This guide is based on the most recent recommendations from the American College of Physicians and CDC Yellow Book 2024 about outpatient treatment of COVID-19.
Specific antiviral treatments recommended for treatment of COVID-19 in high-risk populations are:
Paxlovid (nirmatrelvir–ritonavir): First-choice oral medication for adults and children ages 12 years and older, within 5 days of symptom onset.
Velkury (Remdesivir): Intravenous infusion for adults and children within 7 days of symptom onset.
Lagevrio (Molnupiravir): Oral medication for adults within 5 days of symptom onset.
High-risk populations are defined as:
Age >50 years
People who are taking medicines that weaken their immune system
Patients with moderate to severe lung disease
Patients with liver, kidney, or cerebrovascular disease
Patients with diabetes (type I or II), HIV, cancer, or immunodeficiency
Please note that ivermectin and sotrovimab have been evaluated through clinical trials but are not supported due to lack of evidence of benefits and potential harms with use.
High-risk population recommendations:
At-home rapid test: Consider an at-home combined test for COVID-19 and flu if you are high-risk as both have targeted antiviral treatments. FDA-authorized 3-in-1 Combo Kit.
At-home Blood Oxygen Monitoring: For elderly, immunocompromised, or unvaccinated patients, monitoring of oxygen saturation using a pulse oximeter helps detect low oxygen levels early. Seek immediate medical attention if O2 saturation drops below 90% or if experiencing confusion. Fingertip Pulse Oximeter.
Antivirals: Patients with risk factors for progression to severe COVID-19 (elderly, immunocompromised, unvaccinated, etc) should be prescribed Paxlovid within 5 days of symptom onset.
Symptom management:
NSAIDs: Start at onset of symptoms for fever and aches, continuing for no longer than 1 week. NSAIDs will limit inflammation. Ibuprofen: 200-400 mg every 4-6 hours as needed (max 1200 mg/day). If you cannot take NSAIDs (for example due to bleeding risk), use acetaminophen: 500-1000 mg every 6 hours as needed (max 3000 mg/day).
Saline nasal spray or irrigation: To alleviate nasal congestion. Consider using a Soft Tip Neti Pot.
Decongestants and cough suppressants: Often used in combination to reduce nasal swelling and post-nasal drip. We recommend DayQuil/NyQuil with VapoCOOL in caplet or syrup form (FDA M012).
Supplements:
Zinc supplementation: Though not part of standard recommendations in the USA (as the effect is more pronounced in nutrient-deficient populations), zinc supplementation has been shown in multiple high quality clinical trials to reduce risk of hospitalization and severe symptoms during COVID-19 infection. Also, zinc is known to reduce symptoms of common cold in otherwise healthy people. Take 50-75mg per day (2-3 pills if using 22.5mg natural zinc supplement tablets).
Citations
Centers for Disease Control. (2024). COVID-19. CDC Yellow Book 2024.
Ben Abdallah, S., Mhalla, Y., Trabelsi, I., Sekma, A., Youssef, R., Bel Haj Ali, K., ... & Nouira, S. (2023). Twice-daily oral zinc in the treatment of patients with coronavirus disease 2019: a randomized double-blind controlled trial. Clinical Infectious Diseases, 76(2), 185-191.
Perico, N., Cortinovis, M., Suter, F., & Remuzzi, G. (2023). Home as the new frontier for the treatment of COVID-19: the case for anti-inflammatory agents. The Lancet Infectious Diseases, 23(1), e22-e33.
Qaseem, A., Yost, J., Abraham, G. M., Andrews, R., Jokela, J. A., Miller, M. C., ... & Population Health and Medical Science Committee of the American College of Physicians. (2023). Outpatient treatment of confirmed COVID-19: living, rapid practice points from the American College of Physicians (version 2). Annals of Internal Medicine, 176(10), 1396-1404.
