The non-profit organization I founded, the Covid-19 Early Treatment Fund, funds research on drugs that can treat Covid. Our collaborations with hundreds of researchers and clinicians worldwide gives us a very broad view of what works and what doesn’t work, in both research trials and in the clinic.
I would like to share with you some of the most important things we’ve learned about Covid over the past year.
- An ounce of prevention is worth a pound of cure. Get vaccinated if possible. If you have not yet been vaccinated, taking 0.2mg/kg of ivermectin once a week has been shown to reduce the risk of getting a Covid infection by an average of 85%. It is advisable to take two doses of 0.2mg/kg spread 2 days apart in the first week.
- Covid should be treated early and hard. A virus is like a fire and is always best treated ASAP. If your house was on fire, would you wait until the entire house was consumed by flames before you called the fire department? Of course not, you’d seek help as soon as the fire started. The biggest mistake we see is people waiting too long before seeing a doctor. They shrug off their symptoms thinking it might be a cold. If the symptoms seem like something you’ve never experienced before, it is far better to assume you have Covid and start treatment ASAP because the treatments are extremely safe and side effects are very low. Then, confirm it with a PCR test. If negative, you can stop treatment. However, if you have a loss of taste or smell or any symptom that is unique to Covid, it is safest to assume you have Covid even if your test is negative (since the tests are not 100% accurate). It took 14 years from the first case of HIV before David Ho wrote his famous editorial that HIV should be treated early and hard. Let’s not make the same mistake with this virus. “Early” means you want to start treatment as soon as you know or strongly suspect you have Covid, ideally before you develop symptoms (i.e., start treating after a positive test).“Hard” means hitting the virus simultaneously with at least an antiviral and anti-inflammatory drug combination. This approach has been proven successful in thousands of patients. The earlier you treat, the better the outcomes. If you wait five days after experiencing symptoms before being treated, your chance of being hospitalized can rise from zero to 10% or more. The only hospitalizations we’ve seen in practice are when the patient waits too long before seeing his or her doctor, can’t get aprescription filled in a timely manner, doesn’t take the drug, or the drug quality is an issue. The first two are the most common.
- The combination of ivermectin and fluvoxamine is extremely effective when used ASAP. Two of the most effective drugs to treat Covid early are ivermectin and fluvoxamine. Both drugs should be started together at the same time. If you are treated within 48 hours of first symptoms, research shows that ivermectin should be given at a dose of 0.4mg/kg for a minimum of 5 days or until symptoms resolve, whichever is later. Fluvoxamine should be given as 50 mg twice a day for 14 days. The website www.c19early.com shows that these are the two approved drugs which individually have shown to be the most effective against Covid in two or more studies. Used together, these drugs have no common adverse interactions and have complementary mechanisms of action. For instance, fluvoxamine is a potent anti-inflammatory and, because it is able to penetrate the blood-brain barrier, it is effective in preventing inflammation in your brain. Unlike systemic steroids, fluvoxamine does not impair your ability to fight the virus so it can be used immediately. The fluvoxamine dose effective against Covid is just one third of the FDA-approved dose so side effects are very rare and minimal. I am not aware of anyone who started both drugs within 48 hours of first symptoms who didn’t have a rapid recovery. The best method to catch the virus early is to test regularly, and start treatment upon a positive test. This is because the PCR test can detect Covid before symptoms start.
- The later you start treatment, the longer it may take you to recover and your outcomes will bemore unpredictable. If you wait more than 48 hours beyond the onset of first symptoms, drug treatment will take longer to have a positive effect, higher doses and more drugs will be needed, and your outcomes will be more unpredictable. For example, when patients see their doctors more than 3 days after symptoms, a dose of 100mg twice a day of fluvoxamine is advised starting immediately. We highly recommend people talk to their physician about getting the drugs in advance, so that if they do get sick, they can start treatment immediately rather than waiting days or even a week for the medicine to arrive at the pharmacy.
- Other drugs and supplements for outpatient treatment are effective for early treatment: There are many drugs and supplements that have varying levels of positive effectiveness against the virus including inhaled budesonide, bromhexine, vitamin D, and HCQ. All of these have the greatest value when started as early as possible. There is no benefit to waiting. In general, these drugs (and supplements) are safe with very low side-effect profiles. Your doctor may recommend adding one or more of these drugs at the start of treatment in addition to ivermectin and fluvoxamine. For patients with severe or worsening respiratory symptoms, 4-8mg cyproheptadine 3-4 times a day has been shown to be very helpful as well.
- Children are not exempt from these recommendations. Children are vulnerable too. Some doctors prefer to be “cautious” and refuse treatment to children unless they develop symptoms. I believe this is a huge mistake because outpatient treatment with repurposed drugs has been shown to be extremely safe. I know of children as young as 1.5 years old who have either developed permanent neurological problems from Covid or died because their doctor refused to treat them early. Doctors can prescribe pediatric dosing for affected children. All the doctors I know who have made the mistake of not treating early vow never to make it again.
- Early treatment can prevent long-haul Covid. Nearly a third of people with Covid (even if asymptomatic) still suffer from lingering symptoms a median of 6 months after infection onset. These symptoms may be difficult or impossible to reverse in some people. The good news is that if you treat the virus fast and hard within 48 hours after first symptoms, you can avoid long haul Covid, hospitalization, and death. We haven’t heard of a single counter-example.
- Higher dosing is required for more aggressive variants. There are many variants of the coronavirus. If you are getting treated early and your symptoms are not abating or not starting to noticeably resolve within 24 – 48 hours, you should talk to your doctor about increasing the dose of the drugs you are taking and/or adding additional drugs.
- Not all drugs should be used early, especially systemic steroids. Using systemic oral steroids early on may impair your body’s ability to fight the off virus and is not recommended.
- There are other drugs on the horizon, but they are not yet approved for use in most countries. Antivirals such as proxalutamide and interferon lambda have shown remarkable safety and efficacy in Phase 2 outpatient clinical trials. Expediting the Phase 3 testing and emergency-use approval of these two drugs in India could save countless lives.
- If you are hospitalized, ask your doctor about treatment with cyproheptadine,inhaled adenosine, and fluvoxamine. These three drugs have shown remarkable effectiveness in hospitalized patients and are very safe when given at the recommended dose. Case reports of patients given cyproheptadine have described lung function returning to normal in just 48 hours. Inhaled adenosine via a nebulizer has produced positive improvements in patient oxygen levels in as little as 10 minutes. Fluvoxamine has been shown to decrease the risk of death by 50% in an unpublished study of 58 patients in Croatia.
- If you have long-haul Covid symptoms, four drugs may provide relief. The top four drugs used by Dr. Bruce Patterson who specializes in treating long-haulers are fluvoxamine, ivermectin, maraviroc, and simvastatin. Patterson’s lab has sophisticated software that analyzes blood test results and can quantify the amount of long-haul Covid and pinpoint which drugs should be used. The good news is that with these treatments, a high percentage of patients have been able to return to normal functioning. Long haul patients will notice that exercise uniformly exacerbates long-haul symptoms.
- Drug quality matters. One of our doctors in India reported that fluvoxamine from all the major brands including Cipla, Torrent, Abbott, and Sun Pharma worked as expected, butdrugs from less well-known brands were not as effective or ineffective. The same happened to one brand of ivermectin which was recalled in Brazil.
- If fluvoxamine isn’t available, fluoxetine is a viable substitute. All the data we’ve seen shows that if you can’t get fluvoxamine, using 30mg once a day of fluoxetine (Prozac) is equally effective (equivalent to 50mg twice a day of fluvoxamine).
The recommendations above are based on both scientific studies and the experience of clinicians in treating Covid. For example, Dr. Amol Kothalkar, a cardiologist in Buldhana has been using these principles for the past 3 months on hundreds of patients in India and can attest to their effectiveness.They are also consistent with the superb Covid recommendations made recently by Dr. Vikas Sukhatme, Dean of the School of Medicine at Emory University.
Today, our biggest challenge is no longer the virus. It is challenging conventional thinking to allow us to adopt clinical practices based upon all the available evidence that will minimize the risk of hospitalization and death.
Steve Kirsch is Executive Director of the Covid-19 Early Treatment Fund which funded the clinical trials in the US of fluvoxamine. He has been a medical philanthropist for over 20 years and was recently featured on 60 Minutes for his work on Covid early treatment.
Views expressed above are the author’s own.
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