If you are confused about the recommendations made by different professional groups for the COVID-19 pandemic, you've come to the right place. Before you continue to read this rather long article, let's start with the end in mind and begin with the conclusion that you may have been told. There is no early treatment for COVID-19? Most of the studies are small and are of low quality? We shall wait for bigger and better quality evidence before we can make formal recommendations?
The main aim of research is to analyze the facts in order to predict the future. Science requires questioning and testing. The world does not exist in a 'black or white' manner and most of the time, things do fall into the 'gray' area. Medical science is dynamic and evidence development is constantly in a continuous work-in-progress mode. If a treatment has been shown to work in a small study, would you wait for a bigger study or should you just take it after considering the benefit and risk ratio; especially if the treatment is actually an old drug that has been used for more than 20 years? You be the judge!
The number of options for the treatment of COVID-19 has increased drastically in recent months, thus making it complicated when it comes to choosing the right combination. In general, there are 3 broad categories of medical interventions:
- Prevention or Prophylaxis e.g. vaccine
- Early out-patient treatment
- Hospital treatment
|McCullough et al. Reviews in Cardiovascular Medicine, 2020|
All these treatments come with various technologies and jargons, thus could be overwhelming and confusing for you as a consumer. Generally, multiple treatments and strategies are used in combination to achieve the best possible outcome.
The medical community themselves are battling over ivermectin and hydroxychloroquine on whether they should be used to treat and prevent COVID-19. On one side are experts telling you that more research is needed before the treatment can be fully authorised and confirmed. On the other, are experts telling you that the potential benefits outweigh the risk and a 'wait and do nothing' position is not acceptable. Confused?
How do you deal with different expert groups dishing out conflicting guides? A common issue is that certain groups have pre-defined narrative that they would like to support. Therefore, only studies that support that pre-defined narrative are picked and cited as references. This is what we call as 'cherry-picking'. Cherry picking will naturally lead to a 'biased' and 'manipulated' decision. In order to get the truth out, scientific information needs to be analysed in a comprehensive, updated and non-biased manner.
In this article, we would like to cover 3 popular treatments i.e. Ivermectin, Hydroxychloroquine and Quercetin.
Ivermectin and COVID-19
As of August 2021, there are more than 80 on-going trials globally on Ivermectin for treatment and prevention of COVID-19 on covid-nma.com
Ivermectin is a medication widely used in low- and middle-income countries to treat parasitic worm infections in adults and children. It’s been used for decades for this purpose by over 3.7 billion people, and is considered safe and effective. It has an increasing list of indications due to its antiviral and anti-inflammatory properties, and is included on the WHO’s Model List of Essential Medicines.
|Check out the "P values". These results are not by chance.|
Ivermectin and FLCCC I-MASK+ Early Treatment Protocol
Ivermectin and COVID-19 Updates:
A Cochrane-standard (=highest) review and meta-analysis of Ivermectin against Covid-19 by Bryant-Lawrie, now peer-reviewed and published, concludes that the evidence justify the global adoption.
Results of Ivermectin's success in treating COVID-19 outbreaks in India, Mexico, Peru, Paraquay, Argentina, Brazil and Slovakia.
May 16, 2021: Do the NIH and WHO COVID treatment recommendations need to be fixed
? By Steve Kirsch. Published on TrialSiteNews.Great article on where we stand on the COVID-19 treatment front debate -
Heads up — go over to TrialSiteNews and read this totally brilliant new (very long) article on Ivermectin, hydroxychloroquine and fluvoxamine. It blows the NIH and WHO’s opposition to these drugs out of the water. A total annihilation job. Surgical and hatchet.
According to a review
May 4, 2021: Meta-analysis of Mortality, Need for ICU admission, Use of Mechanical Ventilation and Adverse Effects with Ivermectin Use in COVID-19 Patients (N=15,002). Published on medrxiv.org
Apr 26, 2021: The new FLCCC outpatient protocol (I-MASK+) with the addition of fluvoxamine and nasal/oral "sanitation". Fluvoxamine 50 mg twice daily for 10–14 days. Add to ivermectin if: 1) minimal response after 2 days of ivermectin; 2) in regions with more aggressive variants; 3) treatment started on or after day 5 of symptoms or in pulmonary phase; or 4) numerous co-morbidities/risk factors. Avoid if patient is already on an SSRI (Selective Serotonin Reuptake Inhibitor).
Apr 26, 2021: The new FLCCC hospital treatment protocol (MATH+) with the notable additions of Fluvoxamine and anti-androgen therapy (Dutasteride/Finasteride).
Apr 14, 2021: Open Letter by U.S. Doctors: JAMA Ivermectin Study (Lopez-Medina et al) Is Fatally Flawed, TrialSiteNews reported
. The abstract fails to mention that much larger benefits are seen for serious outcomes, including the original primary outcome, and that the reason for not reaching statistical signficance is the low number of events in a low risk population where most recover quickly without treatment (ivmmeta.com
Mar 30, 2021: Argentina Ministry of Health Clinical Trial: Ivermectin Shows Benefit Treating Outpatients with Mild COVID-19; TrialSiteNew
Mar 10, 2021: Dr. Satoshi Ōmura, co-author of the newly published paper, “Global trends in clinical studies of ivermectin in COVID-19
” was one of the four researchers from Kitasato University in Tokyo, Japan who received the Nobel Prize in Physiology or Medicine in 2015 for their discovery of ivermectin.
“When the effectiveness of ivermectin for the COVID-19 pandemic is confirmed with the cooperation of researchers around the world and its clinical use is achieved on a global scale, it could prove to be of great benefit to humanity. It may even turn out to be comparable to the benefits achieved from the discovery of penicillin—said to be one of the greatest discoveries of the twentieth century.”
—From Global trends in clinical studies of ivermectin in COVID-19, published in the Japanese Journal of Antibiotics, March, 2021.
Mar 5, 2021: [Europe] Ivermectin is now approved for COVID-19 use in 2 European countries: Czech Republic
Feb 25, 2021: Drug used to treat lice and scabies drug could cut Covid deaths by up to 75%, research suggests, DailyMail reported
(more than 16,000 shares).
Feb 25, 2021: Scabies and head lice drug could be 'global solution to the pandemic' says study; Mirror UK reported
Jan 19, 2021: A pilot study published in the Lancet
on January 19, 2021 showed some promising results but the authors concluded that the study warrants further exploration under larger trials with clinical outcomes in patients with risk factors or more severe disease.
Jan 18, 2021: Updated version
of Frequently Asked Questions on Ivermectin in COVID-19 by the FLCCC.
Jan 16, 2021: Apparently, a judge just ordered the Millard Fillmore Suburban Hospital to allow an 80-year old woman to be treated with Ivermectin. According to the family and attorney, the treatment saved the life of Judith Smentkiewicz. Apparently, a doctor ordered the drug off-label in the intensive care unit (ICU), and as she improved, more than likely due to the drug, she was moved to another unit, and the doctor there stepped in and disallowed the use of the drug. Family members immediately involved lawyers and legal action to resume treatment. The New York Supreme Court Judge Henry J. Nowak
aligned with the family; TrialSiteNews
Jan 14, 2021: The National Institutes (NIH) has issued a new statement
on the use of the anti-parasitic drug ivermectin for the treatment of COVID-19. Previously, it recommended against this treatment, but now states that its Panel “has determined that there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19.”
Jan 13, 2021: The BIRD meeting
was convened by Dr. Tess Lawrie in order to present the findings from her rapid systematic review and meta-analysis of studies on the use of ivermectin to prevent and treat COVID-19. Dr. Lawrie presented evidence in the form of a DECIDE evidence-to-decision framework, a format used by the World Health Organization for the development of guidelines and recommendations in medical practice. Twenty experts from around the world and the UK attended the meeting, including 13 clinicians, and seven representatives from the public.
Related Ivermectin and COVID-19 Publications:
- Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 by Kory et al., published on American Journal of Therapeutics.
- Dr. Satoshi Ōmura, co-author of the newly published paper, “Global trends in clinical studies of ivermectin in COVID-19” was one of the four researchers from Kitasato University in Tokyo, Japan who received the Nobel Prize in Physiology or Medicine in 2015 for their discovery of ivermectin. Global trends in clinical studies of ivermectin in COVID-19, published in the Japanese Journal of Antibiotics, March, 2021.
- A multi-centre randomised controlled study in Egypt (Elgazzar, Research Square) reported that the death rate was significantly lower in Ivermectin treated patients group (severe patients) vs non-Ivermectin group (2% vs 20%). 1,300 patients were included in this randomized controlled trial.
- This randomized controlled trial out of Iran (Hashim, pre-print) used Ivermectin and Doxycycline in mild, moderate, and severe hospitalized COVID-19 patients. No patients in the mild and moderate COVID-19 category died and 18% of the severe patients perished taking this medication combo. In the control group, no mild-moderate patients died, but 27% of the severe COVID patients died. The patients who also got Ivermectin had a shorter recovery.
- A randomized, double-blind, placebo-controlled, multicenter, phase 2 clinical trial at five hospitals (Iran) and 180 patients with mild to severe disease (Niaee, ResearchSquare, Nov 2020). Ivermectin as an adjunct reduced the rate of mortality, the duration of low oxygen saturation, and the duration of hospitalization.
- The ICON study in US, published in Chest, Oct 2020 reported that Ivermectin treatment was associated with lower death rate vs Control (13.3% vs 24.5%) during treatment of COVID-19, especially in patients with severe pulmonary involvement.
- A double-blinded randomised controlled study in Bangladesh (Mahmud et al) reported that the death rate was 0% (0/183) in the Ivermectin arm vs 1.67% (3/180) in the control arm in mild to moderate COVID-19 patients.
- The IDEA (Ivermectin, Dexamethasone, Enoxaparin and Aspirin) study from Argentina reported 1 death out of 167 patients studied. The patient that died was a severe COVID-19 patient that required ventilator support.
- The pre-AndroCoV trial from Brazil reported that early detection of COVID-19 followed by a pharmaceutical approach with different drug combinations (Azithromycin, Hydroxychloroquine, Nitazonide, Ivermectin) yielded irrefutable differences compared to non-treated controls in terms of clinical outcomes, ethically disallowing placebo-control randomized clinical trials in the early stage of COVID-19 due to the marked improvements.
- A retrospective study out of Bangladesh (Khan, Archivos de Bronconeumologia 2020). This retrospective study enrolled a total of 325 from April to June 2020. 248 adult COVID-19 patients were looked at in two groups, 115 received ivermectin plus standard care (SC), while 133 received only standard care (SC). This study showed that Ivermectin was efficient at rapidly clearing SARS-CoV-2 from nasal swabs (median 4 days). This was much shorter than in the COVID-19 patients receiving only SC (15 days) or receiving a combination of three antiviral drugs (7–12 days). In addition, fewer Ivermectin patients developed respiratory distress leading to ICU admission. In fact, with Ivermectin, there was a quick hospital discharge (median 9 days) in 114 out of 115 patients; the one remaining patient had been admitted with advanced disease.
Precautionary Note: Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs.
Quercetin and ivermectin interactions? According to Drugs.com: "No interactions were found between ivermectin and Quercetin. This does not necessarily mean no interactions exist. Always consult your healthcare provider."
Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.
Ivermectin for COVID-19: Real-time meta analysis
Check out the evidence tracking on Ivermectin versus COVID-19 from Ivmmeta.com
Related: List of Doctors that will prescribe Ivermectin
Historically, hydroxychloroquine was discovered during efforts to synthesise alternatives to quinine as anti-malarials. Is quinine similar to hydroxychloroquine? Hydroxychloroquine and quinine are both anti-malarial drugs. However, hydroxychloroquine is not the same as quinine as hydroxychloroquine is a synthetic drug while quinine is a naturally occurring compound found in cinchona bark.
Quinine, was first recognized as a potent antimalarial agent hundreds of years ago. Since then, the beneficial effects of quinine and its more advanced synthetic forms, chloroquine and hydroxychloroquine, have been increasingly recognized in a myriad of other diseases in addition to malaria.
Is quercetin same as quinine? No. Quercetin is a phytonutrient
whereas quinine is a naturally occurring compound found in cinchona bark and was used as an antimalarial agent. However, both quercetin and quinine are known to have zinc ionophore properties i.e. they transport zinc into the cells.
Hydroxychloroquine, developed in the 1950s from chloroquine, an old anti-malarial drug, is registered in around 60 countries under trade names such as Plaquenil, Quensyl and Plaquinol.
Hydroxychloroquine and COVID-19
Hydroxychloroquine (HCQ) is not effective when used very late with high dosages over a long period (RECOVERY/SOLIDARITY), effectiveness improves with earlier usage and improved dosing. Early treatment consistently shows positive effects. Negative evaluations typically ignore treatment time, often focusing on a subset of late stage studies.
Lupus patients are put on HCQ and remain on the drug for life. The drug was FDA-approved more than 65 years ago. In 2016, it was the 135th most-prescribed medication in the United States, with more than 4 million prescriptions. Dose escalation studies in lupus patients and in rheumatoid arthritis patients established that 800 mg per day for life and 1,200 mg per day for 6 weeks are extremely well-tolerated.
The WHO says HCQ is safe to take for autoimmune diseases or malaria. However, they admit that there is weak evidence supporting their contention that HCQ is unsafe to take for COVID. But the problem with this is 1) they admit that the certainty of the evidence is “low” to “very low” and 2) they don’t break it out by the disease phase. We are interested in early treatment, not late treatment. You can’t just lump all the studies into one analysis.
In order to see what is actually happening in early treatment patients when they take HCQ, I reached out to Brian Tyson and George Fareed, whose practice has used HCQ in treating more than 6,000 people of all ages with COVID. The risk of diarrhea and nausea/vomiting claimed by the WHO is both “very rare and very minimal.” In general, diarrhea is more likely to be caused by COVID than the drug.
Fareed said he has had “zero cardiac issues” with any patients. They have never had any reason to drop HCQ from their treatment protocol and I don’t know of any physician in the US who has a lower rate of hospitalization for COVID than Tyson and Fareed. If the WHO is right, then how do they explain this anomaly? Tyson and Fareed certainly didn’t get lucky on 6,000 patients and the average age of their patients is 60 years old.
So the bottom line so far is 29 studies all positive, and real-world evidence on thousands of cases is also consistent with the studies. Our hypothesis that the drug is effective is consistent with the data. But the WHO and NIH say we should not use this drug, yet have no plausible explanation for the consistently positive data.
Some scientists will cite the HCQ analysis published in Nature which definitively shows that HCQ is harmful. But that was a meta analysis, which heavily weighted studies of high dose HCQ given to very late stage hospitalized patients. No early treatment outpatient trials were included. The paper says “Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.” I agree!
I’m not arguing for high dose HCQ in late-stage hospitalized patients. That’s a losing proposition. As you can clearly see, all the early treatment results are all positive (top graph) whereas if you look at all stages, that’s when the negative results occur, so it is very important to pay attention to segregating the data when doing meta-analyses.
Here’s a simple analogy as to why drug timing makes a huge difference: a small bucket of water works great if the fire is small (early stage). After the house burns down, the same bucket of water will do nothing to repair the damage, even if we increase the amount of water, and will probably further damage any remains.
Finally, some people may reference the Skipper study, an outpatient HCQ early treatment trial that concluded that “hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19.” I know a few things about that particular study because I was one of the “private donors” who funded it. The summary means that the study was underpowered, not that the drug didn’t work. Indeed, if you look at each metric they looked at, the cohort who got the HCQ always did better. See this analysis for details. There is much more to this study that will come out later that will show that HCQ works even better than the 51.7% drop in hospitalization rate reported in the paper.
In short, HCQ is both effective and safe for early treatment at dosages of 600mg per day and more. If anyone tells you otherwise, please ask them for both clinical studies and real-world evidence to back up their claim. At that point, they will say that they don’t have time to talk to you and walk away. This happens to me all the time. It’s frustrating.
Do you need a prescription for hydroxychloroquine?
Yes, hydroxychloroquine is a prescription drug and you do need it to be prescribed to you by a doctor.
Editor's Note on Hydroxychloroquine (HCQ): The use of HCQ is highly controversial. The best scientific evidence from randomized controlled trials suggests that HCQ has limited/no proven benefit for post exposure prophylaxis, for the early symptomatic phase and in hospitalized patients. 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). Finally, it should be recognized that those studies which are widely promoted to support the use of HCQ are methodologically flawed.
Source: Page 16 of FLCCC Alliance – COVID-19 Management Protocol (version May 25, 2021)
Hydroxychloroquine and COVID-19 Updates
Quercetin and COVID-19
Are there supplements similar to hydroxychloroquine? Quercetin acts as a zinc ionophore (PubMed
2014), the same mechanism of action that hydroxychloroquine has via helping zinc pass the cell wall where it might halt viral replication.
This zinc ionophore activity of quercetin facilitates the transport of zinc across the cell membrane. It is known that zinc will slow down the replication of coronavirus through inhibition of enzyme RNA polymerase (PubMed 2010
). The COVID-19 is an RNA
(RiboNucleicAcid) virus and requires the RNA polymerase
to replicate. Do take note that the study publication was a 2010 publication and is referring to a different coronavirus as compared to the latest coronavirus (COVID-19); though both are from the same family of coronaviruses.
A review published in The Sage Journal (Dec 2020)
, summarizes the antiviral significance of quercetin and proposes a possible strategy for the effective utilization of natural polyphenols in our daily diet for the prevention of viral infection.
An animal study published in the Nature (Aug 2012)
, concluded that quercetin has anti-oxidant, anti-inflammatory and anti-fibrotic (anti-scarring) properties. Another study (JCI May 2012
) on rutin (quercetin molecule bound to a sugar molecule called rutinose), commonly found in fruits and vegetables and sold over the counter as a dietary supplement, has been shown to inhibit the formation of blood clots in an animal model of thrombosis.
As of August, 2021 there have been 3 published studies of quercetin, 2 for early treatment and 1 for prevention. Here’s a chart from c19quercetin.com
that shows this:
Quercetin, Zinc and Vitamin C
Incidentally, ascorbic acid (vitamin C) and the bioflavonoid quercetin (originally labeled vitamin P) were both discovered by the same scientist — Nobel prize winner Albert Szent-Györgyi
. Quercetin and vitamin C also act as an antiviral drug, effectively inactivating viruses.
There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immuno-modulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy.
June 19, 2020, Dr Marik published the paper “Quercetin and Vitamin C: An Experimental, Synergistic Therapy for the Prevention and Treatment of SARS-CoV-2 Related Disease (COVID-19)” in the journal Frontiers in Immunology
. The paper presents evidence for the use of vitamin C and quercetin — based on their biological actions and pharmacokinetics profiles — both as prophylaxis in high-risk populations, and as an adjunct to drugs such as Remdesivir or convalescent plasma in the treatment of hospitalized COVID-19 patients.
Quercetin is also part of the FLCCC I-MASK+ protocol (below) and Zelenko protocol
FLCCC I-MASK+ Prevention Protocol
Quercetin, Zinc, Bromelain and Vitamin C
A case series of 22 patients, published in Medrxiv
revealed that quercetin 800 mg once daily with bromelain 165
mg, in addition to zinc acetate 50 mg and vitamin C 1 g supplements are safe with COVID-19 patients who were on multiple therapies including antivirals and antibacterial medications. The effectiveness of quercetin, bromelain, zinc and ascorbic acid combination was not clear in this study, because of lacking placebo or comparable group.
Quercetin works best when taken with vitamin C and Bromelain, as vitamin C helps activate it and bromelain helps with the absorption. In this study (PubMed), Bromelain also has anti-viral property against COVID-19 virus and anti-clotting property, and therefore may be useful against COVID-19. Caution: Quercetin has one moderate drug interaction with warfarin. Do not take quercetin without medical advice if you are using warfarin.
Ivermectin vs Hydroxychloroquine vs Quercetin
Clinical evidence to date has reported promising results (see above) for Ivermectin in prevention, early treatment as well as late treatment for COVID-19. While both Ivermectin and Hydroxychloroquine might be useful for early treatment, Ivermectin has a broader potential benefit i.e. prevention, early treatment as well as late treatment / hospital treatment (please refer to table below).
Hydroxychloroquine and Quercetin are both zinc ionophores i.e. they transport zinc into the cells.
However, quercetin is less potent than HCQ (hydroxychloroquine) as a zinc transporter, and it does not reach high concentrations in lung cells that HCQ does. Quercetin may help reduce risk of viral illness if you are basically healthy. But it is not potent enough to replace HCQ for treatment of COVID once you have symptoms, and it does not adequately get into lung tissue.
That said, if you simply cannot get hydroxychloroquine or ivermectin, quercetin is a viable stand-in. Quercetin works best when taken with vitamin C and Bromelain, as vitamin C helps activate it and bromelain helps with the absorption. Do not forget to combine it with zinc.
Although ivermectin and hydroxychloroquine are relatively safe drugs, they are still synthetic chemicals that can have side effects. Quercetin and Vitamin D, C, Zinc are nutrients that your body require for optimal health. Nutrients are safer alternatives especially if your risk is low e.g. age below 50 and no other chronic illness.
Other alternatives such as Betadine mouthwash
and Betadine nasal spray
are over the counter products that you could get easily from your nearest pharmacy. An important reminder is to start the treatment early. There's a big difference in terms of outcome depending on how early your treatment is.
Discuss with your doctor on the benefit vs risk for each treatment. If you are on multiple medications, be aware of supplement-drug interactions that might enhance the possibilities of adverse effects.
Other Early Treatment Options
A summary table analysing and tracking COVID-19 early treatments is provided at c19early.com
Although ivermectin and hydroxychloroquine are relatively safe drugs, they are still synthetic chemicals that can have side effects. Quercetin is a phytonutrient that will benefit your body for optimal health.
Nutrients are safer alternatives especially if your risk is low e.g. age below 50 and no other chronic illness. Discuss with your doctor on the benefit vs risk for each treatment. If you are on multiple medications, be aware of supplement-drug interactions that might enhance the possibilities of adverse effects.
The important key takeaway is that you should never attempt to self medicate without the guidance of a licensed medical provider. If you are not a medical doctor, you are likely to find the above information overwhelming. The aim of this article is to empower you with a better understanding of the options available and to discuss the options with your medical doctor.
Post a Comment