As the U.S. enters what will be its third year of battling the COVID-19 global pandemic, the number of lives lost since 2020 are daunting. The U.S. is nearing a million deaths with its 872,332-death toll. Since 2020, scientists, doctors, and researchers have tirelessly worked on testing many different types of treatments and therapies on COVID-19 patients in hopes of finding a cure. COVID-19 infections are responsible for a range of clinical manifestations. Some patients have no symptoms at all, while some have severe pneumonia with acute respiratory distress syndrome, septic shock, and even multi-organ failure that results in death.

There is no one specific antiviral drug approved to treat COVID-19. Treatment of the disease thus far has focused on prevention, symptomatic treatment, and supportive care. This is why such a range of different types of medications have been studied and used to find a cure for COVID-19. The following ten therapies and drugs are just some of the treatments tried and studied so far in the past couple of years. Some of these have shown to be promising, while others are hit-and-miss attempts. However, the scientific and medical community continues to press on and make strides in COVID-19 research.

1. Monoclonal antibodies

This experimental treatment has become the go-to treatment for COVID-19 patients who have tested positive within the last ten days and do not have severe symptoms requiring hospitalization. The FDA describes the monoclonal antibody treatment as an experimental one that uses lab-made proteins that act similar to the body’s immune system to fight off viruses. Research has shown that the antibody infusion reduces the risk of hospitalization and death in people with mild cases.

2. Ritonavir / Lopinavir

These two antivirals are often used together as an HIV medication. Past clinical studies have shown these antivirals have had some effect on treating SARS and MERS, but data on using them for COVID-19 is minimal. In one study conducted during the COVID-19 pandemic, researchers looked at the conditions of 199 hospitalized patients. There was no recovery difference between the patients who received this medicine combination and those who didn’t. The NIH has since recommended against using these two antivirals for COVID-19.

3. Chloroquine and hydroxychloroquine

These two medications have been used for decades to treat autoimmune conditions such as lupus and even treat infectious diseases like malaria. During the first wave of the pandemic, it was initially thought that both of these drugs helped treat hospitalized patients who had mild symptoms. However, studies have shown that neither is very effective at treating COVID-19 and does not prevent the virus. Clinical guidelines have since recommended against either of these being prescribed as a form of treatment for COVID-19.

4. Famotidine

Famotidine is a histamine H2-receptor antagonist that is commonly used for gastric acid suppression. It can be found over-the-counter to treat conditions like heartburn. However, it has been thought to have a potential impact on treating COVID-19. But after four studies involving 46,435 total patients, researchers could not conclude that the medicine had any effect on reducing the risk of mortality, intubation, or the need for intensive care. Studies are continuing to see if the histamine affects patients who have mild cases.

5. Ivermectin

This oral medication is routinely used to treat infections caused by parasites. Sometimes it is even prescribed as a cream to treat skin conditions like lice. One in vitro study found that ivermectin stopped SARS-CoV-2 from replicating. A follow-up study examined the charts of nearly 300 hospitalized patients in Florida between March and May of 2020. Patients who received this medicine had a lower death rate, but this was not a full-bodied study. These patients also received other treatments in conjunction with ivermectin, and researchers were unable to determine the medicine’s true efficacy. The FDA announced in March of 2021 that ivermectin should not be used to treat or prevent COVID as there are very serious risks involved. Ivermectin interacts with many medications and increases a patient’s risk of bleeding.

6. Corticosteroids (i.e., Dexamethasone)

Dexamethasone is a corticosteroid most commonly used to treat autoimmune conditions and allergic reactions. The patients who have benefited the most from this medicine are those who had been on a ventilator or extra oxygen when receiving the therapy. A low daily dose of this steroid, by mouth or IV, lowered the death count significantly. This medication continues to be studied to determine if the results are universal.

7. Luvox / Fluvoxamine

Fluvoxamine is a selective serotonin reuptake inhibitor that has been approved by the FDA for the treatment of obsessive-compulsive disorder and other mental illnesses. This medication has never been approved to treat infections of any kind. However, in a model, this medication was shown to have an anti-inflammatory effect. The medicine’s ingredients bonded to the sigma-1 receptor on immune cells, which reduced the production of inflammatory cytokines. Researchers are working towards clinical studies where the real-time effects on patients could be studied. Since this medication is only used to treat psychiatric conditions, those taking it have reported side effects of nausea, diarrhea, and indigestion. Other side effects reported include neurologic effects like insomnia, anxiety, and headaches. For now, the NIH has stated that there is insufficient evidence to support the use of Fluvoxamine to treat COVID-19.

8. Remdesivir (Veklury)

Remdesivir is an antiviral given through an IV (intravenous) infusion in the hospital. This was the first medicine given FDA approval in 2020 for the treatment of COVID-19.

COVID-19 patients who were hospitalized and given remdesivir recovered faster compared to those who did not receive it. This medication was the first given FDA approval to be used to treat COVID-19 patients based on the substantial effect it had on their recoveries.

9. Azithromycin

Almost everyone has heard of or been prescribed a “Z-pak” at some point in their adult lives. This antibiotic is commonly used to treat bacterial infections like pneumonia. In the past, azithromycin has not been effective against the coronavirus that causes MERS. Some prescribers were trying a combination of azithromycin and hydroxychloroquine for their COVID patients, but doctors and scientists alike have raised concerns about the potential adverse side effects of using the two together.

10. Heparin / Enoxaparin

Heparin and Enoxaparin are anticoagulant medications used to decrease the body’s ability to clot; this helps prevent harmful clots from forming in the vessels. Though this medicine is sometimes referred to as a blood thinner, it does not thin the blood. COVID-19 infections are responsible for a range of clinical manifestations. In hospitalized patients, researchers and doctors have observed the activation of coagulation (clotting) in COVID-19 patients, which can lead to severe hypercoagulability. This is why the use of an anticoagulant such as heparin has been recommended to reduce coagulopathy and the risk of organ damage. Though heparin has been supported by many studies involving COVID-19 patients, it must be proven in clinical trials. Study results thus far have shown this medication would be most beneficial to patients who have been intubated, patients with physical findings of thrombosis, and patients with respiratory failure.

While the race to create effective vaccines aimed at lessening the virus’s impact was successful, effective treatments have remained obscure. There is still a large proportion of the country and world that remains unvaccinated, and the need for a safe therapy that can be administered to all remains imperative. Besides the monoclonal antibodies, there are no treatments that have successfully reduced the progression of the virus from mild and moderate cases to severe and critical ones once a patient has tested positive. Each medication listed above has been tried in studies or clinical trials, but there has been no treatment that is a “one-size-fits-all.” Unlike previous SARS infections, there is growing evidence that COVID-19 infects both the upper and lower respiratory tracts instead of just one or the other. This coronavirus has also shown that it leads to frequent multi-organ impacts, blood clots, and an unusual immune-inflammatory response.

There is still so much we do not know about this coronavirus and its sometimes lasting effects. A small percentage of the people who recover from the virus go on to have symptoms for an indefinite amount of time. These patients are called “COVID long-haulers.” We are only beginning to understand the lifecycle of COVID-19, and the persistence of symptoms for an extended time seems to occur in patients with weak immunity. There is also a need for therapies to be developed to help COVID-19 long-haulers regain the everyday life they had before testing positive. The creation of developing new medications takes a long time, and as we have seen, COVID-19 mutates quickly. Even when a drug is developed, the constantly evolving virus might develop resistance to it by the time it is ready to be given out. This is why current treatments or prevention tools for COVID-19, like the vaccine, have only received emergency approval because it is a race against the virus itself to get ahead. For now, the best protection and treatment come from following current CDC guidelines. While so much remains unknown, there are things we know help prevent COVID-19.