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Dr. Halverson: Current treatment options for COVID-19

Halverson

By Dr. Jim Halverson, Special to the Ojai Valley News

You’ve just tested positive for the SARS-CoV-2 virus. Here are recommendations to care for yourself at home as you isolate from others.

SYMPTOM RELIEF

Acetaminophen 1000 mg every eight hours and/or ibuprofen 600 mg every six hours can lessen fever or muscle aches. Do not take ibuprofen if you have a history of ulcers, kidney insufficiency or are on blood thinners. Check with your health care provider if you have concerns.

Robitussin DM may help lessen the cough often present and is generally safe in dosages recommended on its label.

Stay well hydrated (64 ounces or more of fluids per day). 

Minimize alcohol.

Stay well nourished. Healthy calories help your immune system fight the infection. 

In addition to symptom relief, it is very helpful to have a thermometer and pulse oximeter in your home to monitor your temperature and oxygen level in your blood stream. Knowing what your normal oxygen level is when you are not ill (generally above 95% in individuals without lung disease) can help guide you and your health care provider about whether you should be seen in the office or emergency department.

SUPPLEMENTS

Vitamin D — While vitamin D boosts your immune system and eases inflammation, well-conducted, double-blinded, randomized clinical trials have given conflicting results regarding its helpfulness in preventing or treating COVID-19.  If you are vitamin D deficient, supplementation will likely have already been recommended by your health care provider. If you do not know, it is okay to take vitamin D in moderation (1000-2000 units per day). Avoid higher doses (5000 units or more per day) unless your health care provider has recommended it. It is a fat-soluble vitamin and can cause toxicity at high doses.

Zinc — There is some evidence that zinc helps you get over a cold faster. Some common colds are caused by coronaviruses.  The novel coronavirus that causes COVID-19 is not the same type of virus that causes the common cold. If zinc has any affect at all on helping with symptoms, it is small. In addition, taking too much zinc can actually lower your immune response. If you elect to take it, do not exceed the recommended dosage (8 milligrams per day for adult women and 11 milligrams per day for adult men.) 50 mg per day is too much for most people and can cause copper imbalance or even overdose if taken for an extended period of time.

Other supplements —  Currently, there is insufficient data to support recommendations FOR OR AGAINST the use of any vitamin, mineral, herb or other botanical, fatty acid, or other dietary supplement ingredient to prevent or treat COVID-19. Avoid taking excess amounts without checking first with your health care professional.

PRESCRIPTION MEDICATIONS

There are 4 approved, prescription outpatient medications for the treatment of COVID-19 in the United States. All have limited availability currently. 

I am following the National Institutes of Health guidelines for prioritizing who should be offered the medication if it is available. With current supplies, only immunocompromised individuals not expected to mount an adequate immune response to COVID-19 vaccination or SARS-CoV-2 infection due to their underlying conditions (less than 1% of U.S. adults) and unvaccinated individuals at the highest risk of severe disease (age 75 or older or age 65 or older with additional clinical risk factors) are eligible. Check with your physician if you wish further information.

Oral medications — Paxlovid and Molnupiravir

Paxlovid is authorized for the treatment of mild to moderate COVID-19 in patients aged 18 and over who have tested positive and are at high risk for progression to severe disease. It should be taken as soon as possible after diagnosis and within 5 days of symptoms onset. There are numerous drug interactions that may alter the dosing or use of this antiviral.

Molnupiravir is authorized for the treatment of mild to moderate COVID-19 in patients aged 18 and over who have tested positive for SARS-CoV-2 infection, are at high risk for progression to severe COVID-19 and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate. 

The federal government has purchased about 3 million courses of molnupiravir and 20 million courses of Paxlovid. Production of both medications is expected to increase rapidly in the next few months. Both oral antivirals will be distributed by the federal government to individual states for allocation to health care facilities and pharmacies. They should be available at no charge.

Intravenous medications — Sotrovimab and Remdesivir

Sotrovimab is a monoclonal antibody therapy authorized for the treatment of mild-to-moderate COVID-19 in adults, children 12 years of age and older weighing at least 88 pounds, and pregnant females who have tested positive for SARS-CoV-2 and are at high risk for progression to severe COVID-19. It is given as an outpatient by infusion at approved health care facilities and is available in very limited amounts at both Ojai Valley Community Hospital and Ventura Community Memorial Hospital. 

Current eligibility guidelines will be used. In addition, unvaccinated pregnant women less that 24 weeks are also eligible due to their significant risk of severe disease.

Remdesivir was the first FDA-approved antiviral medication to treat COVID-19. It has been given to inpatients since October,2020. It is now available for outpatients who have tested positive for SARS-CoV-2 and are at high risk for progression to severe disease. It is given via IV infusion for 3 consecutive days at approved outpatient health care facilities. 

Ivermectin, Fluvoxamine, and Fluticasone Furoate —The FDA has not authorized or approved any of these medications for use in preventing or treating COVID-19. Completed clinical trial results, when analyzed by peer review, do not show they are effective. There are ongoing randomized, double blinded clinical trials which will give further information on these three medications in next few months. I currently am not recommending or prescribing any of these medications for COVID-19 prevention or treatment.

There is hope for better outcomes for those who become infected with the SARS-CoV-2 virus. More availability of currently approved medications will occur, and new medications are being tested. 

In the meantime, your best strategy is to stay as healthy as you can. Exercise, avoid excessive alcohol, eat well and get adequate sleep. Get fully vaccinated and keep up to date on vaccine recommendations. Wear a well-fitting, N-95, KN95, or surgical mask covered by a 3-layer or more cloth mask, and avoid large crowds both indoors and outdoors whenever possible.

Stay hopeful, stay well informed, stay safe and stay well.

— Dr. Jim Halverson is a longtime Ojai physician who writes about COVID-19 for the Ojai Valley News.

 

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