On the Treatment of Covid-19

Effectiveness of ivermectin against covid-19 (IVMMETA)

Updated: January 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 or fatal covid-19 (see scientific references below).

Note: Patients are asked to consult a doctor.

Treatment protocol

Prophylaxis

  1. Zinc (25mg to 50mg per day)
  2. Quercetin (250mg to 500mg per day)
  3. Bromhexine (24mg to 36mg per day)*
  4. Vitamin D (2000 IU per day)
  5. Vitamin C (1000mg per day)

Early treatment

  1. Zinc (75mg to 150mg per day)
  2. Quercetin (500mg to 1000mg per day)
  3. Vitamins D (5000 u/d) and C (1000mg/d)
  4. Bromhexine (50mg to 100mg per day)*
  5. Aspirin (162mg to 325mg per day)*

Prescription only

  1. Ivermectin (12mg per day for 2-5 days)*
  2. High-dose vitamin D (up to 100,000 IU)
  3. Hydroxychloroquine (400mg per day)*
  4. Azithromycin (up to 500mg per day)
  5. Prednisone (60mg to 80mg per day)*

(*) Notes:

Contraindications for aspirin and bromhexine must be observed. Ivermectin may also be used prophylactically on a weekly basis. Prednisone is to be used if pulmonary symptoms develop. Correctly dosed HCQ has been shown to be effective and safe for the early treatment of covid-19.

See also

Treatment successes

For more results, see the full scientific references at the bottom of this page.

Ivermectin

  • Ivermectin has shown strong anti-viral and anti-inflammatory effects in numerous controlled and observational studies, reducing covid mortality even in severe cases by up to 90%.
  • A first meta-analysis showed that ivermectin is highly effective in prophylaxis, early outpatient treatment and even late-phase inpatient treatment of Covid-19.
  • Based on these results, the US Front-Line Covid-19 Critical Care Alliance (FLCCC) recommends ivermectin for covid-19 prophylaxis and early treatment.
  • In a study of 33 “long covid” patients, treatment with ivermectin resulted in complete resolution of symptoms in 94% of patients.
  • A preliminary WHO meta-analysis found that ivermectin reduces covid mortality by 75%.

Zinc

  • US physicians reported an 84% decrease in hospitalizations, a 45% decrease in mortality among already hospitalized patients, and an improvement in the condition of patients within 8 to 12 hours based on early treatment with zinc in addition to HCQ.
  • A Spanish study found that low plasma zinc levels (below 50mcg/dl) increased the risk of in-hospital death of covid patients by 130%.
  • A US study reported a rapid resolution (within hours) of covid symptoms, such as shortness of breath, based on early outpatient treatment with high-dose zinc.

Bromhexine

  • Iranian doctors reported in a study with 78 patients a decrease in intensive care treatments of 82%, a decrease in intubations of 89%, and a decrease in deaths of 100%.
  • Chinese doctors reported a 50% reduction in intubations due to bromhexine treatment.
  • A Russian study found a much faster recovery in hospitalized patients receiving bromhexine.
  • A German study discusses the efficacy of bromhexine based on biochemical aspects.

Vitamin D

  • In a Spanish randomized controlled trial (RCT), high-dose vitamin D (100,000 IU) reduced the risk of requiring intensive care by 96%.
  • 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.

Hydroxychloroquine (HCQ)

  • Contrary to media claims, correctly dosed HCQ has been shown to be effective for the early treatment of covid-19, reducing hospitalizations and deaths in high-risk patients by about 60%.
  • HCQ has well-established anti-thrombotic and immunomodulatory properties, which counteract two of the most serious complications of severe covid, i.e. thromboembolisms and auto-immune hyperinflammation, if administered in the early stage of the disease.
  • In contrast, direct anti-viral action of HCQ appears unlikely in vivo, and HCQ’s role as a ‘zinc ionophore’ (improving the cellular absorption of zinc) appears to be irrelevant. Nevertheless, combining anti-thrombotic HCQ with anti-viral zinc has been shown to be beneficial.
  • Regarding safety, a comprehensive study by the European Society of Cardiology confirmed that correctly dosed HCQ is safe for covid patients in all clinical settings.
  • The alleged or actual negative results of some HCQ trials were based on delayed use (ICU) and toxic overdoses (e.g. in the Recovery and Solidarity trials), fraudulent data sets (the Surgisphere scandal), or lacking risk-stratification (as covid remains mild in most people).

Aspirin

  • 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.
  • The US FLCCC Alliance recommends aspirin for prophylactic and early treatment.
Covid survival rate with high-dose vitamin D (red) vs. control (blue) in a nursing home (Annweiler)

Modes of action

  • Zinc inhibits RNA polymerase activity of coronaviruses and thus blocks virus replication, as first discovered by world-leading SARS virologist Ralph Baric in 2010.
  • Ivermectin (an antiparasitic drug) has strong anti-viral and anti-inflammatory properties.
  • 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.
  • 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.
  • Vitamins C and D support and improve the immune system response to infections.
  • Aspirin may help prevent infection-related thrombosis and embolisms in patients at risk.
  • Azithromycin (an antibiotic) prevents bacterial superinfections of the lung.
  • Prednisone (a corticosteroid) reduces covid-related systemic inflammation.
  • HCQ has known anti-thrombotic, anti-inflammatory and possibly anti-viral properties.

See also: An illustration of the mechanisms of action of HCQ, quercetin and bromhexine.

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)

References

Ivermectin

  1. Overview: A summary of international ivermectin covid studies (c19ivermectin.com)
  2. Review: Ivermectin – A Potential Global Solution to the Covid-19 Pandemic (FLCCC)
  3. Review: Review of the Emerging Evidence Supporting the Use of Ivermectin in the Prophylaxis and Treatment of COVID-19 (FLCCC, November 2020)

Zinc

  1. Study: Low zinc levels at clinical admission associates with poor outcomes in COVID-19 (Vogel et al., medRxiv, October 2020)
  2. Study: Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients (Carlucci et al., MedRxiv, May 2020)
  3. Study: Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients (Eric Finzi, International Journal of Infectious Diseases, June 2020)
  4. Study: Zinc Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture (Velthuis et al, PLOS Path, 2010)
  5. Study: Effect of Zinc Salts on Respiratory Syncytial Virus Replication (Suara & Crowe, AAC, 2004)
  6. Study: Zinc for the common cold (Cochrane Systematic Review, 2013)
  7. Review: Zinc supplementation to improve treatment outcomes among children diagnosed with respiratory infections (WHO, Technical Report, 2011)
  8. Article: Can Zinc Lozenges Help with Coronavirus Infections? (McGill University, March 2020)

Quercetin

  1. Study: Small molecules blocking the entry of severe acute respiratory syndrome coronavirus into host cells (Ling Yi et al., Journal of Virology, 2004)
  2. Study: Zinc Ionophore Activity of Quercetin and Epigallocatechin-gallate: From Hepa 1-6 Cells to a Liposome Model (Dabbagh et al., JAFC, 2014)
  3. Study: Quercetin as an Antiviral Agent Inhibits Influenza A Virus Entry (Wu et al, Viruses, 2016)
  4. Study: Quercetin and Vitamin C: An Experimental, Synergistic Therapy for the Prevention and Treatment of SARS-CoV-2 Related Disease (Biancatelli et al, Front. in Immun., June 2020)
  5. Report: EVMS Critical Care Covid-19 Management Protocol (Paul Marik, MD, June 2020)

Bromhexine

  1. Study: TMPRSS2: A potential target for treatment of influenza virus and coronavirus infections (Wen Shen et al., Biochimie Journal, 2017)
  2. Letter: Repurposing the mucolytic cough suppressant and TMPRSS2 protease inhibitor bromhexine for the prevention and management of SARS-CoV-2 infection (Maggio and Corsini, Pharmacological Research, April 2020)
  3. Study: Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy? (Depfenhart et al., Internal and Emergency Medicine, May 2020)
  4. Study: Bromhexine Hydrochloride: Potential Approach to Prevent or Treat Early Stage COVID-19 (Stepanov and Lierz, Journal of Infectious Diseases and Epidemiology, June 2020)
  5. Study: TMPRSS2 inhibitors, Bromhexine, Aprotinin, Camostat and Nafamostat as potential treatments for COVID-19 (Arsalan Azimi, Drug Target Review, June 2020)
  6. Trial: Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial (Ansarin et al., BioImpacts, July 2020)

Aspirin and heparin

  1. Study: Anticoagulant Treatment Is Associated With Decreased Mortality in Severe Coronavirus Disease 2019 Patients With Coagulopathy (Tang et al, JTH, May 2020)
  2. Study: Autopsy Findings and Venous Thromboembolism in Patients With COVID-19 (Wichmann et al., Annals of Internal Medicine, May 2020)
  3. Review: Anticoagulation Guidance Emerging for Severe COVID-19 (Medpage Today)
  4. Study: Platelet gene expression and function in patients with COVID-19 (Manne et al., ASH Blood, September 2020)
  5. Review: Should aspirin be used for prophylaxis of COVID-19-induced coagulopathy? (Hussein et al., Medical Hypotheses, November 2020)

See also


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