The COVID-19 pandemic is one of the greatest challenges modern medicine has ever faced. Doctors and scientists are scrambling to find treatments and drugs that can save the lives of infected people and perhaps even prevent them from getting sick in the first place.
Below is an updated list of 22 of the most-talked-about treatments for the coronavirus. While some are accumulating evidence that they’re effective, most are still at early stages of research. We also included a warning about a few that are just bunk. We are following 22 coronavirus treatments for effectiveness and safety.
WIDELY USED
These treatments have been used widely by doctors and nurses to treat patients hospitalized for diseases that affect the respiratory system, including COVID-19.
PROMISING EVIDENCE
Early evidence from studies on patients suggests effectiveness, but more research is needed. This category includes treatments that have shown improvements in morbidity, mortality and recovery in at least one randomized controlled trial, in which some people get a treatment and others get a placebo.
TENTATIVE OR MIXED EVIDENCE
Some treatments show promising results in cells or animals, which need to be confirmed in people. Others have yielded encouraging results in retrospective studies in humans, which look at existing datasets rather than starting a new trial. Some treatments have produced different results in different experiments, raising the need for larger, more rigorously designed studies to clear up the confusion.
NOT PROMISING
Early evidence suggests that these treatments do not work.
PSEUDOSCIENCE OR FRAUD
These are not treatments that researchers have ever considered using for COVID-19. Experts have warned against trying them, because they do not help against the disease and can instead be dangerous. Some people have even been arrested for their false promises of a COVID-19 cure.
EVIDENCE IN CELLS, ANIMALS OR HUMANS
These labels indicate where the evidence for a treatment comes from. Researchers often start out with experiments on cells and then move onto animals. Many of those animal experiments fail; if they don’t, researchers may consider moving on to research on humans, such as retrospective studies or randomized clinical trials. In some cases, scientists are testing out treatments that were developed for other diseases, allowing them to move directly to human trials for COVID-19.
WIDELY USED
Prone positioning
The simple act of flipping COVID-19 patients onto their bellies opens up the lungs. The manoeuvre has become commonplace in hospitals around the world since the start of the pandemic. It might help some individuals avoid the need for ventilators entirely. The treatment’s benefits continue to be tested in a range of clinical trials.
WIDELY USED
EMERGENCY USE AUTHORIZATION
Ventilators and other respiratory support devices
Devices that help people breathe are an essential tool in the fight against deadly respiratory illnesses. Some patients do well if they get an extra supply of oxygen through the nose or via a mask connected to an oxygen machine. Patients in severe respiratory distress may need to have a ventilator breathe for them until their lungs heal. Doctors are divided about how long to treat patients with noninvasive oxygen before deciding whether or not they need a ventilator. Not all COVID-19 patients who go on ventilators survive, but the devices are thought to be lifesaving in many cases.
PROMISING EVIDENCE
EVIDENCE IN CELLS, ANIMALS AND HUMANS
EMERGENCY USE AUTHORIZATION
Remdesivir
Remdesivir, was the first drug to get emergency authorization from the F.D.A. for use on COVID-19. It interferes with the creation of new viruses by inserting itself into new viral genes. Remdesivir was originally tested as an antiviral against Ebola and Hepatitis C, only to deliver lackluster results. However, a randomized controlled trial published in May concluded the drug reduced the recovery time of people hospitalized with COVID-19 from 15 to 11 days. (The study defined recovery as “either discharge from the hospital or hospitalization for infection-control purposes only.”) The trial did not show any effect on mortality, though retrospective data released in July hints that the drug might reduce death rates among those who are very ill. The F.D.A. responded to this data in May by issuing an emergency authorization in May for remdesivir’s use in critically ill patients who need supplemental oxygen. In August, they expanded that approval after researchers found that patients with less severe forms of COVID-19 seemed to benefit modestly from a five-day treatment course of remdesivir. The revised approval allows the use of the drug on all patients hospitalized with COVID-19, regardless of how severe their disease is. The move was criticized by some experts who said the F.D.A. had expanded remdesivir’s use without strong evidence to back the change.
PROMISING EVIDENCE
EVIDENCE IN HUMANS
Dexamethasone and Other Corticosteroids
Corticosteroids — often called steroids for short — are used to tamp down inflammation and for conditions such as allergies and asthma. In the 1960s, doctors began using them as a treatment for pneumonia and other severe respiratory illnesses, but the results of clinical trials were inconclusive. The COVID-19 pan- demic brought a new interest in these drugs, and a raft of new clinical trials were launched.
In June, a steroid called dexamethasone was the first shown to reduce COVID-19 deaths. A study of more than 6,000 people found that dexamethasone reduced deaths by one-third in patients on ventilators, and by one-fifth in patients on oxygen. It may be less likely to help — and may even harm — patients who are at an earlier stage of COVID-19 infection, however. In its COVID-19 treatment guidelines, the National Institutes of Health recommends only using dexamethasone in patients with COVID-19 who are on a ventilator or are receiving supplemental oxygen.
In September, researchers reviewed the results of trials on dexamethasone, along with two other steroids, hydrocortisone and methylprednisolone. Overall, they concluded, steroids were linked with a one-third reduction in deaths among COVID-19 patients.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS, ANIMALS AND HUMANS
Favipiravir
Originally designed to beat back influenza, favipiravir blocks a virus’s ability to copy its genetic material. A small study in March indicated the drug might help to purge the coronavirus from the airway. Larger, random- ized trials are now underway.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS, ANIMALS AND HUMANS
MK-4482
MK-4482 is another antiviral originally designed to fight the flu. Ridgeback Biotherapeutics and Merck are collaborating to develop it as a treatment for COVID-19. The drug, (previously known as EIDD-2801) produced promising results against the new coronavirus in studies this spring in cells and on animals. Clinical trials started this summer, with a large Phase 3 trial expected to start by October.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS
Recombinant ACE-2 -
To enter cells, the coronavirus must first unlock them — a feat it accomplishes by latching onto a human protein called ACE-2. Scientists have created artificial ACE-2 proteins which might be able to act as decoys, luring the coronavirus away from vulnerable cells. Recombinant ACE-2 proteins have shown promising results in experiments on cells, but not yet in animals or people.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS, ANIMALS AND HUMANS
Ivermectin
For decades, ivermectin has served as a potent drug to treat parasitic worms. Doctors use it against river blindness and other diseases, while veterinarians give dogs a different formulation to cure heartworm. Studies on cells have suggested ivermectin might also kill viruses. But scientists have yet to find evidence in animal studies or human trials that it can treat viral diseases. As a result, Ivermectin is not approved for use as an antiviral.
In April, Australian researchers reported that the drug blocked coronaviruses in cell cultures, but they used a dosage that was so high that might have dangerous side effects in people. The FDA immediately issued a warning against taking pet medications to treat or prevent COVID-19. “These animal drugs can cause serious harm in people,” the agency warned.
Since then a number of clinical trials have been launched to see if a safe dose of ivermectin can fight COVID-19. In Singapore, for example, the National University Hospital is running a 5,000-person trial to see if it can prevent people from getting infected. As of now, there’s no firm evidence that it works. Nevertheless ivermectin is being prescribed increasingly often in Latin America, much to the distress of disease experts.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS
Oleandrin
Oleandrin is a compound produced by the oleander shrub. It can cause irregular heartbeats, making the plant dangerous to ingest. But many plant compounds — even some potentially lethal ones — have proven to be medically useful, and so researchers have investigated oleandrin as a potential treatment for cancer. The U.S. Army Medical Research Institute of Infectious Diseases tested oleandrin on coronavirus-infected cells in May but the experiments were inconclusive. Researchers at Phoenix Biotechnology, a San-Antonio based company, and the University of Texas Medical Branch at Galveston then released a study finding that it was effective in a culture of monkey kidney cells infected with the coronavirus. The study has not yet been published in a scientific journal.
In July, Mike Lindell, the chief executive of My Pillow, a donor to President Trump and a Phoenix investor, attended a meeting at the White House to discuss oleandrin’s use against COVID-19.
But most compounds that kill viruses in cell cultures fail in further testing in animals or humans. What’s more, experts worry about the safety of oleandrin as a treatment for the coronavirus, given the toxicity of the plant. Phoenix Biotechnology is considering selling oleandrin as an over-the-counter supplement. Consumers should be aware that there is no evidence that it’s safe or effective against the coronavirus in people.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS AND HUMANS
EMERGENCY USE AUTHORIZATION
Convalescent plasma
A century ago, doctors filtered plasma from the blood of recovered flu patients. So-called convalescent plasma, rich with antibodies, helped people sick with flu fight their illness. Now researchers are trying out this strategy on COVID-19.
In August, top government scientists reportedly stopped the F.D.A. from giving emergency authorization to convalescent plasma, arguing the evidence was still too weak for such a step. But President Trump an- nounced on August 23 that the authorization would go ahead — a move that generated immediate controversy. In a statement, the N.I.H.’s COVID-19 Treatment Guide- lines Panel underscored the importance of further investigation into convalescent plasma’s effectiveness. Despite the F.D.A.’s emergency authorization, the panel said “there are insufficient data to recommend either for or against the use of convalescent plasma for the treatment of COVID-19.”
A study of the Mayo Clinic’s program suggested that the treatment provided a modest benefit, but only to patients who got treated early in their disease with plasma packed with high levels of antibodies. Outside experts warned that only randomized clinical trials could confirm such a benefit.
Few randomized clinical trials have yet delivered results, and what evidence they’ve produced is mixed.
On September 10, for example, Indian researchers reported on a trial of 464 patients who were moderately ill — the point at which many researchers suspect plasma may provide its biggest benefit. The people who got the plasma fared no better than those that didn’t.
Larger randomized clinical trials are underway, but they’ve struggled to enroll enough participants, some of whom worry they will receive a placebo instead of the treatment itself. Experts say that it’s vital to complete these trials to determine if convalescent plasma is safe and effective. The treatment may only be a stopgap measure until more potent therapies become widely available.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS, ANIMALS AND HUMANS
Monoclonal antibodies
Convalescent plasma from people who recover from COVID-19 contains a mix of billions of different kinds of antibodies. Some of the molecules can attack the coronavirus, but the vast majority are directed at other pathogens. When the pandemic began, scientists began sifting through this slurry of antibodies and picked out a few dozen types that provide a potent defense against COVID-19 in cells and animals according to preclinical studies.
These potent molecules, known as monoclonal antibodies, have a long track record in medicine. Monoclonal antibodies were first investigated in the 1970s, and since then the F.D.A. has approved them for 79 diseases, ranging from cancer to AIDS. Over the summer, companies and universities began giving monoclonal antibodies for COVID-19 to patients in a number of clinical trials. On September 16, Eli Lilly announced promising preliminary results from a monoclonal antibody trial on 452 patients newly diagnosed with COVID-19. The drug reduced their risk of getting hospitalized by 72 percent compared to a placebo. Eli Lilly are continuing their trials, and results from other studies are expected to come out through the end of the year.
On October 2, the White House announced that President Trump received a dose of an experimental antibody cocktail from the drug maker Regeneron.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN CELLS, ANIMALS AND HUMANS
Interferons
Interferons are molecules our cells naturally produce in response to viruses. They have profound effects on the immune system, rousing it to attack the invaders, while also reining it in to avoid damaging the body’s own tissues. Injecting synthetic interferons is now a standard treatment for a number of immune disorders. Rebif, for example, is prescribed for multiple sclerosis.
As part of its strategy to attack our bodies, the coronavirus appears to tamp down interferon. That finding has encouraged researchers to see whether a boost of interferon might help people weather COVID-19, particularly early in infection. Early studies, including experiments in cells and mice, have yielded encourag- ing results that have led to clinical trials.
An open-label study in China suggested that the molecules could help prevent healthy people from getting infected. On July 20, the British pharmaceutical company Synairgen announced that an inhaled form of interferon called SNG001 lowered the risk of severe COVID-19 in infected patients in a small clinical trial. The full data have not yet been released to the public, or published in a scientific journal. On August 6, the National Institute of Allergy and Infectious Diseases launched a Phase III trial on a combination of Rebif and the antiviral remdesivir, with results expected by fall 2020.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN HUMANS
Cytokine Inhibitors
The body produces signaling molecules called cytokines to fight off diseases. But manufactured in excess, cytokines can trigger the immune system to wildly overreact to infections, in a process sometimes called a cytokine storm. Researchers have created a number of drugs to halt cytokine storms, and they have proven effective against arthritis and other inflammatory disorders. Some turn off the supply of molecules that launch the production of the cytokines themselves. Others block the receptors on immune cells to which cytokines would normally bind. A few block the cellular messages they send. Depending on how the drugs are formulated, they can block one cytokine at a time, or muffle signals from several at once.
Researchers are now trying out a number of different cytokine inhibitors against COVID-19 in clinical trials. So far, the results are mixed. In some trials, the drug tocilizumab has shown some evidence of reducing deaths, but has failed to help in others. A similar drug, sarilumab, did not appear to benefit patients in Phase 3 clinical trials.
Another drug, baricitinib, which can affect many types of cytokines at once, has shown some promise when doctors used it in combination with the antiviral drug remdesivir.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN HUMANS
EMERGENCY USE AUTHORIZATION
Blood filtration systems
The F.D.A. has granted emergency use authoriza- tion to several devices that filter cytokines from the blood in an attempt to cool cytokine storms. One machine, called Cytosorb, can reportedly purify a patient’s entire blood supply about 70 times in a 24-hour period. A small study in March suggested that Cytosorb had helped dozens of severely ill COVID-19 patients in Europe and China, but it was not a randomized clinical trial that could conclu- sively demonstrate it was effective. A number of studies on blood filtration systems are underway, but experts caution that these devices carry some risks. For example, such filters could remove benefi- cial components of blood as well, such as vitamins or medications. In September, a team of experts urged that blood filtration for COVID-19 be limited to randomized clinical trials.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN HUMANS
Stem cells
Certain kinds of stem cells can secrete anti-in- flammatory molecules. Over the years, researchers have tried to use them as a treatment for cytokine storms, and now dozens of clinical trials are under way to see if they can help patients with COVID-19. But these stem cell treatments haven’t worked well in the past, and it’s not clear yet if they’ll work against the coronavirus.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN HUMANS
Anticoagulants
The coronavirus can invade cells in the lining of blood vessels, leading to tiny clots that can cause strokes and other serious harm. Anticoagulants are commonly used for other conditions, such as heart disease, to slow the formation of clots. Doctors some- times use them on patients with COVID-19 who have clots, but there’s no clear evidence of what benefits and risks they offer to people with the disease. On September 10, the National Institutes of Health announced three large randomized clinical trials to evaluate anticoagulants on people with COVID-19 who have not yet been hospitalized, people who are being treated in hospitals, and people who have been sent back home.
TENTATIVE OR MIXED EVIDENCE
EVIDENCE IN HUMANS
Vitamin and mineral supplements
Our bodies need vitamins and minerals to work properly. Some researchers are investigating whether supplements might help against COVID-19, but there’s no strong evidence yet that they prevent infections or speed up recovery from them.
Vitamin C is known to tamp down inflammation, and so some researchers are investigating whether it can help with the immune system’s overreaction to COVID- 19 in several clinical trials. No convincing data showing a benefit has emerged yet. It’s also important to bear in mind that it’s possible to ingest too much vitamin C, causing symptoms including diarrhea and nausea.
Vitamin D has also attracted attention. Along with promoting good bone health, it may play some role in helping immune cells function. Some studies have found an association between low levels of vitamin D and higher rates of COVID-19. But such studies cannot establish that this deficiency was the cause of those disease rates. It may be that populations who suffer high rates of vitamin D deficiency are getting hit harder by the coronavirus for other reasons, including poorer access to health care or underlying conditions like obesity. Some clinical trials are underway to test whether vitamin D can help COVID-19 patients.
A 2010 study on the coronavirus that causes SARS found that zinc can put the brakes on the replication of the virus in cultures of cells. Small clinical trials are now underway to see if zinc can provide any benefit to people with COVID-19 or even prevent it. As of yet, however, there is no evidence that it does either.
NOT PROMISING
EVIDENCE IN CELLS AND HUMANS
Lopinavir and ritonavir
Twenty years ago, the F.D.A. approved this combination of drugs to treat H.I.V. Recently, researchers tried them out on the new coronavirus and found that they stopped the virus from replicating. But clinical trials in patients proved disappointing. In early July, the World Health Organization suspended trials on patients hospitalized for COVID-19. They didn’t rule out studies to see if the drugs could help patients not sick enough to be hospitalized, or to prevent people exposed to the new coronavirus from falling ill. The drug could also still have a role to play in certain combination treatments.
NOT PROMISING
EVIDENCE IN CELLS, ANIMALS AND HUMANS
Hydroxychloroquine and chloroquine
German chemists synthesized chloroquine in the 1930s as a drug against malaria. A less toxic version, called hydroxychloroquine, was invented in 1946, and later was approved for other diseases such as lupus and rheumatoid arthritis. At the start of the COVID-19 pandemic, researchers discovered that both drugs could stop the coronavirus from replicating in cells. Since then, they’ve had a tumultuous ride. A few small studies on patients offered some hope that hydroxychloroquine could treat COVID-19. The World Health Organization launched a randomized clinical trial in March to see if it was indeed safe and effective for COVID-19, as did Novartis and a number of universities. Meanwhile, President Trump repeatedly promoted hydroxychloroquine at press conferences, touting it as a “game changer,” and even took it himself. The F.D.A. temporarily granted hydroxychloroquine emergency authorization for use in COVID-19 patients — which a whistleblower later claimed was the result of political pressure. In the wake of the drug’s newfound publicity, demand spiked, resulting in shortages for people who rely on hydroxychloroquine as a treatment for other diseases.
But more detailed studies proved disappointing. Studies on animals such as monkeys and mice found no evidence that hydroxychloroquine stopped the disease. Randomized clinical trials found that hy- droxychloroquine didn’t help people with COVID-19 get better or prevent healthy people from contracting the coronavirus. Another randomized clinical trial found that giving hydroxychloroquine to people right after being diagnosed with COVID-19 didn’t reduce the severity of their disease. (One large-scale study that concluded the drug was harmful as well was later retracted.) The World Health Organization, the National Institutes of Health and Novartis have since halted trials investigating hydroxychloroquine as a treatment for COVID-19, and the F.D.A. revoked its emergency approval. The F.D.A. now warns that the drug can cause a host of serious side effects to the heart and other organs when used to treat COVID-19. In July, researchers at Henry Ford hospital in Detroit published a study finding that hydroxychlo- roquine was associated with a reduction in mortality in COVID-19 patients. The study was not a randomized controlled trial, in which some people got a placebo instead of hydroxychloroquine. The study’s results might therefore not be due to the drug killing the virus. Instead, doctors may have given the drug to people who were less sick, and thus more likely to recover anyway.
Despite negative results, a number of hydroxychlo- roquine trials have continued, although most are small, testing a few dozen or a few hundred patients. A recent analysis by STAT and Applied XL found more than 180 ongoing clinical trials testing hydroxychlo- roquine or chloroquine, for treating or preventing COVID-19. Although it’s clear the drugs are no panacea, it’s theoretically possible they could provide some benefit in combination with other treatments, or when given in early stages of the disease. Only well-designed trials can determine if that’s the case.
PSEUDOSCIENCE OR FRAUD
Drinking or injecting bleach and disinfectants
Disinfectants can help slow the spread of the coronavirus, but only when used properly for cleaning your house and hands. Washing with soap is the best way to keep your hands clean, but alcohol-based sanitizers will do if you’re not near a sink.
It’s important to only use the right products. Never mix bleach and ammonia to disinfect surfaces, for example, because it can release toxic gas. As for hand- sanitizers, make sure to use brands with greater than 60% ethanol or 70% isopropanol. The FDA has warned that some sanitizers contain wood alcohol, or methanol, which can be dangerous.
PSEUDOSCIENCE OR FRAUD
UV light
Researchers have used UV light to sterilize surfaces, including killing viruses, in carefully managed laboratories. But UV light would not be able to purge the virus from within a sick persons’ body. This kind of radiation can also damage the skin. Most skin cancers are a result of exposure to the UV rays naturally present in sunlight.
PSEUDOSCIENCE OR FRAUD
Silver
Several metals do have natural antimicrobial properties, but none has been shown to be effective against the coronavirus. As for silver, the National Institutes of Health warns that “scientific evidence doesn’t support the use of colloidal silver dietary supplements for any disease or condition.” It can also be dangerous, causing people’s skin to turn blue and making it difficult for them to absorb antibiotics and other drugs.
Last updated on October 10, 2020.
© The New York Times
