Treatments

Wikipedia has a list of drugs, a bit outdated.  I plan to do more work on this in the future.

Pretty much all of the monoclonal antibodies are no longer useful. The virus just mutates to avoid them. 🙁

These are certainly good:

  • Dexamethasone, 17% mortality reduction
  • IL-6 blockers, 24% mortality reduction on top of dexamethasone
  • Remdesivir (AKA Veklury), injected. There was some controversy about its effectiveness, especially given its cost, but a more recent study found it cut the chance of going on a ventilator by half.
  • The World Health Organization pre-qualified tocilizumab on 11 Feb 2022.
  • Infusions:
  • Oral therapies:
  • Nasal therapies (also useful as a prophylactic sometimes):
    • Nasal irrigation
      • 20231108 This paper from USA says that people who gargled and irrigated their nose with saline had ~1/3 the hospitalization rate of controls.
      • 20220825 This preprint says that nasal irrigation of good old saline is quite effective at reducing the severity of COVID-19. (The effectiveness that the article gives says that it’s more effective than Paxlovid!)
      • This paper says symptoms resolved 4-7 days earlier for people who irrigated with saline.
      • This paper from right before the pandemic says that people with the common cold (note: many colds are from non-COVID-19 coronaviruses) who irrigated with saline resolved symptoms about two days earlier than those who did not, and their household transmission was 35% lower than for controls. Looking at the graphs of symptoms over time for each group, it looks to me like the difference is mostly in eliminating long-duration outliers.
  • Mouthwashes: I was sceptical that mouthwashes might help reduce transmission or disease severity because killing viruses in the mouth doesn’t get rid of virus in the nose, lungs, gut, or other organs. HOWEVER, there is some evidence that it does help:
    • 20220305: This paper says that in a clinic where patients rinsed with dilute hydrogen peroxide once they entered a treatment room, they found virus in the waiting room’s filter but not in the treatment rooms’ filters.
    • 20020427: This prepandemic paper found that Japanese schoolchildren who gargled with Povidone-Iodine had an absentee rate of 19.8% for upper respiratory infections compared 25.5% in schools where the students did not gargle.
    • 20051019: This prepandemic paper from Japan found that people who gargled with providone/iodine had an 11% lower risk of getting an upper respiratory disease than controls. Interestingly, people who gargled with tap water had a 36% lower risk than controls! (Maybe this is due to the tap water in the study’s city being heavily chlorinated? I saw something about that in a different paper from Japan.)
    • 20020427: This prepandemic paper from Japan found that adults who had histories of ongoing problems with repeated upper respiratory infections decreased their infection frequency dramatically after gargling with providone/iodine regularly (4x/day).
    • For which solution to rinse with:
      • 20210301: This paper measured the effects of various mouthwashes and concluded that hydrogen peroxide (Colgate Peroxyl) was best at killing COVID-19 in the mouth, followed by povidone-iodine, chlorhexidine gluconate (CHG), and Listerine (essential oils and alcohol).
      • This paper (20230703) and this paper (20201210) say povidone iodine gargle reduces viral load in the mouth.
      • 20200815 This review article discusses mouthwashes and viral loads in the mouth, but was kind of wishy-washy about relative merits of different mouthwashes. Same with this review article (20200905).
      • 20210707: This paper found that there wasn’t much difference between Chlorhexidine 0.2% and 1% Povidone-iodine solutions.
    • Eye drops
      • 20201124 This article says that eye drops Lumify and Besivance got rid of COVID-19 in the eye. That probably isn’t going to help you avoid getting COVID-19 any better than a pair of glasses, but maybe? it will help COVID-related conjunctivitis?

There are quite a few papers now that say that the gut biome is messed up by COVID-19. Some explicitly say that probiotics help. See this Twitter thread for a summary.

This paper says that glycine supplements help defend against viruses in general.

Potentially effective?

  • sarilumab
  • inhaled budesonide — one study says that it reduces hospitalization, fever, recovery period
  • amodiaquine (an antimalarial) shows good results in hamsters
  • ADG20, a monoclonal antibody
  • Ciclesonide
  • Vitamin D looked good, then it didn’t, and now here’s a press release saying it is useful.
  • 20231025 This paper found that people who got simvastatin — a statin — were 12% more likely to survive a serious COVID-19 infection. However, this was not enough to meet the prespecified criteria for superiority to controls.

Also see https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/authorization/applications.html

Long COVID

Prevention

These treatments have been shown to reduce the incidence of Long COVID:

Long COVID Treatments

In Galen’s Long Covid Survival Guide, a guy tells what worked (partially) for him with Long COVID. tl;dr: antihistamine, low-dose Naltrexone, nicotine patches, antibiotic Amox-Clav, probiotic, better nutrition, liposomal Glutathione supplement, Melatonin.

Advice

This page has a big section on what to do if you get COVID-19.

Not Effective

  • This paper (20221215) found that gabapentin was effective at restoring smell, but this random controlled trial (20230921) found that it was not. The first paper was smaller and did not have controls, so I trust the second.
  • @@@TBD@@@ list all the monoclonal antibodies which don’t work any more against acute COVID-19