Coronavirus disease 2019 (COVID-19) has been detected in over 40 million people in the United States since the start of pandemic, as of September 29, 2021, per the CDC. This infection indeed overwhelmed healthcare systems all over the world and brought suffering on a global scale. However, we have learned a lot from COVID-19 pandemic. We have become increasingly aware of our health conditions overall, and we have also learnt the importance of hand hygiene, face masking and practicing social distancing.
Additionally, due to the high acuity of the COVID-19 disease process, biomedical research was fueled at a much faster pace to find medications that could help with this infection. While many trials are still underway, I will share some information on the four drugs that have been proven to help in COVID-19 infection with at least moderate quality of evidence and when they should be used.
- Corticosteroids (kor·tuh·kow·steh·roydz) : There is moderately strong evidence that corticosteroids may save lives if given to patients with severe or critical illness in a hospitalized setting. This does not apply to patients who have non-severe infection and are being monitored at home. This medication can be given orally or as an injection.
- Casirivimab (KAS·i·RIV·i·mab) and Imdevimab (im·DEV·i·mab) : These antibodies are sold together as REGEN-COV. There is moderately strong evidence that it may reduce the risk of hospitalization when given to patients with non-severe COVID-19 infection. It may also be beneficial in saving lives if given to hospitalized patients with severe or critical COVID-19 infection if they are seronegative (negative antibody test for COVID-19 in the setting of PCR confirmed COVID-19). This medication is administered as an injection.
- Tocilizumab (taa·suh·li·zuh·mab) : Sold as Actemra, this is an IL-6 receptor blocker that has high quality evidence for its effect in patients with severe or critical illness in a hospitalized setting, reducing the risk of death and risk of being put on a mechanical ventilator. This medication is administered as an injection.
- Sarilumab (sar·IL·ue·mab) : Sold as Kevzara, this is in the same class of medication as Tocilizumab and has similar high quality evidence for its effect in patients with severe or critical illness in a hospitalized setting, reducing the risk of death and risk of being put on a mechanical ventilator. This medication is administered as an injection.
I know many of you are wondering — What about Hydroxychloroquine, Ivermectin, Remdesivir, Kaletra? Based on current evidence, none of these have moderate or high quality evidence to support their benefit. Additionally, there is some evidence suggesting harm to the patients with hydroxychloroquine, ivermectin, Kaletra.
This article is meant to increase general awareness about COVID-19 treatment options, not as a substitute for consulting a physician before taking any medications.
It should also be clearly understood that none of the above mentioned beneficial medications are universally effective. The benefits of these medications are realized by only a fraction of people they are administered to. Hence, prevention via vaccination, hand hygiene, face masking and practicing social distance is still required and probably the most effective way to avoid COVID-19 related illness and death.
-Dr. Vinit Agrawal