Dr Vladimir Zelenko Fact Check: Has Dr. Zelenko Successfully Treated Coronavirus Patients?

The Claim

In an open letter to Trump dated March 23, 2020, and published online in various locations, Zelenko provided his first batch of assertions to support his treatment regime:

I developed the following treatment protocol in the pre-hospital setting and have seen only positive results. […]

The rationale for my treatment plan is as follows. […] We know that hydroxychloroquine helps Zinc enter the cell. We know that Zinc slows viral replication within the cell. Regarding the use of azithromycin, I postulate it prevents secondary bacterial infections. These three drugs are well known and usually well tolerated, hence the risk to the patient is low.

Since last Thursday, my team has treated approximately 350 patients in Kiryas Joel and another 150 patients in other areas of New York with the above regimen. Of this group and the information provided to me by affiliated medical teams, we have had ZERO deaths, ZERO hospitalizations, and ZERO intubations. In addition, I have not heard of any negative side effects other than approximately 10% of patients with temporary nausea and diarrhea.

In sum, my urgent recommendation is to initiate treatment in the outpatient setting as soon as possible in accordance with the above. Based on my direct experience, it prevents acute respiratory distress syndrome (ARDS), prevents the need for hospitalization and saves lives.

Evidence

Dr. Vladimir Zelenko's clinical data was peer-reviewed and published in the International Journal of Antimicrobial Agents in December 2020.

The combination treatment regimen involving zinc, low-dose hydroxychloroquine, and azithromycin (N=141) did result in significantly few hospitalizations and deaths as compared to the control group (N=377). 

Of 141 treated patients, 4 (2.8%) were hospitalized, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group. No cardiac side effects were observed.

The Science behind Zinc, Quercetin, Vitamin D and C 

Some media channels argue that there is very little evidence to support the use of quercetin, zinc, vitamin D and C in supporting the immune system. We have included the scientific evidence together with the sources and references in this article below and we leave it up to you, the reader, to decide who is the 'fact-checker'. 

Data, from peer reviewed studies, scientific data and clinical trials show that synergistic supplement combinations involving zinc and the zinc ionophore quercetin may be effective antiviral prevention and therapeutic agents against COVID-19. An ionophore transports molecules inside cell membranes. COVID-19 viral entry and replication in cells is inhibited by zinc - significantly reducing COVID-19 infection and mortality (Source). Generally, the more zinc that can be brought into respiratory cells, the better off a COVID-19 patient will be.

Quercetin, a natural anti-oxidant and anti-inflammatory compound contained in abundance in various fruits and vegetables, is a zinc ionophore. Zinc ionophores help transport zinc inside the cells COVID-19 attacks - respiratory cells, providing significant antiviral action against COVID-19. Additionally, Quercetin has been shown to be a potent inhibitor of coronaviruses by inhibiting cellular entry as well as inhibiting proinflammatory cytokines. One of the hallmarks of COVID-19 is an imbalanced immune response cascading to cytokine storms and then hyper inflammation which then can lead to acute respiratory distress syndrome (ARDS).

Quercetin has been shown to inhibit proinflammatory cytokine production as well as inflammation due to its antioxidant properties, amongst others. By inhibiting destructive inflammation and potentially the entire cascade, quercetin may prevent severe damage to the respiratory system amongst other organs (source). 

Recent clinical trial data shows that the combination of Vitamin C and Quercetin provided strong preventative protection against COVID-19 infection of healthcare workers when compared to the control group as shown below (source). Specifically, 1.4% (1 out of 71 healthcare workers) of healthcare workers using Quercetin and Vitamin C combination were infected with COVID-19 vs. 21.4% (9 out of 42 healthcare workers) of healthcare workers in the control group were infected with COVID-19 (Total Subjects, n = 113).


Vitamin C is a potent antioxidant, likely immune system optimizer and has been shown to work synergistically with quercetin, likely increasing quercetin’s bioavailability (source). As per Integrative Medicine’s 4th edition, quercetin is a poorly absorbed nutrient but Vitamin C increases the absorption of quercetin and recommends that Quercetin should be blended with Vitamin C (source). Specifically, there is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immunomodulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy (source). It has been shown that Quercetin and Vitamin C markedly inhibited mRNA expression of pro-inflammatory cytokines - as the release of inflammatory cytokines are behind acute respiratory distress syndrome (source). The quercetin and vitamin C combination can prevent the exacerbation of inflammation. 

Zinc is a well known supplement that is generally contained in standard multivitamins. It provides immune support amongst other functions. Zinc inhibits coronavirus replication and is a general stimulant of antiviral immunity (source). Higher levels of intracellular zinc showed to increase intracellular pH; which affect on RNA-dependent RNA polymerase and decreases the replication mechanism of RNA viruses (e.g. COVID-19). Therefore, zinc ionophores (e.g. Quercetin) can likely be used with zinc supplement to act as antiviral against many RNA viruses including influenza and COVID-19. Suggested benefits of zinc supplementation along with zinc ionophores to prevent and treat COVID-19 and other respiratory tract infections are supported by countless studies (source). In most cases, prophylactic and early use of zinc supplementation was more effective than late therapeutic proceedings. Up to 30% of the everyday respiratory infections, briefly named “common cold,” are due to infections with coronaviruses. Studies showed reduced symptom severity, reduced frequency, and duration of the common cold after zinc administration depending on dosage, zinc compound and the start time after initial symptoms (source).

Zinc deficiency is very common especially in the elderly, diabetics, cancer patients, asthma, immunosuppressed and obese - all of which have higher levels of mortality for COVID-19. Furthermore, zinc deficiency is associated with increased risk of infectious disease, pneumonia and severity of COVID-19. Conversely, zinc supplementation is associated with a significant decrease in COVID-19 mortality as long as it is delivered with a zinc ionophore (source).

In short, a balanced zinc homeostasis is essential. 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 minimizes secondary infections. Especially older subjects, patients with chronic diseases and most of the remaining COVID-19 risk groups would most likely benefit.

Vitamin D is essential to a healthy immune system as it initiates the adaptive immune response. Clinical trial data shows that Vitamin D supplementation is safe and protects against acute respiratory tract infection mortality whereas low levels of vitamin D are associated with higher risk for infection and mortality (bmj.com). In addition, a meta-analysis of COVID-19 studies shows that over 90% of studies report positive effects of Vitamin D against COVID-19 (vdmeta.com).

The link between vitamin D and viral infections arose from the observation of the seasonality of vitamin D with lower levels in the winter and concomitant increases in influenza. Conversely, in summer, serum levels of Vitamin D increase and influenza virtually disappears, except during pandemics. Even in pandemics, most deaths occur during cold months.

Hydroxychloroquine

Hydroxychloroquine, a less toxic derivative of Chloroquine is a widely used medication by people with lupus or arthritis. It was first approved in the 1950s. 

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.

As of December 2021 there have been more than 30 studies of Hydroxychloroquine for early treatment – with an overall average improvement of 64%. 

Here’s a chart from c19early.com that shows that hydroxychloroquine is better than ivermectin:
 

The overall improvement for hydroxychloroquine is better than ivermectin (for early treatment); 75% vs 52% in terms of death rate. Crucial point to note is that hydroxychloroquine needs to be given 'early'

The difference in terms of effectiveness for hydroxychloroquine is distinctly different when given early vs late treatment (75% vs 19%), as shown in the summary chart below:


The evidence tracking on Hydroxychloroquine versus COVID-19 is available at c19hcq.com (constantly updated).



Azithromycin

Azithromycin is a widely prescribed generic antibiotic. While it's mainly used to fight bacteria, not viruses, there is some research suggesting the drug has antiviral properties.

Who makes azitromycin? Azithromycin (scientific name) comes in various brand names as well. Zithromax (from Pfizer), Zithromax Tri-Pak (3 days), Zithromax Z-Pak (5 days), Zmax are the brand names available for azithromycin in the US. Generic azithromycin can cost approximately $37 without insurance, while a branded azithromycin such as Zithromax can cost upwards of $200. 

As of December 2021, there are more than 120 studies that have been launched to investigate the benefits of Azithromycin against COVID-19. You can review the status of these trials on clinicaltrials.gov. Several trials are testing azithromycin in combination with hydroxychloroquine.

In a retrospective cohort study published in the Lancet, it is found that 50% of COVID-19 patients who died had bacterial co-infections in pneumonia. Bacterial coinfections have also been shown to increase the risk of mortality for COVID-19 patients [Chen et al].

One potential concern is serious heart side effects. Both drugs can cause abnormal changes in the rhythm of the heart. These can be fatal, particularly for susceptible patients who already have heart problems. Many studies are using EKG tests to closely monitors patients receiving this treatment combination.

While QT-prolonging medication use has been associated with increased risk of death, this risk may be smaller than the potential benefit from treatment of COVID-19 for some patients (American College of Cardiology).

About Dr Vladimir Zelenko

He graduated with a B.A. degree with high honors in Chemistry from Hofstra University. After receiving an academic scholarship to attend S.U.N.Y. at Buffalo School of Medicine, he earned his M.D. degree in May 2000. Dr. Zelenko completed his family medicine residency at South Nassau Communities Hospital in Oceanside, N.Y. in May 2004. Since then, Dr. Zelenko has practiced family medicine in New York’s Hudson Valley. He has been described by his patients as like a family member to thousands of families, and is a medical adviser to the volunteer ambulance corps in Kiryas Joel, New York.

When asked about studies that seemed to discredit the efficacy of HCQ in treating the Chinese coronavirus, Zelenko explained “You don’t fire a gun without a bullet in it and then say the gun doesn’t work when you don’t kill the target. The studies that were done on HCQ did not include the use of Zinc.  HCQ is what opens the cell and enables Zinc to attack the virus. One is not effective without the other, or without a suitable substitute for HCQ. The studies were designed to fail.”

Dr. Zelenko says that both prophylaxis measures and actual case treatments need to be customized to the individual. As a general rule, he says, those people who are in the higher risk groups, both by age and by other pre-existing conditions, require more aggressive actions on both the preventative and diagnostic side.

“This virus remains relatively stable inside the host for about the first five days,” Zelenko says. “After that it starts to multiply rapidly. It also starts to migrate from sinus to lungs and cardio areas where involvement becomes more severe and treatment becomes more difficult. The key is early intervention.” Zelenko again mentioned his 84% success rate in high-risk patients.


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