What medications are being used to treat COVID-19?

September 17, 2020 | by Edward-Elmhurst Health
Categories: Healthy Driven Life

With the number of people infected by the novel coronavirus (COVID-19) rising every day, scientists are working around the clock to find ways to effectively treat the virus.

Since antibiotics don’t work against viruses, the body’s immune system must typically fight them off until they run their course. This is challenging when symptoms become severe, as in some cases of the novel coronavirus.

This is a complex disease process; it is a new virus that we have only known about for a short time. While new medicines are being developed to fight COVID-19, doctors are currently relying on a range of older medicines to treat infected patients.

“It is important to understand that there are currently no FDA-approved medications for the treatment of the coronavirus.  All medications that are currently being used are being done so based on clinical experience gained from treating other diseases,” says Phillip Williams, Pharm.D., MBA, Associate Vice President of Pharmacy Services for Edward-Elmhurst Health.

The FDA has granted an EUA (emergency use authorization) for remdesivir and convalescent plasma.  This is not a traditional FDA approval based on large complex clinical trials. The EUA is a mechanism the FDA has to allow medications to be used in emergency situations because they have shown some benefit and good safety data. 

It is important to note that the FDA has rescinded the EUA for hydroxychloroquine due to lack of efficacy against the virus and safety concerns, especially cardiovascular safety. 

The EUA for remdesivir was recently expanded to allow utilization in a wider range of patients who go to the hospital, test positive for the coronavirus, and have moderate to severe disease.  The EUA for convalescent plasma has recently come under some scrutiny and it currently is being recommended for individuals with more advanced disease.

“New information is being disseminated daily. This new information is constantly being reviewed and evaluated to determine if and when we should incorporate new medications into our treatment decisions and when we should alter what is currently being done,” says Williams.

Current treatment for mild to moderate COVID-19 symptoms may include supportive care such as hydration (IV fluids), pain and fever control, and breathing treatments. Sometimes antibiotics are used to treat concurrent bacterial infections.

There is some information cautioning patients about taking non-steroidal anti-inflammatory medications, such as ibuprofen (Motrin) and naproxen (Aleve). This information has not been studied or confirmed and therefore, it is difficult to make a recommendation. Acetaminophen (Tylenol) is an effective medication for mild pain and fever control. 

Patients with more severe symptoms are typically admitted to the hospital and treated with various medications to slow the progression of the disease and relieve symptoms. Some patients need supplementary oxygen and mechanical ventilatory support. 

We have learned a great deal about how to optimally treat patients with severe disease and incorporated new techniques and medications that have had a very positive effect on recovery and reduced mortality.

Techniques such as proning (having patients lay on their stomach), as well as the addition of glucocorticoids, such as dexamethasone and blood thinners (heparin), have helped our patients recover quicker. Patients who develop clotting complications as a result of the virus may receive blood thinners. 

The current methodology to treat COVID-19 involves using antiviral medications, anti-inflammatory medications, immune system modulators, and anti-malaria medications. Examples of specific medications being used for COVID-19 include: remdesivir, glucocorticoids, tocilizumab and convalescent plasma. 

In treatment with convalescent plasma, patients previously infected and recovered may have antibodies that could be transferred to sick patients via plasma transfusion.

If you have had COVID-19 and recovered, you may want to consider donating your plasma so that others may use it and potentially have a more positive outcome from the disease.  You can contact your local blood collection center for instruction on how to give.

There are also investigational drugs for COVID-19 being studied in clinical trials underway across the globe.

What about an allergy to medications? For patients who have received any of these medications previously and experienced an allergic reaction, doctors would potentially prescribe alternate medications. In some incidences, an alternative may not be available and doctors would treat the allergic reaction if it occurs. 

Keep in mind that nausea, vomiting, diarrhea, drowsiness are common side effects of medications, not allergic reactions. An allergic reaction would be a rash, tongue swelling, shortness of breath/trouble breathing, etc. 

Many are wondering when a vaccine to prevent COVID-19 will become available. “It typically takes 18-24 months to develop a safe and effective vaccine. We are all hoping that this time frame will be shortened but there are no guarantees of when a vaccine will be available,” says Williams.

There are many companies in different stages of developing and testing vaccines. None of them have completed their clinical trials to date. There are many different types of vaccines being developed and tested as well. These vaccines will provide some level of immunity based on how they work inside the human body.

The hope is to have the necessary data available as soon as possible to submit to the FDA for approval.  Some manufacturers are closer than others. It is difficult to estimate when the clinical trials will be completed, when the data will be submitted to the FDA and when the FDA will approve the vaccine for use in the United States.

What is unique about this vaccine discovery process is that the United States government, through Operation Warp Speed, is providing financial support to the vaccine manufacturers to begin producing vaccine before the vaccine is approved. Therefore, if and when the vaccine is approved, some quantity of vaccine will be immediately available. 

The U.S. government and Operation Warp Speed, via the Centers of Disease Control and Prevention, will work with individual state health departments, who in turn will work with local county health departments, on the distribution and administration of the vaccine.

To date, we’ve learned that there will be a 4-phase approach to vaccinating the public: 

  • Phase I will involve frontline healthcare workers, first responders, individuals essential to maintain daily life, individuals who reside in nursing homes or long-term care facilities, and high-risk individuals in the community.
  • Phases II-IV will expand access to the vaccine over time with the goal of vaccinating 80% of the population throughout calendar year 2021. 

It is important to remember that this is a fluid situation that is literally changing by the day and these phases and the individuals within the phases may, and probably will, change.  It is all dependent on when a vaccine(s) is/are approved, how many are available, and how quickly more vaccines can be produced.  No one has a crystal ball and all of this is dependent on the clinical trials of the various vaccines and the timing of FDA approval.

If we have a vaccine or vaccines approved for use by the end of calendar year 2020, it is probably reasonable that we will be vaccinating people throughout calendar year 2021. If the approval comes later and into the spring or summer of 2021, then we will have to push these timelines back accordingly.

Doctors continue to emphasize the importance of infection prevention and control measures to slow the spread of the virus.

“For now, our best defense is social distancing and limiting your exposure to others to prevent transmission of the virus,” says Williams. “Stay hydrated, get plenty of rest, eat healthy foods and isolate yourself as much as possible.”

It is important to note that treatment information is changing daily, and medications are being added and removed based on evolving experience and information about COVID-19. 

Fortunately, most people who become ill with COVID-19 will be able to recover at home. However, if you begin to experience more severe symptoms, such as an elevated fever, shortness of breath and/or trouble breathing, seek immediate medical attention.

At Edward-Elmhurst Health, our top priority is the safety and protection of patients, staff, physicians and the community. For updates on our planning and response efforts as we work to stop the spread of COVID-19, please check EEHealth.org/coronavirus.

The information in this article may change at any time due to the changing landscape of this pandemic. Read the latest on COVID-19.

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