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 blood level 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 ttreatment 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, both 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; small 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.
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