Dr. Russell Vinik, GBS Medical Director
Additional Considerations and Treatment Options if you get COVID-19
- Isolate yourself immediately. Your family members are not destined to get sick. On average 25% of household contacts get COVID. This can be reduced with isolation.
- Test close contacts. Close contacts should be tested about 5 days after exposure to an infected person with COVID-19.
- Get a Pulse Oximeter. These can be purchased at any drug store or online for <$20. This is a simple way to be sure you are getting enough Oxygen. Seek medical care immediately if your oxygen saturation goes below 90%
- Medication Options. Most treatment involves prevention of virus replication. Antiviral treatment is only effective when given early in the course of COVID. This one important reason to get tested early.
Treatment Options
Monoclonal Antibodies – See GBS Summary “Monoclona Antibodies for Treatment of COVID-19”
Oral Agents: Note, Paxlovid and molnupiravir will initially be in very short supply. Each state will likely develop criteria for distribution of the medication to the people who are most likely to benefit from treatment.
- Paxlovid – Developed by Pfizer is a new medication combined with ritonavir (a drug used to treat HIV). Press reports from the manufacturer indicate this medication, when started within 5 days of symptom onset reduced hospitalization or death by 88%. Pfizer filed in the United States for Emergency Use Authorization of this medication on November 16, 2021. Ritonavir has multiple interactions with other medications, thus will require a careful review of all one’s medications before prescribing.
- Molnupiravir –a new oral medication developed by Merck and Ridgeback for treatment of COVID-19. This medication works by inducing mutations in the virus which prevent the virus from further replicating. While interim analysis of the first half of the study showed a 50% reduction in hospitalization or death, the drug showed no benefit in the second half of the study leading to significant questions about its efficacy. Importantly, results from initial studies indicate a high risk of birth defects when given to pregnant animals. Thus, this drug can only be given to non-pregnant women with a reliable form of contraception. In addition women should not breast feed while taking the medication and for 5 days after stopping the medication. There is some concern that one of the metabolites of this drug can incorporate into DNA potentially leading to long-term malignancy risk. Thus, any use of this medication will require a significant discussion of benefits/risks between patient and provider.
Fluvoxamine – Fluvoxamine is a type of antidepressant which was approved by the FDA in 2008 for treatment of obsessive compulsive disorder. This drug is generic and inexpensive. One recent large trial in Brazil, patients treated within 7 days of symptom onset showed a significant reduction in the need for hospitalization and death in patients who took fluvoxamine. This reduction was most pronounced in people who took more than 80% of their doses. Most common side effects include: nausea, tiredness, insomnia, and dry mouth. This drug has not yet been endorsed by the CDC or WHO for treatment of COVID-19. The mechanism where this may be effective for treating COVID-19 has not been clearly established.
Remdesivir – an intravenous medication developed for treatment of Ebola. Most data for this medication is in hospitalized patients.
The most studied medication to reduce the inflammatory response to COVID later on in the course of illness is dexamethasone, an anti-inflammatory corticosteroid. In addition several injectable medications used to treat autoimmune disorders including baricitinib, sarilumab, and tocilizumab can improve outcomes in hospitalized patients with COVID-19.
