The Wall Street Journal reports:

The Food and Drug Administration last week authorized two oral antiviral medicines for the early treatment of Covid-19. But don’t get too excited. The U.S. will still have a meager treatment arsenal this winter.

The U.S. has been relying on monoclonal-antibody treatments, but most don’t hold up against the Omicron variant. One, by GlaxoSmithKline and Vir Biotechnology, does better at neutralizing the variant, but supply is limited. Pfizer’s newly authorized antiviral pack Paxlovid will also have to be rationed. There will be more of Merck and Ridgeback Biotherapeutics’ newly authorized antiviral, molnupiravir, but patients may be reluctant to take the drug. Some scientists worry it could cause DNA mutations in people, though the FDA determined that the likelihood of this was low when used on a short-term basis.

Yet a promising alternative isn’t getting its due: fluvoxamine, a pill the FDA approved in 1994 to treat obsessive-compulsive disorders. Doctors often prescribe it off-label for anxiety, depression and panic attacks. Studies show that fluvoxamine is highly effective at preventing hospitalization in Covid-infected patients, and it’s unlikely to be blunted by Omicron.

Doctors hypothesize that fluvoxamine can trigger a cascade of reactions in cells that modulate inflammation and interfere with virus functions. It could thus prevent an overreactive immune response to pathogens—what’s known as a cytokine storm—that can lead to organ failure and death. It also increases nighttime levels of melatonin—the hormone that makes you sleepy—which evidence suggests can also mitigate inflammation. [Continue reading…]