Treatment of COVID-19

Study of schau research and science unit

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Method

Integration of pharmacological, epidemiological and clinical aspects.

Weight on feasibility, possible side-effect risk and evidence. New substances always have many unknown risks, while well known substances provide a better knowledge of risks.

Descriptive explanation of postulated scientific medical conclusions.

This paper show the state of the art at end of april 2020. New findings may change the conclusions.

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Conclusion

Covid-19 is a disease that demands specific treatment at least when severe symptoms begin. As with every viral disease you get  best results in treating Covid-19 when you begin treatment as early as possible. Even though there do not yet exist many double blind randomized studies on treatment of Covid-19 it is not responsible not to treat it if symptoms do not stay mild. Medical doctors know that they have to take what they are convinced of working best and not to wait for official guidelines. Letting patients untreated until they have to get intubation is irresponsible.

The most promising COVID-19 treatment strategies are:

-1.) Chlorine Dioxide Solution

-2.) Hydroxychloroquinesulfate + Azithomycin + Zinc (Zelenko-Protocol)

-3.) Ivermectine

-4.) Other Chloroquin based protocols (e.g.Nitazoxanide)

-5.) Pluripotent stem cells from placenta-tissue (only in severe cases)

-6.) Favipiravir

-7.) Beta-Interferon in addition to an antiviral substance (in severe cases)

-8.) Hyperbolic oxygenation (only in severe cases)

-9.) Vitamin C

-10.) Remdesivir (only in severe cases)

-11.) Ritonavir / Lopinavir (Kaletra, only in severe cases)

-12.) Ribavirin and other antiviral Substances (only in severe cases)

-13.) Substances against autoimmune diseases (only in severe cases and in combination with other substances)

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Ranking of the most promising COVID-19 treatment strategies

First choice should be prevention through well known substances with antiviral activity:

Elderberry juice, garlic, ginger and vitamin C are the best known. In most cases of a infection with SARSCoV2 that will be sufficient to help your immune system to cope with it.

There are even hints that nicotine may be protective (link in French). https://www.sciencesetavenir.fr/sante/covid-19-l-hypothese-d-un-effet-protecteur-de-la-nicotine-a-l-etude_143699

Covid-19 is a well treatable disease. There is no more need for panic, restrictions and shut-downs.

1.

Chlorine Dioxide Solution (CDL) seems to be able to reduce the viral load in the body and to improve oxygenation in affected organs. It is easily available everywhere and save if taken in the right dosage.

The fact Chloride Dioxide is used as industrial disinfectant makes it difficult to believe that it can be a potent medicament in the same time.

FDA started a study on its’ effect on COVID-19:

https://clinicaltrials.gov/ct2/show/NCT04343742

The antimicrobial effects of CLO2 are well known:

https://medcrave.com/index.php?/articles/det/5318/Chlorine-Dioxide-

It kills influenza viruses:

https://jewlscholar.mtsu.edu/handle/mtsu/5085

https://www.microbiologyresearch.org/docserver/fulltext/jgv/89/1/60.pdf?expires=1587915728&id=id&accname=guest&checksum=D9B1D5DD84C1B03D9F179B061E94D904

CLO2 prevents haemagglutinin-associated complications in viral infections:

https://www.microbiologyresearch.org/docserver/fulltext/jgv/93/12/2558_vir044263.pdf?expires=1587915791&id=id&accname=guest&checksum=AA21D236B92B35FBA42C86C2B67E4DBA

It helps infected animals:

https://www.jstage.jst.go.jp/article/bio/15/2/15_2_45/_article

It seems to help in even very low concentrations:

https://www.seirogan.co.jp/medical/pdf/report24.pdf

2.

The Zelenko-Protocol was the most successful treatment in the early stage of Covid-19 so far. Hydroxychloroquine 200 – 200 – 200 mg in combination with 220 mg zinc and 500 mg Azithromycin over 5 days eliminates Covid-19 symptoms in almost all cases.

If you begin that treatment to late, when the systemic phasis of the disease with viremia happened already it may not work so well anymore.

https://internetprotocol.co/hype-news/2020/04/14/a-detailed-coronavirus-treatment-plan-from-dr-zelenko/

https://www.reuters.com/article/us-health-coronavirus-usa-hydroxychloroq/special-report-doctors-embrace-drug-touted-by-trump-for-covid-19-without-hard-evidence-it-works-idUSKBN21O2VO

https://docs.google.com/document/d/e/2PACX-1vT4I4Ls6RAsDqSaKBVIdLPIKFNs7tbWWzZ3eP1NrNltiiZqmUHK-rPDLxeN2qvt0es1S-v6jP29S_T1/pub

3.

Ivermectin shows high potential in reducing viral load in first studies and it is relatively safe and well available due to its’ use in veterinary medicine.

Patel initiated a multicentric study that shows good results so far:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3580524

Ivermectin is used as a itch agent in humans. Tolerance is well known: apart from liver enzyme elevations and rare facial swellings, serious side effects are not likely to occur. As it does not have cardiac side-effects it should be considered as alternative treatment for patients that may not tolerate Hydroxychloroquine Sulfate well due to QT-time prolongations.

https://www.sciencedirect.com/science/article/pii/S0166354220302011

If you are interested in how ivermectin works exactly, read this manuscript:

https://www.preprints.org/manuscript/202004.0334/v1

4.

Other combinations with chloroquine.

Additional treatment with antibiotics seems to improve the effect of chloroquine (as of hydroxychloroquine sulfate or phosphate), as zinc does, too. This may be necessary due to bacteriophagic infection of moouth bacteria that get more pathogenic. Direct antiviral effects of some antibiotic substances, like Nitazoxanide are discussed.

https://clinicaltrials.gov/ct2/show/NCT04361318

You may find more information about it here:

https://covidprotocols.org/protocols/04-therapeutics-and-clinical-trials/

5.

First trials with pluripotent stem cells from placenta-tissue for treatment of severe cases of Covid-19 show excellent results

https://cells4life.com/2020/04/placenta-cells-improve-covid-19-patients/

https://instituteofcelltherapy.com/en/news/institute-of-cell-therapy-develops-covid-19-treatme

nt-protocol-based-on-placental-mesenchymal-stem-cells/

https://www.cerahgeneve.ch/resources/covid-19-free-online-scientific-resources/

The therapeutic principle seems to work in China:

http://www.xinhuanet.com/english/2020-04/24/c_139004793.htm

6.

Favipiravir, known as Avigan, is a japanese antiviral substance, that is relatively well known and it seems to have an improving effect on COVID-19. Side-effects are relatively mild, as long as you are not pregnant.

https://www.researchsquare.com/article/rs-23106/v1

But its potential seems limited.

https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx

https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30086-8/fulltext

7.

The use of Beta-Interferon in addition to an antiviral substance seems to be helpful for severe cases.

https://www.pharmaceutical-journal.com/news-and-analysis/features/the-hunt-for-an-effective-treatment-for-covid-19/20207883.article?firstPass=false

8.

Hyperbaric oxygenation (only in severe cases).

When it comes to the systemic phase local of Covid-19 lack of oxygen in affected organs play an important role. That is why oxygenation is so important. While CDS does that from inside by its chemical reaction oxygen can also be provided from outside.There are some positive reports about it.

https://www.dynamed.com/condition/covid-19-novel-coronavirus

It seems logic to use it in severe cases, though there is no metaevidence given so far.

http://metaevidence.org/viewMApredictive2.aspx?exposition=617&pathology=87

9.

Vitamin C has well proven antioxidant properties. Besides the prophylactic use for reducing infection risk it may also work in the systemic stage of Covid-19. Studies show its efficiency:

https://www.researchgate.net/publication/340178205_Can_early_and_high_intravenous_dose_of_vitamin_C_prevent_and_treat_coronavirus_disease_2019_COVID-19

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172861/

10.

Remdesivir

Since that miracle report from the US-CDC Remdesivir made many hopes, but recent studies show that it helps not all of the severe cases and has important side-effects.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

https://www.sciencealert.com/inadvertently-released-results-suggest-covid-1-drug-failed-in-human-trial

11.

Ritonavir / Lopinavir (Kaletra, only in severe cases).

This standard therapy for AIDS-patients was used a lot when we did not know much about the pathomechanisms of Covid-19. Some patients with respiratory insufficiency may have profited, but the data is not that convincing.

https://www.nejm.org/doi/full/10.1056/NEJMoa2001282

“There was some evidence that LPVr reduced mortality at 28 days [19.2% versus 25.0%; difference – 5.8%, (95% CI, −17.3 to 5.7)], shortened ICU stays (difference -5 days; 95% CI -9 to 0), and shortened time to hospital discharge by 1 day. There was no effect of LPVr on the proportion of patients with clinical improvement at 28 days, time from randomization to death, nor duration of oxygen therapy or mechanical ventilation.”

https://www.cebm.net/covid-19/lopinavir-ritonavir-a-rapid-review-of-the-evidence-for-effectiveness-in-treating-covid/

12.

Other antivirals are listed in this study of Avindra Nath and Bryan Smith:

https://www.medlink.com/page/neurological_complications_of_coronavirus_infections_knowns_unknowns_and_wh

13.

Substances that are in use against different autoimmune diseases may help managing the immune dysregulation in severe case of COVID-19, but those medicaments are only useful in combination with other curing substances.

https://www.fau.eu/2020/04/22/news/research/anti-inflammatory-drugs-protect-against-covid-19/

https://www.researchgate.net/publication/340068994_COVID-19_infection_and_rheumatoid_arthritis_Faraway_so_close

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30152-2/fulltext

In Summary CDS (Chlorine Dioxide Solution) seems to have the best data and the best perpectives to become the standard cure for COVID-19. It is very easy available everywhere (see here how – explained in German) and very potent.

This study of Zhang, Zie, and Hashimoto shows a good overview, even though Chlorine Dioxide is not yet mentioned and Ivermectin not with all available data.

https://www.sciencedirect.com/science/article/pii/S0889159120305894

And very informative is the paper of van de Merve, if you understand dutch:

https://www.jpvandemerwe.nl/corona/pdf/coronapaper.pdf