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Oseltamivir (Tamiflu) is an antiviral medication used to treat and prevent influenza A and influenza B (flu). It is said to reduce symptom duration even when initiated more than 2 days after symptom onset. Oseltamivir does inhibit influenza virus replication and transmission following ocular-only aerosol inoculation of ferrets.

Can the replication and transmission of the SARS-CoV-2 (2019-nCoV) virus in humans be inhibited in a similar way by the use of oseltamivir?


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  • I recommend narrowing this question to focus on either the ferret-versus-human aspect or the influenza-versus-SARS-CoV-2 aspect, not both.
    – Mark
    Mar 19 '20 at 20:53
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As of August 24, 2020, the jury is out on your question--Can the replication and transmission of the SARS-CoV-2 (2019-nCoV) virus in humans be inhibited in a similar way by the use of oseltamivir? It could be answered definitively only in a randomized trial.

The company that manufactures Tamiflu—the branded version of oseltamivir--seems not to consider oseltamivir promising for this virus, with considerable pessimism about its use for the treatment of COVID-19.

Thus, on April 29, 2020, Roche, the manufacturer of Tamiflu, issued provided the following information about Tamiflu and COVID-19.

Tamiflu and Use in Coronavirus (COVID-19)

This response corresponds to your request for information on the use of Tamiflu® (oseltamivir phosphate) for the treatment of novel human coronavirus (COVID-19).

This response was developed according to principles of evidence-based medicine and includes information from case series and reports with 5 or more patients.

In Brief

There are currently no medicines approved to specifically treat human coronaviruses. Tamiflu is designed to be highly specific to the influenza virus. Due to this high specificity, it is extremely unlikely that Tamiflu would be effective at treating the coronavirus.

Independent laboratory testing conducted by Hong Kong University, School of Public Health demonstrates that Tamiflu does not have any antiviral effect on the novel coronavirus.

Two case series describe the use of oseltamivir in patients hospitalized for COVID-19 in Wuhan, China.

The PDF document that includes this information from Roche can be found by Googling medinfo.roche.com>COVID-19>Tamiflu.

The document from Roche then provides detail on the case series.

The first case series was published in the Lancet.

In a Lancet publication describing 41 patients, 38 patients were empirically treated upon hospital admission with oseltamivir 75 mg twice daily along with antibiotic therapy.4 Common symptoms presented by these patients included fever, cough, and myalgia or fatigue. All patients had pneumonia and abnormalities in chest CT images. The median time from onset of symptoms to hospital admission (n=41) was 7 days (range, 4-8). The median time from onset of symptoms to ICU admission (n=16) was 1Th0.5 days (range, 8-17). Oseltamivir treatment was administered in 12 of the 13 patients, who received ICU care, and in 26 of the 28 patients, who did not receive ICU care. There was no statistical difference between the proportion of oseltamivir-treated patients admitted to the ICU compared with oseltamivir-treated patients not admitted to the ICU (92% vs. 93%, p=0.46).

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [supplementary appendix appears online]. Lancet 2020;395:497-506. https://www.ncbi.nlm.nih.gov/pubmed/31986264

The second case series was published in JAMA.

In a JAMA publication, 138 patients with COVID-19 were admitted to the hospital at a median time of 7 days from the onset of symptoms.6 Of the 138 patients, 124 patients received oseltamivir. The dose of oseltamivir was adjusted based on the severity of the disease, and was not reported. The authors noted no effective outcomes were observed.

Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. E-pub Date: aheadofprint February 2020. DOI # 10.1001/jama.2020.1585 . https://www.ncbi.nlm.nih.gov/pubmed/32031570

The question of whether oseltamivir has an effect on transmissability and/or infection with the SARS-CoV-2 virus would be definitively answered in a randomized, double-blind, placebo controlled clinical trial.

On August 24, 2020, no randomized, double-blind, placebo controlled clinical trials involving oseltamivir were registered at Clinical Trials.gov.

https://clinicaltrials.gov/accessed 8/24/2020

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This drug is not one of the candidates for the WHO mega study "Solidarity" nor do I see it in any other prospective trial. Without trial data your question can not be answered.

WHO and partners are organizing a study to compare untested treatments throughout several countries. “This large, international study is designed to generate the robust data we need to show which treatments are the most effective”, said the WHO chief. “We have called this study the SOLIDARITY trial”. And to date, Argentina, Bahrain, Canada, France, Iran, Norway, South Africa, Spain, Switzerland and Thailand have confirmed that their participation. “To suppress and control epidemics, countries must isolate, test, treat and trace”, he said, otherwise “transmission chains can continue at a low level, then resurge once physical distancing measures are lifted”.

The trial is simple with two endpoints - death or discharge from hospital, and uses 4 drug protocols.

https://news.un.org/en/story/2020/03/1059722

You can read about the trial design and rationale, and the drugs being tested here

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