COVID-19 - Prevention and Treatment

Understanding COVID-19

The infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which was first identified in Wuhan, China, is called COVID-19. This infection was previously referred to as the 2019 Novel Coronavirus (2019-nCoV) respiratory disease. The World Health Organization (WHO) then declared COVID-19 as the official name of this infection on 11th February 2020.

It belongs to the family called coronaviruses, which comprises other strains that result in the common cold to more serious infections like severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Similar to these strains, SARS-CoV-2 also primarily affects and infects the respiratory tract. The severity of the infection can be mild to fatal. Most infected patients, about 81 %, show only mild symptoms. Only the remaining 19 % of patients develop moderate to severe symptoms due to pneumonia and acute respiratory distress syndrome (ARDS).

Transmission of SARS-CoV-2

Coronavirus can spread from one person to another through:

1. Large respiratory droplets or aerosols generated when an infected person sneezes, coughs, talks, sings, or drips.

2. Kissing or shaking hands with someone who is infected.

3. Touching the mouth, eyes, or nose after touching a contaminated surface.

What Are the Signs and Symptoms of COVID-19?

Dry cough, fever, fatigue, loss of taste and smell sensation, and shortness of breath (breathing difficulty) are the most common symptoms of COVID-19. These symptoms can start between 2 and 14 days after exposure (incubation period).

Less common symptoms of COVID-19 include the following:

• Headache.

• Diarrhea.

• Sore throat.

• Body aches.

• Skin rashes.

• Redness and irritation in the eyes.

COVID-19 also exhibits some serious symptoms like:

• Confusion.

• Chest pain.

• Speech loss.

• Loss of mobility.

• Confusion.

• Difficulty in breathing.

According to research published in the Annals of Internal Medicine, the median incubation period (the period between exposure to the virus and the appearance of first symptoms) is said to be 5 days. Almost 98 % of infected individuals will develop symptoms before 12 days.

Another study suggests that a loss of smell and taste is an early sign of the coronavirus infection. They also found that patients who developed loss of smell and taste before any other symptoms of COVID-19 usually suffered from mild infection.

What Are the Risk Factors of COVID-19?

The CDC has included the following group of people in the list of people who are more prone to develop life-threatening complications if they get infected with the coronavirus:

• Older adults (people above 65 years of age).

• People who have pre-existing medical conditions like heart disease, asthma, COPD (chronic obstructive pulmonary disease), and diabetes.

• People who live in long-term care facilities, old age homes, or nursing homes.

• Immunocompromised people.

• People under treatment for cancer.

• HIV patients.

• Morbidly obese individuals.

A recent study suggests that people who smoke may be more susceptible to this virus. Evidence also suggests that those who use e-cigarettes are at a higher risk of developing severe respiratory infections.

How to Prevent COVID-19?

Vaccines seem to be like the light at the end of a tunnel in this pandemic. Getting the vaccination at a person’s turn is an important preventive measure to prevent the spread of COVID-19 and curtail the pandemic. In addition to vaccination, some effective preventive measures are:

• Wash the hands. Using warm water and soap, lather by rubbing all the surfaces of the hands together, including the nails, for 20 seconds. Make sure wash the hands:

  • Prior to and after cooking.

  • After using the restroom.

  • When they are visibly soiled.

  • After working with pesticides or heavy metals.

  • When the hands are oily or greasy.

  • Prior to and after eating.

• If soap and water are not readily available, make use of an alcohol-based hand sanitizer containing more than 60 % alcohol.

  • Take a coin size of hand sanitizer on the palm and rub together all surfaces of the hands, including nails, for 20 seconds.

  • Please wait till the sanitizer dries up, and do not wipe the hands on a cloth.

  • Hand sanitizer will not be effective if the hands are muddy, oily, greasy, or contaminated by heavy metals.

• Do not touch the mouth, eyes, nose, or face without washing the hands first.

• Stay away from people who are sick and exhibit symptoms of influenza-like illnesses.

• Make sure when a person sneezes or coughs use a tissue or the bent elbow.

• Clean and disinfect high-contact surfaces like doorknobs, light switches, tabletops, toilets, faucets, etc., using soap and water first and then with 0.1 % sodium hypochlorite or an EPA-registered disinfectant.

• Use disinfectant wipes to clean and disinfect mobile phones and other devices.

• Using a face mask can reduce exposure to the deadly virus. Doctors recommend purchasing and wearing a face mask (N-95) at all times whenever a person steps out of the house, for example, when going to grocery stores, markets, etc. Face masks will remind a person not to touch the face and prevent the spread of the virus.

• Maintain social or physical distancing. Means, keeping at least 6 feet (2 meters) distance from others, avoiding gatherings, and staying out of crowded places.

• In case a person develops signs of upper respiratory tract infection, such as cough, sore throat, runny nose, etc., isolate themselves. That is, stay home and away from other people for 14 days.

• STAY HOME as much as possible and go out only when it is very much needed. Especially, those who share an increased risk of contracting the disease should avoid going out as much as possible.

What Are the Approved Vaccines for COVID-19?

1. Moderna (National Institutes of Health) - It is a two-dose mRNA vaccine (mRNA-1273) that started testing in March 2020. This vaccination is given in 2 doses for a period of 28 days. In clinical trials, typical side effects were noted, which were only mild. These kinds of effects were pointed out in the first seven days after vaccination. The vaccines do not contain any live coronavirus, so it is impossible to develop COVID-19 due to a vaccination.

2. BioNTech, Pfizer, and Fosun Pharma - The pharmaceutical company Pfizer, in collaboration with BioNTech (a German biotech company) and Fosun Pharma, produced a two-dose mRNA vaccine (Tozinameran or BNT162b2). After administering this vaccine to adults on 9th November 2020, the company's data showed that the vaccine was 90 % effective. The FDA then reported that after the first dose, the Pfizer vaccine gave some protection and almost complete protection after the second dose on 8th December 2020. On 11th December 2020, this vaccine was given EUA by the FDA. Reports showed an allergic reaction in a healthcare worker. The usage of this vaccine is recommended for people who are over 16 years of age. A lower dose of BioNTech and Pfizer called Comirnaty is approved for use in children aged 5 and above.

3.Gamaleya Research Institute - It is a Russian institute, which developed a vaccine (Sputnik V or Gam-COVID-Vac) that has two ingredients, a recombinant adenovirus type (rAd26) and type 5 (rAd5) vectors. In August 2020, the vaccine received a "conditional registration certificate." The clinical trial in Russia involved 40,000 volunteers, and clinical trials were announced in the UAE, India, Venezuela, and Belarus. Phase I and II trials found that the vaccine showed an immune response with mild side effects. The Sputnik V vaccine is 91.4 % efficient with mild side effects, and its vaccine efficacy against severe cases of Coronavirus is 100 %. After assuring all the safety standards, Data and Safety Monitoring Board (DSMB) recommended a shift to phase III from phase II. Phase III trials showed strong efficacy and immunogenicity with 91.6 % efficacy. Sputnik V depends on the virus's genetic instructions for developing the spike protein. Sputnik V uses double-stranded DNA, unlike the Pfizer-BioNTech and Moderna vaccines, which build the instructions in a single-stranded RNA.

4. AstraZeneca and the University of Oxford (Covishield in India) - In April 2020, AstraZeneca and the University of Oxford announced the development of a recombinant adenovirus vaccine (AZD1222). It was based on a chimpanzee adenovirus that takes coronavirus proteins in the body. Phase III clinical trials began in Brazil, the U.S., and South Africa in August 2020. When a volunteer developed transverse myelitis (a spinal inflammatory disorder), the study was halted in September 2020. A week later, the trials restarted in the U.K. and Brazil, and the FDA authorized the U.S. trial to resume in October 2020. It was reported in November 2020 that the vaccine produced a strong immune response in a clinical trial involving participants over 70 years of age. But, the data released on 8th December 2020 showed that the vaccine was only 70 % effective. The efficiency was identified to be around 62 % when administered in two separate and full doses. An increase in efficiency of up to 90 % was achieved when the vaccine was given a half dose followed by a full dose. Leaving a more extended gap between the first and second doses improves the jab's overall effectiveness (it was seen in a sub-group who were given the vaccine this way), and it was observed to be 70 % effective after the first dose.

5. Bharat Biotech, Indian National Institute of Virology, and Indian Council of Medical Research - The inactivated virus vaccine (BBV152 or Covaxin) produced by the Indian company Bharat Biotech in collaboration with the Indian National Institute of Virology began the phase III trial in October 2020. The report on Phase I trials showed the vaccine to be safe and produce antibodies against SARS-CoV-2. More than 26,000 participants were involved in phase III trials, and now Covaxin has been declared the first official vaccine in India. This whole virion-inactivated COVID-19 vaccine candidate confirmed a temporary vaccine efficiency of 81 % in its Phase 3 clinical trial. The trials comprised 25,800 subjects, the largest ever conducted in India, in conjunction with the Indian Council of Medical Research. The world health organization (WHO) has validated Covaxin by including it as the eighth vaccine with an emergency use listing (EUL).

6. Sinovac Biotech - This is a Chinese company that developed an inactivated SARS-CoV-2 vaccine (CoronaVac). The phase III trials began in Brazil, Indonesia, and Turkey. The vaccine was granted emergency approval by the Chinese government for use on individuals at high risk of developing severe COVID-19 infection. The United Arab Emirates, which supported the Sinopharm vaccine earlier this month, said that the vaccine was 86% effective, according to interim results of its stage three trial. Sinovac said that the COVID-19 vaccine is safe for children between the ages of 3 to 17 years.

7. Wuhan Institute of Biological Products and Sinopharm - The vaccine BBIBP-CorV, an inactivated virus vaccine, is being tested by the Chinese company Sinopharm and developed by the Wuhan Institute of Biological Products. As the phase I clinical trial showed positive results, phase III trials began first in UAE and then in Morocco and Peru, which showed an efficacy of 86 %. Bahrain and UAE have already approved the vaccine for use.

8. Johnson & Johnson - In February 2021, the U.S. Food and Drug Administration announced an emergency use authorization (EUA) for the third vaccine for the restriction of coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The EUA supports the Janssen COVID-19 Vaccine to be administered (single-shot) in the U.S. for use in people who are above 18 years of age. Thailand also cleared Johnson & Johnson's single-shot COVID-19 vaccine for local emergency use, the third manufacturer to win the approval. Trial results taken after 14 days of the Johnson & Johnson vaccine showed 66.9 % efficacy against moderate infections and 76.7 % against severe infections. The efficacy was 66.1 % and 85.4 % in moderate and severe cases, respectively when taken after 28 days of vaccination. The Johnson & Johnson vaccine has also been granted EUA for booster doses in individuals above 18 years who have had their primary vaccines.

9) CanSino Biologics - It is a Chinese vaccine backed by the Chinese military, in which Adenovirus Ad5 is used to bring the proteins of coronavirus into the cells. It has been approved in China for general use since February 25, 2021. Emergency use of this vaccine is authorized by countries like Pakistan, Argentina, Hungary, Mexico, Ecuador, Chile, Moldova, Malaysia, and Indonesia. An increased efficacy rate of about 96 % is shown by this vaccine against severe infections.

10) Beijing Institute of Biological Products and Sinopharm - Beijing institute of biological products and research developed an inactivated vaccine that was proven to be 86 % effective against the coronavirus. The EUA for this vaccine was granted by WHO on May 7, 2021. It comes with a vaccine vial monitor, to indicate the vaccine safety for usage, which is the first of its kind to have an indicator.

What to Do If a Person Came in Contact With a COVID-19 Infected Person?

If a person came in contact with a person who later tested to be COVID-19 positive, the best thing a person can do is self-isolate. Stay home, as it might take 2 to 14 days to show symptoms. So to prevent the spread, isolate from others for 14 days.

What to Do If a Person Develop Symptoms of Influenza-Like Illness?

In case a person develops a fever, cough, or other mild symptoms of COVID-19, do not panic. People with mild symptoms have been known to get better at home. But, call and talk to the doctor, keep track of the symptoms, and look out for warning signs.t

If a person sick and exhibiting symptoms of influenza-like illness, follow these steps to prevent the spread of the virus:

1. Isolate themselves at home and avoid going out to public places, except for medical care.

2. Take rest, and keep drinking water or fluids to keep the body hydrated.

3. For fever, a person can take over-the-counter medicines like Paracetamol (Acetaminophen).

4. Stay in a separate room, and do not come in contact with others at home.

5. Use a separate bathroom if possible.

6. Wear a face mask to cover the nose and mouth if a person is around caregiver and pets. A person can choose not to wear a mask when they are alone.

7. Keep taking temperature and note down all the other symptoms.

8. Cover the mouth and nose with a tissue when a personsneeze or cough. Immediately throw away the tissue in a closed bin and wash hands.

9. Keep washing the hands with soap and water.

10. Do not share personal items, such as dishes, glasses, eating utensils, and bedding with people in home.

A person should stay away from others and isolate himselffor at least 10 days, beginning from the day of the first symptom.

When to End Self-Isolation or Self-Quarantine?

According to the CDC, people with COVID-19 symptoms can end self-isolation if:

1. It has been 10 days since the first symptom.

2. It has been 10 days since they were tested positive.

3. No fever for 3 consecutive days without medications.

How Are COVID-19 Patients With Severe Symptoms Managed?

The treatment options for critically ill patients are:

• Mechanical Ventilation (Intubation) - To help the patient breathe, a tube is inserted into the patient’s lungs through the nose or mouth. This tube is then connected to a respirator, which sends oxygenated air into the lungs and removes carbon dioxide.

• Intravenous (IV) Electrolytes - They are given through the veins to prevent dehydration.

• Sedation - Antipsychotic or anti-anxiety medications are administered to patients with symptoms like delirium or confusion.

When to Consult a Doctor?

If or any of relative shows the following signs and symptoms, seek immediate medical care:

• Breathing difficulties or gasping for air.

• Chest pain or chest discomfort.

• Confusion.

• Lips or the face turns bluish.

• Inability to stay awake.

Before visiting the hospital, call the hospital and inform them that are bringing in someone with possible COVID-19 symptoms. Also, when call for an ambulance, please notify the operator that want emergency medical care for someone who may have COVID-19.

What Are the Approved Medicines for Treating COVID-19?

Approved Drugs for COVID-19:

• Remdesivir (Veklury) is currently the only medicine authorized by the FDA to treat coronavirus disease 2019 (COVID-19). The approval was based on conclusion that hospitalized patients who received Remdesivir (Veklury) recovered faster. Some critically sick patients with COVID-19 have been managed with high doses of intravenous (IV) vitamin C, hoping that it will speed recovery. However, there is no clear or reliable scientific proof that it works for COVID-19 infections, and it is not a regular part of treatment for this new infection. Remdesivir is also being investigated in sequence with other medications. A study published that hospitalized COVID-19 patients who received both Remdesivir and Baricitinib (Olumiant) recovered about one day faster than those who only got Remdesivir (7 days to 8 days). Additionally, patients had a 30% higher chance of clinical recovery at day 15 when using both medications together. Patients who got both drugs were also less likely to require ventilation or die on day 29 than those who only got Remdesivir (23 % vs. 28%). The FDA granted a EUA on 19th November 2020 for Baricitinib to be used in sequence with Remdesivir for patients hospitalized with COVID-19 who require extra oxygen or breathing assistance. The NIH currently promotes using Baricitinib with Remdesivir only if corticosteroids (such as Dexamethasone) cannot be used.

• According to the Ministry of Health and Family Welfare (MoHFW), Remdesivir should not be used in those, not on oxygen support or in home isolation. It can be considered only in the following circumstances:

• In those with moderate to severe disease (requiring supplemental oxygen) after 10 days of onset of symptoms. (NOTE - They should NOT be on IMV or ECMO).

• Remdesivir can be used for 5 days to treat hospitalized COVID-19 patients.

• RFT and LFT must be monitored and Remdesivir should not be used if GFR is < 30ml/min/m2; AST/ALT > 5 times UNL)

• Recommended dose of Remdesivir is 200 mg IV on day 1 followed by 100 mg IV OD for next 4 days.

• Nitric Oxide Nasal Spray (FabiSpray) – FabiSpray has been launched recently in India for treating adult patients suffering from COVID-19. The drug has been approved by the Drugs Controller General of India, and it can now be purchased with a prescription from a registered medical doctor. It has anti-microbial properties and is mainly designed to kill the COVID virus in the upper respiratory tract. It can be beneficial for adult patients with COVID-19 who are at higher risk of disease progression. Several studies were conducted on the clinical efficiency of nitric oxide nasal spray (NONS). The studies reveal that NONS can reduce the duration and severity of symptoms, reduce hospital admissions, and decrease the infectivity period. Nitric oxide serves as a physical and chemical barrier and fights the virus in the mucosal lining of the upper respiratory system. Thus, preventing the spread of the virus further to the lungs. Nitric oxide is also known to stop the replication of the severe acute respiratory syndrome (SARS) virus, which is associated with the COVID virus. The phase three trials of the NONS conducted in India demonstrated a reduction in viral load by 94 percent in 24 hours and 99 percent in the 48 hours. It is approved in India, and the phase three trial is also going on in countries like Malaysia, Singapore, Hong Kong, Nepal, Sri Lanka, Taiwan, Nepal, Brunei, Cambodia, Laos, Myanmar, Timor-Leste, and Vietnam.

Drugs with Emergency Use Authorization:

1) Virafin - Virafin, the antiviral drug from Zydus Cadila, a Cadila Healthcare Limited, received Emergency Use Authorization in India. The Drug Controller General of India (DCGI) granted the emergency use of Virafin in moderate COVID-19 infections as it reduces the use of oxygen demand. Virafin is a Pegylated Interferon alpha-2b (PegIFN), which is helpful in treating moderate COVID-19 infections in adults. These interferons are said to be the first line of defense for our body as it fights against viral infections. Especially the production capacity of interferon-alpha in elderly people is reduced when subjected to viral infections, thus resulting in a higher death rate. Virafin is a safe drug, and eryone well know its safety profile as it is used in the treatment of chronic cases of hepatitis B and C. And now it is used in the treatment of moderate cases of COVID-19. It is said that a single subcutaneous dose of Virafin, when administered during the early stages of the disease, will help with reduced COVID-19 complications and with faster recovery of the patients. The drug reduces the multiplication of the virus on early administration and makes the treatment more convenient. Various trials of Virafin were conducted across India, and the results showed up with:

• Reduced need for supplemental oxygen.

• Able to control respiratory distress.

The International Journal of Infectious Diseases published the results of the phase 2 trial of the Virafin drug. Out of 20 participants who were under the control arm and received standard of care, the clinical improvement was 68.42 % on the 13th day, and 19 people had further improvement (95 %) on the 15th day. It was found that:

• Therapy plus standard of care - RT-PCR negative on days seven and fourteen.

• Control arm - RT-PCR negative up to 63 % and 68 % on the 7th and 14th day.

Phase 2 trial also resulted in mild adverse reactions. Phase 3 trial showed better clinical improvement in moderate COVID-19 cases as the drug reduced supplemental oxygen usage to 56 hours from 84 hours, and 91.15 % of patients administered with the Virafin drug were RT-PCR negative by the 7th day.

2) Dexamethasone - It is a steroid used to reduce inflammation and swelling in various conditions. Researchers at the University of Oxford found this drug to reduce fatality rates in critically ill COVID-19 patients (by 1/3rd). A moderate dose of Dexamethasone decreased the death rate of people hospitalized with COVID-19 on a ventilator and people taking supplemental oxygen but not on a ventilator. Intake of three different corticosteroids like Hydrocortisone, Dexamethasone, and Methylprednisolone showed reduced death rates compared to taking one.

3) Bamlanivimab and Etesevimab - The emergency use of the drug, Bamlanivimab, and Etesevimab, was given approval by the FDA on February 9th, 2021, in individuals above the age of 12 years. Administering this drug reduces the risk of disease progression and hospitalization in individuals. Also, the viral load in the patients after giving this drug was drastically low from day 11. However, using only Bamlanivimab does not bring about the same results. As the Omicron cases surged, this regimen is not expected to provide clinical benefit for patients with omicron infection so its circulation has been paused and is not recommended by FDA.

4) Bamlanivimab (LY-CoV555) - Bamlanivimab prevents the SARS-CoV-2 infection in the human cells by blocking its entry into the human body. This drug was granted emergency use authorization by the FDA on November 9th, 2020, to be used in individuals above 12 years. It reduces the risk of infection in individuals. Bamlanivimab should be used only in mild and moderate infections and is not recommended to be used in people with severe infections who are hospitalized. Intravenous infusion in an outpatient setting is the recommended way of administering Bamlanivimab.

5) Casirivimab and Imdevimab (REGN-COV2) - An antibody cocktail made up of monoclonal antibodies, Casirivimab and Imdevimab, helps in reducing the viral load and providing relief from COVID-19 symptoms. It was granted EUA by the FDA on November 21st, 2020, to be used in mild and moderate cases. Hospitalized patients are not suitable for taking this drug. Just like Bamlanivimab, this antibody cocktail should also be given in an outpatient setting through intravenous infusion. Also known as REGN-COV2, it helps in treating infections in people who have no own antibodies despite having an increased viral load. Because the Omicron VOC has significantly reduced in-vitro resistance to Casirivimab and Imdevimab, the distribution of Casirivimab with Imdevimab has been suspended in the United States; as this combination is not expected to provide clinical benefit for patients with Omicron infection.

6) Sotrovimab - FDA approved the emergency use of Sotrovimab in patients above 12 years with mild and moderate infections. It is used to reduce the risk of disease progression, hospitalization, and death.

The panel previously recommended Sotrovimab, an anti-SARS-CoV-2 mAb, as a treatment option for COVID-19 patients who are not hospitalized. Although Sotrovimab is effective against the Omicron BA.1 and BA.1.1 subvariants, it is not effective against other Omicron subvariants like Omicron BA.2. As a result, Sotrovimab distribution has been halted, and the panel no longer advises using it to treat COVID-19.

7) Propofol-Lipuro - Propofol-Lipuro was authorized for emergency use to bring about the effect of sedation. Patients above 16 years of age and those under mechanical ventilation are the ideal candidates.

8) Tixagevimab Plus Cilgavimab - These anti-SARS-CoV-2 mAbs are recombinant human antibodies that bind to nonoverlapping epitopes of the SARS-CoV-2 spike protein RBD. The combination of Tixagevimab 150 mg and Cilgavimab 150 mg that was originally approved has been shown to be ineffective against the Omicron BA.1 and BA.1.1 subvariants. The FDA did, however, update the EUA to allow a combination of Tixagevimab 300 mg and Cilgavimab 300 mg, which is predicted to preserve action against these subvariants. In-vitro activity of Ixagevimab with Cilgavimab against the Omicron BA.2 subvariant was maintained.

9) Bebtelovimab - Bebtelovimab is likely to have an action against a wide range of SARS-CoV-2 variants, including the Omicron VOC and its BA.1 and BA.2 subvariants, as well as the Omicron VOC and its BA.1 and BA.2 subvariants. Bebtelovimab works in the same way as other approved anti-SARS-CoV-2 mAbs that have shown proven clinical effects in this cohort. To completely assess the efficacy of Bebtelovimab in a high-risk group, large randomized controlled trials are still needed. Bebtelovimab should be given as an IV injection, and patients should be observed for at least an hour afterwards.

Drugs That Are Used, but Not Recommended:

1. Hydroxychloroquine and Azithromycin - A study where 20 COVID-19 patients were given these drugs showed them to be virologically cured within 6 days. Now, national health institutions, however, do not recommend the use of this drug because of the fact that they do not treat or prevent COVID-19 infection.

2. Hydroxychloroquine Sulfate - On 9th March 2020, the journal called Clinical Infectious Diseases suggested that Hydroxychloroquine (a malaria drug) effectively killed the coronavirus in lab experiments. After issuing an emergency use authorization (EUA) in March 2020, the FDA revoked the EUA on 15th June 2020.

3. Ivermectin - A study conducted in Australia showed this anti-parasitic drug to be effective against SARS-CoV-2. Although low death rates were observed in the conducted clinical trials, Ivermectin has not been recommended for treating COVID-19 patients by the FDA since March 2021.

4. Lopinavir, Ritonavir, and Oseltamivir - This combination of drugs is said to have helped an old Chinese woman to recover from severe COVID-19 pneumonia completely. But, a study presented in the New England Journal of Medicine showed no benefit.

5. Interferon-beta-1a - It is a drug used in the treatment of multiple sclerosis. It was initially attributed that interferons exhibited antiviral activity against the coronavirus. However, later it was revoked by the National health institution as it did not have beneficial effects against COVID-19.

6. Arthritis Drugs - In early January 2020, hospital administrators in the United Kingdom announced that Tocilizumab and Sarilumab, drugs used to treat arthritis, can decrease the length of time spent in a hospital by ten days. They added that the two drugs could lessen the risk of death from COVID-19 by 24 percent for severely ill people with the disease. It shortens the days of hospitalization when given within 24 hours of staying in the intensive care unit. The use of these drugs is not recommended by the NIH in ICU patients.

7. Kaletra - This is a combination of two drugs - Lopinavir and Ritonavir, that works against HIV. Clinical trials are done to understand whether this drug combo also fights against SARS-CoV-2. There have been mixed results.

Investigational Medicines:

At present, the FDA has not approved any drug for the treatment of COVID-19. Various studies are ongoing to understand the effectiveness of the following drugs:

1. Bemcentinib - It has been reported to exhibit antiviral action against the Ebola virus, Zika virus, and other enveloped viruses. Its effectiveness in the treatment of hospitalized COVID-19 patients is in progress. BerGenBio ASA, a clinical-stage biopharmaceutical company, stated on April 26, 2022, that the primary efficacy endpoint was met in a randomized phase II study of Bemcentinib in combination with standard of care (SoC) therapy, ACCORD2, in hospitalized COVID-19 patients.

2. Bevacizumab - Studies are ongoing to determine its effectiveness as a treatment for lung injury and acute respiratory distress syndrome (ARDS) in severely ill COVID-19 patients are ongoing.

3. Colchicine - It is an anti-inflammatory drug, which was studied in preventing COVID-19 complications in high-risk patients. The results published on 2 April 2022 stated that Colchicine shortened the time to recovery by an average of five days in severe COVID-19 cases and two days in moderate COVID-19 cases in the current study. There was no evidence of a link between this add-on medication and mortality. The only negative effects were gastrointestinal distress and diarrhea. As a result, there appears to be a potential role for Colchicine as a supplement in the treatment of severe COVID-19 patients.

4. Favipiravir - It is an antiviral drug used as a treatment for influenza and is being used in clinical trials as a treatment for pneumonia caused by the new coronavirus. Favipiravir therapy in mild COVID-19 patients did not reduce the time for viral clearance within 15 days of initiating treatment in this clinical investigation. More research and trials are needed.

5. Fluvoxamine - This drug is previously used to treat people with obsessive-compulsive disorder. In mid-November 2020, a study with 152 participants stated that the medication is adequately easing symptoms of COVID-19. In early February 2021, a study showed Fluvoxamine could help prevent moderate COVID-19 symptoms from turning more dangerous. According to a recent meta-analysis of fluvoxamine clinical trials, it may have a significant impact on reducing hospitalization.

6. AT-527 - This drug was produced by Boston biotech Atea Pharmaceuticals in partnership with drugmaker Roche. Atea started a phase II trial in May 2020, examining the medication in people hospitalized with moderate COVID-19. Patients with mild to moderate COVID-19 were enrolled in Aetna's clinical trial, with about two-thirds of them being low-risk with modest symptoms. Atea's antiviral, AT-527, was no better than the placebo at driving SARS-CoV-2 decreases in the whole study group, causing the trial to miss its primary aim.

7. EIDD-2801 - This drug was designed by scientists at a nonprofit biotech company controlled by Emory University. Research in mice has revealed that it can decrease the replication of multiple coronaviruses, including SARS-CoV-2. Pharmaceutical companies Merck and Ridgeback Biotherapeutics LP approved an agreement in May 2020 to improve this drug. In April 2020, a phase I trial of this drug began in the UK, which was followed by a phase II trial in July 2020. Unlike Remdesivir, EIDD-2801 can be administered orally, which would make it possible for a more significant number of people. The UK Medicines and Healthcare Products Regulatory Agency was the first to grant EIDD, conditional marketing authorization on November 4, 2021. The US Food and Drug Administration awarded EIDD early use authorization on December 23, 2021. (EUA).

8. Merimepodib (VX-497) - This is produced by ViralClear Pharmaceuticals Inc. This drug has been earlier shown to have antiviral and immune-suppressing results. It was tested on hepatitis C but had only moderate effects. A phase II trial of this drug was started, where people with severe COVID-19 will be given either Merimepodib with Remdesivir or Remdesivir with a placebo. This phase II trial was stopped in October 2020 over concerns about this drug’s security.

9. Niclosamide - ANA Therapeutics began a phase II and III trial in October 2020 of oral Niclosamide, a drug used for years to treat tapeworms. Initial studies showed the drug to have antiviral and immune-modulating actions. Current data suggests Niclosamide inhalation powder is a promising COVID-19 antiviral treatment.

10. Umifenovir - This antiviral was tested along with the drug Lopinavir/Ritonavir to treat COVID-19. In mid-April 2020, it was reported that this combination of drugs did not improve the outcomes for hospitalized patients with mild to moderate COVID-19. A July 2020 review of 12 studies showed that Arbidol did not improve people's results with COVID-19.

11. Apilimod - In late July 2020, Yale University published a trial with AI Therapeutics on a drug known as Apilimod. Yale officials said the medication had been proven reliable in managing autoimmune diseases and follicular lymphoma. They said primary research shows that Apilimod can prevent the cellular entry of the new coronavirus. The FDA has awarded the drug fast-track status. In Phase II efficacy trials, Apilimod is being considered as a COVID-19 treatment modality.

12. Blood Thinners - In mid-September 2020, U.S. researchers published that they had started two clinical trials to see the occasion of utilizing blood thinners to treat COVID-19. In mid-February 2021, a study informed that blood thinners administered as a preventative treatment to a person within 24 hours of their hospitalization for COVID-19 overcame the disease's risk of death.

13. Cannabinoid Drug ARDS-003 - In mid-September 2020, officials at Canada-based Tetra Bio-Pharma stated that they had received FDA approval to begin a phase I trial of a synthetic cannabinoid drug to manage COVID-19. Company officials said that the medication might protect patients from ARDS, which is the frequent cause of death for people with severe COVID-19. Interactions with numerous signaling pathways have proven cannabis' diverse anti-inflammatory and antiviral properties.

14. Celltrion - This South Korean company began a phase III trial in October 2020 of its monoclonal antibody treatment, CT-P59. It is being tested in people who have been in close association with a person with COVID-19 to inspect whether the drug can prevent infection. In September 2021, Celltrion's Regdanvimab, also known as Regkirona, was licensed for usage in Celltrion's home nation of South Korea.

15. Edesa Biotech Inc - This has received permission to perform a phase II trial of its monoclonal antibody drug, EB05. The company believes its medication could decrease the overactive immune responses correlated with acute respiratory distress syndrome. Edesa Biotech reported new phase 2 results on October 19, 2021, stating that EB05 demonstrated a reduction in mortality in numerous patient groups. When compared to the placebo + SOC group, the relative risk reduction in critically ill hospitalized patients treated with EB05 + SOC was 61.1 %. Health Canada approved the commencement of phase 3 trials on January 13, 2022.

16. Eli Lilly - In early October, Eli Lilly announced that a new treatment comprising two antibodies revealed promising outcomes in reducing SARS-CoV-2 levels. The treatment was administered to people with COVID-19 who were not hospitalized. In June 2021, India has given emergency use approval to Eli Lilly and Co's (LLY.N) antibody medication combination for the treatment of mild-to-moderate COVID-19, increasing the country's array of medicines to face the second wave of the pandemic.

These drugs should not be consumed without the advice of a doctor. Self-medication is not acceptable as many drugs are not approved and might produce serious side effects.

Conclusion:

Stay away from the virus by following adequate preventive measures and getting vaccinated. When a person has similar symptoms or has come in contact with a COVID-affected or suspected individual, isolate themselves from others so as not to spread the disease. When infected, reach out to healthcare professionals at the earliest. With the doctor's advice, patients with mild to moderate symptoms can stay at home while their body fights this infection. Medical intervention and hospitalization are only required for people with severe symptoms.