A year into the global COVID-19 pandemic, almost 1.6 million people have died worldwide from the virus.In the midst of a current resurgence, we spoke with Joseph Feuerstein, MD, who has been battling the virus on the hospital frontline and is a COVID-19 survivor himself. 

In the beginning, when infection rates were exploding, we threw the kitchen sink at the virus to help sick patients—antibiotics…the ­antimalaria drug hydroxychloroquine…an HIV medication called Kaletra. Now, we have a much better idea of what improves outcomes, and new insights are constantly evolving best-care practices. Here’s what we’ve learned so far…

Proning. If you’re sick enough to be admitted to the hospital, your oxygen-saturation levels are almost certainly low. Proning, flipping a patient onto his/her stomach, is a low-tech but extremely effective way of increasing the amount of oxygen that reaches the lungs. In this facedown position, gravity helps distribute oxygen more easily throughout the lungs. In a remarkable study, 25 patients who would normally have been put on ventilators were placed in the prone position instead. After just one hour, oxygen-saturation levels improved enough in 19 of the patients that they were able to avoid intubation at that time. Proning is helpful for hospitalized COVID-19 patients regardless of whether they are awake or have been placed on a mechanical ventilator. 

Dexamethasone. This powerful steroid, which helps reduce the ­inflammation that is common in severe COVID-19 cases, has been shown to reduce mortality by approximately one-third for patients on ventilators and by about one-fifth for patients requiring only oxygen. As with the other powerful treatments mentioned here, dexamethasone is for hospitalized patients with severe respiratory issues and difficulty maintaining healthy oxygen-saturation levels. It has long been used by doctors to treat certain cancers and cancer-related side effects, so it is very well-understood. It’s also inexpensive.

Bamlanivimab. Until now, there haven’t been any truly effective treatments for patients with mild-to-­moderate COVID-19. The recommendation was that you stay home, more or less battle through the symptoms, and hope for the best. The FDA recently approved the antibody treatment bamlanivimab to help milder symptoms from progressing to severe in high-risk patients age 12 or older. The drug contains man-made antibodies that are similar to the antibodies of patients who recovered from COVID-19. Scientists think that these antibodies may help limit the amount of virus in the body and give the body more time to learn how to make its own antibodies. Bamlanivimab is administered in one dose via IV and works by blocking the virus’s ability to enter healthy cells. 

Exciting: In a New England Journal of Medicine study, 452 nonhospitalized adult patients with mild-to-­moderate symptoms were randomly assigned to receive varying doses of bamlanivimab or a placebo. The majority of patients cleared the virus by day 11…but only 1.6% of those in the bamlanivimab group required hospitalization or an emergency room visit, compared with 6.3% of ­placebo-treated patients.

Antiviral drugs. These medications that held so much hope are showing mixed-to-disappointing results in the studies. The injectable ­antiviral medicine remdesivir, originally developed to treat patients with Ebola and hepatitis C, was officially approved in October as the first drug to treat COVID-19 in hospitalized patients ages 12 and up to help speed up recovery time. That would reduce both health-care costs and risk for ­hospital-acquired infections. In one study, remdesivir reduced average recovery time from 15 to 10 days when compared with a placebo. 

Hydroxychloroquine is another antiviral that causes continued debate within the medical community, with studies showing mixed results…some positive, some ineffective. 

A new study from the World Health Organization’s global Solidarity trial was the largest yet on these medications. It included 11,330 adults from 30 countries hospitalized for COVID-19. Neither remdesivir nor ­hydroxychloroquine—nor the antivirals lopinavir and interferon—had meaningful beneficial effect on patients’ mortality, need for ventilation or length of hospital stay versus patients who did not receive trial medications. 

Supplements that can help reduce risk and severity. For positive cases, in the hospital or at home, I ­recommend…

Vitamin D: 2,000 international units (IU) to 4,000 IU, depending on current blood level. Studies show a significant correlation between vitamin D deficiency and COVID-19 mortality. In one Spanish study, more than 80% of hospitalized COVID-19 patients were deficient in vitamin D.

Vitamin C: 500 mg to 1,000 mg/day. Research suggests it has stimulating effects on multiple cell types of the immune system and antiviral effects.  

Zinc: 30 mg to 50 mg/day. Zinc prevents viral replication and has other antiviral properties. But beware: If you take high doses for many months, it can cause a copper deficiency, so you need regular blood tests. The US recommended tolerable limit for zinc is 40 mg a day.

Melatonin: 3 mg to 6 mg/day for its antiviral properties and anti-inflammatory effects on lungs, according to a review of studies on this hormone, which is more commonly known for its ability to help with sleep.  

Beware: Don’t take elderberry, quercetin or echinacea if you have COVID-19—these could stimulate the immune system in the acute phase, which would be dangerous for the progression of the virus.

On the horizon: Some research suggests that the antidepressant fluvoxamine (Luvox), typically used to manage obsessive-compulsive disorder, may suppress serious symptoms in COVID-19 patients. A November JAMA study found that when 80 patients took fluvoxamine within seven days of onset of COVID-19 symptoms, none developed the severe respiratory issues that could require hospitalization (versus the 8.3% of placebo recipients who did). The drug’s anti-inflammatory properties may help prevent cytokine storms—the body’s massive, sometimes deadly, inflammatory reaction to coronavirus and other infections. 

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