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chemist with vial
chemist with vial

Is COVID-19 Treatable?

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Updated on February 17, 2022

Fighting the COVID-19 pandemic is a top priority in medical research and pharmaceutical development. While treatment may be able to shorten the course of COVID-19 in those who become infected, the currently authorized or approved COVID-19 vaccines offer the best chance of avoiding a serious case of coronavirus disease.

What are the recent advancements in treating COVID-19? What therapies are in development? Paul Auwaerter, M.D., M.B.A., an infectious diseases expert, and Arturo Casadevall, M.D., Ph.D., an expert in microbiology and immunology, provide an update.

How is COVID-19 treated?

Treatment for COVID-19 depends on the severity of the infection. For milder illness, resting at home and taking medicine to reduce fever is often sufficient. Antiviral pills such as Paxlovid or molnupiravir may be prescribed by a doctor if a patient is eligible. When taken soon enough after symptoms set in, these pills may lessen the chance of COVID-19 worsening.

The more severe cases require hospitalization, with treatment that might include IV antivirals such as remdesivir, corticosteroids — such as dexamethasone — supplemental oxygen, assisted ventilation and other supportive measures.

An intravenous infusion of a monoclonal antibody such as sotrovimab, which spurs activity against the omicron variant, or use of blood plasma of a person previously infected with COVID-19 are other potential therapies, Auwaerter says.

“The Food and Drug Administration also gave emergency authorization to use convalescent plasma [CP]. The data supporting the usefulness of CP for hospitalized patients is less robust than that for remdesivir or dexamethasone, but studies are ongoing to better clarify its role,” he notes.

Medications for COVID-19

Pharmaceutical companies and laboratories worldwide are working to develop medicines for COVID-19. Many clinical trials are underway to test drugs, including investigational compounds and medications already approved by the FDA for other illnesses, to see if one or more can be used to treat COVID-19.

Antiviral Medication

Antiviral medications are available to treat several diseases, such as influenza. Antiviral drugs don’t kill a virus but instead limit the production of new viruses in host cells. Effective antiviral treatments can shorten the duration of the illness and lessen complications in some people.

COVID Pills: Paxlovid and Molnupiravir

In late 2021, two companies announced they had developed pills to treat COVID-19. One pill is called mulnupiravir, now produced by Merck. The other is called Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use), developed by Pfizer. Both medications were granted an emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) in December, 2021.

On December 22, 2021, the FDA issued an EUA for Pfizer’s Paxlovid for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms, or about 88 pounds) with positive results of direct SARS-CoV-2 testing.

People must be at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 — no later than five days of symptom onset.

On December 23, 2021, the FDA issued an EUA for Merck’s molnupiravir to treat mild-to-moderate COVID-19 in adults with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progression to severe COVID-19.

Remdesivir

One antiviral drug, remdesivir, was initially developed for activity against the Ebola and hepatitis C viruses. The National Institutes of Health reported that in a U.S. clinical trial (ACTT-1), remdesivir helped hospitalized patients with COVID-19 recover faster when compared with patients who did not receive the drug.

“Final results of the ACTT-1 trial show a 31% shorter recovery time [10 days versus 15 days] in patients who were treated with remdesivir,” Auwaerter says. “In the study, patients who were able to leave the hospital or return to their normal activities were considered recovered. The patients who appeared to benefit most were those who needed supplemental oxygen but who were not so ill as to require intensive care unit stays or mechanical ventilation.”

On Oct. 22, 2020, the FDA approved the drug for the treatment of all hospitalized adult and pediatric patients with suspected or laboratory-confirmed COVID-19, whether the illness is mild or severe. The drug is an intravenous medication with a course of treatment that lasts five to 10 days.

“New data has recently led to an additional FDA indication approved on January 21, 2022. Remdesivir can be given as a three-day infusion on an outpatient basis for patients 12 years and older with mild-to-moderate COVID-19 who have at least one qualifying risk factor for severe disease,” Auwaerter says.

Monoclonal Antibodies

“Several monoclonal antibodies have received emergency use authorization,” Auwaerter says. “However, only one, sotrovimab, is effective against the omicron variant of this virus, which is now predominant in the U.S.

“Sotrovimab appeared to reduce the need for hospitalization for patients at high risk for developing severe COVID-19 by 85%,” he explains, although the study was performed earlier in the pandemic before the omicron surge. “The monoclonal antibody is given by intravenous infusion, and it is best to have it done early in the illness, such as within three to four days after the onset of symptoms, if possible.”

Previously heavily used monoclonal antibodies casirivimab/imdevimab and bamlanivimab/etesevimab combinations do not appear to have sufficient activity against the omicron variant. Therefore, Health and Human Services (HHS) has halted distribution of these agents, and in January 2022 the CDC’s treatment panel recommended against using this treatment in patients infected with omicron.

Immunomodulators

Many studies have clarified the role of the monoclonal antibody tocilizumab in managing SARS-CoV-2 infections. In June 2021, the FDA granted an EUA for tocilizumab for the treatment of adults and children hospitalized with severe COVID-19. This biologic agent can reduce inflammation and is FDA-approved to treat autoimmune illnesses, such as rheumatoid arthritis.

“In patients with severe COVID-19,” Auwaerter says, “these and similar drugs that combat inflammation appear to be most helpful in patients worsening with higher oxygen requirements while receiving the corticosteroid dexamethasone. Studies have suggested that there is a reduced need for going on a ventilator and reduced mortality if the drug is used in combination with a steroid.

“An additional immunomodulator such as tocilizumab is recommended in similar scenarios. The Janus kinase inhibitor baricitinib used for rheumatoid arthritis, appears to benefit the same sort of patients as tocilizumab. Fewer large studies are supporting its use, so it is not as widely used as tocilizumab for the patients with COVID-19 who are worsening, despite treatment with dexamethasone and remdesivir.”

gloved hands hold a bag of convalescent plasma

From our Newsroom

Findings from a Johns Hopkins-led study, posted to preprint site MedRXiv, support antibody-rich blood as an early treatment option.

Dexamethasone for COVID-19

Results from the RECOVERY clinical trial show that the steroid drug dexamethasone reduces deaths in hospitalized patients who have COVID-19. Dexamethasone has been used for years to treat inflammation from many diseases, including asthma, Crohn’s disease and certain cancers.

“Using dexamethasone to treat COVID-19 appears to be most beneficial for patients who require mechanical ventilation and, to a lesser degree, patients who need supplemental oxygen,” Auwaerter says. “The study showed a trend toward worse outcomes for patients who don’t need oxygen and who are less ill, so the drug may not be the best choice for all hospitalized patients with COVID-19.”

Dexamethasone may be processed differently in Black people than in other people. Johns Hopkins researchers note that this difference, along with other considerations, means more research on the drug will be helpful to more solidly confirm its role as a safe, effective treatment for COVID-19.

Convalescent Blood Plasma Therapy

When people become infected and ill from a virus and then get better (convalesce), their immune system has successfully produced antibodies to fight that virus. Doctors have used forms of antibody therapy for over a hundred years in medical treatment.

On Aug. 23, 2020, the FDA granted an EUA for plasma antibodies, which means they are likely to be both beneficial and safe for patients. “Coming from the FDA as opposed to a pharmaceutical company, this was a big step in establishing this therapy as an effective treatment,” Casadevall says.

Since April 2020, more than 500,000 Americans have been treated with convalescent plasma, and an analysis of population level trends shows a strong correlation between convalescent plasma use and mortality. Casadevall says, based on this data, the use of convalescent plasma in the U.S. may have resulted in about 100,000 fewer deaths than had it not been used.

“Convalescent plasma remains available in the U.S. under FDA EUA. However, its use declined in early 2021 as the epidemic initially abated and because of mixed efficacy data from randomized clinical trials. While epidemiological and observational studies strongly support the notion that early administration with convalescent plasma reduces mortality, the results of randomized controlled trials have been inconsistent, some suggesting efficacy and others finding no effect on mortality,” Casadevall notes.

“What has become apparent in the past year is that numerous variables affect convalescent plasma efficacy, including the amount of antibody, the timing of administration and the geographic provenance of the plasma — local is best. Despite this complexity, convalescent plasma has found a niche in the treatment of immunosuppressed patients who cannot make their own antibody responses,” he says.

“Convalescent plasma was supposed to be a stopgap therapy until potent antivirals and monoclonal antibodies became available. Unfortunately, antiviral drug development has been slow,” Casadevall explains. “Monoclonal antibodies are available, but they are approved only for outpatient use. Until better therapies are developed, convalescent plasma is likely to maintain a role in therapy, and there are numerous studies trying to understand how to improve its efficacy.”

At Johns Hopkins, clinical trials led by Shmuel Shoham, M.D., and David Sullivan Jr., M.D., are determining if plasma antibodies can shorten the course of COVID-19 or protect family members of people infected with the coronavirus.

Casadevall points out that on December 27, 2021, the FDA updated its EUA to permit its usage in outpatients and limited its scope to use in immunosuppressive patients and those on immunosuppressive therapies. “The FDA did not define the category of immunosuppressive, which provides physicians considerable latitude to decide on patients at high risk,” he says.

“Recently a tool was published by JAMA Open to help physicians identify those patients who are more likely to benefit from therapy.”

Coronavirus COVID-19 Vaccines

Several COVID-19 vaccines have been authorized for emergency use or approved among specific age groups by the U.S. Food and Drug Administration (FDA). Johns Hopkins Medicine views both FDA-approved COVID-19 vaccines as highly effective at preventing serious disease, hospitalization and death from COVID-19.

Booster doses and additional doses of COVID-19 vaccines are available and recommended for those previously vaccinated for COVID-19. Data from several studies show boosters’ efficacy in protecting people from severe coronavirus disease, including those infected with delta and omicron variants.

Learn more about coronavirus vaccine safety and what you need to know about the COVID vaccines.

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Coronavirus (COVID-19)

What you need to know from Johns Hopkins Medicine.