Treatments

Wikipedia has a list of drugs, a bit outdated.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

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:
  • 20230405: the US FDA approved vilobelimab for critically ill patients.
• Oral therapies:
  • Pfizer’s Paxlovid, a combination of two protease inhibitors (nirmatrelvir and ritonavir) is 89% effective against severe disease. Probably will cost ~US$500 per treatment course. It was approved for emergency use in the EU on 2021-12-16, in the USA on 2021-12-22, and in Canada on 2022-01-17.There is anecdata that Paxlovid cures Long COVID, for example this case report.
    • This paper from 2022-09-22 / USA says that Paxlovid is useful for adults of any age.
    • This article from 2022-06-14/USA says that a study of the effectiveness of Paxlovid on adults who were not at high risk was inconclusive.
    • This paper from 2022-12-13 from the USA says that Paxlovid reduces hospitalization by 40% and deaths by 70%.
    • This paper from 2022-11-05 from the USA says that Paxlovid reduces the risk of developing Long COVID by 26%f.
  • Marck’s molnupiravir (trade name Lagevrio) is 30% effective against severe disease (originally it was 50%, but I guess they redid their calculations or something). It works by mutating the virus to death. Approved 4 November by the UK. Probably will cost ~US$700 per treatment course.
  • Metformin:
    • This paper from 2022-08-18 from the USA says that metformin reduces the chance of at least one of death, hospitalization, emergency visits, and hypoxemia by 16%.
    • This paper from 2022-12-24 from the USA says that it reduces Long COVID by almost half.
    • This preprint from 2023-06-07 from the USA says that metformin reduced the COVID-19 viral load by 3.6x over placebo.
  • This 2023-02-22 press release reports that patients who took Ensitrelvir Fumaric Acid (brand name Xocova) took 80% less time to test negative.
  • 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.
  • In the pipeline:
    • Preliminary results for Novartis’ Ensovibep say that it’s 78% effective at preventing hospitalization. This article says it works against BA.1.
    • Baricitinib reduces deaths by 13% on top of whatever other benefit patients are getting from other drugs (3 March 2022).
    • Sabizabulin reduces deaths among hospitalized patients from 50% to 20%, according to the manufacturer. On 20230302, the US FDA declined to give it an emergency use authorization, but that was mostly due to concerns about the study size being too small; I had the impression that it will probably turn out to be a good drug.
    • A cheap liver drug called UDCA might help, but it’s speculative.
    • peginterferon lambda — which this 20230209 study says cuts the risk of severe infection by 50%
• Nasal therapies (also useful as a prophylactic)
  • Nasal irrigation
    • 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 from are 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.
    • 20210409 This paper from the UK says that people infected with COVID-19 who inhaled budesonide (a corticosteroid) twice per day early in the infection had less severe illness and recovered about one day faster.
  • SaNOtize:
    • The nasal spray SaNOtize was approved in India on 10 Feb 2022, manufactured under the name VirX (now FabiSpray).
    • SaNOtize/VirX is available now in India (as FabiSpray), Israel and Bahrain (as Enovid), and Thailand, Singapore, Hong Kong, Nepal, South Africa, Germany.
    • Here’s the preprint on the effectiveness study.
  • Viraleze:
    • Article on animal trials.
    • Paper on animal studies.
    • Paper on small human trial.
  • 35B5 monoclonal antibody:
    • Paper on small trial effectiveness
  • Intranasal photodynamic therapy
    • Paper on small human trial in Canada.
    • Paper on small human trial in Spain.
  • Intranasal corticosteroids
    • 20210823 Paper showing 22% lower risk in people who were already taking intranasal corticosteroids
  • I don’t have links to research backing it the claims, but Covixyl claims to help prevent COVID-19 and Betadine Cold Defense Nasal Spray claims to help prevent colds.
• 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.

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.

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:

• Vaccination cuts the risk of Long COVID by 15-40%
  • 20230228 review article from Australia.
  • 20230228 paper from France: 16.6% v 7.5% risk.
  • 20220702 paper from Italy ~40%
  • 20220525 from US: ~15% (Veteran’s Affairs, so mostly of old white men)
  • 20221128 paper from USA: Rheumatology patients had 50% lower risk of Long COVID.
  • 20210901 paper from UK
  • March 2022 review article from UK
• Metaformin cuts the risk of Long COVID by about 40%.
• Paxlovid
  • 20221105 preprint from USA: cuts risk by about 25%
• 20230222 press release claiming that ensitrelvir fumaric acid/ensitrelvir/Xocova reduces Long COVID risk by 45%.

Long COVID Treatments

• Vaccination:
  • 20230228 paper from Japan: About half of the unvaccinated people who had Long COVID got better after an mRNA vaccination.
• Guanfacine (an ADHD drug) plus N-acetylcysteine (an anti-oxidant used to treat traumatic brain injury):
  • 20221125 paper about the treatment
  • 20221213 article about the treatment
• Stellate ganglion block:
  • 20230131 article on a clinic in Texas treating loss of smell.
  • 20220115 case study (2 patients).
  • 20220814 case study (1 patient).
  • 20230405 mass media article about one woman who had smell restored in December 2022 with a stellate ganglion block.
• BC007 (Berlin Cures is trying to bring it to market):
  • July 2021 article about one case.
  • 20211230 in-depth article about BC007.
  • 20230703 Berlin Cures announces start of Phase 2 trials of BC007.
• 20230113 Review article with a section on treatments.

Advice

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