Maybe you’ve heard that the pandemic is over in the United States. (It’s not.) Masks are no longer required in most places and large gatherings are becoming commonplace again. Most of the country is in the green, according to the U.S. Centers for Disease Control and Prevention’s tracking site, which monitors COVID-19 transmission and hospitalization rates. Many people have been relying on vaccines to control outbreaks, and there is renewed attention on getting newly available treatments to sick people.

But coronavirus cases are on the rise again with more than a quarter of counties reporting high levels of transmission. And those are official numbers. No one really knows how many at-home tests come back positive and are never reported (SN: 4/22/22). Those cases are driving hospitalization rates up, with pockets of yellow and orange popping up on the CDC’s map, indicating that hospitals are entering the danger zone for being overwhelmed. Deaths have remained fairly low. That could change if another wave of infection sweeps the country. 

“Maybe we think we’re on the edge of the woods, but we’re not out of it yet,” says Mark Denison, a coronavirus researcher at Vanderbilt University Medical Center in Nashville.

Preventing hospitalizations and deaths is what vaccines were designed to do, but even the very good COVID-19 vaccines aren’t perfect. And with new immune-evasive variants of the coronavirus, even vaccinated people and those who previously had COVID-19  — particularly the elderly or people with weakened immune systems or other health concerns — can wind up in the hospital. 

The next line of defense against that bad outcome are three antiviral drugs and a monoclonal antibody that may keep people newly diagnosed with COVID-19 from becoming severely ill and dying. 

The test-to-treat initiative

About 20,000 pharmacies, hospitals, urgent care centers and other places have the antiviral pills Paxlovid (a combo of two medications), made by Pfizer. The federal government plans to extend that number to 40,000 in the coming weeks, Ashish Jha, the White House COVID Response director, said April 26 during a news briefing.The main downside to remdesivir is that it has to be administered intravenously. “There’s nothing convenient about that,” says Abraar Karan, an infectious diseases physician at Stanford University. Researchers are working on an oral form of remdesivir. Early experiments suggest it’s effective at protecting mice against severe illness. Tests still have to be done to see if it works for people, too.

Two other drugs, Paxlovid and molnupiravir, come in pill form. They are theoretically more readily available, but many people don’t know about them or how to get them. And some social media posts suggest that it’s not as easy as it sounds for everyone to lay their hands on the drugs after a positive COVID-19 test, even when they do know about them. The main downside to remdesivir is that it has to be administered intravenously. “There’s nothing convenient about that,” says Abraar Karan, an infectious diseases physician at Stanford University. Researchers are working on an oral form of remdesivir. Early experiments suggest it’s effective at protecting mice against severe illness. Tests still have to be done to see if it works for people, too.

Two other drugs, Paxlovid and molnupiravir, come in pill form. They are theoretically more readily available, but many people don’t know about them or how to get them. And some social media posts suggest that it’s not as easy as it sounds for everyone to lay their hands on the drugs after a positive COVID-19 test, even when they do know about them.