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Early on in the pandemic, healthcare providers had very few options for treating patients hospitalized with COVID-19. While drugs like the highly publicized hydroxychloroquine have been proven to be ineffective, others have risen to the top with enough evidence that they help to shorten illness and save lives:
Monoclonal antibodies are produced in a laboratory and serve to enhance or mimic the immune system's response to disease. Monoclonal antibodies are already used to treat other diseases, including cancer, rheumatoid arthritis, multiple sclerosis, and Crohn's disease.
Monoclonal antibodies, like the ones produced by the pharmaceutical companies Regeneron and Lilly, are drugs that have shown promise when given to patients early in the course of their disease. This treatment is available in very limited supply for emergency use in people at high risk for severe COVID-19 or hospitalization.
Michigan Medicine is currently using bamlanivimab and etesevimab for patients at high risk for severe COVID-19. These are investigational medicines, available under FDA emergency use authorization:
- In non-hospitalized adults and adolescents 12 years of age and older
- With mild to moderate symptoms
- Who weigh 88 pounds or more
- Who are at high risk for developing severe COVID-19 symptoms or the need for hospitalization
Bamlanivimab/etesvimab is given through a one-time intravenous (IV) infusion and requires an hour of observation afterward. The most common reported side effects after the infusion are nausea, diarrhea, dizziness, vomiting, muscle aches, headache, and fatigue.
It is important to consult with your primary care provider as soon as you test positive for COVID-19 so your provider can determine if you are eligible for and would benefit from monoclonal antibody therapy.
Remdesivir is a FDA-approved antiviral drug that works by blocking the virus from replicating in the body. Michigan Medicine has been using the treatment since the spring of 2020, first as part of a clinical trial, then under emergency use authorization and now with full FDA approval. It's been demonstrated that patients who are hospitalized for moderate or severe COVID and treated with remdesivir tend to go home sooner.
However, so far the drug appears to have no effect on whether people die from COVID. And it appears to have no effect on patients with severe disease who are on high-flow oxygen or a mechanical ventilator.
Dexamethasone, a drug that is 60 years old, is a corticosteroid that works by decreasing the body’s misdirected response to disease and is turning the tide for many patients with severe COVID-19. It has long been studied for the treatment of acute respiratory disease syndrome and sepsis.
The drug should not be given to outpatients as it can be harmful if given during an active viral infection, and it needs to be used with careful follow-up. This drug may also be harmful if given early in the course of the disease.
Supplemental oxygen is standard of care for patients with low oxygen levels, and blood thinners are standard treatment to reduce the risks of blood clotting.
Less Effective Treatments
Other treatments have been shown over time to be ineffective, like the highly publicized hydroxychloroquine.
Early on, convalescent plasma, an old therapy where patients are given blood plasma from people who recovered from COVID-19 and generated antibodies against SARS-CoV-2, received emergency use authorization from the FDA. It was used by providers desperate to offer any therapy, but there is currently little good trial data to support its use and trials are still ongoing.
Similarly, over-the-counter supplements like vitamin C, D, and zinc, currently have no evidence to support their use.
For more details about the treatments outlined above, visit the Michigan Health Blog post, "COVID-19 Therapies: Where Are We?"