Robert Oliveri Med First Urgent Care & Family Practice

Stages and treatment of covid affliction (EVMS)

Updated: January 2021
Languages: German, English
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Based on the bachelor scientific evidence and current clinical experience, the SPR Collaboration recommends that physicians and authorities consider the post-obit covid-xix treatment protocol for the condom and early treatment of people at high risk or high exposure.

Numerous international studies have shown that prophylactic and early treatment can significantly reduce the gamble of severe and fatal covid-19 (see scientific references beneath).

Annotation: Patients are asked to consult a doctor.

Treatment protocol

Prophylaxis

Goal: Supporting immune organization, reducing viral load if infected.

Vitamin D3 (2000 IU per mean solar day)
Vitamin C (500mg per day)
Zinc (20mg to 30mg per day)
Quercetin (250mg per twenty-four hours)
Mouthwashes and nasal spray

Early treatment (*)

Goal: Preventing disease progression (anti-viral, anti-thrombotic, anti-inflammatory).

Zinc (75mg to 100mg per 24-hour interval)
Quercetin (500mg per 24-hour interval)
Aspirin (325mg per day)*
Bromhexine (48mg per day)*
Arginine (3g to 5g per day)
Artemisia annua (tea/powder)
Mouthwashes and nasal spray

Prescription only

Goal: Preventing or reversing disease progression.

Loftier-dose calcifediol*
Sulodexide (LMW heparin)
Fluvoxamine or cyproheptadine*
Steroids: Budesonide or prednisone*
Anti-androgen treatment
Amantadine
Ivermectin (come across below)

Novel drugs

Goal: Targeted anti-viral treatment.

Monoclonal antibodies
Paxlovid (Pfizer)
Molnupiravir (Merck)*

(*) Notes

The early treatment phase includes post-exposure prophylaxis (PEP).
Bromhexine is bachelor prescription-gratuitous in most of Europe, but not in the US.
Steroids and cyproheptadine are only used if respiratory symptoms develop.
Molnupiravir (the Merck pill) is not a recommended handling (see below).
Counterindications and maximum dosages must be observed for all drugs.
On hydroxychloroquine (HCQ), see Severe covid: A postviral autoimmune assault

Run across also

FLCCC Covid-19 Prophylaxis and Handling Protocols (FLCCC)
Early Outpatient Handling of COVID-19 (McCullough et al.)
Covid-19 Early Treatment Report Overview (c19early.com)

Full general notes

The early handling of patients equally soon as the first typical symptoms announced and even without a PCR test is essential to prevent progression of the affliction. In contrast, isolating infected high-run a risk patients at domicile and without early treatment until they develop serious respiratory bug, every bit often happened during lockdowns, may be counterproductive.

People at high risk living in an epidemically active area should consider safety treatment together with their doctor. The reason for this is the long incubation menstruation of covid (up to 10 days): when patients first notice that they contracted the disease, the viral load is already at a maximum and there are often simply a few days left to react with an early treatment intervention.

Early handling based on the to a higher place protocol is intended to avoid hospitalization. If hospitalization nevertheless becomes necessary, information technology is recommended to avoid invasive ventilation (intubation) whenever possible and to employ oxygen therapy (HFNC) instead.

Handling studies

Results of trials and studies on the early treatment of covid.

Ivermectin

Ivermectin (an antiparasitic drug) has anti-viral and anti-inflammatory backdrop.

Several controlled and observational studies on ivermectin found anti-viral and anti-inflammatory furnishings and a pregnant reduction in covid morbidity and mortality.
However, several positive ivermectin studies turned out to be unreliable or fraudulent.
Once low-quality studies are excluded from the analysis, the do good of ivermectin is no longer statistically significant, although a moderate benefit might still be possible.
Three loftier-quality randomized trials of ivermectin are notwithstanding ongoing.
Read more: The Ivermectin Debate (SPR)

Zinc and quercetin

Zinc inhibits RNA polymerase action of coronaviruses and thus inhibits virus replication. Quercetin (a institute polyphenol) supports the cellular assimilation of zinc and has boosted anti-viral properties.

A Castilian written report plant that low plasma zinc levels (beneath 50mcg/dl) increased the risk of in-hospital death of covid patients by 130%.
The states studies found an 84% decrease in hospitalizations and a 45% decrease in mortality based on adventure-stratified early treatment with zinc and HCQ.
A US case study reported a rapid resolution of covid symptoms, such equally shortness of breath, based on early outpatient treatment with loftier-dose zinc.
An Italian randomized trial found a significantly reduced hospitalization charge per unit and mortality in covid patients receiving quercetin.

Bromhexine

Bromhexine (a mucolytic coughing medication) inhibits the expression of cellular TMPRSS2 protease and thus the entry of the virus into the jail cell, as starting time described in 2017.

A randomized Iranian trial with 78 patients found a decrease in intensive intendance treatments of 82%, a subtract in intubations of 89%, and a decrease in deaths of 100%.
Another Iranian study (randomized, double-bullheaded, multi-center, preprint) with 370 contact persons institute a 53% reduction in symptomatic confirmed covid.
A Chinese trial found a 50% reduction in intubations in patients receiving bromhexine.
A Russian written report found a faster recovery in hospitalized patients receiving bromhexine.
A Russian prophylaxis study plant a reduction in symptomatic covid from 20% to 0%.

Vitamin D3

Vitamin D3 supports and improves the immune system response to infections.

A Spanish randomized controlled trial found a 96% reduction in the risk of requiring intensive care in patients receiving high-dose vitamin D (100,000 IU).
Some other Spanish report with 930 hospitalized patients found a 87% reduction in ICU handling and a 79% reduction in bloodshed in patients receiving high-dose vitamin D.
A study in a French nursing domicile found an 89% decrease in mortality in residents who had received high-dose vitamin D either shortly before or during covid-nineteen affliction.
A retrospective British written report of approximately yard hospitalized covid patients establish an 80% reduction in mortality with high-dose vitamin D.
A large Israeli written report establish a strong link between vitamin D deficiency and covid-19 severity.
For an overview of all covid-19 vitamin D studies, encounter hither.

Aspirin and heparin

Aspirin and heparin have anti-platelet and anti-thrombotic effects.

A meta-study including 15,000 patients found a reduction in covid mortality of 53% in patients who were receiving aspirin as early or safe treatment.
A study published in PLOS One constitute a reduction in covid mortality at 30 days from 10.5% (control group) to 4.3% (with aspirin) in 70,000 US veterans taking aspirin.
A retrospective US study with 400 patients found a reduction in ICU treatments by 43% and a reduction in bloodshed by 47% in the group of patients treated early with aspirin.
A Mexican randomized controlled trial institute a 40% reduction in hospitalization in patients receiving sulodexide (a heparin combination).

Arginine

Arginine is an amino acid supporting endothelial function, immune regulation, and tissue repair.

A small randomized controlled trial, published in The Lancet E-Clinical Medicine, constitute that hospitalized covid patients receiving 3g of arginine per twenty-four hour period had a significantly reduced need of respiratory support at 10 days and a significantly shorter length of hospitalization.
A metabolomic analysis in covid ICU patients, published in Critical Care Explorations, found that depression levels of arginine very strongly predicted the chance of death.
A report published in PNAS found that plasma arginine and arginine bioavailability were significantly lower in adult and pediatric covid patients compared to controls.
Encounter also: l-Arginine and COVID-xix: An Update (Nutrients, Nov 2021)

Artemisia annua (tea, powder, or extract)

Artemisia annua plant excerpt has known antimalarial and antiviral properties.

An in vitro written report by the German Max Planck Institute, published in Nature Scientific Reports, constitute artemisia annua to be constructive against SARS-CoV-ii at realistic doses.
An in vitro study by US researchers, published in the Periodical of Ethnopharmacology, plant artemisia annua hot-h2o extracts to be effective against SARS-CoV-2 replication.
In a modest clinical trial, published in Antimicrobial Agents, the viral load decreased significantly faster in covid patients treated with artemisinin-piperaquine.
In a 2005 in vitro written report, published in Antiviral Enquiry, artemisia annua was already identified as effective against the original SARS-1 virus.
In Madagascar, the commencement country to use artemisia annua extract against covid, covid bloodshed and excess bloodshed accept remained very low, even for African standards.
In a simulation study by a Harvard research group, the anti-malaria drug amodiaquine was identified as almost effective against SARS-CoV-2 replication.

Mouthwashes and nasal sprays

Mouthwashes and nasal sprays target the initial infection and viral replication.

Several small studies found that mouthwashes (gargling) based on povidone-iodine and nasal sprays based on povidone-iodine or nitric oxide may foreclose a coronavirus infection or reduce its duration or symptoms (more about this).
The German Lodge for Hospital Hygiene (DGKH) recommends anti-viral mouthwashes and nasal sprays for prophylaxis and early treatment.
Some observers argued that traditional nasal rinsing and gargling practices in South Eastern asia may have helped successfully limiting coronavirus infections in these countries.
State of israel started mass product of nasal sprays based on nitric oxide in early 2021.

Anti-androgen treatment

Anti-androgen treatment inhibits the expression of the TMPRSS2 cellular protease used by SARS-CoV-ii, which is driven by androgen hormones (i.east. male sexual hormones).

A offset randomized, double-blinded and placebo-controlled trial in Brazil found that proxalutamide reduced hospitalization rates in male patients by 91%.
Another randomized, double-blinded and placebo-controlled trial in Brazil plant that proxalutamide reduced mortality in hospitalized patients (male and female) by 78%.
However, the two Brazilian trials take been criticized by other researchers. A United states stage 3 study of proxalutamide found no significant benefit.
Previous studies found that men receiving anti-androgens – typically used against prostate cancer or hair loss – were at a much lower risk of severe covid.

Fluvoxamine and Cyproheptadine

These drugs inhibit serotonin-induced pulmonary vasoconstriction.

The TOGETHER trial establish that fluvoxamine outpatient treatment of covid patients reduced disease progression (hospitalizations or ER visits) significantly by 32%.
The results of two preliminary Usa trials betoken that early treatment with fluvoxamine may strongly reduce the chance of severe covid, hospitalization and expiry.
In a pocket-sized US case study, cyproheptadine chop-chop improved the condition of hospitalized covid patients
Fluvoxamine and cyproheptadine target serotonin metabolism and serotonin-induced pulmonary vasoconstriction, which according to emerging bear witness may be a cardinal mechanism driving severe covid and covid-related respiratory failure.
Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and reduces platelet serotonin concentration; cyproheptadine is a direct serotonin receptor antagonist. In addition, fluvoxamine is a sigma-1 receptor antagonist and has an anti-inflammatory effect.

Corticosteroids

Corticosteroids (eastward.g. prednisone, budesonide) reduce covid-related inflammation.

A study by the University of Oxford, published in the Lancet, found a significant reduction in urgent care visits and hospitalizations in patients receiving budesonide (an asthma drug).
The British PRINCIPLE trial found that budesonide accelerated recovery past 3 days and reduced hospitalizations and deaths from x.3% to 8.5%.
The early on outpatient treatment protocol adult by McCullough et al. recommends the use of prednisone if (and only if) covid-related respiratory symptoms develop.

Amantadine

Amantadine is a medication used against influenza and some neurological conditions.

A Danish study, published in December 2021 in Nature communications biology, showed that amantadine inhibits two of the four ion channels of SARS-CoV-2.
A study by the German language Robert Koch Institute (RKI), published in March 2021 in Viruses, showed that amantadine inhibits SARS-CoV-two replication in jail cell culture. However, according to the RKI the required dose can only be accomplished via inhalation.
A small-scale Polish observational study, published in December 2021 past Medpress, found that covid patients receiving amantadine had a depression hospitalization charge per unit.
A small Shine study, published in July 2020, plant that patients receiving amantadine against neurological atmospheric condition had mostly asymptomatic covid.

Monoclonal antibodies, Molnupiravir, Paxlovid

These novel drugs have directly anti-viral properties.

Monoclonal antibodies have been shown to be constructive in early on treatment merely ineffective in the treatment of already hospitalized patients (mail service-viral phase). In improver, monoclonal antibodies rapidly lose efficacy against new viral variants.
Plasma from convalescents has been shown to be ineffective in both early and belatedly handling of covid patients.
Molnupiravir (Merck) has a questionable efficacy tape. In addition, the mechanism of activity is potentially Dna-toxic and may promote dangerous mutations of the virus. French wellness authorities rejected authorization of the drug.
Paxlovid (Pfizer) directly inhibits viral replication and, according to initial data, has been shown to be very constructive in early handling (reducing hospitalizations and deaths in at-adventure groups past nearly 90%). Paxlovid, however, will not be available until mid-2022.