — Final Report”. New England Journal of Medicine, 383(19), pp.1813-1826. Available at: https://www.nejm.org/doi/full/10.1056/nejmoa2007764
Information for Clinicians on Investigational Therapeutics for Patients with COVID-19. CDC (2020). Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html (Accessed: 9 January 2022).
Coronavirus (COVID-19) Update: FDA Authorizes Additional Monoclonal Antibody for Treatment of COVID-19. FDA (2021). Available at: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-monoclonal-antibody-treatment-covid-19 (Accessed: 9 January 2022).
FDA (2021). Coronavirus (COVID-19) Update: FDA Authorizes Additional Oral Antiviral for Treatment of COVID-19 in Certain Adults. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-oral-antiviral-treatment-covid-19-certain
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