On the Treatment of Covid-19

Effectiveness of ivermectin against covid-19 (IVMMETA)

Updated: June 2021
Languages: German, English
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Based on the available scientific evidence and current clinical experience, the SPR Collaboration recommends that physicians and authorities consider the following covid-19 treatment protocol for the prophylactic and early treatment of people at high risk or high exposure.

Numerous international studies have shown that prophylactic and early treatment can significantly reduce the risk of severe and fatal covid-19 (see scientific references below).

Note: Patients are asked to consult a doctor.

Treatment protocol

Prophylaxis

  1. Ivermectin (12mg once per week)*
  2. Bromhexine (16mg to 24mg per day)*
  3. Vitamin D3 (2000 IU per day)
  4. Zinc (20mg to 40mg per day)
  5. Quercetin (250mg per day)
  6. Mouthwashes and nasal lavage

Early treatment

  1. Ivermectin (18mg per day for 2-5 days)*
  2. Bromhexine (50mg to 100mg per day)*
  3. Aspirin (162mg to 325mg per day)*
  4. Zinc (75mg to 100mg per day)
  5. Vitamin D3 (5000 IU per day)*
  6. Quercetin (500mg per day)
  7. Mouthwashes and nasal lavage

Prescription only

  1. Sulodexide (LMW heparin)*
  2. Fluvoxamine or cyproheptadine*
  3. Steroids: Prednisone or budesonide*
  4. High-dose vitamin D (up to 80,000 IU)*
  5. Monoclonal antibody treatment

(*) Notes

  • Ivermectin requires a prescription in the US and in most EU states (more).
  • Bromhexine is available prescription-free in most of Europe, but not in the US.
  • Cyproheptadine and steroids are only used if respiratory symptoms develop.
  • Vitamin D for early treatment should be used in its fast-acting form, calcifediol.
  • Counterindications and maximum dosages must be observed for all drugs.

See also

Treatment successes

Results of trials and studies on the early treatment of covid.

Ivermectin

  • Numerous controlled and observational studies on ivermectin found strong anti-viral and anti-inflammatory effects and a reduction in covid mortality of 50% to 80%.
  • A preliminary WHO meta-analysis found a reduction in covid mortality of 75%.
  • A US-Canadian study published in Nature Communications Biology showed that ivermectin strongly (>90%) inhibits the main coronavirus replication enzyme (3CLpro).
  • If not available locally, ivermectin can be bought from certified Indian pharmaceutical exporters on Indiamart. However, some countries may not allow its importation.

Zinc

  • A Spanish study found that low plasma zinc levels (below 50mcg/dl) increased the risk of in-hospital death of covid patients by 130%.
  • US studies found an 84% decrease in hospitalizations and a 45% decrease in mortality based on risk-stratified early treatment with zinc and HCQ.
  • A US case study reported a rapid resolution of covid symptoms, such as shortness of breath, based on early outpatient treatment with high-dose zinc.

Bromhexine

  • A randomized Iranian trial with 78 patients found a decrease in intensive care treatments of 82%, a decrease in intubations of 89%, and a decrease in deaths of 100%.
  • A Chinese trial found a 50% reduction in intubations in patients receiving bromhexine.
  • A Russian study found a faster recovery in hospitalized patients receiving bromhexine.
  • A Russian prophylaxis study found a reduction in symptomatic covid from 20% to 0%.
  • A German study discusses the efficacy of bromhexine based on biochemical aspects.

Vitamin D

  • A Spanish randomized controlled trial found a 96% reduction in the risk of requiring intensive care in patients receiving high-dose vitamin D (100,000 IU).
  • Another randomized trial in Spain with 930 hospitalized patients found a reduction in ICU treatment of 80% and in mortality of 60% in patients receiving high-dose vitamin D.
  • A study in a French nursing home found an 89% decrease in mortality in residents who had received high-dose vitamin D either shortly before or during covid-19 disease.
  • A retrospective British study of approximately 1000 hospitalized covid patients found an 80% reduction in mortality with high-dose vitamin D.
  • A large Israeli study found a strong link between vitamin D deficiency and covid-19 severity.
  • For an overview of all covid-19 vitamin D studies, see here.

Aspirin and heparin

  • A US study showed that aspirin has a strong antiplatelet and anticoagulant effect in covid patients, which could help prevent infection-related thrombosis, embolism and stroke.
  • Another US study found a reduction in covid mortality at 30 days from 10.5% (control group) to 4.3% (with aspirin) in veterans taking aspirin.
  • A retrospective US study with 400 patients found a reduction in ICU treatments by 43% and a reduction in mortality by 47% in the group of patients treated early with aspirin.
  • A Mexican randomized controlled trial found a 40% reduction in hospitalization in patients receiving sulodexide (a heparin combination).

Mouthwashes and nasal sprays

  • Several small studies found that mouthwashes (gargling) based on povidone-iodine and nasal sprays based on povidone-iodine or nitric oxide may prevent a coronavirus infection or reduce its duration or symptoms (more about this).
  • The German Society for Hospital Hygiene (DGKH) recommends anti-viral mouthwashes and nasal sprays for prophylaxis and early treatment.
  • Some observers argued that traditional nasal rinsing and gargling practices in South East Asia may have helped successfully limiting coronavirus infections in these countries.
  • Israel started mass production of nasal sprays based on nitric oxide in early 2021.

Fluvoxamine and Cyproheptadine

  • Fluvoxamine and cyproheptadine target serotonin metabolism and serotonin-induced pulmonary vasoconstriction, which according to emerging evidence appears to be a key mechanism driving severe covid and covid-related respiratory failure.
  • Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and reduces platelet serotonin concentration; cyproheptadine is a direct serotonin receptor antagonist.
  • The results of two preliminary US trials indicate that early treatment with fluvoxamine may reduce the risk of severe covid, hospitalization and death to near zero.

Corticosteroids

  • A study by the University of Oxford, published in the Lancet, found a significant reduction in urgent care visits and hospitalizations in patients receiving budesonide (an asthma drug).
  • The British PRINCIPLE trial found that budesonide accelerated recovery by 3 days and reduced hospitalizations and deaths from 10.3% to 8.5%.
  • The early outpatient treatment protocol developed by McCullough et al. recommends the use of prednisone if (and only if) covid-related respiratory symptoms develop.

Monoclonal antibody therapy

  • Monoclonal antibodies have been shown to be ineffective in late treatment of covid, but very effective in early treatment. This is because severe covid is characterized by hyper-inflammation, not viral replication.
  • Some monoclonal antibodies have lost their effectiveness against new virus variants.
  • Convalescent plasma therapy has been shown to be ineffective in both early and late treatment of covid.
Covid survival rate with high-dose vitamin D (red) vs. control (blue) in a nursing home (Annweiler)

Modes of action

  • Ivermectin (an antiparasitic drug) has anti-viral and anti-inflammatory properties.
  • Bromhexine (a mucolytic cough medication) inhibits the expression of cellular TMPRSS2 protease and thus the entry of the virus into the cell, as first described in 2017.
  • Zinc inhibits RNA polymerase activity of coronaviruses and thus blocks virus replication, as first discovered by world-leading SARS virologist Ralph Baric in 2010.
  • Quercetin (a plant polyphenol) supports the cellular absorption of zinc and has additional anti-viral properties, as first discovered during the SARS-1 epidemic in 2003.
  • Vitamin D3 supports and improves the immune system response to infections.
  • Aspirin may help prevent infection-related thrombosis and embolisms in patients at risk.
  • Fluvoxamine and cyproheptadine prevent serotonin-induced pulmonary vasoconstriction.
  • Corticosteroids (prednisone, budesonide) reduce covid-related systemic inflammation.
Ivermectin inhibiting the main SARS-CoV-2 replication enzyme 3CLpro (Mody et al, edited)

Additional notes

The early treatment of patients as soon as the first typical symptoms appear and even without a PCR test is essential to prevent progression of the disease. In contrast, isolating infected high-risk patients at home and without early treatment until they develop serious respiratory problems, as often happened during lockdowns, may be counterproductive.

People at high risk living in an epidemically active area should consider prophylactic treatment together with their doctor. The reason for this is the long incubation period of covid-19 (up to 14 days): when patients first notice that they contracted the disease, the viral load is already at a maximum and there are often only a few days left to react with an early treatment intervention.

Early treatment based on the above protocol is intended to avoid hospitalization. If hospitalization nevertheless becomes necessary, experienced ICU doctors recommend avoiding invasive ventilation (intubation) whenever possible and using oxygen therapy (HFNC) instead.

It is conceivable that the above treatment protocol, which is simple, safe and inexpensive, could render more complex medications, vaccinations, and other measures largely obsolete.

Stages of covid disease (EVMS)

See also


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