Other Drugs that might help fight Covid-19

Many of these reports are preliminary but are included for you to find information from publications and reviews.

All reports and text in this website are supported by links to their sources, while personal comments are in red in italics. Please click on the bold dark blue links which will take you to the source data, so that you can evaluate its veracity yourself.

Most of these claimed cures (listed basically alphabetically) have proponents who have presented reports of their effectiveness. The information has been aggregated here to help guide you.
However, in a time of emergency when remedy's that have little risk to the patient are being proposed, it is challenging to finance acceptable studies, for out of patent medicines that will not return a profit to any investor.

Additionally, there seems to be an urge to find a dramatic new cure rather than re-purposing old medicines that will reduce the effects of Covid-19.
For comments on Ivermectin and repurposing drugs click HERE.


Aspirin may protect against COVID-19, Israeli research finds

  • People who take small doses are 29% less likely than others to test positive, researchers say; those who do get COVID recover faster, and with reduced aftereffects. They cross-referenced 10,477 results with medical records covering what preventive drugs patients take. Aspirin users who are diagnosed with COVID-19 are likely to have a shorter illness - by about two days - and be less likely to suffer from aftereffects of the coronavirus. The aspirin study focused on people who take "baby" 75 milligram doses of the drug for primary prevention of cardiovascular diseases, but don't already have such diseases. Results were adjusted to account for age and co-morbidities.
    Aspirin May Help Prevent Serious COVID-19 Complications: Here's Why Aspirin May Help Prevent Serious COVID-19 Complications:
    Potential Benefits of Aspirin in Hospitalized COVID-19 Patients - December 3, 2020.

  • IV Aviptadil Shows Benefit in COVID Recovery, Survival - Release touts promise of the drug, but is light on data - March 29, 2021

  • Aviptadil (Zyesami), an investigational formulation of vasoactive intestinal peptide delivered by IV infusion, shortened time to recovery and demonstrated a survival benefit for certain critically ill COVID-19 patients versus placebo in a 196-patient randomized trial, manufacturer NeuroRx said. Aviptadil (INN) is a mixture of an analog of vasoactive intestinal polypeptide (VIP) with phentolamine for the treatment of erectile dysfunction

  • Azithromycin is a commonly used macrolide antibiotic with antiviral properties

  • Azithromycin is a commonly used macrolide antibiotic that has antiviral properties mainly attributed to reduced endosomal transfer of virions as well as established anti-inflammatory effects. It has been commonly used in COVID-19 studies based on French reports demonstrating markedly reduced durations of viral shedding, fewer hospitalizations, and reduced mortality combined with HCQ compared to those untreated. The combination of HCQ and azithromycin has been used as a standard of care in other contexts as a standard of care in more than 300,000 older adults with multiple comorbidities. This agent is well-tolerated, and like HCQ, can prolong the QTc in <1% of patients. The same safety precautions for HCQ listed previously could be extended to azithromycin with or without HCQ. Azithromycin provides additional coverage of bacterial upper respiratory pathogens that could potentially play a role in a concurrent or secondary infection. Thus, this agent can serve as a safety net for patients with COVID-19 against the clinical failure of the bacterial component of community-acquired pneumonia. One of many dosing schemes is 250 mg po bid for 5 days and may extend to 30 days for persistent symptoms or evidence of bacterial superinfection.

  • Inhaled budesonide (Pulmicort), a steroid generally used to treat asthma

  • Inhaled Steroid (budesonide - Pulmicort) for Early COVID-19 Passes Another Test - New analysis in the pragmatic PRINCIPLE trial, demonstrates speedier recovery for patients treated at home - April 12, 2021. Median times to self-reported recovery were 10 days in the budesonide group compared with 13 days among those receiving standard care in the randomized open-label trial. Rates of hospitalization or death 28 days after treatment assignment were 7.6% with budesonide versus 9.8% for usual care (probability of superiority 0.954). Some secondary outcomes, including rates of early sustained recovery and further healthcare encounters, also favored the steroid treatment.

  • Is Asthma Tx a Breath of Fresh Air for Early COVID-19 Patients? Inhaled budesonide (Pulmicort), a steroid generally used to treat asthma, dramatically reduced the need for hospitalization in COVID-19 patients within a week of symptom onset, a small randomized trial in the U.K. found.

  • Budesonide is an inhaled corticosteroid that is currently being studied for its efficacy with COVID-19. It is a common, safe prescription therapy that is FDA-approved for breathing issues and has helped thousands survive Covid worldwide. UPDATE: The most recent study by Oxford University (randomized control trial) showed a 90% reduction in hospitalization for people with COVID.

  • The STOIC study found that inhaled budesonide given to patients with COVID-19 within seven days of the onset of symptoms also reduced recovery time the need for urgent care and hospitalisation in people with COVID-19, researchers at the University of Oxford have found.

  • Two monoclonal antibodies administered together, bamlanivimab and etesevimab received emergency use authorization

    Monoclonal antibodies administered together, bamlanivimab and etesevimab, received emergency use authorization (EUA) for mild to moderate COVID-19 patients at risk of severe disease, the FDA said late Tuesday. The treatment was authorized for adult and pediatric patients, including those age 65 and older with chronic medical conditions, the agency said. They specified that the combination is not authorized for hospitalized COVID-19 patients or those who need oxygen therapy due to the disease, as it has not been studied in this population and may be associated with worse outcomes when given to patients requiring high-flow oxygen or mechanical ventilation.
    Monoclonal Antibodies: Eli Lilly's bamlanivimab, bamlanivimab/etesevimab combo and Regeneron's casirivimab/imdevimab The FDA issued an EUA for bamlanivimab in November, for treating mild-to-moderate COVID-19 in adult and pediatric outpatients (ages 12 and up), followed by an EUA for the combination of bamlanivimab and etesevimab in February for the same indication. Casirivimab/imdevimab was also authorized in November, for treating mild-to-moderate disease in patients 12 and up. Despite the authorizations, NIH doesn't recommend the therapies in its COVID-19 treatment guidelines. "There are currently insufficient data to recommend either for or against the use of bamlanivimab or the casirivimab plus imdevimab combination for the treatment of outpatients with mild to moderate COVID-19," according to an NIH statement. "The preliminary data on the use of these agents are from Phase 1 and 2 clinical trials that included relatively few participants and reported only a small number of clinical events related to COVID-19," it continued. "Final results from large Phase 3 randomized controlled trials will further inform the Panel's recommendations on the use of these monoclonal antibodies." One barrier to practical application is that they require intravenous infusion -- most easily delivered in hospitals yet hospitalized patients aren't eligible for them.
    Rolling review of U.S.-based Eli Lilly's antibodies bamlanivimab and etesevimab to treat COVID-19
    Lilly's bamlanivimab and etesevimab reduced hospitalizations and death in Phase 3 trial for early COVID-19 - 10 March 2021.
    Lilly announces additional doses of neutralizing antibody therapy purchased by U.S. government to treat COVID-19. Feb 26, 2021.
    Europe begins rolling review of Eli Lilly's antibodies for COVID-19 - 11 March 2021.
    Monoclonal antibody bamlanivimab appeared to work for end-stage renal disease (ESRD) patients in early data from dialysis providers, but there are plenty of questions that remain.
    The US government is no longer distributing Eli Lilly's bamlanivimab into California, Arizona and Nevada because of the prevalence of a viral variant that is not susceptible to the monoclonal antibody, FDA acting commissioner Janet Woodcock told physicians
    Today, 16 April 2021 the U.S. Food and Drug Administration revoked the emergency use authorization (EUA) that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone

    Anti-inflammatory oral drug colchicine improved COVID-19 outcomes for patients with relatively mild cases

  • Colchicine for Early COVID-19? Trial May Support Oral Therapy at Home Anti-inflammatory oral drug colchicine improved COVID-19 outcomes for patients with relatively mild cases, according to certain topline results from the COLCORONA trial announced in a brief press release. Overall, the drug used for gout and rheumatic diseases reduced risk of death or hospitalizations by 21% versus placebo, which "approached statistical significance." However, there was a significant effect among the 4,159 of 4,488 patients who had their diagnosis of COVID-19 confirmed by a positive PCR test: 25% fewer hospitalizations, 50% less need for mechanical ventilation, 44% fewer deaths

  • From the January 2021 American Journal of Medicine Colchicine is a non steroidal antimitotic drug that blocks metaphase by binding to the ends of microtubules to prevent the elongation of the microtubule polymer. This agent has proven useful in gout and idiopathic recurrent pericarditis. The GRECCO-19 randomized open-label trial in 105 hospitalized patients with COVID-19 found that colchicine was associated with a reduction in D-dimer levels and improved clinical outcomes. The clinical primary end point (2-point change in World Health Organization ordinal scale) occurred in 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = 0.02).43 Because the short-term safety profile is well understood, it is reasonable to consider this agent along with corticosteroids in an attempt to reduce the effects of a cytokine storm. A dosing scheme of 1.2 mg po, followed by 0.6 mg po bid for 3 weeks can be considered. See below for 'No convincing eveidence'.

  • Neither the NIH nor WHO have any guidelines concerning this oral anti-inflammatory drug often used to treat gout, although it is still being investigated as a potential COVID treatment. The colchicine arm of the RECOVERY trial was recently halted because an independent data monitoring committee found the drug wasn't helping hospitalized patients with COVID. However, top-line results from the COLCORONA trial, which were announced in January via a press release, showed improved outcomes for patients with mild illness from COVID-19.

  • Indian Dr Darrell DeMello describes how he has treated 3,000 patients, with only 29 hospital admissions and 6 deaths (all diabetics except one) with ivermectin and colchine. Not one patient can be described as a long haul patient.
  • Dexamethasone is a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects.

  • Dexamethasone was tested in hospitalized patients with COVID-19 in the United Kingdom's national clinical trial RECOVERY and was found to have benefits for critically ill patients.
    According to preliminary findings shared with WHO (and now available as a preprint), for patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth.
  • Dexamethasone is relatively cheap - about 5 pounds, or $7, per course.
    Dexamethasone, a corticosteroid with potent anti-inflammatory effects, is recommended for use in many categories of patients hospitalized with COVID-19, but not for those with mild-to-moderate disease who aren't in the hospital. While it recommends against dexamethasone for those hospitalized but not on supplemental oxygen, NIH recommends it for those who need supplemental oxygen, high-flow or noninvasive ventilation, and mechanical ventilation or ECMO. According to findings from the RECOVERY trial, dexamethasone use in those who required mechanical ventilation cut the risk of death by about 35% compared with usual care. Overall mortality also was lower in all hospitalized patients who received the drug.

    Doxycycline is another common antibiotic in the American Journal of Medical publication

  • Doxycycline with multiple intracellular effects that may reduce viral replication, cellular damage, and the expression of inflammatory factors. This drug has no effect on cardiac conduction and has the main caveat of gastrointestinal upset and esophagitis. As with azithromycin, doxycycline has the advantage of offering antibacterial coverage for superimposed bacterial infection in the upper respiratory tract. Doxycycline has a high degree of activity against many common respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, anaerobes such as Bacteroides and anaerobic/microaerophilic streptococci and atypical agents like Legionella, Mycoplasma pneumoniae, and Chlamydia pneumoniae. One of many dosing schemes is 200 mg po followed by 100 mg po bid for 5 days and may extend to 30 days for persistent symptoms or evidence of bacterial superinfection. Doxycycline may be useful with HCQ for patients in whom the HCQ-azithromycin combination is not desired.

  • Anti-ulcer drug Famotidine, costs about $5 per month

    Famotidine, is cardio-protective and antiviral, and has been found recently to have anti-Covid-19 effects. "It was one of the drugs used in the cocktail to treat President Trump" Rogosnitzky said.

    Favipiravir

  • Favipiravir an oral selective inhibitor of RNA-dependent RNA polymerase, is approved for ambulatory use in COVID-19 in Russia, India, and other countries outside of the United States. It has been previously used for the treatment of some life-threatening infections such as Ebola virus, Lassa virus, and rabies. Its therapeutic efficacy has been proven in these diseases. Like, the antimalarials and antibiotics, favipiravir has no large-scale randomized trials completed at this time, given the short time frame of the pandemic. A dose administration could be 1600 mg po bid on day 1, following by 600 mg po bid for 14 days.

  • Molnupiravir

  • Merck has put a lot of money into patent-protected molnupiravir (also known as EIDD-2801), descibed as last of the small molecule coronavirus hopes and wants to prioritise this drugs.
    Antiviral drug 'Molnupiravir' blocks Covid-19 virus within 24 hours: Study "This is the first demonstration of an orally available drug to rapidly block SARS-CoV-2 transmission. MK-4482/EIDD-2801 could be game-changing," said study author Richard Plemper from GSU.

  • How Molnupiravir Moved to the Head of the 'COVID Pill' Pack - Work on the broad-spectrum antiviral started over a decade ago at Emory - April 28, 2021
    Molnupiravir is a small molecule drug being investigated as an oral antiviral with broad spectrum activity against RNA viruses such as SARS-CoV-2. The drug acts as a ribonucleoside analog for an enzyme called RNA-dependent RNA-polymerase, which SARS-CoV-2 uses to replicate. Essentially, molnupiravir insinuates itself into the RNA of the virus, which increases the viral mutation rate to the point that the virus can no longer replicate and dies -- a process called viral error catastrophe.
  • Sildenafil, known better as Viagra is an anti-inflamatory

    "Sildenafil, for pulmonary hypertension and erectile dysfunction, protects the lungs, heart and kidneys and is an anti-inflammatory," Rogosnitzky continued.

    Tocilizumab and sarilumab reduced the risk of dying from COVID-19 by 24%

  • Tocilizumab and sarilumab that treat rheumatoid arthritis. Those who took the treatment spent 10 days less in the hospital than those who didn't, according to the study. The new UK study - funded by the government's REMAP-CAP trial - had not been peer-reviewed or published as at 9 January 2021.

  • The COVID-19 NIH Treatment Guidelines Panel's Statement on the Use of Tocilizumab for the Treatment of COVID-19 - March 5, 2021. Tocilizumab is a recombinant humanized anti-interleukin (IL)-6 receptor monoclonal antibody approved by the Food and Drug Administration (FDA) for the treatment of certain rheumatologic disorders and cytokine release syndrome induced by chimeric antigen receptor T cell (CAR-T cell) therapy. It is hypothesized that modulating the levels of proinflammatory IL-6 or its effects may reduce the duration and/or severity of COVID-19 illness. To date, no IL-6 inhibitor is FDA-approved or authorized for the treatment of COVID-19.
    On February 3, 2021, the COVID-19 Treatment Guidelines Panel (the Panel) issued a statement on the use of tocilizumab that included recommendations based on a preliminary report of results from the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP). Since the statement was issued, the Panel has reviewed published results of REMAP-CAP1 and the preliminary results of the open-label, pragmatic Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial,2 released on February 11, 2021. Based on this review, the Panel has updated its recommendations on the use of tocilizumab in certain populations of patients with COVID-19.
    The Panel recommends the use of tocilizumaba (single intravenous dose of 8 mg/kg of actual body weight, up to 800 mg) in combination with dexamethasone (6 mg daily for up to 10 days) in certain hospitalized patients who are exhibiting rapid respiratory decompensation due to COVID-19. Tocilizumab can cost roughly 500 pounds, or $700, per treatment, meaning that it may be less widely available. Even that price, though, is less than the cost per day of an intensive care bed in Britain.
    On March 5, the NIH updated its guidance regarding the anti-interleukin-6 (IL-6) monoclonal antibody tocilizumab for COVID-19, as new data from RECOVERY and another large trial became available. It now recommends using tocilizumab in combination with dexamethasone in certain hospitalized COVID patients exhibiting rapid respiratory decompensation. That includes those who have been admitted to the ICU within the previous 24 hours who require invasive mechanical ventilation, noninvasive mechanical ventilation or high-flow nasal cannula oxygen, or -- outside the ICU -- patients with rapidly increasing oxygen needs who require noninvasive ventilation or high-flow oxygen and have significantly increased markers of inflammation. The agency says tocilizumab should be avoided for "significantly" immunocompromised patients. There's no evidence for using other IL-6 inhibitors in COVID-19, but many remain under study.
  • "This is a treatment that reduces mortality, shortens hospital stay and reduces the chances of people needing invasive mechanical ventilators," Martin Landray, PhD. The research is part of the RECOVERY trial at Oxford, which has been testing potential COVID-19 treatments since March 2020. Tocilizumab was added in April 2020 and tested through January 2021. As part of the drug trial, more than 2,000 patients received the anti-inflammatory drug, and 2,000 others received standard care without the drug. Overall, 596 people died in the tocilizumab group, compared to 694 deaths in the standard care group. For every 25 patients treated with the drug, one life could be saved, the researchers said in a statement. The research team also found that the risk of progressing to mechanical ventilation dropped from 38% to 33%, and patients in the tocilizumab group were more likely to be discharged from the hospital within 28 days.

    Anti-cholesterol fibrates - fenofibrate - ubiquinone, ezetimibe and rosuvastatin

    "Anti-cholesterol fibrates, which cost $10-$20 per month, protect the kidneys and heart, are anticoagulant, anti-inflammatory, mildly antiviral and have been found by [Hebrew University researcher] Dr. Yaakov Nahmias to have potent anti-Covid-19 effects for which clinical trials are planned," Rogosnitzky concluded.

    Nahmias, director of the university's Grass Center for Bioengineering and its BioDesign medical innovation team, found that cholesterol-lowering drug fenofibrate (a PPAR-alpha agonist) interferes with the coronavirus' ability to reproduce in the lungs. He and Dr. Benjamin tenOever at New York's Mount Sinai Medical Center reported promising results in July. At the webinar, Nahmias said his team used retrospective clinical data to show that PPAR-alpha agonists effectively reduce risk of severe Covid-19 in people with metabolic risk factors such as obesity. "Obesity is more of a risk factor than asthma, though this virus damages the lungs," Nahmias said. After studying how the virus behaves in lung cells, Nahmias' lab used his pioneering Tissue Dynamics organ-on-a-chip technology to see the effects of the virus on metabolic processes.
    "We found this SARS-CoV-2 virus causes a massive metabolic response, generating fatty acids that cause lipotoxicity in the lungs," he said. "We know what kinds of drugs can correct this problem, including statins and fibrates among others. Fibrates shut down the virus in five days. They can't block the infection but can block secondary symptoms." His findings were validated in biopsies and data from 1,531 Covid-19 patients in Tel Aviv and Jerusalem. "Those taking fibrates spent five fewer days in the hospital and the rate of ICU admissions dropped from about 45% to about 8%," Nahmias reported. These patients also had reduced lung inflammation.

    Three other generic cholesterol-lowering drugs - ubiquinone, ezetimibe and rosuvastatin - were found to significantly reduce risk of Covid-19 severity in a systematic analysis of electronic health records led by Dr. Ariel Israel, director of research and data at Clalit Health Services.

    Mining a database of medication purchases of the HMO's 4.5 million members, Israel's team used statistics and probability tools to find which drugs had a coincidental protective effect on hospitalized and non-hospitalized Covid-19 patients. "Our findings support the hypothesis that coronavirus hijacks the cholesterol synthesis pathway to boost production of cellular cholesterol it needs as an RNA virus," Israel said. The three generic cholesterol drugs identified "are safe and widely prescribed," he said. Randomized controlled trials could prove their protective effects against Covid-19.

    REGENERON'S Casirivimab and Imdevimab antibody cocktail is first combination therapy to receive FDA emergency use authorisation.

    Regeneron said it has developed a two-antibody treatment that has reduced viral levels and improved symptoms of the novel coronavirus in nonhospitalized patients, CNBC reports. The treatment improved symptoms for those who had mild-to-moderate COVID-19 symptoms. Dr. Jeanne Marrazzo, the director of the division of infectious diseases at University of Alabama at Birmingham, told CNN that the research shows this is an early sign of an early treatment. It is said that Regeneron was given to President Trump. "What I think is fascinating is that it shows that antibodies really matter and the antibody to the spike protein was really helpful, particularly when people made the antibodies themselves," Marrazzo told CNN. "Whether it's antibody therapy or vaccine that target these proteins, it sounds like we are on the right track. I think that's really encouraging."

    Vitamin B12, vitamin A, zinc and magnesium. Vitamin D links here.

    The medical records analysis also found protective effects in patients taking vitamin B12, vitamin A, zinc and magnesium.
  • From the American Journal of Medical publication Zinc Lozenges and Zinc Sulfate Zinc is a known inhibitor of coronavirus replication. Clinical trials of zinc lozenges in the common cold have demonstrated modest reductions in the duration and severity of symptoms. By extension, this readily available nontoxic therapy could be deployed at the first signs of COVID-19. Zinc lozenges can be administered 5 times a day for up to 5 days and extended if needed if symptoms persist. The amount of elemental zinc lozenges is <25% of that in a single 220-mg zinc sulfate daily tablet. This dose of zinc sulfate has been effectively used in combination with antimalarials (HCQ)in the early treatment of high-risk outpatients with COVID-19.
  • .
  • What is the best dose of zinc for Covid-19 prevention?


  • Dubbed EXO-CD24, Israeli hospital claims may have found cure for COVID-19

  • Israeli hospital claims may have found cure for COVID-19 Preliminary testing shows that 29 out of 30 virus patients in serious condition that were administered the drug, dubbed EXO-CD24, once a day made a full recovery within five days; similar treatment announced by Hadassah Medical Center.

    Professor Nadir Arber from the Integrated Cancer Prevention Center at the hospital tested a medication he has been developing on patients in moderate and serious condition suffering from the virus with a 95% positive result. Arber says the medicine, named EXO-CD24, is inexpensive and effective and must be given once daily for five days.
    Of the 30 patients that were given the drug, 29 showed a marked improvement within two days and were released from the hospital three to five days later. One patient also recovered but her recovery took a few days longer, the hospital said.

    "The drug is based on exosomes, [vesicles]} that are released from the cell membrane and used for intercellular communication. We enrich the exosomes with 24CD protein. This protein is expressed on the surface of the cell and has a known and important role in regulating the immune system," explained Dr. Shiran Shapira, director of the laboratory of Prof. Nadir Arber, who has been researching the CD24 protein for over two decades. "The preparation is given by inhalation, once a day, for only a few minutes, for five days," Shapira said. The media may also mention that unlike vaccines the drug EXO-CD24, can work in hours, not weeks. This is only a phase one trial (just proving it does not hurt the people it is given to). It may not survive Phase II and III.


  • ZYESAMI™ - Aviptadil

    NeuroRx Announces that ZYESAMI™ (Aviptadil) has successfully demonstrated 10-Day accelerated recovery from respiratory failure in critically ill patients with Covid-19 treated with High Flow Nasal Oxygen at 28-Day interim endpoint. NeuroRx to file for Emergency Use Authorization in this patient population if positive results continue to be demonstrated at day-60 endpoint in line with FDA's New Guidance - Feb 23, 2021. At 28 days, patients treated with ZYESAMI™ demonstrate 35% higher likelihood of recovery from respiratory failure with continued survival compared to patients treated with placebo.

    Following is an extract describing early outpatient treatment of SARS-CoV-2 from the American Journal of Medicine

    January 2021 - The American Journal of Medicine recently published an article about "early outpatient treatment of SARS-CoV-2" which includes many drugs including hydroxychloroquine.
    Yes, you read that correctly. The absolute state of the medical field suggests HCQ!

    Few of the approaches listed in the American Journal of Medical publication have specific regulatory approved; thus, all would be appropriately considered acceptable "off-label" use due to their potential antiviral and other properties. This publication outlines key pathophysiological principles that relate to the patient with early infection treated at home. Therapeutic approaches based on these principles include
    1) reduction of reinoculation,
    2) combination antiviral therapy,
    3) immunomodulation,
    4) antiplatelet/antithrombotic therapy, and
    5) administration of oxygen, monitoring, and telemedicine.

  • Suggested is fresh air with open windows in hospital settings rather than negative air pressure.

  • Zinc Lozenges and Zinc Sulfate See above.
  • Antimalarials - Hydroxychloroquine (HCQ) is an antimalarial/anti-inflammatory drug that impairs endosomal transfer of virions within human cells. HCQ is also a zinc ionophore that conveys zinc intracellularly to block the SARS-CoV-2 RNA-dependent RNA polymerase, which is the core enzyme of the virus replication. The currently completed retrospective studies and randomized trials have generally shown these findings:
    1) when started late in the hospital course and for short durations of time, antimalarials appear to be ineffective,
    2) when started earlier in the hospital course, for progressively longer durations and in outpatients, antimalarials may reduce the progression of the disease, prevent hospitalization, and are associated with reduced mortality. In a retrospective inpatient study of 2541 patients hospitalized with COVID-19, therapy associated with an adjusted reduction in mortality was HCQ alone (hazard ratio [HR] = 0.34, 95% confidence interval [CI] 0.25-0.46, P <0.001) and HCQ with azithromycin (HR = 0.29, 95% CI 0.22-0.40, P <0.001). HCQ was approved by the US Food and Drug Administration in 1955, has been used by hundreds of millions of people worldwide since then, is sold over the counter in many countries, and has a well-characterized safety profile that should not raise undue alarm. Although asymptomatic QT prolongation is a well-recognized and infrequent (<1%) complication of HCQ, it is possible that symptomatic arrhythmias could develop in the setting of acute illness. Data safety and monitoring boards have not declared safety concerns in any clinical trial published to date. Rare patients with a personal or family history of prolonged QT syndrome and those on additional QT prolonging, contraindicated drugs (e.g., dofetilide, sotalol) should be treated with caution a plan to monitor the QTc in the ambulatory setting. A typical HCQ regimen is 200 mg bid for 5 days and extended to 30 days for continued symptoms. A minimal sufficient dose of HCQ should be used because, in excessive doses, the drug can interfere with the early immune response to the virus.

  • Azithromycin See above
  • Doxycycline See above
  • Favipiravir See above

  • IMMUNOMODULATORS
  • The manifestations of COVID-19 that prompt hospitalization and that may well lead to multi organ system failure are attributed to a cytokine storm. The characteristic profile of a patient acutely ill with COVID-19 includes leukocytosis with a relative neutropenia. These patients have higher McCullough et al Outpatient Treatment for COVID-19 serum level of cytokines (ie, TNF-a, IFN-g, IL-1b, IL-2, IL-4, IL-6, and IL-10) and C-reactive protein than control individuals. Among patients with COVID-19, serum IL-6 and IL-10 levels appear even more elevated in the critically ill. As with any acute inflammatory state, early treatment with immunomodulators is expected to impart greater benefit. In COVID-19, some of the first respiratory findings are nasal congestion, cough, and wheezing. These features are due to excess inflammation and cytokine activation. Early use of corticosteroids is a rational intervention for patients with COVID-19 with these features as they would be in acute asthma or reactive airways disease. The RECOVERY trial randomized 6425 hospitalized patients with COVID-19 in a 2:1 ratio to dexamethasone 6 mg po/IV daily for up to 10 days and found dexamethasone reduced mortality (HR = 0.65, 95% CI 0.51-0.82, P <0.001). One potential dosing scheme for outpatients starting on day 5 or the onset of respiratory symptoms is prednisone 1 mg/kg given daily for 5 days with or without a subsequent taper.
  • Colchicine See above

  • ANTIPLATELET AGENTS AND ANTITHROMBOTICS
    Multiple studies have described increased rates of pathological macro- and micro-thrombosis. Patients with COVID-19 have described chest heaviness associated with desaturation that suggests the possibility of pulmonary thrombosis. Multiple reports have described elevated Ddimer levels in acutely ill patients with COVID-19, which has been consistently associated with an increased risk of deep venous thrombosis and pulmonary embolism. Necropsy studies have described pulmonary microthrombosis in COVID-19. These observations support the notion that endothelial injury and thrombosis play a role in oxygen desaturation, a cardinal reason for hospitalization and supportive care. Based on this pathophysiologic rationale, aspirin 81 mg daily can be administered as an initial antiplatelet and anti-inflammatory agent. Ambulatory patients can be additionally treated with subcutaneous low-molecular-weight heparin or with short-acting novel anticoagulant drugs in dosing schemes similar to those use in outpatient thromboprophylaxis. In a retrospective study of 2773 inpatients with COVID-19, 28% received anticoagulant therapy within 2 days of admission, and despite being used in more severe cases, anticoagulant administration was associated with a reduction in mortality (HR = 0.86 per day of therapy, 95% CI: 0.82-0.89; P <0.001). Additional supportive data on the use of anticoagulants reducing mortality has been reported in hospitalized patients with elevated D-dimer levels and higher comorbidity scores.53 Many acutely ill outpatients also have general indications for venous thromboembolism prophylaxis applicable to COVID-19.

  • DELIVERY OF OXYGEN AND MONITORING Because ambulatory centers and clinics have been reticent to have face-to-face visits with patients with COVID-19, telemedicine is a reasonable platform for monitoring. Clinical impressions can be gained with audio and video interviews by the physician with the patient. Supplemental information, including vital signs and symptoms, will be important to guide the physician. A significant component of safe outpatient management is the maintenance of arterial oxygen saturation on room air or prescribed home oxygen under direct supervision by daily telemedicine with escalation to hospitalization for assisted ventilation if needed. Self-proning could be entertained for confident patients with good at-home monitoring. Many of the measures discussed in this article could be extended to seniors in COVID-19 treatment units in nursing homes and other nonhospital settings. This would leave the purposes of hospitalization to the administration of intravenous fluid and parenteral medication, assisted pressure or mechanical ventilation, and advanced mechanical circulatory support.

  • SUMMARY
    Acute COVID-19 has a great range of clinical severity from asymptomatic to fatal. In the absence of clinical trials and guidelines, it is prudent to deploy treatment for COVID-19 based on pathophysiological (the functional changes) principles with hospitalisations and mortality mounting. We have proposed an algorithm based on age and comorbidities that allows for a large proportion to be monitored and treated at home during self isolation with the aim of reducing the risks of hospitalization and death.

    FDA - Donate Covid-19 plasma if you have fully recovered

  • If you have fully recovered from COVID-19, you may be able to help patients currently fighting the infection by donating your plasma. Convalescent plasma from patients who have already recovered from coronavirus disease (COVID-19) may contain antibodies against COVID-19. Giving this convalescent plasma to hospitalized people currently fighting COVID-19 may help them recover. FDA has issued an emergency use authorization for convalescent plasma to be used in hospitalized COVID-19 patients and is being investigated for the treatment of COVID-19. Content current as of: 10/22/2020 and still on the FDA U.S. Food and Drug Administration as at 8 March 2021.

  • Debated and Failed? Therapies.
    All the therapies on this page could be considered as debated by some!

  • Anticoagulation - NIH recommends that all adults hospitalized for COVID-19 who aren't pregnant should receive prophylactic anticoagulation to prevent venous thromboembolism (VTE). (Pregnant patients hospitalized for severe COVID-19 should also get prophylactic anticoagulation unless it's contraindicated.) The agency notes that there are currently insufficient data to recommend either for or against the use of thrombolytics or higher-than-prophylactic-doses of anticoagulation in hospitalized patients outside of a clinical trial.
  • Major NIH-Funded Trial of Convalescent Plasma in Covid-19 Outpatients Stopped Early Due to Futility This news comes less than a week after a major "meta-analysis" (or "study of studies") was published in JAMA which found that when combining data from the best clinical trials studying convalescent plasma's effectiveness in treating covid-19 (mostly among hospitalized patients with more serious disease), no benefit was found with respect to saving lives, decreasing the percentage of patients who progressed to more serious or critical disease, and a number of other important indicators.
    In another blow to convalescent plasma, the much-hyped proposed treatment for covid-19, the "Convalescent Plasma in Outpatient with COVID-19," or "C3PO" trial has stopped recruiting new patients and has been halted early, Brief19 has learned.
    Nevertheless, some had held out hope that less sick patients who did not yet require hospitalization might fare better and that convalescent plasma might still have a role to play. That is what the C3PO study was designed to study.
    But no matter how you slice it, this is a huge setback for convalescent plasma and more egg on the face of Dr. Stephen Hahn, former commissioner of the US Food and Drug Administration under Donald Trump.
    Convalescent plasma has an FDA emergency use authorization to treat hospitalized COVID-19 patients. Only high-titer plasma is now authorized, however, and with restriction to hospitalized patients who are early in their disease course or those who have impaired humoral immunity. The scope of authorization was narrowed in February, to specify the use of only high-titer plasma. However, NIH guidelines state there are insufficient data to recommend for or against the use of convalescent plasma in the treatment of COVID-19. Clinical studies have showed mixed results, and an NIH-sponsored study of the agent was recently halted for futility.

  • Remdesivir, an antiviral, is currently the only FDA-approved therapy for COVID-19. It prevents SARS-CoV-2 from replicating by binding to RNA-dependent RNA polymerase, a key enzyme the virus needs to propagate. It was approved in October for hospitalized COVID-19 patients ages 12 and up who weigh at least 88 lbs. Its original Emergency Use Authorization (EUA) has been revised to also allow for treatment of hospitalized pediatric patients under 12 who weigh at least 7.7 lbs. NIH guidelines recommend the use of remdesivir in hospitalized patients who require supplemental oxygen, either on its own, or in combination with dexamethasone. For those requiring high-flow or noninvasive ventilation, NIH recommends remdesivir only in combination with dexamethasone. The NIH originally recommended remdesivir for use in mechanically ventilated patients, but limited its scope of use in December, due to a "lack of data showing benefit at this advanced stage of the disease."
    Remdesivir for the Treatment of Covid-19 - Final Report. Those who received remdesivir had a median recovery time of 10 days, as compared with 15 days among those who received placebo. The Kaplan-Meier estimates of mortality were 6.7% with remdesivir and 11.9% with placebo by day 15 and 11.4% with remdesivir and 15.2% with placebo by day 29.
    Remdesivir (Veklury) Shows Some Benefit in Minority Groups
    - Real-world outcomes in mostly Black and Hispanic patient population - March 24, 2021
    WHO recommends against the use of remdesivir in COVID-19 patients regardless of disease severity, as there is currently no evidence that remdesivir improves survival and other outcomes in these patients. 20 November 2020. Gilead Sciences said the regimen to use remdesivir to conquer the novel coronavirus will require six vials over five days. Each vial will cost $390 in the United States and other developed countries, with a total cost of $2,340. For private insurance companies the total will be $3,120.


  • RECOVERY trial halts recruitment for colchicine study after finding 'no convincing evidence' It may be the end of the road for colchicine, an inexpensive oral anti-inflammatory drug commonly used to treat gout, as a potential Covid-19 treatment - at least in hospitalized patients.

  • CytoDyn tries to squeeze positive news out of a failed leronlimab Covid-19 study. CytoDyn acknowledged that leronlimab - an anti-CCR5 antibody that had already been turned away at the FDA's doorsteps once - had failed the primary endpoint of lowering all-cause mortality at Day 28, as the result was not statistically significant.


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