Best Treatment for COVID-19 Delta Variant?
While all viruses spread and replicate, doctors are concerned about how rapidly the Delta variant is spreading. The Delta variant (also referred to as B.1.617.2) of COVID-19 is a newer strain of the COVID-19 virus that appears to spread more easily and quickly than other variants, which may lead to more cases of COVID-19. It was initially identified in India in December 2020 and was first detected in the United States in March 2021.
What Is the Treatment for the COVID-19 Delta Variant? I-MASK+ Prevention & Early Outpatient Treatment Protocol for COVID-19 was designed for use as a prevention and in early outpatient treatment, for those who test positive for COVID-19. Component nutrients include vitamin D, C, melatonin, quercetin and zinc.
All the component medicines are FDA-approved (except ivermectin), inexpensive, readily available and have been used for decades with well-established safety profiles.
IMPORTANT UPDATE TO FIGHT THE DELTA VARIANT
Dual anti-androgen Therapy
Fluvoxamine: 50 mg twice daily for 10 days.
Consider fluoxetine (Prozac) 30mg daily for 10 days as an alternative (it is often better tolerated).
Avoid if patient is already on an SSRI.
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COVID-19 Delta Variant Symptoms
The COVID-19 Delta variant may have symptoms that differ slightly from the original coronavirus strain and include:
- Headache
- Sore throat
- Runny nose
- Fever
Cough and loss of smell are less common with the Delta variant compared to the original coronavirus strain (Source).
Other symptoms of COVID-19 may include:
- Shortness of breath
- Chills
- Muscle pain/body aches
- Changes in or loss of sense of taste
- Fatigue
- Diarrhea
- Nausea
- Vomiting
- Loss of appetite
- Congestion
- Abdominal pain
- Feeling unwell (malaise)
Emergency warning signs of COVID-19 that require immediate medical attention (go to a hospital’s emergency department):
- Difficulty breathing
- Persistent pain or pressure in the chest
- Bluish lips or face
- New confusion or inability to arouse
How Is the COVID-19 Delta Variant Diagnosed?
All variants of COVID-19 are diagnosed with a medical history which includes any recent known exposure to COVID-19, and a physical exam to check for symptoms of COVID-19.If COVID-19 is suspected tests used to diagnose the virus include:
Regular COVID tests do not test for variants. Testing for variants requires genomic sequencing, which not all labs can do and it can be expensive. State health departments may run tests to help determine prevalence of a particular variant in that state, but it is unlikely individual patients would learn which variant they are infected with.
- PCR tests (genetic or molecular test)
- Results can take hours to up to one week
- More accurate than an antigen test
- Antigen test
- Results are available in less than one hour
- Less accurate than a PCR test
Regular COVID tests do not test for variants. Testing for variants requires genomic sequencing, which not all labs can do and it can be expensive. State health departments may run tests to help determine prevalence of a particular variant in that state, but it is unlikely individual patients would learn which variant they are infected with.
FLCCC (Front Line COVID-19 Critical Care) I-MASK+ Protocol
All the component medicines are FDA-approved (except ivermectin), inexpensive, readily available and have been used for decades with well-established safety profiles.
IMPORTANT UPDATE TO FIGHT THE DELTA VARIANT
Once again FLCCC medical team strengthened the I-MASK+ prevention & early treatment protocol to counter the new COVID-19 variant.
PREVENTION Protocol (for Delta variant)
Should I take ivermectin as a prophylaxis? For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) I-MASK+ protocol recommends:
Anti-Virals & AntiSeptics
- Gargle mouthwash: 2 x daily – gargle (do not swallow) antiseptic mouthwash with cetylpyridinium chloride (e.g. Scope mouthwash™, Crest mouthwash, Colgate mouthwash) or povidone/iodine 1 % solution as alternative (e.g. Betadine® Antiseptic Sore Throat Gargle™).
- lvermectin
- Chronic Prevention: 0.2 mg/kg per dose (take with or after a meal) — twice a week for as long as disease risk is elevated in your community
- Post COVID-19 Exposure Prevention: 0.4 mg/kg per dose (take with or after a meal) — one dose today, repeat after 48 hours
- Vitamin D3: 1000–3000 IU/day. (Amazon) (iHerb)
- Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon) (iHerb)
- Quercetin: 250 mg daily. (Amazon) (iHerb)
- Zinc: 30 - 40 mg/day (elemental zinc). Zinc lozenges are preferred. (Amazon) (iHerb)
- Melatonin: 6 mg before bedtime (causes drowsiness). (Amazon)
Ivermectin Alternative
- Nigella Sativa 40mg/kg daily (black cumin seed)
To be used if ivermectin not available or added to ivermectin for optimal prevention.
Notes:
- High risk Individuals: > 60 years with co-morbidities (hypertension, diabetes, chronic lung disease, chronic kidney disease), obesity, long term care facilities, etc.
- Post COVID-19 exposure: To use if a household member is COVID-19 positive, or you have prolonged exposure to a COVID-19 positive patient without wearing a mask.
- 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.
- Due to the possible drug interaction between quercetin and ivermectin (may increase ivermectin levels), these drugs should not be taken simultaneously (i.e. should be staggered morning and night).
- Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.
- Vitamin D3 RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese.
- When Is the Best Time to Take Vitamin D? Morning or Night? It is possible that increasing vitamin D levels during the day may act, in part, as a signal that suppresses melatonin generation (source). Therefore, it's better to take vitamin D (with meal) during the day and melatonin to be taken just before bedtime.
- It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored.
- Please consult with a qualified doctor and only use human ivermectin. Ivermectin for animals contain excipients (binding and storage compounds such as polyethylene glycol (PEG)) that are known to cause liver failure in high doses.
Related:
EARLY TREATMENT PROTOCOL
For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC I-MASK+ protocol recommends:
1. First line agents (use any or all medicines; listed in order of priority/importance)
Anti-Virals
- Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if: 1) in regions with more aggressive variants; 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors.
- and/or Nitazoxanide: 500 mg 2 x daily for 5 days after meals. Combine with ivermectin (preferred) or substitute if ivermectin is not available. (Nitazoxanide is often unavailable or high-priced in the USA)
Anti-Septic Anti-virals
- Antiviral mouthwash: Gargle 3 x daily (do not swallow; must contain chlorhexidine, povidone-iodine, or cetylpyridinium chloride). (e.g. Scope mouthwash™, Crest mouthwash, Colgate mouthwash, Betadine® Antiseptic Sore Throat Gargle)
- Iodine Nasal Spray: Use 1 % povidone iodine commercial product as per instructions 2–3 x daily. If 1 %-product not available, must first dilute the more widely available 10 %-solution and apply 4–5 drops to each nose every 4 hours. (No more than 5 days in pregnancy.)
Anti-Coagulants + Immune Fortifying
- Aspirin: 325 mg/day unless contraindicated. (Amazon)
- Vitamin D3: 5,000 IU daily. Preferred forms if available: Calcitriol (Rocaltrol) 0.5 mcg on day 1, then 0.25 mcg daily for 7 days – or Calcifediol 0.5 mg on day 1, then 0.2 mg on days 3 + 7, then 0.2 mg weekly until recovered.
- Melatonin: 10 mg before bedtime (causes drowsiness). (Amazon)
Synergistic Therapies
- Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon) (iHerb)
- Quercetin: 250 mg twice a day. (Amazon) (iHerb)
- Zinc: 100 mg/day. Zinc lozenges are preferred. (Amazon) (iHerb)
Nutritional Therapeutics (New)
Pulse Oximeter
FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%. (Amazon)
Other Alternatives:
- Optional: Betadine nasal spray applied 3 times a day (Ref) (Amazon)
- Optional: Xlear Nasal Spray with Xylitol: use twice a day (Ref) (Amazon)
- Optional: Azithromycin 250 mg twice a day. (Ref) (Find a Doctor).
- Optional: Bromhexine 8 mg three times a day (Ref) (Lazada Malaysia*)
* Not available on Amazon
2. Second line agents (listed in order of priority /importance)
Add to first line therapies above if:
1) ≥5 days of symptoms;
2) Poor response to therapies above;
3) Significant comorbidities
- Spironolactone 100 mg 2 x daily for ten days
- Dutasteride 2 mg on day 1, followed by 1 mg daily for 10 days. If dutasteride is not available, use finasteride 10 mg daily for 10 days.
Fluvoxamine
Consider fluoxetine (Prozac) 30mg daily for 10 days as an alternative (it is often better tolerated).
Avoid if patient is already on an SSRI.
Monoclonal antibody therapy
Casirivimab/imdevimab: 600 mg each in a single subcutaneous injection for patients with one or more risk factors as follows: Age > 65y; obesity; pregnancy; chronic lung, heart, or kidney disease; diabetes; immunosuppressed; developmental disability; chronic tracheostomy; or tube feeding.
Note on Monoclonal Antibodies: Delta variant is the predominant VoC (variant of concern) in the United States. The Delta variant contains the L452R mutation, which results in a modest decrease in in-vitro susceptibility to the combination of bamlanivimab and etesevimab, although the clinical implications of this finding are not fully known. Sotrovimab and casirivimab plus imdevimab appear to retain activity (source: covid19treatmentguidelines.nih.gov).
3. Third line agent
To consider if after day 7–10 from first symptoms and patient has either: abnormal chest x-ray, shortness of breath, or oxygen saturations of 88–94%. If oxygen saturation is lower than 88%, emergency room evaluation should be sought.
Prednisone or Methylprednisolone: 1mg/kg daily for 5 days followed by slow taper or escalation according to patient response.
Over the Counter Alternatives:
- Optional: Betadine nasal spray applied 3 times a day (Ref) (Amazon)
- Optional: Xlear Nasal Spray with Xylitol: use twice a day (Ref) (Amazon)
- Optional: Azithromycin 250 mg twice a day. (Ref) (Find a Doctor).
- Optional: Bromhexine 8 mg three times a day (Ref) (Lazada Malaysia*)
* Not available on Amazon
Behavioral Prevention:
- Face Masks - Must wear cloth, surgical, or N95 mask (without valve) in all indoor spaces with non-household persons. Must wear a N95 mask (without valve) during prolonged exposure to non-household persons in any confined, poorly ventilated area.
- Social Distancing - Until the end of the COVID-19 crisis, we recommend keeping a minimum distance of approx. 2 m / 6 feet in public from people who are not from your own household.
- Wash Hands - We recommend, after a stay during and after outings from home (shopping, sub - way etc.), a thorough hand cleaning (20–30 sec. with soap), or also to use a hand disinfectant in between.
For an up-to-date overview of all published studies on ivermectin in the treatment and prevention of COVID-19 we recommend visiting c19ivermectin.com; in addition, a meta-analysis of all studies can be found at ivmeta.com (constantly updated). For adoption and regulatory status of ivermectin globally, check out "Countries using Ivermectin".
For post-covid or long covid syndrome, check out FLCCC I-Recover Post-COVID Protocol. For a simplified version of the I-MASK+ protocol, the FLCCC has also developed the I-MASS protocol.
Key Takeaway
Treat early! As soon as you have symptoms, start treatment as early as possible. If treatment is delayed i.e. after 5 days of symptoms, your chances of severe COVID are higher.
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