I tested positive for COVID-19 but only experienced mild symptoms. What can help me recover at home?
Let your doctor know you have COVID-19. Some people at increased risk for severe COVID-19 disease may be candidates for oral antiviral therapy or intravenous monoclonal antibody therapy, both of which can reduce the risk of hospitalization and death.
If you have been told to recover at home, these steps can help reduce symptoms:
- Although you don't need bed rest, you should get plenty of rest.
- Stay hydrated.
- To reduce fever and relieve pain, take acetaminophen or ibuprofen. Be sure to follow instructions. If you are taking any combination of cold or flu medications, keep track of all ingredients and dosages. For acetaminophen, the total daily dose for all products should not exceed 3,000 mg.
Is it safe to take ibuprofen to treat COVID-19 symptoms?
Early in the pandemic, there were concerns that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve) might not be safe for people with COVID-19. However, if you have COVID-19, the CDC now recommends taking medications such as ibuprofen or acetaminophen to relieve fever. The World Health Organization says there is no evidence that ibuprofen has any negative effects on COVID-19 patients.
What treatments can help people at increased risk of severe COVID-19 avoid hospitalization?
The FDA has granted emergency use authorization (EUA) to three monoclonal antibody treatments for the treatment of at-risk, non-hospitalized adults and children 12 years and older with mild to moderate symptoms who have recently tested positive for COVID-19. Developing severe COVID-19 or being hospitalized as a result. These therapies must be given intravenously (via an IV) as soon as symptoms appear.
The monoclonal antibody treatments approved under EUA are: a combination of casirimab and imdevimab called REGN-COV, made by Regeneron; a combination of bamlanivimab and etesevimab, made by Eli Lilly; and GlaxoSmithKline Sotrovimab. Laboratory studies have found that only one FDA-authorized monoclonal antibody treatment—sotrovimab—is effective against the Omicron variant.
Additionally, the FDA has approved the oral antiviral drugs Paxlovid and molnupiravir, which have been shown to reduce the risk of hospitalization and death in people at increased risk for severe COVID-19 disease.
If I get COVID-19, are there antiviral drugs that can reduce my risk of hospitalization?
The FDA has authorized two antiviral pills to treat COVID-19.
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On December 22, 2021, the FDA approved an oral antiviral pill called Paxlovid to treat mild to moderate COVID-19 in people 12 years and older who are at increased risk of severe illness. Treatment is only available by prescription after a positive COVID-19 test and within five days of the onset of symptoms. The FDA's authorization was based on study results released by the drug's manufacturer, Pfizer, showing Paxlovid significantly reduced the risk of COVID-related hospitalization and death compared with placebo.
The Phase 2/3 study, known as EPIC-HR, is randomized, double-blind and placebo-controlled. Study participants had symptomatic, confirmed early-stage COVID-19, were at increased risk of severe illness due to age or underlying medical conditions, and were not hospitalized. 2,246 study participants took placebo or Paxlovid (three tablets twice daily for five days), starting treatment within five days of symptom onset.
By 28 days after treatment, those who took Paxlovid within 5 days of symptom onset had an 88% reduced risk of COVID-related hospitalization or death compared with placebo. Side effects of Paxlovid and placebo were comparable and usually mild. They include impaired taste, diarrhea, high blood pressure and muscle aches.
Paxlovid is a protease inhibitor antiviral therapy consisting of a drug called nirmatrelvir and the HIV drug ritonavir. Nirmatrelvir was developed by Pfizer; it interferes with the coronavirus's ability to replicate. Ritonavir slows the breakdown of nimaterevir, which translates into higher blood levels of nimaterevir and a stronger antiviral effect for a longer period of time.
Pfizer's press release also announced laboratory study results showing that Paxlovid is effective against the Omicron variant.
Paxlovid is not authorized to prevent infection, prevent post-exposure (pre-diagnostic) illness, or treat people hospitalized with severe COVID-19. Antiviral drugs are also not a substitute for vaccinations. COVID vaccines, including booster doses, remain more important than ever. We need layers of defense against this viral threat.
Monupivir
On December 23, 2021, the FDA authorized molnupiravir, an oral antiviral drug produced by Merck, for the treatment of mild to moderate COVID-19 in people 18 years of age and older who are at increased risk for severe disease. Treatment is only available by prescription after a positive COVID-19 test and within five days of the onset of symptoms. However, the FDA said the use of monupivir should be limited to situations where other COVID-19 treatments are "unavailable or clinically inappropriate."
In November, Merck released study results showing that monupivir reduced the risk of hospitalization and death by 30% compared with placebo in patients with mild or moderate COVID-19 who were at high risk for severe COVID.
The findings are based on data from 1,433 study participants from the United States and around the world. To be eligible for the randomized, placebo-controlled, double-blind study, participants must have been diagnosed with mild to moderate COVID-19, started experiencing symptoms no more than five days before enrolling in the study, and already had at least one risk factor Putting them at increased risk of adverse outcomes from COVID-19. None of the participants was hospitalized at study entry. About half of the study participants took the antiviral drug monopiravir: four capsules taken by mouth twice a day for five days. The remaining study participants received a placebo.
Patients taking monupivir were 30% less likely to be hospitalized or die from COVID-19 compared with those taking a placebo. During the 29-day study period, 48 of 709 participants (6.8%) taking monupivir were hospitalized, and one person died. In the placebo group, 68 of 699 participants (9.7%) were hospitalized, including 9 deaths in this group. This antiviral drug is effective against several COVID variants, including the Delta variant. Scientists are studying the effectiveness of monopiravir against Omicron variants.
Side effects of monupivir include diarrhea, nausea, and dizziness. This medication is not recommended for use during pregnancy.
Molnupiravir is developed by Merck and Ridgeback Biotherapeutics. It works by interfering with the COVID virus's ability to replicate.
Is the antidepressant fluvoxamine effective in treating COVID-19?
A large study published in The Lancet Global Health in October 2021 found that the antidepressant fluvoxamine (Luvox), which can be taken orally at home, significantly reduced the risk of severe illness in some COVID-19 patients. Risk of hospitalization.
The Lancet study recruited nearly 1,500 adults in Brazil. Most study participants were unvaccinated, had symptoms, had early confirmed COVID-19, and were at increased risk of severe disease due to underlying health conditions. About half received a placebo, and the other half were told to take a 100-mg fluvoxamine pill twice a day for 10 days.
The fluvoxamine group was significantly less likely to require hospitalization or an extended emergency room stay than the placebo group (11% vs. 16%). The randomized, placebo-controlled trial was conducted by an international research team and confirmed preliminary findings published in JAMA last year.
Common side effects of fluvoxamine include headache, nausea, diarrhea, dizziness, and sexual side effects. In the Lancet trial, dozens of participants assigned to fluvoxamine stopped taking the drug because of side effects. Additionally, because study participants took the medication (or placebo) at home, they were not taking the medication as prescribed. But in this case, medication compliance made a difference: Those who took fluvoxamine as directed on more than 80 percent of possible days were significantly less likely to die than those in the placebo group. But the number of deaths in the placebo group was not significantly different from that in the perfluvoxamine group, which included widespread compliance.
Fluvoxamine belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It was approved by the FDA in 1994 for the treatment of obsessive-compulsive disorder (OCD) and anxiety disorders. Fluvoxamine appears to fight COVID by reducing inflammation, a hallmark of severe COVID infection. The drug may also have antiviral properties. Because it's already on the market, doctors can prescribe it off-label to COVID patients as they see fit.
Additionally, high-quality studies are expected to replicate the Lancet findings and answer remaining questions. For example, will fluvoxamine help symptomatic COVID patients who are vaccinated, or those without risk factors for severe disease? And, might people who already take daily fluvoxamine for mental health problems also gain some protection against COVID-19?
What are monoclonal antibodies? Can they help treat COVID-19?
Monoclonal antibodies are man-made versions of the antibodies our bodies naturally produce to fight invaders, such as the SARS-CoV-2 virus. Three monoclonal antibody treatments for COVID-19 have received emergency use authorization (EUA) from the FDA. These treatments are available to treat non-hospitalized adults and children 12 years and older with mild to moderate symptoms who have recently tested positive for COVID-19 and are at risk for severe COVID-19 or hospitalization. These therapies must be given intravenously (via an IV) as soon as symptoms appear.
Monoclonal antibody treatments approved under EUA are:
- A combination of casirimab and imdevimab called REGN-COV, made by Regeneron
- A combination of bamlanivimab and etesevimab made by Eli Lilly and Company
- sotrovimab, manufactured by GlaxoSmithKline.
All three treatments authorized by the FDA attack the coronavirus's spike protein, making it harder for the virus to attach and enter human cells. This has translated into a disadvantage when fighting the Omicron variant, which has more than 30 mutations on its spike protein. Laboratory studies found that only one FDA-authorized monoclonal antibody treatment -- sotrovimab -- was effective against Omicron.
As of January 2022, the number of patients who would benefit from monoclonal antibody therapy far exceeds the supply and infrastructure to deliver this treatment. Once oral antiviral drugs become more available, high-risk patients will have more treatment options.
Monoclonal antibody treatments may also help save lives in specific subgroups of hospitalized COVID-19 patients. Some COVID patients become sicker due to an overreaction of the body's immune response (cytokine storm) to the viral infection. When this happens, the body overproduces interleukin-6 (IL-6), a protein associated with inflammation, in lung cells. For these severely ill hospitalized patients, the FDA has granted EUA for tocilizumab (Actemra), a monoclonal antibody that blocks the effects of IL-6, thereby suppressing excessive immune system responses.
What is convalescent plasma? Will it help COVID-19 patients?
When people recover from COVID-19, their blood contains antibodies produced by their bodies that fight the coronavirus and help them recover. Antibodies are found in plasma, a component of blood.
In August 2020, the FDA issued an Emergency Use Authorization (EUA) for convalescent plasma for patients hospitalized with COVID-19. However, clinical evidence that this treatment is effective is limited. Therefore, the FDA narrowed the scope of its authorization in February 2021. Convalescent plasma is now authorized only for people who are immunocompromised, whether due to a medical condition or a treatment that suppresses the immune system. Treatment can be performed on both hospitalized and non-hospitalized patients.
Who can donate plasma for COVID-19?
In order to donate plasma, a person must meet several criteria. They must have tested positive for COVID-19, recovered, been symptom-free for 14 days, currently tested negative for COVID-19, and have sufficiently high antibody levels in their plasma. The donor and patient must also have compatible blood types. After the plasma is donated, it will be screened for other infectious diseases, such as HIV.
Each donor produces enough plasma to treat one to three patients. Donating plasma should not weaken the donor's immune system or make the donor more susceptible to reinfection with the virus.
