There Are Few Good COVID Antivirals, but That Could Be Changing

COVID caseloads have plummeted in many areas with high vaccination rates. But as the number of people being infected daily worldwide still exceeds 400,000 and the highly contagious Delta variant of the virus spreads rapidly, treatment options are limited. Two of the current best available treatments, monoclonal antibodies and the drug remdesivir, are given by infusion. Patients only benefit during the first week or so of infection, when the virus is still present and replicating in the body. These medications are expensive and often unavailable outside of large teaching hospitals. In many instances, patients are treated too late, after the disease has already shifted to a more dangerous hyperinflammatory state.

Doctors want to give pills that infected people can take conveniently at home when symptoms first appear. Toward that end, the Biden administration announced in June that it would spend more than $3 billion on a program aimed at developing next-generation antiviral therapies—not just for COVID but also for other viruses that pose a future threat.

In an interview with Scientific American, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he was cautiously optimistic that the new Antiviral Program for Pandemics (APP) would save lives and prevent surging hospitalizations. “It’s an ambitious program,” he said. “But if we can block the virus early on, then we can avoid the progression to advanced stages of the disease, which are so devastating to so many.”

Why is there still such a paucity of antivirals for COVID? Experts point to several factors. Antiviral research has been long neglected in general, and coronaviruses never garnered the sustained attention and funding that could have made more COVID treatments available sooner. “No one cared about coronaviruses,” says Timothy Sheahan, a virologist at the University of North Carolina at Chapel Hill. “Most of the coronaviruses that make people sick cause the common cold. And those that cause more severe disease were no longer considered a problem. The first SARS [severe acute respiratory syndrome] outbreak was over, and Middle East respiratory syndrome [MERS] wasn’t deemed a global threat.”