Your COVID Toolkit Is Better Than Ever — Here's What Actually Works Right Now

A Familiar Surge, But a Fuller Arsenal

Health surveillance systems reported increases or likely increases in infections in 47 states in late August 2026 , and if it feels like déjà vu, that's because it is — but with a critical difference. This time around, doctors and researchers have a more robust set of tools to fight back. From a promising nasal spray to a repurposed diabetes drug, the options available to prevent and treat COVID-19 in 2026 are meaningfully better than anything available in prior surges.

The XFG.1.1 variant and its sublineages accounted for nearly half of all U.S. cases in July. XFG, known as "Stratus," is a highly contagious recombinant strain. But experts note it's "still within the family of past omicron variants," which is probably why we're not seeing a dramatically larger peak this summer. COVID-19 has established a unique biannual pattern, with separate summer and winter surges, unlike other respiratory pathogens such as influenza or RSV. Knowing that rhythm — and preparing for it — is half the battle.

Prevention: Vaccines, Masks, and a Surprising Nasal Spray

Based on FDA recommendations, manufacturers Moderna, Pfizer-BioNTech, and Novavax are updating the COVID vaccine for the 2026–2027 season to target the XFG variant. The updated vaccine is not yet available, but is expected to be in doctors' offices and pharmacies in time for fall. In the meantime, only 17.5% of American adults and 8.9% of children received the 2025–2026 COVID vaccine, according to CDC data — a troublingly low number that helps explain why the virus keeps finding new hosts.

Perhaps the most surprising addition to the prevention toolkit is azelastine, an over-the-counter antihistamine nasal spray most people know as an allergy remedy. The FDA has approved azelastine (Astepro) only for treating allergy symptoms, but a study in JAMA Internal Medicine found that using it three times a day significantly reduced the likelihood of contracting COVID. Azelastine also appeared to reduce the risk of colds caused by rhinoviruses. The one catch: some people find the aftertaste unpleasant. Other antihistamines have also drawn research interest, with early clinical studies hypothesizing that targeting mast cells and histamine receptors might benefit COVID-19 patients.

If You Do Get Sick: Antivirals Old and New

If you test positive and are in certain high-risk groups, you may be eligible for Paxlovid, which can reduce your risk of long COVID and help you get better faster. Doctors emphasize starting it early. Now there's also a newer option: Xocova (ensitrelvir) is designed to help prevent illness after exposure — say, if a family member is sick with the virus. In a clinical study, it reduced the risk of symptomatic COVID-19 by 67 percent. That makes it a genuinely new category of protection: a post-exposure pill you can take before symptoms even begin.

Ensitrelvir works as an orally active 3C-like protease inhibitor used to treat SARS-CoV-2 infection, and real-world studies suggest early treatment with ensitrelvir may improve symptoms and reduce the number of days to return to work. For those who can't access or tolerate Paxlovid, it represents a meaningful alternative.

The Long COVID Wild Card: Metformin

One of the most significant recent developments has nothing to do with a new drug — it's an old one finding a new purpose. Multiple randomized clinical trials and electronic health record studies now show that metformin, a widely used and well-established medication, significantly reduces the risk of developing Long COVID when taken during or shortly after acute infection with SARS-CoV-2. In the COVID-OUT trial, metformin reduced the risk of Long COVID by 41% overall, and among people who started it within three days, that number jumped to 63%.

Long COVID affects millions of people after infection, causing fatigue, brain fog, shortness of breath, and other lasting symptoms. The fact that a cheap, widely available drug can cut that risk so dramatically is a genuine game-changer. New evidence from randomized trials and target trial emulations suggests that metformin may offer a practical and effective strategy to reduce this risk when started early in acute infection. If you test positive, it's now worth an immediate conversation with your doctor about whether metformin is right for you — because the window to take it is narrow, and the potential benefit is enormous.