Best COVID-19 treatments, according to doctors

Antiviral treatments and antibody therapies are most effective if you test early

Three pharmacy workers sort bags and bins of prescription medicine at Sanford Health.

As soon as symptoms of COVID-19 appear, it’s important to get tested right away. It can make all the difference in what treatment options are available to you and how effective they are.

“That’s when we can be most effective with treatment, particularly if you’re high risk,” said Jeremy Cauwels, M.D., chief physician for Sanford Health. “And it’s when you can make the most difference in making sure you don’t spread the virus.”

In December, the U.S. Food and Drug Administration issued emergency use authorization for two new oral antiviral medications used for those with COVID-19 at high risk for hospitalization.

Available antiviral treatments for COVID patients

Merck’s Molnupiravir and Pfizer’s Paxlovid are both approved pills to treat COVID-19 patients with mild to moderate COVID-19 before they develop serious illness or need hospitalization. After testing positive, patients who are eligible could start treatment at home.

“Merck’s Molnupiravir is showing to be about 30% effective,” Dr. Cauwels said. “Although 30% is better than nothing, it’s certainly not better than our antibody infusions and not as good as vaccination.”

Get vaccinated: COVID-19 vaccine at Sanford Health

In comparison, data about Pfizer’s Paxlovid is showing higher efficacy.

“That drug looks a lot more promising,” said Jesse Breidenbach, Sanford Health’s senior executive director of pharmacy. “The last data submitted to the FDA shows that it’s maintaining an 89% reduction rate in hospitalization or death from COVID-19.”

Instead of visiting a clinic or hospital for treatment, patients could receive a prescription for one of the oral antiviral medications, similar to getting an antibiotic for bacterial pneumonia or Tamiflu for influenza, explained Dr. Cauwels.

With both drugs, timing is key. According to the FDA, they must be given within the first five days of illness immediately after a patient is diagnosed with COVID-19.

“If you get sick, the earlier you can get tested, the better you’re going to be,” Dr. Cauwels said.

Veklury (remdesivir) is another antiviral drug that received FDA approval. It’s approved for patients who are admitted to the hospital with COVID-19 and for outpatient infusions to prevent hospitalization. Remdesivir is a three-day infusion that’s highly effective at reducing hospitalization by 85% when administered early in the illness.

Recently, the FDA expanded the emergency use authorization to include the use of remdesivir as a treatment for patients younger than 12 years old.

As soon as someone starts to experience symptoms, they should take a test, isolate as much as possible and wear a mask.

Reducing illness with monoclonal antibody therapy

The approval of the new antiviral pills gives providers another tool for treating COVID-19 that could provide some relief to overwhelmed hospitals and medical facilities.

“We know the federal government has already purchased about 10 million courses of Pfizer’s Paxlovid, so its approval will hopefully take a lot of pressure off the monoclonals, which would then take pressure off our infusion centers,” Breidenbach said.

Since the fall of 2020, Sanford Health has given over 12,300 monoclonal antibody infusions.

Given the limited availability of monoclonal antibodies, this outpatient therapy is reserved for high-risk COVID-19 patients. The treatment is a one-time infusion of laboratory-made proteins that mimic the immune system’s ability to fight off viruses. Receiving an infusion of antibodies jumpstarts a body’s defenses and prevents the virus from infecting more cells.

“Many patients see a dramatic turnaround within 12 to 48 hours after their infusion,” Dr. Cauwels said. “They go from feeling pretty miserable to pretty good, so it’s really been a remarkable treatment for those who get it early enough.”

Antibody treatment must be given within 10 days of symptom onset, although the earlier it’s received, the more effective it is.

“What we can say right now is that it does a wonderful job of reducing hospitalization and death by up to 70%,” Dr. Cauwels added. “That’s a big number of people for us to keep from landing in the hospital and potentially dying.”

The value of early testing

When patients test positive for COVID-19, a computer algorithm helps determine if they’re eligible for antibody or other COVID-19 treatments. Those who meet the criteria may be over the age of 65, overweight, or have chronic kidney disease, among other factors. As soon as test results are available on My Sanford Chart, a patient’s doctor is notified if they’re a candidate.

Some patients with COVID-19 may experience mild illness for the first five to seven days of their infection. But it’s often after that first week when they develop more serious symptoms and finally get tested.

“I always tell my patients that even if you have mild symptoms like a cold or cough, don’t presume it’s that or allergies,” said Avish Nagpal, M.D., a Sanford Health infectious disease specialist in Fargo, North Dakota. “Get tested for COVID-19 and influenza because antiviral treatments for both are timebound.”

Over the past few months, Sanford Health in Fargo has averaged around 40 antibody infusions each day. Sanford Health has also been coordinating treatment centers in many smaller communities, from Chamberlain, South Dakota, to Tracy, Minnesota.

“We’re working as hard as we can to move vaccinations and infusions to where our patients are,” Dr. Cauwels explained. “Our goal is to do the hard work on our end to make it easy for them to get the care they need.”

Knowing what works – and what doesn’t

Ivermectin, an antiparasitic drug that’s used throughout the world to treat parasites, is among the drugs that aren’t recommended as a treatment for COVID-19.

“Early in the course of the pandemic, there was a rush to treatments without evidence, and now we’ve had a lot more time to see which are or aren’t effective against COVID-19,” Breidenbach said. “Ivermectin is something that has not panned out as effective in clinical trials.”

The FDA hasn’t approved Ivermectin to treat or prevent COVID-19. Taking large doses of the drug can cause serious side effects, along with supply shortages when it’s needed for other uses.

“The risks definitely outweigh the benefits,” Breidenbach said. “You have a high risk of having negative outcomes and toxicities and a low to no proven benefit.”

Vaccination is the best protection

The best and safest form of protection against COVID-19 is the vaccine.

“It’s more effective than any pill so far to the tune of up to 95% in almost all the variants we’ve seen,” Dr. Cauwels said. “And a booster is at least 80% effective against omicron.”

Vaccination decreases the chances of hospitalization, serious illness and death. Breidenbach emphasizes that even Sanford Health’s data shows that serious illness and hospitalization rates are much higher for those who are unvaccinated.

Meanwhile, evidence shows that a booster or third dose may provide much longer, lasting protection than the initial doses.

“People who are vaccinated are still being affected, but the severity of illness is much lower and you’re probably not going to be hospitalized,” he said.

Information in this story was accurate when it was posted. As the COVID-19 pandemic changes, scientific understanding and guidelines may have changed since the original publication date.

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Posted In Chamberlain, Coronavirus, Expert Q&A, Fargo, Immunizations, Sioux Falls, Tracy