As vaccination campaigns unfold across the world, almost 1 in 3 people worldwide have received at least one dose of a COVID-19 vaccine. But with so many people unable or unwilling to get a vaccine, the dreaded coronavirus won’t go away anytime soon.

As 99.5% of people killed by COVID-19 in the past 6 months were unvaccinated, researchers are still working on various treatments that could improve survival rates and reduce symptom intensity. Let’s have a look at some of the most promising ones.

As the pandemic unwinded, we’ve seen several potential treatments being trialed. From the hydroxychloroquine saga to steroids and even patient blood plasma, there’s been no shortage of COVID-19 trials. But it’s not always easy to tell what works, and trials haven’t been spared of controversy.

For instance, despite being touted by many as a useful drug, there’s still no strong evidence that ivermectin is an effective treatment against the coronavirus.

Potential treatments

Something that has been showing promise is dexamethasone, a glucocorticoid medication used to treat a range of conditions, from rheumatic problems, skin diseases, severe allergies, and asthma to brain swelling and eye pain following eye surgery.

Many doctors have been using corticosteroids as a treatment for COVID-19 even in the early stages of the pandemic — which makes a lot of sense. In patients whose immune systems are over-reacting (which is often what damages the lungs and other organs), corticosteroids like dexamethasone, which are also readily available and inexpensive, can be very useful as anti-inflammatory drugs.

Trials have backed this up and currently, the NIH recommends the use of dexamethasone in some people hospitalized with severe COVID-19, especially in those who require respiratory support.

It’s especially important to push effective treatments in areas where vaccinations are lagging.

Tocilizumab, a drug used for the treatment of rheumatoid arthritis, can also help some patients. A recent review found that “tocilizumab may have substantial effectiveness in reducing mortality among COVID-19 patients, especially among critical cases.” Another study noted that while the drug may not have a significant impact in non-critical cases, it can offer a “survival benefit” in critical cases.

Another approved treatment for COVID-19 is Remdesivir, developed by Gilead. Remdesivir was initially hailed with much promise, but more extensive surveys have shown that the biggest improvement is in the recovery time. Patients who received the drug had a median recovery time of 10 days as compared with 15 days. The drug also seems to offer a modest reduction of lower respiratory tract infections.

Rigel Pharmaceuticals’ drug fostamatinib (marketed in the US as TAVALISSE) could also show promise. The drug has recently been approved by regulators for a condition called chronic immune thrombocytopenia (a disorder that can lead to easy or excessive bruising and bleeding). More recently, the drug is also investigated for treating hospitalized coronavirus patients. In April 2021, a Phase II trial carried out with the NIH found that the drug halved the risk of serious adverse effects compared to standard treatment care. Rigel is currently gathering participants for a Phase III trial.

Another drug in the pipeline for COVID-19 is Lenzilumab, a monoclonal antibody that is currently undergoing assessments for controlled asthma and rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial from the NIH is currently advancing, looking to assess the efficacy of Lenzilumab on 400 patients.

Something else which has been trialed is blood plasma from COVID-19 survivors. When people recover from the disease, their blood contains antibodies that can fight the coronavirus; if transferred to other people, this could also help others fight the disease more easily — or so the theory goes.

However, despite promising initial studies, recent reviews have found less convincing data. Some studies showed promising results, others didn’t, but the overall sample sizes are still relatively small, and the matter is far from settled.

Why it’s so hard to figure out what works

Ultimately, there is no unique, standardized treatment for COVID-19, and sometimes, different countries seem to have different ideas of what works. The main problem is that developing antiviral treatments is always hard — any antiviral drug needs to target a specific part of the virus’ lifecycle, and must be able to kill the virus while leaving the cell it occupies unharmed.

To make matters even worse, viruses tend to adapt quickly to treatments, and through mutations, can develop resistance to drugs.

However, treatments and patient care have progressed, and research is coming up fast. According to Harvard, the US government alone is investing over $3 billion to develop new antiviral medications both for COVID-19 and for future pandemic threats.

The best way to protect yourself is still through vaccination. Breakthrough infections (infections that break through the vaccine) are very rare, and when they do happen, they still pose a far smaller risk than in the unvaccinated.