On July 11, 2024, Dana Allen, 52, of Chicago, Ill., started to experience body aches. Initially, she shrugged the symptom off as lingering pain from a physical therapy procedure. But when a wave of fatigue hit, she decided to take a COVID test. “After not getting it once in the last four years, I thought this was behind me,” she says. Unfortunately, the test was positive, and Allen was left to navigate her next steps: how to handle isolation and whether to opt for antiviral treatment.
If Allen’s story sounds familiar, you might be one of the thousands of people across the country who’ve developed COVID-19 this summer. With the rise of at-home tests, case counts became less dependable, so the Centers for Disease Control and Prevention (CDC) now relies primarily on viral levels in wastewater. For context, the concentration of viral activity in wastewater is 3.5-times higher than this time last year.
Some good news: More than 98 percent of the United States population has some level of protective immunity from COVID-19 thanks to prior vaccinations or infections. While experts are clear that the virus can still be dangerous, advances in treatment and prevention have reduced the overall risk of hospitalization, death, and complications like long COVID. In fact, even during this recent surge, death rates in July 2024 remain at the lowest-ever level in the last four years.
Researchers and regulators have provided evidence-based guidelines for administering newly developed treatments to patients who are at high risk of, or already are, experiencing severe disease. If you’ve recently tested positive—or you want to prevent the virus in the first place—read on to learn your options.
How to Prevent COVID
When it comes to COVID, the best way to ward off serious complications is to stay up-to-date on vaccinations. Immunocompromised people can also opt for preventive treatments as recommended by their doctor.
COVID Vaccines
Viral variants are constantly evolving—the current leading variants of KP.3, KP.2, JN.1, and others are known collectively as “FLiRT.” The CDC recommends that everyone 6 months and older receive a vaccine for the 2024–2025 season, whether or not they have been previously vaccinated or contracted the disease. The recommendation is to receive the vaccine as soon as it’s available in your area. If you got sick in the summer, there’s no need to wait a certain amount of time afterward to get the shot. Many people choose to receive it alongside the flu vaccine in September or October.
Even though the new vaccines will be based on “old” variants, the CDC maintains that vaccinations cut the risk of severe disease by more than half. How can they be sure? In 2023, more than 95% of adults hospitalized for COVID had not received a vaccine—signaling the protective powers of vaccines despite changing variants. Additionally, a recent study published in 2024 found that the most recent COVID booster shots offered protection against the JN.1 variant, which dominated September 2023 through January 2024, and reduced the risk of severe disease by more than 50%, despite being formulated based on previously dominant variants.
Vaccines against COVID-19 are widely considered safe and effective. Adverse health effects are very rare, and the data shows they are far outweighed by the benefits. For example, one of the most serious risks—blood clotting—occurs in only 4 out of 1 million patients and can be treated. Long COVID, on the other hand, occurs in 10% of the unvaccinated population. It carries the side effects of chronic pain, brain fog, and difficulty breathing, and there is no known cure.
COVID Pre-Exposure Prophylaxis (PrEP)
In March 2024, the Federal Food and Drug Administration (FDA) granted emergency use authorization (EUA) for Pemgarda (pemivibart) for high-risk patients. A form of pre-exposure prophylaxis (PrEP), Pemgarda is a drug meant to prevent (not treat) COVID for immunocompromised people over 12 years old.
This drug is not for people who have been diagnosed with or recently exposed to COVID-19. Instead, it’s a therapy given as an infusion to help the roughly 3% of people in the United States who are immunocompromised increase SARS-CoV-2-specific antibodies. A type of monoclonal antibody, Pemgarda delivers lab-formulated antibodies to patients who have trouble creating their own antibodies in response to vaccines. Protection lasts for up to three months, at which time patients can choose to get another infusion.
In clinical trials, side effects from Pemgarda included headache, nausea, and fatigue. Four of the 623 patients who received a dose experienced a severe allergic reaction. The drug was associated with a 70 percent risk reduction in the development of symptomatic COVID-19 for the JN.1 variant.
What Are Your Treatment Options When You Test Positive for COVID?
The best course of treatment will depend on your health status. Scientists have found that the severity of COVID-19 outcomes is linked to age, as well as a wide range of underlying conditions, including diabetes, pregnancy, hypertension, obesity, heart disease, depression, cancer, dementia, substance use disorders, and more.
If you fall into one of these groups, or are over 50, the National Institutes of Health (NIH) recommends starting a prescription antiviral as soon as possible after a positive test result—typically within 5 days. Options in preferred order include:
Paxlovid (ritonavir-boosted nirmatrelvir)
The recommended first option by the NIH, Paxlovid is an oral antiviral pill designed to prevent the virus from replicating inside your body so the disease doesn’t worsen. In clinical trials performed in 2021, it decreased the chances of hospitalization by 89%. In addition, Paxlovid has been shown to have minimal side effects. Much has been made about the return of symptoms after finishing the course of Paxlovid (known as the “Pax rebound”); however, this phenomenon is relatively uncommon and can happen whether you choose to take medicine or not. Research shows that 2.3% of people who take Paxlovid experience a rebound as opposed to 1.7% who do not.
One important concern to keep in mind: Paxlovid comes with a boxed warning about significant drug-drug interactions. Check this list to see if any of the drugs you are taking could cause an interaction. Serious side effects may occur when Paxlovid is taken alongside drugs including blood pressure medications (such as Sildenafil, Tadalafil, and Vardenafil) and cardiovascular drugs (including Amiodarone, Clopidogrel, and more).
Other drug-drug interactions may occur in certain classes of drugs, including some migraine medications, lipid-modifiers, and neuropsychiatric drugs. To avoid an adverse reaction, your healthcare provider may recommend modifying or pausing your medication—or choosing a different antiviral. Check here for the full list and talk to your provider about all current medications, including over-the-counter drugs and supplements, before you start Paxlovid.
Veklury (remdesivir)
Remdesivir emerged early in the pandemic and remains the next-best choice if Paxlovid isn’t an option. Data from the end of 2021 suggests that, if remdesivir is administered within seven days of the onset of symptoms, it can keep 87% of high-risk patients out of the hospital. However, since the drug is given intravenously, it must be administered at a hospital or clinic. The frequency is once a day for three days.
Lagevrio (molnupiravir)
This oral antiviral drug was granted emergency-use authorization in 2023. The NIH suggests it only if Paxlovid and remdesivir aren’t options. Studies show that it reduces hospitalization rate by 30%, but it has the potential to cause birth defects. While these defects have only occurred in trials with animal subjects, the NIH does not recommend this drug for pregnant or lactating people and advises sexually active adults with childbearing potential to abstain from sex or use a reliable method of birth control for three months following their last dose.
What about monoclonal antibodies?
Synthetically developed antibodies designed to target the virus, monoclonal antibodies were some of the first treatments authorized to manage COVID-19 in 2020. While these treatments were highly effective early on, none of the existing antibodies seem to help against the most recent variants. The NIH currently doesn’t recommend using any of these treatments.
COVID Treatment Protocol at Home
The NIH emphasizes that while you are sick with COVID, you should be resting and drinking fluids to avoid dehydration. You can take over-the-counter drugs, such as acetaminophen, naproxen, and ibuprofen, to help manage symptoms like headaches, muscle aches, and fever.
Once a hallmark protocol for the disease, the CDC no longer recommends an isolation period of a specific length following a positive test result. Instead, in guidance updated March 2024, it grouped COVID recommendations along with flu and RSV. The updated guidance is that people stay home, and wait at least 24 hours after they feel better and any fever has abated to resume contact with others and normal activities. The CDC also encourages extra care in the 5 days following this return to normal: washing hands more frequently, keeping windows open, distancing, and wearing a well-fitting mask.
If Hospitalized for COVID, Know This
If you have trouble breathing, it’s important to seek medical care. If your illness is severe enough to require hospitalization, it’s likely that you have systemic inflammation. Doctors may recommend Decadron (dexamethasone) or another corticosteroid that will dampen your immune response. If you are high-risk, you may receive infusions of the antiviral Veklury (remdesivir) as well. The NIH also recommends physicians add blood thinners, such as heparin, to your regimen to help prevent dangerous clots from forming during treatment.
If you’re in critical condition, you may need several of the previously mentioned therapeutics along with drugs to treat a variety of complications, such as bacterial pneumonia or renal failure. For those who require supplemental oxygen, immune system modulators like Olumiant (baricitinib) and Tocilizumab (actemra) may be added as well.
Making Your Way Through the Current COVID Wave
As with any relatively new disease, the recommendations around and medications for COVID-19 are constantly evolving. MedShadow will help keep you up-to-date on recent developments—but it’s beneficial to reference resources from the CDC and NIH as well to get healthy, stay healthy, and protect yourself against waves to come.
