As much of the U.S. attempts to return to a tentative “normal,” the national conversation has shifted from vaccinations and mask mandates to COVID-19 treatments. Even as Omicron and its subvariants have rendered some COVID-19 treatments ineffective, new treatments have emerged. These include Paxlovid, the first at-home antiviral COVID-19 treatment, and bebtelovimab, the sole monoclonal antibody to stand up to BA.2. From steroids and antivirals to monoclonal antibodies, many COVID-19 treatments have experienced their moment in the spotlight—and their fair share of misinformation.
With improved treatments, many available for home use, some people have promoted the idea that vaccination is no longer important or that the pandemic is effectively over. That isn’t the case. Here’s a breakdown of what COVID-19 treatments are available and what they can and can’t do for people fighting COVID-19. Of course, only a health care provider can tell you which treatment is right for you.
Prevention is always better than treatment
It’s important to remember that in medicine and public health, a preventative method (the vaccine, in the case of COVID-19) is always preferable to any treatment. There’s no way of knowing how your body will react to a COVID-19 infection or treatments. Maybe you’ll have a mild fever and headache—or maybe you’ll wind up in the hospital with low oxygen and pneumonia or worse. Even with more effective drugs and treatment protocols available, COVID-19 remains deadly, killing hundreds of Americans every day, the majority of them unvaccinated. Additionally, not everyone is eligible for all COVID-19 treatments. Many are limited to people who are high-risk and must be taken within days of when symptoms set in.
The highly infectious Omicron subvariants have mutated enough from earlier variants of the virus that some standard treatments are less effective against them. We can’t know in advance if the next variant will be more severe (like Delta) or more infectious (like Omicron). It’s better to protect yourself by getting vaccinated before new variants emerge. Vaccines take the guesswork out of the equation, dramatically reducing your risk of catching COVID-19 or getting seriously ill.
Authorized or approved COVID-19 treatments
COVID-19 wreaks havoc on the body in two ways: One is the damage from the virus itself spreading throughout the body; the other is caused by the immune system going into overdrive, damaging the lungs and other organs. Steroid treatments are anti-inflammatory and target COVID-19’s second mode of damage, tempering the immune response. These treatments are used for people who are already quite ill with COVID-19 and whose immune systems are causing harm rather than fighting off the infection.
Dexamethasone is a corticosteroid that can reduce the risk of organ damage and death from COVID-19 inflammation. The National Institutes of Health (NIH) recommends the use of dexamethasone for hospitalized COVID-19 patients on supplemental oxygen or ventilators. In some severe COVID-19 cases, doctors prescribe dexamethasone in combination with remdesivir.
Antiviral treatments are drugs that prevent viruses from replicating and spreading in the body. Early antiviral treatment can shorten the length of COVID-19 infection and slow the progression of the disease. But the treatments have a relatively brief window of effectiveness against COVID-19 because, beyond a certain point, simply slowing replication will not be enough to reverse the course of the disease.
In December, the FDA authorized the use of the antiviral pill Paxlovid, the first at-home treatment for mild-to-moderate COVID-19. The treatment reduces the risk of hospitalization and death by up to 88 percent. It’s authorized for use in recently diagnosed (within five days of symptom onset) COVID-19 patients ages 12 and up who are at high risk for severe illness. For these patients, the NIH recommends Paxlovid over monoclonal antibodies and other authorized antiviral treatments. The treatment has remained effective against BA.2.
Remdesivir, the only drug that is approved by the FDA for COVID-19 treatment, is used to treat COVID-19 patients aged 28 days and older. As of April, remdesivir is the only COVID-19 treatment approved for children under age 12. After Paxlovid, remdesivir is the preferred treatment for mild-to-moderate high-risk COVID-19 patients within seven days of symptom onset. The drug was originally developed as a potential Ebola treatment. In early studies, it was found to reduce the recovery time of COVID-19 patients. The most pronounced effect was seen in patients requiring supplemental oxygen but not ill enough to need ventilation. Doctors administer remdesivir intravenously in a hospital. Like Paxlovid, remdesivir is effective against BA.2.
Molnupiravir is the third antiviral to receive FDA emergency use authorization and the second at-home COVID-19 treatment authorized to reduce the risk of hospitalization and death in mild-to-moderate cases. The FDA recommends molnupiravir only when other treatments are not available. When taken early in the illness, the treatment cuts hospitalization risk in half. It does so by blocking viral replication and preventing mild or moderate COVID-19 from progressing to severe illness.
Like antiviral treatments, monoclonal antibodies need to be taken early: within 10 days of getting sick with COVID-19. They are most effective in patients with mild-to-moderate symptoms who are at high risk of progressing to severe disease or hospitalization. Importantly, the treatment is not a substitute for COVID-19 vaccination; it provides another layer of protection for people who are at high risk of severe COVID-19, including immunocompromised people.
Monoclonal antibodies are analogous to the antibodies produced by the body in response to COVID-19 vaccination or infection. The same mutations that allow Omicron subvariants to partially evade vaccine and natural immunity also reduce the effectiveness of most monoclonal antibody treatments against them.
First authorized in February, bebtelovimab is now the only monoclonal antibody treatment that is effective against BA.2. The treatment is authorized for use in nonhospitalized, high-risk COVID-19 patients ages 12 and up. It is recommended only when preferred antiviral treatments—Paxlovid and remdesivir—cannot be used.
In January, the FDA ended use of the monoclonal antibody treatments REGEN-COV and bamlanivimab-etesevimab due to their low effectiveness against Omicron. Although sotrovimab remained effective against Omicron, it failed against BA.2, resulting in the FDA pausing use in the U.S.
Authorized by the FDA in December, Evusheld is a preventative monoclonal antibody treatment for moderately-to-severely immunocompromised people ages 12 and up. Evusheld is a preventative, pre-exposure treatment that cannot be used in people who have COVID-19 or have recently been exposed to COVID-19. The treatment is for immunocompromised people who cannot safely be vaccinated or those who may not have had a sufficient immune response to vaccination.
No matter what you might hear, COVID-19 treatments are not a substitute for vaccination, which is still the best protection. Even the most effective treatment is no magic bullet; it’s just one more tool in the fight against COVID-19.