Thursday, December 23, 2021

OTC COVID Rxs For Omicron

 Surprised Before Christmas,

  Three fairly close family members got diagnosed with COVID yesterday and the day before, one with fever, headache, exhaustion and hurting all over, the usual COVID symptoms. The other two have mild symptoms. One is vaccinated and one was treated for a positive test at hospital screening, without ever getting sick, so we were never completely sure if it was a real positive or a false positive.

  Delta-COVID remains in circulation, and most of the hospitalized patients in the US probably have it. Most hospitals will not know what type a patient has. It's not routinely reported that way. I never got such a notification as a clinic doctor.

  When I look at Texas COVID statistics here: I see that the number of positive test results and percent positive are spiking up, while total tests done have been about steady since the end of October. 
Deaths are steady and low, and hospitalizations are down. 
That implies to me that Texans are not more worried, but that the new Omicron strain is spreading rapidly during the final Christmas rush. 

  We are reconsidering the big family Christmas Eve party. Is it OK to go if you just brought medicines to the infected? 
There is a spread of attitudes among family members, as there probably is in your family. Some are aghast that anybody "exposed" should go out at all for 10 days after exposure. A test is not useful for 72 hours after known exposure, because it is likely to be falsely negative. After 72 hours from exposure, viral loads in the nose should be high enough to detect if infection has occurred. 
That puts anybody who tended to the sick yesterday out of circulation for Christmas and Christmas Eve.

  I don't mean to whine. People have plans and feelings. We are more aware of what is going on, the range of views, and the intricacies of disease progression and spread. You are likely facing a similar spread scenario, even if people are not aware of that yet.

  Delta is still out there infecting people. Some people will get sicker from any variant. People with minimal symptoms will attend parties, and are shopping and socializing every day. Omicron does make people variously ill. Being miserable, but not needing oxygen, is still being miserable.

  In September, while Delta-COVID was rising rapidly, I posted  OTC COVID Rxs, Azelastin To Zinc  That was not so long ago. The information is about the same. 
  We have learned that those who have had their gallbladders out might need to double the doses of vitamin-D listed, since fat and fat-soluble vitamins are more poorly absorbed. Take vitamin-D, especially big booster doses with some fatty food like avocado or cheese, please.
  We've learned the benefit of a baby aspirin, 81 mg per day, as prophylaxis, is substantial, and that it should continue through the course of illness.

  The brief shopping list should include: Vitamin-D 5000 unit pills , baby aspirin 81 mg, or regular 325 mg aspirin, if you only plan to treat yourself when ill, zinc 50 mg pills, quercetin (any form, with or without bromelain) to help the zinc get into the infected cells, and lecithin (granules or capsules) to help the quercetin be absorbed in the stomach. The lecithin is likely to help absorption of vitamin-D, also, but I don't know that for certain.
  You might also want to get an antihistamine, like cetirizine. You might want to get some Pepcid (famotidine). You might want to get some vitamin-C. 
You might also want to get some ivermectin at your local feed store, if you don't keep it around for man and beast, already. 
Here we go with the revised Omicron Christmas last minute rush update:

  All of this advice except for ivermectin applies to pregnant women. That is a group with a lot of questions. 
Ivermectin remains controversial. It is widely used in pregnancy in Africa for parasitic diseases, and disparaged in the west.
I remain deeply disturbed at how expectant-mothers are being treated with experimental gene therapies by the medical machine these days. 

  Firstly, don't use ibuprofen or Aleve. Do not use NSAIDs when sick with COVID-19. [Aspirin once per day is used specifically to reduce blood clots.]
I saw information from China in February 2020, and again from France in April 2020 that NSAIDs like these worsened hospital patient outcomes. 
I don't know how confirmed that is, nor do I want to await further word. 
It is easy to avoid them, and they interfere with the anticoagulant effects of aspirin, anyway, which matters.

  Support the normal functioning of your immune system with Vitamin-D. Every B-cell and T-cell in your immune system has vitamin-D receptors on it and won't work properly and intelligently if a lot of them are empty. Dr. Grimes has a fascinating medical vitamin-D website:

  For most people, in the long term, 5000 units per day of vitamin D-3 (the kind you can buy) is a good dose, and will get people into the normal range.
Exceptions to that are people who absorb it poorly and metabolize it poorly. Those people are the ones who still have a low level after months of taking 5000 units per day. You have to do the test to know you need more. People with a lot of body fat distribute their dose into a larger fat volume, and often need more.
  A person who has a body weight over 100 kg (220 lb.) might do better to take 10,000 units per day. People without a gallbladder will not absorb vitamin-D as well and should take it with a little fatty or oily food, not a lot, of course. Checking a blood test after at least 3 months would help confirm what is best. Taking 10,000 units per day for the first month or 2, in order to normalize blood level is good.

  What is the ideal one time dose of vitamin-D to normalize one's blood level, assuming a low starting point?
A lot of effort has gone into answering that question, and it can be found here:
​  ​Vitamin D3 doses >300,000 IU were similarly effective in patients with 25(OH)D concentrations >20 ng/mL; all 3 studies (29,34,39) observed mean concentrations >30 ng/mL at 4 weeks, though the results peaked at day 3 (reaching 67.1 ± 17.1 ng/mL from 21.7 ± 5.6 at baseline) in the study of Rossini et al (34). Sanders et al (29) showed long-term efficacy of a 500,000 IU dose; the 25(OH)D concentration remained >30 ng/mL at 12 weeks and was significantly increased at 1 year in a cohort of women with osteoporosis.
  That dose, 3000,000​ International Units of vitamin D3, by mouth, corresponds to #60 pills of 5000 units, a month's worth of taking 2 pills per day. The level peaked at mid-normal in 3 days, and stayed in the normal range at 30 days. An even higher dose, a whole #100 pill bottle of 5000 unit vitamin-D pills produced a 12 week blood level that was still normal.
  People are very, very reluctant to take that many vitamin-D pills at once, even when they are sick with COVID. 
I'm sure of that. People give me feedback.
"Trust the science", or something.​ All I can do is give my best advice, with references.

  Here is a flashback to "Vitamin-D Christmas":

  Jumping to Z-for-zinc, this paper is the Gospel of Zinc, which has been shown effective against coronavirus "common colds" since 1996, reducing severity and shortening duration of illness. Zinc is clearly good, but it needs to get inside of the cells in order to directly interfere with viral replication. It is nice to have zinc adequacy when you get inoculated with COVID, but you can sure increase your dose when you get a positive test result.
​  ​In most cases, prophylactic zinc supplementation was more effective than therapeutic proceedings (106–108, 111). Up to 30% of the everyday respiratory infections, briefly named “common cold,” are due to infections with coronaviruses (112). Studies showed reduced symptom severity, reduced frequency, and duration of the common cold after zinc administration (99, 100, 113, 114) depending on dosage, zinc compound and the start time after initial symptoms (115).....Zinc supplementation improves the mucociliary clearance, strengthens the integrity of the epithelium, decreases viral replication, preserves antiviral immunity, attenuates the risk of hyper-inflammation, supports anti-oxidative effects and thus reduces lung damage and minimized secondary infections...

​  What is the optimum preventive-dosing of zinc? The prophylactic dose needs to assure zinc adequacy, without crowding out the absorption of copper. 12 - 25 mg per day seems to be an agreed recommendation. 
Not exceeding 50 mg/day prophylactically is also broadly agreed.​ (We get about 12 mg/d in a supplement and eat lots of fresh vegetables.)

  What about taking zinc when you are sick with coronavirus? What should be done differently?
This gets fancier, and includes quercetin, a plant polyphenol found in foods from onions to green tea. 
Quercetin acts as a zinc-ionophore and helps zinc get into human cells, including human cells infected with coronavirus, where it inhibits viral production.
Taking quercetin together with zinc during active infection has been advised in treatment protocols since at least June 2020, when I first saw it. I was having difficulty prescribing hydroxychloroquine, because of the medical politics which had arisen after President the-Donald had advocated for it. It was already in fairly wide use by that time. One good thing about HCQ is that it is a zinc ionophore, so I was looking for alternate zinc ionophores, and had heard that quercetin was the main one, especially the available one. 
(I did not get a good idea of how long quercetin persists in the bloodstream after ingestion. That would be expensive to study...)

  What has been studied is quercetin absorption from the gut, which is poor, but helped by taking it with a meal.
  It turns out that taking a little lecithin with your quercetin can increase absorption by up to 20 X
They call the mix of 250 mg quercetin + 250 mg sunflower lecithin, in a gel-cap, "Quercetin Phytosome".  

  We ordered some after seeing this article: Other benefits of quecetin against SARS-CoV-2 are also postulated. They didn't give zinc, just "quercetin phytosome".

Results: The results revealed a reduction in frequency and length of hospitalization, in need of non-invasive oxygen therapy, in progression to intensive care units and in number of deaths. The results also confirmed the very high safety profile of quercetin and suggested possible anti-fatigue and pro​ ​appetite properties.

​Ground-laying research about the highly-bioavailable formulation, "quercetin phytosome", mixed with lecithin, and readily available in the retail market.
​  ​Quercetin (3,3′,4′,5,7-pentahydroxyflavone) is a natural flavonoid compound widely found in vegetables, fruits, and nuts. Major dietary sources of quercetin are apple, onions, tomatoes, broccoli, lettuce, and black and green tea...  increasing the water solubility of quercetin would enhance its oral bioavailability...
​  ​A more soluble formulation of quercetin based on lecithin, Quercetin Phytosome, has recently been developed, and was found to facilitate the attainment of very high plasma levels of quercetin—up to 20 times more than usually obtained following a dose of quercetin—when the novel formulation was administered orally in human volunteers, and it did not have any notable side effects.

  You can buy any quercetin (with or without bromelain) and take it with a little lecithin (1/4 tsp granules) and your zinc.
I advise this 3 times per day for 10 days, or until well, but the limiting factor is queasiness from zinc. Take what you can stomach.
Take it all with some food. All of these things are absorbed better with a meal.
If you want to take quercetin prophylactically with your zinc, once per day dosing with lecithin is a good way to do it. Increase to 3 times per day if you catch COVID.

  COVID has 2 phases, which the Chinese already explained in early 2020. The first week of symptoms (which begins about 5 days after exposure/inoculation) and the second week, where the person either improves with the antibody response the body makes, or gets deathly ill from it. 
  In the second week the battlefield against the virus, and virus-producing cells, lays waste to organs like the lungs, kidneys, blood vessels and heart. 

  People with inflammatory conditions, like diabetes and obesity, are prone to get hit much harder in the second week. This is the time that people crash fast and get put on high dose steroids and blood thinners in the hospital, to reduce the collateral damage, the "Cytokine Storm". Those treatments are not over-the-counter.

  There are some accommodations you can make in anticipation of that.
Aspirin is not safer than Tylenol, but one baby-aspirin per day is very safe for most people.​ 
People already taking low-dose aspirin (81 mg) per day experienced a protective effect in this study.
  The treatment reduced the risk of reaching mechanical ventilation by 44%. ICU admissions were lower by 43%, and an overall in-hospital mortality saw a 47% decrease...
​  ​Israeli researchers reached similar results in a preliminary trial at the Barzilai Medical Center in March. In addition to its effect on blood clots, they found that aspirin carried immunological benefits and that the group taking it was 29% less likely to become infected with the virus in the first place.

  You might decide to take a 325 mg aspirin or two per day, and 1000 mg of vitamin-C three times per day before you get to the second week.
The potential benefits outweigh the risks for those with hypertension, diabetes, and obesity.. 

 Those who are more inflammation-prone should consider increasing aspirin dose to 1-2 X 325 mg  Aspirin per day, to get full benefit of the anticoagulant effect if they are getting fever and feeling miserable.  All the inflammation makes micro clots through the circulation of lungs and kidneys, even brain and heart, and sometimes big clots, too causing overt occlusion of blood supply to heart, lungs and brain.

  Vitamin-C has a benefit to cleaning up the oxidative damage and debris where the immune system is fighting the virus, and blasting infected cells with little oxidative-bombs. 1000 mg of vitamin-C 3 times per day is a modest dose in this context. It has been used up to 10X that dose IV in hospital studies last year.

(Astepro).​   I​ admit that I am stretching a bit to include this as OTC, but it is approved as such. I would spray it up both nostrils twice per day​ ASAP.
​  ​The 0.15% strength of azelastine nasal spray is now approved for nonprescription treatment of rhinitis – a common allergy to pollens, dust mites, mold and more -- in adults and children 6 years of age or older, the agency said. The 0.1% strength remains a prescription product for younger children.

Azelastin, hydroxyzine and diphenhydramine were found to inhibit SARS-CoV-2 replication in cell cultures. They are available​ antihistamines​.
Among the three medications, azelastine was found to inhibit the SARS-CoV-2 virus at a dose that was smaller than the amount prescribed as a nasal spray. The other two antihistamines required higher drug concentrations than currently recommended dosing levels to achieve antiviral activity in cells.

Famotidine (Pepcid) was found to reduce COVID-19 progression, severity and deaths last summer. It likely inhibits cytokine storm effects, but that; is not certain. 
The dose I heard the best reports on was 60 mg 3 times per day, more than cited in the range here​: 20-40 mg twice per day should work to full effect..
Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19
​   ​Famotidine use in hospitalized patients with COVID-19 is associated with a lower risk of mortality, lower risk of combined outcome of mortality and intubation, and lower levels of serum markers for severe disease in hospitalized patients with COVID-19.​..​
​  ​Famotidine was administered orally in 83% of cases and intravenously in the remaining 17%. Dosing for oral administered famotidine was 20 mg/d in 95.2% of cases and 40 mg/d in the remaining 4.8% of cases. Intravenous famotidine was administered as a 20 mg/2 mL solution in all cases, For inpatient famotidine use, the median total dose was 80 mg (range 40–160 mg) and was received over a median of 4 days (range 2–8 days).

​  You might well take 10 mg Zyrtec (cetirizine) twice per day with your Pepcid.
A more recent cohort study used cetirizine and famotidine in hospitalized patients with severe to critical pulmonary symptoms. This study confirmed beneficial reductions in inpatient mortality and symptom progression, probably by minimizing the histamine-mediated cytokine storm
  This article is sparse on details, but the Pepcid + Zyrtec combination might be what they used to treat long-COVID.
Antihistamines might be effective in long-COVID
​  ​Regarding therapeutic intervention, almost 60% reduction in symptom burden was observed in long-COVID patients treated with histamine receptor antagonists. Specifically, of 25 patients in the treatment group, 5 reported complete resolution of all symptoms, 13 reported improvements, 6 reported no change, and 1 reported deterioration of symptoms.

​  The media, Tony Fauci and the AMA all beat really hard on ivermectin, the stupid people who use it and the criminals who prescribe it last summer. It really helps.
Ivermectin is not over the counter in the US.
WARNING: If you take an ivermectin dose to deworm 50 horses, 500 times a typical human dose, you might get sick and die, maybe.​

​  ​In a trial on human volunteers, doses of 60, 90, and 120 mg were included to establish a significant safety margin for administration of this drug. No central nervous system effects, using pupil size as the parameter, were detected at the maximum dose level. No adverse events were reported in subjects who received 120 mg of ivermectin, which is 10 times the proposed dose of 0.2 mg/kg for treatment of scabies. There was minimal accumulation following multiple dosing (three times per week) with ivermectin, which was consistent with the half-life in the body of about one day.
​  A safety margin of ten times the recommended dose sounds good, but it gets better. During a program for treating children with scabies in the Solomon Islands, an 8 mg/kg accidental overdose (40 times the recommended dose) in a child caused acute emesis, mydriasis and sedation which rapidly reversed. In a study of poisoning due to ivermectin and the related molecule avermectin, “Seven patients manifested severe symptoms, such as coma (7), aspiration with respiratory failure (4), and hypotension (3), after a mean ingestion of 100.7 mg/kg avermectin (15.4 mg/kg for ivermectin and 114.9 mg/kg for abamectin). One of the seven patients died, the other six recovered. This was from an average of 500 times the recommended dose rate.

Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19

Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19
​(We wanted to hike Machu Picchu last summer, so I was paying a lot of attention to Peru. The mountainous regions were handing out ivermectin and having very low case counts and deaths, compared to the cities. 
​Last​ winter Peru got a new president, who outlawed ivermectin. Look what happened. 
(Sorry. It's a copyrighted image. First link​)

Stuffing Stockings


  1. Christmas greetings to you and Jenny! Great summary. Things are getting wild again. 3 new positives among colleagues this week - all jabbed, 2 boosted in the last 2 mos. The response: Be sure to get your booster!

    1. Thanks LS: Numbers are small, but it looks like every additional "vaccine" dose may increase chances of catching Omicron.

  2. Man, sorry to hear about the sicknesses and keeping all in heavy prayers. Everyone's plans have changed, but better safe then sorry. Merry Christmas and happy New year. Hoping 2022 is better. I turn 60 new years Eve and so very thankful I've been well and safe so far. My entire family has been safe and count my blessings daily. Keep up the great work keeping everyone informed with the TRUTH....God bless you and yours.

  3. Thank you for this timely update.

    Two small questions if I may:

    1. Should Pepcid and Claritin (loratadine) be taken from the onset of symptoms?
    2. Will azithromycin that is 6-12 months past its expiry date be safe to take?

    Many thanks for this blog and your contributions at TAE. Here’s hoping that we will be done with this madness next year. All the best in 2022.


    1. "Should Pepcid and Claritin (loratadine) be taken from the onset of symptoms?"
      A: It's good to have a diagnosis first, but yes, if it is COVID.

      "Will azithromycin that is 6-12 months past its expiry date be safe to take?"
      A: It should be safe. It does not turn to poison. I'm not certain of its potency, but most hard pills like that are pretty chemically stable over time.

      This is just what I know off the top of my head. It's not personal medical advice.

  4. Thanks John, will get some supplies though I have been exposed on multiple occasions and think I may have natural immunity. Oxy

  5. Late to this party, but it's early July; I am 60 years old and came down with Omicron, probably BA.4 or .5 judging from the symptomology. Your review of OTC solutions answered a lot of questions--but damn, this has been tough. In all my years I've never been so sick. 103º fever for 5 days; controlled by NSAIDS, I kept it down to about 99-100º just to cook the little beasties. Ironically, the respiratory symptoms stopped when the fever spiked.

    Now two weeks into this fight, there are days when I feel better; there are also days when I feel a lot worse (but no fever). Confusion and splitting headaches, along with profound exhaustion, continue. N.B.: I have no gallbladder and am taking 20K IU of D3/day along with Quercetin and HCQ (I have rheumatoid arthritis).

    Hydrating like mad; eating when I can; sleeping when I can.

    I appreciate your blog. Hail the Texas Republic from the People's Republic of Hawaii!