According to the CDC, most people who become ill with COVID-19 will not require any specific treatment, with over-the-counter fever and pain reducers to relieve aches and pains associated with illness advised. Ensuring adequate hydration and rest are also considered important for recovery.
The CDC also recommends that individuals with one or more underlying health conditions contact a health care provider immediately following a positive COVID-19 test to discuss treatment and intervention options.
FDA Approved Treatments
Vekluky (Remdesivir)
The FDA has approved Remdesivir for use in COVID-19 patients 28 days of age and older and who weigh at least 3 pounds. Remdesivir, an antiviral medication administered intravenously, must be given in an acute care setting such as a hospital or similar facility. This drug, initially approved for use under EUA in May 2020, received FDA approval for use in SARS-CoV-2 positive hospitalized individuals aged 12 years and older and weighing at least 40 pounds in October 2020. The FDA has since expanded its approval of the drug to include children as young as 28 days of age, and for use in outpatient settings, for the treatment of mild to moderate COVID-19 illness.
Approval for the use of Remdesivir in infants and young children was based on an open label study of only 53 children, with no placebo control. In this study, 72 percent of children suffered adverse events, but 21 percent of these serious adverse events were considered by the investigators to be unrelated to the medication. Three children died during the study, from either COVID-19 or a pre-existing condition.
In 2020, the World Health Organization (WHO) reported that preliminary results of a larger international study found that Remdesivir “appeared to have little or no effect on hospitalized COVID-19.” Additionally, the European Society of Intensive Care Medicine stated in 2020 that Remdesivir should not be used routinely in COVID-19 patients. In 2021, the Journal of the American Medical Association (JAMA) concluded that
“remdesivir treatment was not associated with improved survival but was associated with longer hospital stays. Routine use of remdesivir may be associated with increased use of hospital beds while not being associated with improvements in survival.”
The Lancet similarly concluded later in 2021 that:
“No clinical benefit was observed from the use of remdesivir in patients who were admitted to hospital for COVID-19, were symptomatic for more than 7 days, and required oxygen support.”
Paxlovid (Nirmatrelvir/ritonavir)
In May 2023, the FDA approved Paxlovid, an oral anti-viral medication, for the treatment of mild-to-moderate COVID-19 in adults considered at high risk for developing severe COVID-19 illness. The drug manufactured and packaged under EUA, however, will continue to be made available under EUA to adults and to children aged 12 through 17 years of age not covered by the FDA approval.
Paxlovid, manufactured by Pfizer, initially received approval under EUA for use in SARS-CoV-2 positive children aged 12 years and older considered at high risk for severe disease, to be given as soon as a diagnosis is made and within five days of symptom onset.
Side effects of the medication include diarrhea, impairment of taste, high blood pressure, and muscle aches. One of the components of Paxlovid, Ritonavir, can cause liver damage. This medication may also lead to HIV-1 drug resistance in persons with undiagnosed or uncontrolled HIV-1. The medication is not recommended for use in persons with kidney or liver disease. According to the FDA, an analysis of the medication in 1,039 individuals reported a 0.86 fatality rate in persons who received Paxlovid, compared to the placebo group (1,046 individuals) that reported a 6 percent death rate. Studies on the medication are ongoing. Paxlovid has the potential to cause severe or life-threatening reactions if taken with common medications such as antidepressants, anticoagulants, and statins.
A case study published in September 2022 suggested that individuals treated with Paxlovid may experience COVID-19 rebound infections. This information prompted the CDC in 2022 to issue an emergency alert to health care providers regarding the risk of “rebound” COVID-19 infection in individuals treated with Paxlovid. The alert stated that additional treatment with Paxlovid was not recommended and those experiencing a relapse in symptoms should re-isolate for at least five days and wear a mask for at least ten days. During 2022, several individuals, including Dr. Anthony Fauci, President Joe Biden, and First Lady Jill Biden reported rebound COVID-19 infection after taking Paxlovid.
In late April 2022, Pfizer announced that Paxlovid did not prevent symptomatic COVID-19 illness in household contacts of persons who took the medication.
