Effective Treatment of COVID-19

In the beginning of March the Brazilian doctor Luiz Cristiano Maciel Cardoso published a video on Facebook and declared the end of the COVID-19 pandemic. Supposedly he had found out that the cancer drug flutamide would be an effective treatment and declared that he has conquered the pandemic with this miraculous treatment option. On March 22 he himself took the video down, but copies of the video are still circulating. The entire thing seems to be not more than a hoax, but mirrors the desire of everyone to find a cure for the pandemic that is affecting the lives of all of us.¹⁾Faustino M. É falso que médico tenha curado pacientes com Covid-19 com flutamida. Aos Fatos, March 22, 2021 Unfortunately there is no silver bullet or magic cure, but a combination of sensible measures will greatly enhance the chance of a positive outcome.

Pathology

Before talking about treatment options, we need to understand more clearly how the disease is developing inside the body.²⁾Parasher A COVID-19: Current understanding of its pathophysiology, clinical presentation and treatment Postgraduate Medical Journal Published Online First: 25 September 2020. doi: 10.1136/postgradmedj-2020-138577
Azer S. A. COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics Transmission is happening normally via respiratory droplets from person to person. For this reason, social distancing, wearing masks and general hygiene measures can help a lot in prevention.

The first site of invasion is normally the respiratory tract. The spike protein on the surface of the virus binds to the cell membrane and is therefore able to inject an RNA sequence inside the cell. This sequence instructs the cell to replicate the virus. The more the virus replicates, the more cells are going to be affected. Normally the nonspecific immune system would detect the invader and start to fight it off. In contrast to the specific immunity that remembers past infections and facilitates their recognition, nonspecific immunity is able to fight the virus even on the first encounter. The problem is that the virus is able to suppress the interferon response, an important part of the nonspecific immunity. For this reason, a person can stay up to 14 days without developing any symptoms, while the virus is freely multiplying itself.

When the disease migrates from the nasal cavity to the upper respiratory tract, it will manifest itself with symptoms like fever, malaise and dry cough. About 80% of all infected persons have an immune system strong enough to fight the virus before it reaches the lung. A strong immune system is essential at this point.

When the disease migrates to the lung, it is getting more dangerous. If the disease continues long enough, a significant amount of cells in the lung will die. Those that are especially affected are the pneumonocytes which are responsible for the air exchange in the alveoli of the lung.

At the same time, the pneumonocytes will release the so-called cytokynes, which are produced to attract immune cells like neutrophils and T cells. Those will get involved in a fierce battle to combat the virus, but will cause in this process inflammation and cell damage. As a result, the air exchange is being limited, oxygen saturation in the blood will be reduced, and oxygen needs to be applied. If the disease gets severe, the use of a ventilator may be needed.

Oxygen shortness can lead to a change of the body’s pH, accumulation of lactic acid, electrolyte changes and further cell damage. In more sever cases the inflammation spreads through the circulatory system, and may cause the formation of thrombosis, inflammation of the heart muscle, arrhythmia and heart failure. Those complications can be potentially deadly. In the digestive system, the disease can cause diarrhea, nausea, vomiting and abdominal pain. Headaches, dizziness, seizures and other neurological conditions are reported as well. In some cases, the disease can cause liver or kidney damage or even multiple organ failure.

Prevention

As a preventive measure, all efforts should be made to strengthen your immune system. A study conducted in Madrid, found that people who did at least 2 times per week a 30-minute exercise session had an 8 times higher survival rate compared to the inactive group.³⁾Salgado-Aranda R et.al. Influence of Baseline Physical Activity as a Modifying Factor on COVID-19 Mortality: A Single-Center, Retrospective Study. Infect Dis Ther (2021). https://doi.org/10.1007/s40121-021-00418-6 To improve your immunity, other lifestyle factors like for example adequate sleep and healthy nutrition are equally important. Our Coronavirus Immunity Challenge will give you plenty of details on how to keep your Immunity in top performance.

In addition to that, you should consider the following supplementation:

• Vitamin C: 500 mg / day
• Zinc: 20 mg / day
• Magnesium 400 mg / day
• Vitamin D: 4,000 IU / day
• Probiotics: at least 1 billion CFU´s daily. Do not take indefinitely.
• N-Acetyl Cysteine (NAC): 500 mg / day. An aminoacid with antioxidant potential.

You should also look at prebiotic foods like banana, onion and garlic. Besides helping your intestinal flora, they will help to fortify your immunity. Look at fruits that are high in vitamin C like orange, grapefruit, papaya and red bell pepper.

Obesity is a risk factor that can increase mortality up to 4 times according to a recent study.⁴⁾Tartof S. et.al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Annals of Internal Medicine, November 17, 2020 https://doi.org/10.7326/M20-3742 In case of obesity extra care should be taken to practice an immune boosting lifestyle. Other diseases like Diabetes, Cancer, Asthma or Heart Disease will need to follow the same measures.

A contrast shower was shown to be beneficial in strengthening your immunity as well. You should start with a hot shower of at least 3 minutes, as hot as you can tolerate. Switch then to cold for 30 to 60 seconds. If you like you can repeat the cycle three times, otherwise get out of the shower and quickly dry yourself with vigorous motion. If you have heart disease, or you are fragile because of age, be milder in the temperature change.

A sauna, be it a Swedish sauna or a steam sauna, can be very effective as well. If you are interested, we have some units of the Portable Steam Sauna available.

Treatment

We have seen already that the progressive development of the disease can lead to a variety of different symptoms. Accordingly, the applied treatment protocol will change according to the phase of the disease. We will be looking at the most adequate options in every disease stage.

At the First Signs of Infection

No matter, whether you are infected by the coronavirus or any kind of flu bug, taking prompt action at the first signs of symptoms will be key to an effective treatment. You should do one of these treatments as soon as possible:

• Contrast Shower: Do 4 to 7 cycles of 3 minutes hot and 30 to 60 seconds of cold. Be vigorous and try to increase your temperature change with every cycle.
• Hot Foot Bath: Wrap yourself into a blanket and put your feet into a bucket of hot water, as hot as you can tolerate it. Add some hot water every 5 minutes and continue the treatment for 20 to 30 minutes. When starting to sweat, put a cold cloth on the forehead, and drink plenty of water.

The next two treatment options are a bit more vigorous. If you have a circulatory disease that impedes you to do jogging, you should avoid those treatments, because they put a strain on your body and make your heart pump faster.

• Steam Sauna: Put yourself inside a sauna tent and expose your body to a steam source. You can do that with a pot of boiling water on a mobile cooking plate, but there are portable steam saunas available as well. Put a cold cloth with ice water on your head and change frequently as you are coming to a sweat. Stay for 20 to 25 minutes and go straight into bed afterward in order to continue sweating for another 30 minutes. Consider using a different mattress, or putting a plastic underneath your sheet, since you will be sweating a lot. Finish then with a shower.
• Hot Bath: Get inside a hot bath, as hot as you can tolerate, and add hot water every 5 minutes. Keep a cold cloth on your forehead and work up a sweat for about 20 minutes. A study found out that raising the body temperature to 39°C (102°F) was leading to a tenfold increase in the interferon response, which is exactly the component that is impaired by the coronavirus in the early course of the disease.⁵⁾Downing J et.al. Hyperthermia in humans enhances interferon-gamma synthesis and alters the peripheral lymphocyte population. J Interferon Res. 1988 Apr;8(2):143-50 DOI: 10.1089/jir.1988.8.143

Finish each of those treatments with at least one hour of bed rest afterward. This will multiply the immune boosting effect. Drink plenty of water or teas to stay hydrated.

A good recipe for strengthening the immune system is the so-called Russian Penicillin. The basic recipe is very simple. You take one entire lemon and peel it. Then you take 2-3 cloves of garlic and a pinch of salt. Blend it up in one quart of water (1 liter) and drink it during the day. If you want you can add orange, grapefruit or onions to the recipe, all of those have beneficial properties.

On the immune boosting supplementations, it might be helpful to increase the dose in case of treating the disease:

• Vitamin C: 1,000-2,000 mg / day
• Zinc: 40 – 75 mg / day for up to 1 week⁶⁾Hemilä H, Petrus EJ, Fitzgerald JT, Prasad A. Zinc acetate lozenges for treating the common cold: an individual patient data meta-analysis. Br J Clin Pharmacol. 2016 Jul 5. DOI: 10.1111/bcp.13057
• Vitamin D: up to 60,000 IU / day. If you need to do more than 2-3 weeks of treatment, it shoud be accompanied with adequate blood tests.⁷⁾A Rastogi et.al. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study). Postgraduate Medical Journal Published Online First: 12 November 2020. doi: 10.1136/postgradmedj-2020-139065

We did already an article with the title: Can Vitamin D Prevent COVID-19? We stated that Vitamin D is fundamental in prevention and treatment of COVID-19 and cited several studies that could confirm this findings. Besides the vitamin D supplementation, try to implement a daily sunbath, that will help in many ways in the recuperation process.

Quercetin is a flavonoid with antiviral properties. In vitro studies have shown that it is able to interfere in the replication cycle of the coronavirus. There are no populational studies published in relation to COVID-19, but it shows interesting antiviral properties, especially in combination with vitamin supplementation.⁸⁾Agrawal P. Quercetin: Antiviral Significance and Possible COVID-19 Integrative Considerations. https://doi.org/10.1177/1934578X20976293

Diet-wise, you should avoid heavy meals and double up on fruits, especially citrus fruits and other Vitamin C sources. Cut out all sources o sugar, even natural cane sugar, molasses, maple syrup and similar. Honey can be used in moderation.

At the dental office, a 1% hydrogen peroxide solution is used as a mouth rinse, for patients and dentists alike, in order to avoid the spread of the virus. Some have advocated a wider use of this mouth rinse for the general population. In the early stage of the infection, a gargle or mouth rinse can definitely help to reduce the viral load in this region. They advise to rinse no more than 4 times a day, and prolonged use can disrupt the presence of healthy bacteria in the mouth.⁹⁾Caruso A et.al. Might hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection? Infect Control Hosp Epidemiol. 2020 Apr 22 : 1–2. doi: 10.1017/ice.2020.170
COVID19 and Hydrogen Peroxide – Urgent Health Tips. My Dental Co. Website, accessed May 13, 2021 If you do not want to apply hydrogen peroxide, you can use salt water, sage or any other substance with antiviral properties.

Herbs

There are several herbs that could be used in a COVID-19 treatment situation. A team was screening the available literature for natural products that proved to have antiviral activities against different types of human coronavirus. They found that extracts of the red spider lily (Lycoris radiata), Japanese gentian (Gentiana scabra Bunge), Chinese yam (Dioscorea batatas Decne), Sickle senna (Cassia tora L.), Mulberry Mistletoe (Taxillus chinensis), golden chicken fern (Cibotium barometz L.) and Echinacea purpurea L. showed a promising effect, and clinical trials should be done to prove their efficiency for COVID-19.¹⁰⁾Khalifa S. et.al. Screening for natural and derived bio-active compounds in preclinical and clinical studies: One of the frontlines of fighting the coronaviruses pandemic. Phytomedicine. 2020 Aug 29;153311. doi: 10.1016/j.phymed.2020.153311.

Another review study analyzed plants that could be possibly used in treating COVID-19 symptoms. They found 5 plants to be especially promising. Licorice (Glycyrrhiza glabra) has a soothing effect on the respiratory tract and is indicated in case of a cough or sore throat. Elderberry (Sambucus nigra) showed positive effects in clinical trials treating colds or flu. It has expectorant properties and is indicated in various respiratory conditions, fever and headaches. The common ivy (Hedera helix) has been show effective in the treatment of bronchitis and the common cold. It has expectorant properties and should be used in case of a persistent cough. Marsh mallow (Althaea officinalis) is indicated to treat a persistent dry cough. Myrrh (Commiphora molmol or Commiphora myrrha) has an anti-inflammatory effect and is indicated in a variety of respiratory conditions. They found also potentially promising results for a list of 12 more plants including garlic, Echinacea, Eucalyptus and others.¹¹⁾Silveira D et.al. COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy? Front Pharmacol. 2020 Sep 23;11:581840. DOI: 10.3389/fphar.2020.581840

The herb Dysphania ambrosioides, commonly known as Mexican Tea, was studied by Brazilian scientists, and they found that it contains substances that are able to inhibit the Sars-CoV-2 virus.¹²⁾Silva F. et.al. Flavonoid glycosides and their putative human metabolites as potential inhibitors of the SARS-CoV-2 main protease (Mpro) and RNA-dependent RNA polymerase (RdRp). Mem Inst Oswaldo Cruz. Vol. 115, September 2020. DOI: 10.1590/0074-02760200207 Populational studies are needed to certify the effectiveness in COVID-19 treatments. The plant has several different medicinal applications, among others it is known for its anti-inflammatory and immune stimulating properties. You can use it in form of a tea, putting one tablespoon of the dried leafs in one cup of boiling water and let it steep for 10 minutes. Use 2-3 cups per day. The plant should not be applied for prolonged usage, since it could manifest a toxic effect in long term use.

In Pakistan a randomized controlled trial was done on hospital patients applying the combination of honey with black seed (Nigella sativa). Patients treated with this combination cleared the virus 4 days earlier than the control group. Recuperation and hospital discharge was happening much earlier, and in severe cases mortality rate was fourfold lower.¹³⁾Ashraf S et.al. Honey and Nigella sativa against COVID-19 in Pakistan (HNS-COVID-PK): A multi-center placebo-controlled randomized clinical trial. doi: https://doi.org/10.1101/2020.10.30.20217364

Propolis is another promising remedy for prevention and treatment of COVID-19. In a Brazilian study, patients hospitalized for COVID-19 were put either on standard care alone, or received 400mg/day of a propolis extract in the second group, or 800mg/day in the third group. Patients with standard care alone needed an average stay of 12 days in the hospital. That was reduced to 7 days with the supplementation of 400mg/day of propolis, and to 6 days with 800mg/day. Cases for acute kidney injury were reduced as well.¹⁴⁾Duarte Silveira M A et. al. Efficacy of propolis as an adjunct treatment for hospitalized COVID-19 patients: a randomized, controlled clinical trial. doi https://doi.org/10.1101/2021.01.08.20248932 Considering that most drugs proved to be inefficient in hospitalized patients, those findings are pretty impressive.

Those are the herbs that were specifically studied in relation to COVID-19. There are numerous other herbs, that may be just as effective, but no study is available to prove its efficacy. The lifestyle center Uchee Pines Institute is recommending the following list of herbs:¹⁵⁾Adeogun O, Sandoval, M. COVID-19 (Coronavirus Disease 2019). Uchee Pines Website

• American Ginseng – avoid in pregnancy, 200-400mg twice daily
• Siberian Ginseng – insufficient evidence to recommend for children or pregnancy, don’t take for longer than 2 months, 400mg 3 times daily
• Panax Ginseng – (Asian Ginseng), don’t use more than 6 months, avoid in children and pregnancy, 200mg daily
• Andrographis – (Indian Echinacea), avoid in pregnancy, 200mg daily
• Thuja – (cedar leaf oil), avoid in pregnancy and lactation, 18-36mg 3 time daily, for 2 weeks
• Echinacea – 800mg 3 times daily for prevention, up to 5 times daily with symptoms
• Elderberry – only use the ripe fruit, dosage not specified.
• Umckaloabo – (African geranium), insufficient info for pregnancy/lactation, dose not specified

Early Treatment

It is a good idea to take a COVID-19 PCR test if available for you. If confirmed positive, or you have strong reasons to believe to be infected, you should take immediate measures for stronger treatment. Besides fever, cough, fatigue and headache, a loss of smell and taste is a very typical symptom for COVID-19 infection. Studies have shown that early treatment greatly increases the chance for recuperation.

One of the drugs that seems to be effective in early stage is nitazoxanide, also known under the brand name alinia. It is mainly used to treat certain parasites like giardia, but has reportedly a broad-spectrum antiviral activity. Furthermore, nitazoxanide displays the potential to boost the innate immune system and reduce the cytokine storm.¹⁶⁾Lokhande A, Devajaran P. A review on possible mechanistic insights of Nitazoxanide for repurposing in COVID-19. DOI: 10.1016/j.ejphar.2020.173748 A study showed that viral load was reduced in 48% of patients treated after a 7 day period, compared to 15% in the placebo group.¹⁷⁾Silva M et.al. Efficacy of Nitazoxanide in reducing the viral load in COVID-19 patients. Randomized, placebo-controlled, single-blinded, parallel group, pilot study. doi https://doi.org/10.1101/2021.03.03.21252509 Further studies are in development to confirm these findings.

Hydroxychloroquine has been hotly debated for a long time, but we want to look at the available evidence. Studies on hospitalized patients did not show any efficiency, like many other drugs as well. But a review found 29 studies of early treatment of COVID-19, and all of them showing favorable results, although only 13 were statistically significant.¹⁸⁾HCQ is effective for COVID-19 when used early: real-time meta analysis of 229 studies. https://hcqmeta.com/ Another meta-analysis was not able to determine any benefit, probably because early treatment and late treatment studies were mixed together, a large number of studies was excluded, and no pooling of data was attempted in order to gain a better statistical significance.¹⁹⁾Singh B et.al. Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19 (Review). DOI: 10.1002/14651858.CD013587.pub2. It is interesting to state that chloroquine is allowing zinc to enter the cell and inhibit viral replication.²⁰⁾Xue J et.al. Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. doi:10.1371/journal.pone.0109180 We can conclude that chloroquine will develop its full capacity only if administered in combination with Zinc, just there are very few studies available using this combination.

Another interesting option seems to be ivermectin, a drug widely available for the treatment of parasites. Being used at a large scale in many developing countries around the world, it has an excellent safety profile. The drug can help in impeding the binding of the virus to the cells. A meta analysis of 6 early treatment studies showed a 75% average reduction in mortality.²¹⁾Hill A et.al. Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection. DOI:10.21203/rs.3.rs-148845/v1
Ivermectin is effective for COVID-19: real-time meta analysis of 49 studies. https://ivmmeta.com/
Lawrie T. Ivermectin reduces the risk of death from COVID-19 – A rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care Alliance. https://www.e-bmc.co.uk/ Some studies seem to show limited benefits, that do not justify its use.²²⁾López-Medina E et. al. Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19. JAMA. doi:10.1001/jama.2021.3071 Besides that, critiques are saying that sample sizes of the available studies are small, and the study design sometimes flawed, having though not sufficient scientific evidence to promote their use. Several others prefer to use the limited evidence available in a responsible way to save lives.

Despite of limited scientific evidence at that time, ivermectin was approved as a COVID-19 treatment since May 2020 in Peru and Bolivia, and a few other countries have followed in the meantime. In Brazil, a factory with 12,000 workers adopted a weekly preventive dose of ivermectin. The responsible doctor states in an interview, that they had very few cases of infection, and no cases of hospitalization or death.²³⁾Medico de GTFoods em Maringa. Facebook, March 12, 2020

The dose of the drug depends on the weight of the person. It is important to note that ivermectin preparations for animals are improper for human use, since the dosage for horses and cows is completely different than for humans.

Another case study comes from the town of São Lorenço in the Brazilian State of Minas Gerais. They adopted an early treatment protocol using ivermectin, azithromycin, dexamethasone, zinc and vitamin D. For almost a month they had not a single case in the intensive care units, and almost no hospitalizations for COVID-19. With the recent surge all over Brazil, there were recorded 4 cases in intensive care by the end of March. It is difficult to tell, which component of the protocol was responsible for the result, but it shows that early treatment can significantly increase the chance for success.²⁴⁾Piva A. Cidade mineira não tem um único doente internado por covid-19. Revista Oeste, March 15, 2021
Dourado C. Prefeito defende tratamento precoce, mas São Lourenço entra na onda roxa. Estado de Minas, March 16, 2021
Statistics on the Facebook page of the town hospital

Monoclonal antibodies are another treatment option that proved to be effective as an early treatment option, and there are two options that have received FDA approval. Bamlanivimab and the combination of casirivimab/imdevimab are available and you may consult your hospital whether they are eligible to recieve this treatment. They work in blocking the spike proteins of the virus and reducing its infectivity.²⁵⁾An EUA for Bamlanivimab—A Monoclonal Antibody for COVID-19. JAMA. 2021;325(9):880-881. doi:10.1001/jama.2020.24415
Chen P et.al. SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19. N Engl J Med 2021; 384:229-237 DOI: 10.1056/NEJMoa2029849

If Symptoms Persist

One of the common symptoms is fever. Many people will try to lower the fever with ibuprofen, paracetamol or another antipyretic drug. This is actually the worst thing you can do. Fever actually stimulates the immune system to fight the infection. If you cut the fever, you may feel better at the moment, but you reduce the activity of the immune system to fight the infection.

It is important to state again that the most effective treatment of COVID-19 is a well-functioning immune system. Even for the common flu, there are only a handful of antiviral drugs available with very limited efficiency. The deciding factor that will eventually fight off the virus is the immune system, and strengthening the immune response will be the most important treatment to follow.

In case of fever, strict bed rest is the best course to follow. We have seen already the importance to feed the fever with bed rest. On top of that, sleep is essential for the functioning of the immune system. During the Spanish flu, the early initiation of total bed rest was part of a successful treatment protocol. The bed rest needs to be continued for 2 to 3 days after the fever subsides, in order to avoid the development of pneumonia or other types of secondary complications.²⁶⁾Elliott LE. The Value of Sanitarium Treatment in Respiratory Diseases. Life & Health. 1919 May 1; 34(5):103-4. In case of COVID-19, we have seen many cases with marked improvements, followed by a sudden return of the disease, or one of its complications. If symptoms improve, continue your treatment protocol for several days, until you obtain a negative PCR test or you are completely sure of your total recovery. Even though you may feel better, you need to continue treatment for as many days as you had a fever.

Give plenty of water or teas throughout the treatment period. The patient will most likely be sweating a lot, and needs to be hydrated. On top of that, extra water can flush out a number of substances through the urine and clean out the body. Hot teas can help to induce sweating and fever.

In case of cough, an onion poultice can help. Blend ½ of a medium-sized onion in a blender with just enough water to make a paste. Spread it on a paper towel like the onion is the sandwich filler and the paper towel is the bread, so you have paper towel on the outside with the onion on the inside. Place it on the chest and then wrap it with plastic food wrap and secure it in place. Cover with a tight t-shirt and then a flannel or thick sweater and leave on overnight. Remove and wash off in the morning.²⁷⁾Adeogun O, Sandoval, M. COVID-19 (Coronavirus Disease 2019). Uchee Pines Website

Hot and cold fomentations on the chest are an excellent treatment for coughing. Considering the lung damage in advanced COVID-19, it is certainly a treatment that is highly indicated. During the Spanish Flu pandemic, this treatment was part of a successful treatment regimen.²⁸⁾Elliott LE. The Value of Sanitarium Treatment in Respiratory Diseases. Life & Health. 1919 May 1; 34(5):103-4. Place a hot fomentation for 3 minutes, followed by a towel that was immersed in ice water for a minute. Repeat 5-7 times. To increase the effect, put a hot fomenation or heating pad on the back, and the feet in a basin of hot water during the treatment, taking care to add hot water every 5 minutes. Finish the treatment by rubbing the body with a cold cloth and drying immediately. Repeat 2-3 times daily if needed.

Steam Inhalation is another interesting treatment to improve mucus elimination and clear up the lungs. There are commercial steam inhalators available, or you can just put a sheet over a pot with boiling water. Add a few drops of peppermint or eucalyptus oil if you want. To treat the cough, you can also mix a few drops of eucalyptus oil in honey. Use about one drop for every tablespoon. You may find even raw eucalyptus honey, that contains all the beneficial properties of the pollen from the eucalyptus trees.

If the patient is still strong enough, you can continue to apply a hot foot bath 2-3 times a day. Just if fever persists for a long time, the patient may become so weak that he is not able to adequately react to the hot stimulus. In this case, fomentations will be the more adequate treatment.

What you should avoid during early treatment are antipyretic and anti-inflammatory drugs (like ibuprofen, parecetamol, diclofenac, loratadine), antibiotics, and corticosteroids, since they weaken the immune system.

If the Disease Aggravates

If you develop shortness of breath, or blue lips it is a sure sign that the disease is affecting the lungs. In this case you need to look out for medical help. In order to facilitate breathing, you may be put on oxygen. That helps to guarantee that oxygen levels do not drop in the blood and cause other complications. If you want a tool to evaluate your situation for yourself, you acquire an oximeter. If your Oxygen saturation in the blood is above 95%, then you are fine, and no lung impairment is taking place. If the saturation drops below 90%, you may be in need of supplemental oxygen. Higher altitudes may lead to slightly lower oxygen saturation.

It is important to state that effective drug treatments are getting extremely scarce when it comes to advanced COVID-19 patients. The WHO organized a rather large study including four of the most promising treatment options, and concluded that none of them, not even the expensive antiviral drug Remdesvir showed statistically significant benefit in hospitalized patients.²⁹⁾WHO Solidarity Trial Some preliminary studies show though promising results for proxalutamide³⁰⁾Cadegiani et al., Press Conference (Preprint) The Proxa-Rescue AndroCoV Trial and a few other drugs for the late stage treatment of COVID-19.

That far, treatment is entirely focusing on dealing with symptoms. Besides giving oxygen, corticosteroids are normally prescribed in order to reduce the cytokine storm. This is important to limit the damage of the lungs in the acute stage. Please note that corticosteroids are recommended only after the patient has sufficient lung damage to require oxygen, and a significant cytokine storm was setting in.³¹⁾Therapeutic Management of Adults With COVID-19. NIH, acessed April 7 Before this point it would only prejudice the immune response without necessity. Even though that corticoids are suppressing the activity of the immune system, efforts should continue to strengthen the immunity, since this is the only mechanism that will fight the virus and promote the real cure of the disease. Especially Vitamin D was proven to show an immunomodulating effect, improving overall immunity while helping to reduce the cytokine storm.

In relation to thrombosis protection, N-Acetyl Cysteine (NAC) might be an interesting option. Several studies show that NAC is able to reduce the formation of thrombosis in various situations. Although there are no specific studies that prove its efficiency in case of COVID-19, it is probably safe to conclude, that the mechanisms involved would apply to this disease as well.³²⁾Coronavirus Pandemic Update 69: “NAC” Supplementation and COVID-19 (N-Acetylcysteine). Medcram. Youtube, May 11, 2020

The AdventHealth hospital in Ocala, FL has developed a treatment protocol that they have baptized ICAM. It is an acronym of the 4 different treatment components. I stands for Immunosupport, which was given in form of Vitamin C and Zinc supplementation. C stands for corticosteroids that were used to control inflammation. A stands for anticoagulants to prevent blood clotting, and M for macrolides to help fight infection. In their own hospital, they have proven a 96.4% survival rate with this treatment protocol. Like other protocols, it does little to attack the actual virus, but treats successfully COVID-19 symptoms, giving the immune system extra time to respond. Further studies supposedly showed no benefits compared to standard treatment protocols, but I still would consider it as an interesting protocol for hospitalized patients.³³⁾Facebook Post

Recuperation

Especially if lung damage has occurred, fatigue is a common symptom in the recovery phase. In a study of COVID-19 patients that were hospitalized, more than half reported fatigue even 2 month after recovery.³⁴⁾Carfi A et.al. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-605. doi:10.1001/jama.2020.12603 Another study found 55% of patients had an abnormal echocardiogram, so you definitely want to check on your heart if you experience fatigue.³⁵⁾Dweck M et.al. Global evaluation of echocardiography in patients with COVID-19. https://doi.org/10.1093/ehjci/jeaa178

If you get tired, you need to limit the amount of work you do during this recovery phase. If you go beyond your strength in this phase, you can cause a relapse, some kind of a secondary infection or some other type of complication. In some cases physiotherapy can help in recuperation. In any case, start with some light exercise and build up gradually. Be sure to get to bed early and take good care of your health. You should spend a lot of time outdoors in the fresh air and sunshine. Just be sure to use appropriate clothing for the climate to avoid chilling.

Try to focus on an anti-inflammatory diet. Use plenty of fruits and vegetables. Avoid saturated fats and increase the amount of Omega 3 fatty acids in your diet. Flaxseed and Chia are among the best sources. If you made use of some medication, it is definitely recommended to use some probiotics to improve your intestinal flora.

Supplementation with NAC seems to be helpful in recovering from fatigue. A daily contrast shower can be helpful to strengthen your immunity and increase circulation, which in turn speeds up the healing process. Keeping a cheerful state of mind can do wonders as well. The impact of thoughts and attitudes on our health is greater than we think.

Conclusion

Treatment of COVID-19 definitely varies greatly, depending on the stage of the disease. For the most part it is focusing on treating symptoms and side effects of the disease, and giving the immune system proper time to do its work. In elderly patients, the immune response takes longer to kick in, which will aggravate the disease and prolong the recovery time.

We see as a common thread the importance of a strong immune system in all phases of the disease. At the end, only the immune system is able to fight off the virus and really cure the disease. In order to help you to have a strong immunity and be prepared for the virus, we have prepared the10 day Coronavirus Immunity Challenge for you. Participate now to find out what you can do to have maximum protection against the coronavirus that is circulating around the entire globe.