COVID-19 is now a household phrase but remember that it didn’t even have a name two years ago, being a disease never before seen in humans. The first treatment option that was available was supportive therapies. Meaning, if COVID-19 had ravaged your lungs, causing your oxygen to drop or blood pressure to fall, we strived to restore the appropriate levels. Supportive therapies are oftentimes the first thing that we can do for a new infection because, at that time, vaccination and specific treatment options were not yet available.
Two years later, I think the real change to supportive therapies is a humbleness around COVID-19, and a sense of understanding around how effectively we can help patients. I try to always tell patients when they come into the hospital that there isn’t a cure for COVID, but we can try to mitigate the damage and shorten their hospital stay.
Currently, for potentially severe cases, monoclonal antibodies are a good treatment tool. MAb treatment gives you specific antibodies to fight the virus if you test positive for COVID-19. The challenge here is timing and resource availability. If you wait too long or get a treatment too soon it may not prevent you from getting severe illness. You also need to get these treatments in a hospital or clinic setting with a medical staff to monitor you, so easy access is an issue, especially for more rural patients. The U.S. Department of Health & Human Services has set up a site to assist patients and providers identify a location near them.
Convalescent plasma is also something that doctors have used for 100+ years whenever we get a new outbreak of something. Similar to mAbs, which give you one antibody to lead the fight against the infection, a plasma treatment provides the patient with a bunch of different antibodies from someone who has survived the virus. Again, timing is a challenge. Also, as you will see with current and past trials, results vary and oftentimes the plasma does not provide a benefit for a majority of people, just a very specific subgroup. So, I tend to only use this in the most severe cases as a last effort. However, similar to supportive therapy, after two years of working with COVID patients, we have gotten better at knowing who this treatment will benefit and creating precision medicine.
In addition, steroids have been a tried-and-true tool. When patients get severe COVID, the immune system overreacts to the infection, which can cause other problems, mainly sepsis. So medical teams have been using steroids for these severe cases, with the purpose of fighting the overbearing inflammatory response. It should be understood that anti-inflammatories should only be used in the most severe cases because they will weaken your immune system.
Pills on the Horizon
From a curative standpoint, we were always hoping to come up with a good antiviral, similar to an at-home antibiotic. The challenge is that viruses are hard to beat because they invade our cells, so we need to find something that will not damage our cells in the process. For the last few years, many pharmaceutical companies have been testing current medications in hopes of repurposing them as COVID-19 treatments as well.
Pfizer is very excited about the possibility of using ritonavir, currently an HIV treatment, to create a COVID antiviral. This medication is co-administered to slow down the metabolism breakdown so that PAXLOVID™, an investigational SARS-CoV-2 protease inhibitor antiviral, can remain active in the body longer, giving it more time to fight the virus. Another antiviral that has gotten some attention is remdesivir, though reactions have been varied so it is only suggested for severe cases. Merck is trying to create their own antiviral, which will work very similarly to ritonavir. Hopefully, these will be shown to be effective and then approved by the FDA for Emergency Use within the next year, and that will be a game changer.
Just like all other current treatments, the caveat there is timing. If you wait too long the medication will not be able to do what it needs to. You will have the same problem if you take the medication before you actually need it. If you do take the pills, you will want to monitor any side effects, though they should be common symptoms such as headaches or nausea which often accompany medication use. One other thing to consider is that the pills may be a very costly option that is not widely available to the public or covered by insurance. There are still a lot of unknowns.
It’s All About Timing
Timing is a key component to all treatments, so patients need to be very aware of their symptoms and contact their physicians as soon as possible so they can work together to get that timing right. If I have a patient who tests positive for COVID, the first thing I do is ask how they are feeling. I ask, “Do you have fever, chills, a cough, are you short of breath?” Shortness of breath is a really important symptom to recognize because that means the lungs are going to have to start overworking for whatever reason, so a trip to urgent care or the ER may be needed.
If they don’t have any alarming symptoms, I will then ask when they began so that we can chart out a course of action. If it has been about two weeks, they are probably toward the end of the infection and so I tell them to hold on tight because the immune system is doing what it needs to do. If symptoms started two or three days prior, those are the patients that I want to check in daily with me so we can monitor symptoms and decide if more drastic action is needed. This is especially important for individuals with pre-existing conditions such as diabetes, high blood pressure or any organ transplant. These are also the groups that I would strongly consider recommending mAb therapies.
If they are a lung patient to begin with, I often encourage them to use their inhalers as often as they need to. They also can use a pulse oximeter to monitor oxygen levels. In my practice with COVID-19 patients, if oxygen levels are falling, patients tend to develop symptoms. I personally have not seen a patient with asymptomatic COVID who has life-threatening hypoxemia or low blood oxygen levels. However, we want to stay in touch so we can tackle problems early and quickly.
Treatment is Not Prevention
It is this delicate balance for treatment options that makes the preventative vaccine really one of the strongest tools we have. The vaccine can be given at any time as long as the patient is not currently infected with COVID-19 and will help prevent severe infections that can lead to the need for all the other treatments mentioned. The vaccine is also the best way to make sure you have a “smart immune system” or one that can recognize the virus and attack it with sophistication and precision.
Disclaimer: The information in this article was medically reviewed and accurate at the time of posting. Because knowledge and understanding of COVID-19 is constantly evolving, data or insights may have changed. The most recent posts are listed on the EACH Breath blog landing page. You may also visit our COVID-19 section for updated disease information and contact our Lung HelpLine at 1-800-LUNGUSA for COVID-19 questions.
Blog last updated: January 11, 2022