You just tested positive for Covid – now what do you do? This scenario is becoming increasingly more common although the prognosis is better than ever. The current Covid variants of Omicron BA.1 and BA.2 are more contagious than earlier variants, but less lethal. That means your chances of getting Covid are higher, but your chances of serious illness or death are lower.

Many people who are already vaccinated are getting Covid. My wife recently had that experience. But fortunately, vaccination is still the best means of lowering your risk of serious illness, hospitalization, or death. Mask mandates are declining so fewer people are wearing masks. The decision to wear or not wear a mask is still yours to make, but don’t be fooled into thinking that will guarantee you don’t get Covid.

What are the current treatments for Covid treatment?

Jared S. Hopkins, writing in The Wall Street Journal, gives us an update on current therapeutics for Covid. There are now antiviral oral treatments for Covid. Paxlovid is an antiviral pill manufactured by Pfizer. Molnupiravir is an antiviral pill manufactuered by Merck and Ridgeback Biotherapeutics. Both are currently available but generally used only in high-risk patients.

Low risk patients, the young and healthy, are usually treated with simple over-the-counter remedies such as Tylenol or Advil and cold-remedies for associated cough or congestion. High-risk patients should monitor fever, cough, and especially shortness of breath, which may be an indicator of developing pneumonia. Shortness of breath is the most important sign that you should seek medical treatment as soon as possible. Early treatment may allow outpatient care, as was the case in the treatment of my wife’s pneumonia. Antibiotics, fluids, and possibly a short course of steroids can arrest early lung inflammation.

Where can I get the antiviral pills?

Both pills are limited to prescriptions from a doctor. There are some differences in effectiveness. Molnupiravir has been shown to reduce hospitalization and death by 30 percent. Paxlovid has been shown to be 89 percent effective in achieving the same. But both have some safety risks and limitations. Paxlovid is taken with another antiviral pill, ritonavir, which can interact with other medications in dangerous and life-threatening ways. Drugs that interact with Paxlovid include common ones such as the cholesterol-lowering pill simvastatin, the antipsychotic lurasidone and the sedative triazolam. It is important to tell your doctor all other drugs you are taking before prescribing these antivirals. Pregnant women and children should avoid the molnupiravir pill, which was not authorized for these patients.

Are these drugs effective against the Omicron variants?

Molnupiravir and paxlovid have both been found to be effective against the Omicron variants. The antiviral drug remdesivir, given by infusion only, has also been found to be effective.

What about monoclonal antibody treatments?

We heard much about monoclonal antibody treatments early in the Covid pandemic, but not so much lately. These drugs are lab-engineered molecules that mimic the natural antibodies produced by the immune system to fight off viruses. They are administered by infusion or injection at hospitals or clinics. There are three manufacturers of these treatments, Eli Lilly, GlaxoSmithKline, and Vir Biotechnology.

Some variations in effectiveness have been found depending on the Covid variant. The GlaxoSmithKline treatment, sotrovimab, was effective against Omicron BA.1 but less so with BA.2. Therefore, the FDA has restricted use of the drug in territories where the BA.2 variant is dominant. Earlier treatments such as regeneron have been restricted in treating any Omicron variant. A new drug from Lilly, called bebtelovimab, has been found to be effective against the Omicron variants and is used for treatment of mild to moderate Covid disease in nonhospitalized individuals 12 and older who are at high risk of severe disease. Those at low risk of severe disease are not considered good candidates for these treatments.

What does the National Institutes of Health recommend?

The NIH recommends paxlovid as the first option for patients with mild to moderate symptoms but who are at high risk of developing severe disease and becoming hospitalized. If the drug is unavailable, or can’t be taken for some reason, then sotrovimab should be administered. Remdesivir is considered the third option. The last two options are bebtelovimab and molnupiravir.

If I am hospitalized, what are the best treatments?

Monoclonal antibody treatments are generally not used once a patient is hospitalized. Remdesivir is fully approved for treatment of people who are hospitalized with Covid. Other treatment options include dexamethasone, a steroid approved in the 1950s for treatment of inflammation. (My wife responded quickly to this treatment and didn’t need hospitalization.) Patients who don’t respond to dexamethasone may be given an immune-suppressing rheumatoid arthritis drug called Olumiant, which received emergency-use-authorization from the FDA when a study showed it helped hospitalized patients recover more quickly. A similar drug, actemra, has also shown effectiveness.

What about ivermectin?

Ivermectin, an antiparasitic drug in use for many years to treat river blindness, has been found to be effective against Covid in some studies. The FDA has not authorized its use for treating Covid, but many doctors still use it for this purpose. In the latest trial, researchers found that the drug didn’t reduce hospitalizations. Nevertheless, ivermectin has achieved some notoriety in treatment of Covid and prescriptions of the drug have increased recently.

How about hydroxychloroquine?

This drug enjoyed some popularity with treating physicians early in the course of the pandemic. But when President Trump touted its effectiveness, it suddenly was the object of pushback from the media and the public-health community. The drug has been used for decades in the treatment of lupus and rheumatoid arthritis, so its safety has never been an issue. The drug initially showed promise but the academic community now recommends against the use of hydroxychloroquine. It is not clear if this is based on science or politics.