The question that I, as a COVID-19 Early Treating Physician, blogger,
and human being with friends and family, get asked about COVID is "What
can I do myself, because my doctor says there's no treatment outside the
hospital".
There are multiple effective supplements and repurposed medicines to
treat COVID outside the hospital, which people should take to avoid
having to go inside the hospital and get IVs and breathing machines.
As a Public Health Physician (MD), acting in the interest of the good
of other human beings, with no anticipation of reward, I would like to
give advice to all readers, to reduce their risk of mortality and
morbidity during this pandemic.
This is the advice I give my patients.
I won't accept any payment for this advice.
Give your neighbor a bottle of vitamin-D. Don't try to give me anything of value.
An Ounce of Prevention:
Vitamin D deficiency is a major risk factor for catching COVID-19,
being sick enough to need hospitalization, and dying from it.
Don't
take that risk, please. Vitamin-D comes from sunshine entering
superficially into the skin, and causing a photochemical reaction that
creates vitamin-D. The great majority of people who do not work outdoors
are deficient in vitamin-D, mildly, moderately or severely. Black
people in New York and in Northern Europe, rich and poor alike, were
some of the most deficient in vitamin-D last spring. Do you recall how
that went?
Above and below the sub-tropics, the winter sun is too weak to produce vitamin-D, even if you can bare your skin at midday.
Vitamin-D supplementation is cheap, safe and effective. Somebody may
have already screamed, "Don't take too much" at you. I agree.
What's
a good dose and what's "too much". The dose I have taken for over a
decade is 1/8 of 1 milligram per day. That is 125 micrograms, or 5000
units.
1 mg of vitamin-D3 is 40,000 units. Weird, right? 1 mg sounds like nothing, and 40,000units sounds like WAY TOO MUCH.
I
have been checking pre-treatment and treatment vitamin-D levels on
people since 2006 and I'll say that if you weigh 100# or more, you can
safely take 5000 units per day of vitamin-D for as long as you may live.
I have seen a couple of people get slightly high levels after years of
10,000 units per day, not any sign of toxicity, and they backed off to
5000 units after a month off. Levels normalized.
You can take 10.000 units (1/4 mg) per day for the first 2 months, to get your level up into the normal range.
I recommend it, especially if you have extra fat. Vitamin-D distributes into fat, slowing the rise in blood level.
Upper mid normal appears to be ideal.
Zinc has been known since the 1990s to shorten the severity and
duration of some "common colds", namely those caused by coronaviruses.
The
studies used dosages of roughly 150 to 250 mg per day of zinc, usually
as lozenges, spread out through the day in divided doses.
What
zinc does inside a cell, infected by a coronavirus, is to reduce its
ability to make more coronaviruses. That is ideal in the period of
exposure and early infection, to reduce viral replication enough to let
the innate immune system keep the virus from getting the better of you.
Take 50 mg per day of oral zinc, as a tablet or lozenge, together with
250 mg of Quercetin, also readily available, a natural product of onions
and other vegetables. Quercetin helps zinc get into cells, which is
where zinc is effective. (It's really hard to eat enough onions to get
that much.)
Prescription antiviral prophylaxis may also be appropriate for some
people with weaker immune systems and higher risk of severe COVID-19,
such as those with diabetes, obesity, sleep apnea, heart disease, kidney
disease and cancer. Almost no western doctors will prescribe
hydroxychloroquine or ivermectin for this purpose, after the
politicization of hydroxychloroquine last spring when then President
Trump advocated for it.
The science
of its efficacy in prophylaxis has been born out. In medical workers,
bothe hydroxychloroquine and ivermectin weekly prophylaxis are about 75%
effective, reducing infections by 75% in the group taking either,
compared to the similar groups not taking weekly prophylaxis.
You likely just heard the unfair bad press, not things like The Lancet
admitting later that its anti-HCQ data from "Surgisphere", compiled from
all of those hospitals, was actually not compiled from hospitals, but
fabricated. Big headline, little retraction much later.
Hydroxychloroquine prophylaxis would need to be prescribed, and is
dangerous enough in overdose to have killed the poor guy who took the
fish tank product last year. I'm not advising you to try to get any, nor
to take it. (It is preferable as prophylaxis in pregnancy, an uncommon
need.)
Ivermectin has a remarkably broad safety profile, and has been served
up about as many times as McDonald's hamburgers, to man and beast alike,
for various forms of worms and parasites. It does cause birth defects
in rats, when given at high doses, so don't use it in pregnancy, please.
Like
most medicines to treat coronavirus illness, ivermectin does different
things against the virus, than it does on regular days. Ivermectin
inhibits the transport of the viral RNA into the cell nucleus, where it
would be transcribed, manufacturing new viruses. It does other things,
like reduce inflammation during cytokine-storm, in the second and third
weeks of illness, helping the people who get really badly sick.
Ivermectin is effective in prophylaxis, in early illness and also in
later, severe illness, and through multiple mechanisms. Ivermectin is
what I prescribe since last August.
Ivermectin is now available mail-order from India, and from a reliable source.
The
preventive, "prophylactic" dose of ivermectin is based upon body
weight, and it can be taken weekly, once an initial level inside of the
cells is established. Ivermectin leaves the cells very slowly, so it can
just be topped-off once per week. There are some slight variations on
this, but I'll describe the one I prescribe. It uses the same
body-weight dosing that you will find wherever you look up ivermectin
dosing for humans or animals. For every 5 kg, or 11 pounds of body
weight, a person takes 1 mg of ivermectin at that dose.
For most people I treat, that is 12 to 18 mg of ivermectin per dose.
For COVID-19 prophylaxis, this dose is taken Day #1, Day #2 and then every seventh day after that.
If you forget, take it when you remember, and get back to the original schedule after that.
The Pound of Cure:
I'm sorry if you have to do this, but it is mostly the same, with
higher doses, and some more additions, to help avoid systemic damage.
If you have not been taking vitamin-D3 for long, increase your dose to 5000 units 3 times per day for 10 days.
The
best thing is if you can get calcifediol, an immediately bioavailable
form of vitamin-D, which does not need slow activation in the liver, and
which saved lives and reduced ICU admissions in a Spanish hospital
study. We can't get it in the US.
Increase your dosing of 50 mg zinc and 250 mg quercetin to 3 times per day, also.
Add 1000 mg of vitamin-C 3 times per day to the vitamin-D, zinc and quercetin.
Aspirin is sometimes added in treatment of active disease, because
SARS-CoV-2 inflames the lining of arteries and arterioles, causing
clotting in small and large blood vessels. Aspirin is used as an
anti-clotting agent. If you have mild illness, related to nasal
symptoms, some fatigue, headaches and body aches, but no fever, no
diarrhea, and no breathing problems, you probably don't need aspirin.
However, if you have systemic illness, including fever, breathing
problems and/or gut problems like diarrhea and vomiting, you stand to
benefit from 1 to 2 tablets of 325 mg aspirin per day. The sicker you
are the more likely that 325 mg twice per day is for you.
Clotting
issues persist, so this should continue 30 days. If you have been
taking 2 per day, and feel pretty well after 10 days, then it is good to
back down to 1 per day. A lot of lung problems come from the
blood-vessel side, not the air side. This is a weird infection.
Ivermectin dose for treatment is the same for the first 2 days, the
cellular loading dose of 1 mg per 5 kg or 11# on days #1 and 2 of
treatment.
This is followed with that same dose on days #4 and 6 of treatment, and that is the full course.
Many
physicians dose for fewer than 4 days, and so have I, but this seems to
reduce the number of days of feeling bad in my experience.
I typically also treat with 10 days of 100 mg doxycycline twice per
day, which is Dr Borody's protocol, as widely used in India, to very
good effect. Doxycycline is a broad spectrum antibiotic, which will
treat any secondary bacterial infection on top of COVID Pneumonia, and
which also has some antiviral benefits. It is also anti-inflammatory,
which is of benefit.
You would be well served to have an accurate thermometer and pulse
oximetry devices at home. You need to know if you have a fever. You can
presume that you have systemic illness at that point. You need a
decision point and a fever over 100.5 degrees F is a good one. Temps
between 99.5 and 100.5 might mean early/mild illness. Early experience
in China was that people fared worse with things like ibuprofen and
naproxen. I have not seen good follow up on that in the west. Still, I'd
choose acetaminophen for symptoms.
The pulse oximeter shows pulse and calculates blood oxygenation. It's good for measuring heart rate.
Sicker people's hearts beat faster. I see it all the time. A heart rate over 110 means you are getting much sicker.
Don't ignore it!
It
is good to buy an inexpensive pulse oximeter and get to know what your
usual baseline is. For most people it is 97% to 99% saturation. It will
be lower if you live at high altitude. Dropping 2 points from normal
means your lungs are not working right. It likely means COVID Pneumonia,
if you have a positive test, already. Some people will read a little
higher than they really are, so if you read a little low (95%), and feel
short of breath, you may actually need oxygen. You may need to go to a
hospital.
If your pulse oximeter reads 93% or below, you really should be promptly evaluated at a hospital.
You might need to check in.
One dramatically important feature of COVID-19 is just how fast people
can go from not-too-bad to choosing between ICU and the morgue.
Really fast. An hour or two.
Rising heart rate and falling oxygen mean that it is time to go to the nearest real hospital ER.
Don't drive yourself, please. You may become confused or pass out at the wheel.
Resources:
Swiss
Policy Research has a very good list of medical articles about all the
treatments I have listed, except doxycycline here. (Thanks Bill)
Swiss
Policy Research has information about how ivermectin works here, and it
is also the group who arranged for the delivery of ivermectin from
India to those abroad who place orders. Jeremy in Devon informed me of
this link, and he also informed me that his shipment came in, "enough to
treat his whole village". I think that was a little under 2 weeks for
him, but it might have been a little over that. (Brexit
notwithstanding...)
Yours In Service,
John Day MD"
