Currently, there are no drugs capable of treating the new coronavirus. Therefore, in most cases, treatment is done only with some measures and medications capable of relieving the symptoms of COVID-19.
The mildest cases that have symptoms of the common flu, can be treated at home with rest, hydration and use of fever and analgesic remedies. On the other hand, the most severe cases, in which there are more intense symptoms and complications such as pneumonia, they need to be treated in the hospital, often in Intensive Care Units (ICU). This is to ensure there is proper administration of oxygen and the monitoring of vital signs.
The drugs that are approved for the treatment of coronavirus, by Anvisa and the Ministry of Health, are those capable of relieving the symptoms of the infection, and they include:
- Antipyretics: These lower the temperature and fight fever.
- Analgesics: They relieve muscle pain throughout the body.
- Antibiotics: They treat possible bacterial infections that may arise together with COVID-19.
These remedies should only be used under the guidance of a doctor. Although they are approved for the treatment of the new coronavirus, they are not able to eliminate the virus from the body, but are only used to relieve symptoms and improve the comfort of the infected person.
Remedies that are being studied
Apart from remedies that help relieve symptoms, several countries are developing studies on infected patients, to try to identify a vaccine.
The drugs being studied should not be used without the guidance of a doctor, or as a way to prevent infection, as they can cause various side effects and put life at risk.
The following is a list of the main drugs being studied for the new coronavirus:
This is a broad-spectrum antiviral remedy that was developed to treat the Ebola virus epidemic, but has not presented results as positive as other substances. However, due to its broad action against viruses, it is being studied to understand if it can present better results in the elimination of the new coronavirus.
The first laboratory studies with this remedy, in the United States and China showed promising effects, since the substance was able to prevent replication and multiplication of the new coronavirus, as well as other viruses of the coronavirus family.
However, before it can be advised as a form of treatment, this medicine needs to undergo several studies with humans to understand its true efficacy and safety. Thus, there are currently about 6 studies that are being done with a high number of patients infected with COVID-19, both in the United States, Europe and Japan. The results should only be released in April and there is no evidence for now that Remdesivir can be used to treat the new coronavirus in humans.
Updated on April 29, 2020:
According to an investigation by Gilead Sciences, in the United States, the use of Remdesivir in patients with COVID-19 seems to present the same results in a treatment period of 5 or 10 days and in both cases patients are discharged from the hospital in about 14 days and traces of side effects are too low. This study does not indicate how effective the drug is to eliminate the new coronavirus and therefore other studies continue to be done.
Updated on May 16, 2020:
A study conducted in China on 237 patients with severe effects of COVID-19 infection reported that patients treated with this remedy had a slightly faster recovery compared to control patients, with an average of 10 days compared to the 14 days presented by the placebo-treated group.
Updated on May 22, 2020:
The preliminary report of another investigation made in the United States with The Remdesivir also pointed out that the use of this drug seems to reduce recovery time in hospitalized adults, as well as reducing the risk of lower respiratory tract infection.
Updated on July 26, 2020:
According to a study by Boston University’s School of Public Health, Remdesivir decreases treatment time in ICU patients.
Updated on November 5, 2020:
The final report of the study that was done in the United States with Remdesivir indicated that the use of this drug reduces the average recovery time in hospitalized adults from 15 to 10 days.
Updated on November 20, 2020:
WHO advised against the use of Remdesivir remedy in the treatment of patients hospitalized with COVID-19 due to a lack of conclusive data indicating that Remdesivir decreases the mortality rate.
Dmethhasone is a type of corticosteroid that is widely used in patients with chronic respiratory problems, such as asthma. It can also be used in treatment of other inflammatory problems such as arthritis or inflammation of the skin. This medicine has been tested to reduce the symptoms of COVID-19 as it can help to reduce inflammation in the body.
According to a study being done in the UK, Dmethhasone appears to be the first drug tested to greatly reduce the mortality rate of patients in severe condition with COVID-19. According to the results of the study, Dmethhasone was able to decrease the mortality rate by up to 1/3 after 28 days of infection with the new coronavirus, especially in people who are in need of a ventilators.
It is important to note that Dmethhasone does not treat coronavirus from the body, it only relieves symptoms and avoid more serious complications.
Updated on June 19, 2020:
The Brazilian Society of Infectious Diseases recommended the use of Dmethhasone for 10 days for the treatment of all patients with COVID-19 hospitalized in the ICU using mechanical ventilation. However, corticosteroids should not be used in mild cases or as a method of prevention.
Updated on July 17, 2020
According to scientific research carried out in the United Kingdom, treatment with Dmethhasone for 10 days in a row decreases the mortality rate in patients with very severe infection on the new coronavirus, who require a ventilator. In such cases, the mortality rate decreases from 41.4% to 29.3%. In the other patients, the effect of Dmethhasone treatment did not present such marked results.
Updated on September 2, 2020:
A meta-analysis based on 7 clinical trials concluded that the use of Dmethhasone and other corticosteroids may reduce mortality in critically ill patients infected with COVID-19.
Updated on September 18, 2020:
The European Medicines Agency (EMA) approved the use of Dmethhasone in the treatment of adolescents and adults infected with the new coronavirus, who are in need of oxygen support.
3. Hydroxychloroquine and chloroquine
Hydroxychloroquine, also known as chloroquine, are the two substances used to treat patients with malaria, lupus and other specific health problems, but which are not yet considered safe in all cases of COVID-19.
Study conducted in France and China , showed promising effects of chloroquine and hydroxychloroquine in reducing viral load and reducing the transmission of the virus into cells, reducing the virus’s ability to multiply, thus providing a faster recovery. However, these studies were conducted in small samples and not all tests were positive.
According to the Brazilian Ministry of Health, chloroquine can only be used in people hospitalized for 5 days, under permanent observation, to assess the emergence of possible serious side effects, such as heart problems or changes in vision.
Updated on April 4, 2020:
One of the ongoing studies done in France with the combined use of hydroxychloroquine with the antibiotic azithromycin, showed promising results in a group of 80 patients with mild symptoms of COVID-19. In this group, there is a decrease in the viral load of the new coronavirus in the body after about 8 days of treatment, which is less than the average of 3 weeks presented by people who did not have any specific treatment.
In this investigation, out of the 80 patients studied, only 1 person died, as she was admitted to the hospital at a very advanced stage of the infection, which may have hindered treatment.
These results continue to support the theory that the use of hydroxychloroquine may be a safe way to treat COVID-19 infection, especially in cases of mild symptoms. It also decreases the risk of transmission of the disease. However, it is necessary to wait for the results of other studies that are being conducted with the drug, to obtain results from a larger population sample.
Updated on April 23, 2020
The Brazilian Federal Council of Medicine approved the use of Hydroxychloroquine in association with Azithromycin at the physician’s discretion in patients with mild symptoms, but who do not require ICU admission. Other viral infections, such as Influenza or H1N1, were ruled out and the diagnosis of COVID-19 was confirmed.
Thus, due to the lack of robust scientific results, this combination of medicines should only be used with the patient’s consent and with the doctor’s recommendation, after assessing the possible risks.
Updated on May 22, 2020:
According to a study conducted in the United States with 811 patients, the use of Chloroquine and Hydroxychloroquine, with or without azithromycin does not have beneficial effects on the treatment of COVID-19. It seems to double the mortality rate of patients, since these drugs increase the risk of heart problems, especially arrhythmia and atrial fibrillation.
To date, this is the largest study done with hydroxychloroquine and chloroquine. Since the results presented go against what has been said about these drugs, further studies continue to be done.
Updated on May 25, 2020:
The World Health Organization (WHO) temporarily suspended research done on hydroxychloroquine that it coordinated in several countries. The suspension should be maintained until the safety of the medicine is reassessed.
Updated on May 30,2020:
State of Espírito Santo in Brazil, withdrew the use of chloroquine on patients with COVID-19 in severe condition.
In addition, prosecutors from the Federal Prosecutor’s Office of São Paulo, Rio de Janeiro, Sergipe and Pernambuco requested a suspension of regulations indicating the use of hydroxychloroquine and chloroquine in the treatment of patients with COVID-19.
Updated on June 4, 2020:
The journal “The Lancet” withdrew the publication of a study of 811 patients that demonstrated that the use of hydroxychloroquine and chloroquine as it did not have beneficial effects on the treatment of COVID-19, due to difficulty in accessing the primary data presented in the study.
Updated on June 15, 2020:
The FDA, which is the leading drug regulator in the United States, has withdrawn emergency permission for the use of chloroquine and hydroxychloroquine in the treatment of COVID-19, justifying the high level of risk of the drug and the apparent low potential for the treatment of the new coronavirus.
Updated on July 17, 2020:
The Brazilian Society of Infectious Diseases recommends that the use of hydroxychloroquine in the treatment of COVID-19 be abandoned at any stage of infection.
Updated on July 23, 2020:
According to a Brazilian study made jointly between the Albert Einstein, HCor, Sírio-Libanês, Moinhos de Vento, Oswaldo Cruz and Beneficência Portuguesa hospitals, the use of hydroxychloroquine with or without azithromycin does not have any effect on the treatment of mild to severe patients infected with the new coronavirus.
Mefloquine is a medicine used in the prevention and treatment of malaria in people who intend to travel to endemic areas. Based on studies that have been done in China and Italy, is being studied in Russia. A therapeutic regimen in which mefloquine is combined with other medicines, to verify its effectiveness in controlling COVID-19 disease, but there are still no conclusive results.
Thus, the use of mefloquine for the treatment of infection by the new coronavirus is not yet recommended because further studies are needed to prove its efficacy and safety.
Ivermectin is a vermifugus used for the treatment of infestation by parasites, which cause problems such as oncoercosis, elephantiasis, pediculosis (lice), ascaridíase (roundworm), scabies or intestinal strongyloidyasis, recently showed very positive results in the treatment of the new coronavirus in vitro.
A study conducted in Australia tested ivermectin in the laboratory in vitro cell cultures, found that this substance was able to eliminate the SARS-CoV-2 virus within 48 hours. However, clinical trials in humans are needed to verify its efficacy in vivo, as well as the therapeutic dose and safety of the medicine, which is expected to take place in a period of 6 to 9 months.
Updated on July 2, 2020:
The Regional Council of Pharmacy of São Paulo (CRF-SP) launched a technical note in which it stated that the drug ivermectin shows antiviral action in some in-vitro studies, but that further research is needed to consider that ivermectin can be used safely in humans against COVID-19.
Thus, it advises that the sale of ivermectin should only be made with presentation of medical prescription and within the doses and times prescribed by the doctor.
Updated on July 10, 2020:
According to a clarification note released by ANVISA, there are no conclusive studies proving the use of ivermectin for the treatment of COVID-19 and the use of the drug to treat infection with the new coronavirus should be the responsibility of the doctor who is guiding the treatment.
Moreover, the first results released by the Institute of Biomedical Sciences (ICB) of USP, shows that ivermectin, although able to eliminate the virus from infected cells in the laboratory also causes the death of these cells, indicating that this remedy may not be the best treatment solution.
Tocilizumab is a medicine that decreases the action of the immune system and therefore it is typically used in the treatment of patients with rheumatoid arthritis, to decrease the exacerbated immune response, reducing inflammation and relieving symptoms.
This medicine is being studied to assist in the treatment of COVID-19, especially in the more advanced stages of infection, when there is a large number of inflammatory substances being produced by the immune system, which can aggravate the clinical picture.
According to a study done in China on 15 patients infected with COVID-19, the use of tocilizumab has been shown to be more effective and cause fewer side effects compared to corticosteroids, which are the drugs commonly used to control inflammation generated by the immune response.
However, more studies need to be conducted to understand the best dose, determine the treatment regimen and find out the possible side effects.
Updated on 29 April, 2020:
According to a new study conducted in China on 21 patients infected with COVID-19, treatment with tocilizumab reduces the symptoms of infection soon after administration of the drug, decreasing fever, relieving the feeling of tightening in the chest and improving oxygen levels.
This study was done on patients with severe symptoms of the infection and suggests that treatment with tocilizumab should be started as soon as possible when the patient moves from a moderate situation to a severe situation of infection by the new coronavirus.
Updated on July 11, 2020:
New research by the University of Michigan in the United States concluded that the use of tocilizumab in patients with COVID-19 reduces the mortality rate in patients under ventilation, although it has increased the risk of other infections.
7. Convalescent plasma
Convalescent plasma is a type of biological treatment in which it is taken from people who have already been infected with coronavirus and who have recovered. A blood sample is taken through centrifugation processes to separate the plasma from red blood cells. Finally, this plasma is injected into the sick person, to help the immune system fight the virus.
The theory behind this type of treatment is that antibodies that were produced by the body of the person who was infected, and left in plasma, can be transferred into the blood of another person who still has the disease. This helps to strengthen the immunity and facilitate elimination of the virus.
According to Technical Note No. 21 released by Anvisa, in Brazil, convalescent plasma can be used as an experimental treatment in patients infected with the new coronavirus, provided that all health surveillance rules are followed. In addition, all cases THAT USE convalescent plasma for the treatment of COVID-19 should be reported to the General Coordination of Blood and Blood Products of the Ministry of Health.
Avifavir is a medicine produced in Russia with favipiravir as the active ingredient. According to the Russian Direct Investment Fund (RDIF), it is capable of treating coronavirus infection and has been included in covid-19 treatment and prevention protocols in Russia.
According to the studies that were done in 10 days, Avifavir did not present new side effects and in 4 days, 65% of the patients treated presented negative test for COVID-19.
To date there are no proven natural remedies that eliminate coronavirus. However, WHO recognizes that the Plant Artemisia annua can help in the treatment, especially in places where access to medicines is more difficult and the plant is used in traditional medicine in various regions of Africa.
The leaves of the Artemisia annua plant are traditionally used in Africa to help in the treatment of malaria and therefore the WHO recognizes that studies are valid to understand whether the plant can also be used in the treatment of COVID-19, since some synthetic malaria drugs have also shown promising results.
However, it is important to note that the use of the plant has not been confirmed against COVID-19 and that further research is needed.