What antivirals are needed if you have COVID-19? By Dr. Edsel Maurice Salvana

1. If you are not part of the vulnerable population and are fully vaccinated with only mild symptoms, you DO NOT NEED ANTIVIRALS. You only need supportive care. 

Stay home, rest and 99.9% of the time you will be ok. If you get short of breath or your pulse ox goes to 94% or below, go to the emergency room. Contact your doctor or the LGU BHERTs if you have questions. 

2. If you are part of the vulnerable population (A2 or A3), you may benefit from antivirals even if you only have mild symptoms. Most of the antivirals were studied in the unvaccinated population, so it is unclear how much more is added in the fully vaccinated population and this needs to be properly assessed for optimal benefit versus risk. It is important that these only be given under the direction and supervision of a competent doctor. 

The drugs used for this purpose include paxlovid (89% decreased risk of hospitalization and death), remdesivir (short course, IV only, 3 days only, 87% decreased risk of hospitalization and death) or molnupiravir (30% decreased risk of hospitalization and death). 

These need to be given within 5 days of symptom onset, and only to those with confirmed COVID-19. Some drugs may interact with these antivirals, particularly with the ritonavir component of Paxlovid, so do NOT experiment. Molnupiravir is potentially mutagenic, so don't give to pregnant women and do not use for more than 5 days. Above all DO NOT USE THESE ANTIVIRALS FOR PROPHYLAXIS. They can cause serious problems if misused. 

3. For patients with severe and critical COVID-19, these need to be treated in the hospital. These patients may be given remdesivir, dexamethasone, baricitinib, tocilizumab and other meds as appropriate. Paxlovid and molnupiravir DO NOT WORK for severe and critical COVID-19 patients. 

Antivirals for COVID-19 represent an added tool for decreasing the burden of COVID-19 on our society as long as they are PROPERLY used. The best way to decrease your risk of severe COVID-19 remains vaccination and boosting. Wear a mask to further decrease risk of transmission. Isolate if you have symptoms, regardless of test results. Call your doctor if you have questions. Stay safe!