EVMS Covid19 Management Protocol

There are promising therapies to prevent and treat Covid19 infections.  Check out the following Covid19 management protocol developed by Paul Marik, MD, Professor of Medicine and Chief of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School.

EVMS COVID-19 Management Protocol

The bottom line is to start supplements and Ivermectin early, at the first sign of Covid19 infection.

Symptomatic patients at home (for the duration of acute symptoms)
• Vitamin C 500 mg and Quercetin 250–500 mg 2x/day
• Zinc 75–100 mg/day (elemental zinc)
• Melatonin 10 mg at night (the optimal dose is unknown)
• Vitamin D3 2000–4000 IU/day.
• Highly recommended Prescription: Ivermectin 0.15–0.2 mg/kg orally (repeat on day 3).  Adults, 3mg tab, 4 tabs on day 1 and repeat on day 3.

• Aspirin 81–325 mg/day (unless contraindicated). ASA has antiinflammatory, antithrombotic, and
antiviral effects.  Platelet activation may play a major role in propagating the
prothrombotic state associated with COVID-19.
• B complex vitamins

• Optional: Famotidine 40 mg BID (reduce dose in patients with renal dysfunction) [82-88].
• Optional: Omega-3 fatty acid – 4 gram/day EPA/DHA.  Omega-3 fatty acids have anti-inflammatory properties and play
an important role in the resolution of inflammation. In addition, omega-3 fatty acids may have
antiviral properties.

• In symptomatic patients, monitoring with home pulse oximetry is recommended (due to
asymptomatic hypoxia). The limitations of home pulse oximeters should be recognized, and
validated devices are preferred.  Multiple readings should be taken over the course of the
day, and a downward trend should be regarded as ominous.  Baseline or ambulatory
desaturation < 94% should prompt hospital admission.

• Not recommended: Hydroxychloroquine (HCQ). The use of HCQ is extremely controversial.[101]
The best scientific evidence to date suggests that HCQ has no proven benefit for post exposure
prophylaxis, for the early symptomatic phase and in hospitalized patients. [102-120] Considering
the unique pharmacokinetics of HCQ, it is unlikely that HCQ would be of benefit in patients with
COVID-19 infection (it takes 5–10 days to achieve adequate plasma and lung
concentrations).[112,121-123] Finally, it should be recognized that those studies which are
widely promoted to support the use of HCQ are severely methodologically flawed.[124-127]
• Not recommended: Systemic or inhaled corticosteroids (budesonide). In the early symptomatic
(viral replicative phase), corticosteroids may increase viral replication and disease severity.[128]
An OpenSAFELY analysis in patients with COVID-19 demonstrated a higher risk of death in COPD
and asthmatic patients using high dose ICS. [129] The role of ICS in the pulmonary phase is
unclear as patients require systemic corticosteroids to dampen the cytokine storm, with ICS
having little systemic effects.

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