COVID-19 cocktail and discussion of virus mechanisms
The two primary keys to this virus are its ACE2 receptor affinity, and ORF3b protein which suppresses interferon. When it proliferates, each time it binds to an ACE2 receptor, and uses it for entry, that receptor, and the rest of the ACE2 receptors on that cell are destroyed. So those infected cells need to be replaced. Vitamin D is necessary for ACE2 management, and is critical to normalizing RAS system. ORF3b protein suppressing interferon production hamstrings each infected cell’s ability to fight infection. This interferon suppression is why this virus is having such a long clinical course and it is key to how COVID-19 lengthens each phase of infection, and generates silent pneumonia. Vitamin C is necessary for optimum interferon production.
Perspective: improving vitamin D status in the management of COVID-19.
https://www.nature.com/articles/s41430–020–0661–0
500,000 IU is their treatment of intubated patients. They found the break level for vitamin D testing to be >95 nmol vitamin D. That has until recently been thought to be potentially pathological, but has been shown to be fine up to 120 nm. So don’t be shy about nailing your cases with high dose vitamin D.
Vitamin C Is an Essential Factor on the Anti-viral Immune Responses Through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection.
https://pubmed.ncbi.nlm.nih.gov/23700397/
— Will comment that it’s not just initial response. Keep vitamin C high. Up to 30–40 grams per day. At 15–20+ grams/day this will cause some diarrhea, although if spaced out by the hour it may not. To the extent possible, a gram an hour. This can be delivered orally.
SARS-CoV-2 ORF3b is a potent interferon antagonist whose activity is further increased by a naturally occurring elongation variant.
https://www.biorxiv.org/content/10.1101/2020.05.11.088179v1
Type 1 interferons as a potential treatment against COVID-19.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138382/
In another study of SARS-1 (2003), several (but not all) interferons worked.
Those were: Roferon, Wellferon, Alferon, and Betaferon.
Note that most of those have generics now. Consider hitting severely ill patients with one of those 4, or a generic that is supposed to be the same.
In addition — tight junctions of cells lining blood vessels are maintained by shear force sensing of blood flow. The lining cells don’t carry ACE2 receptors. ACE2 is on the pericytes behind them in the blood vessel walls. So exercise is a good thing to the extent it can be tolerated. (Obviously, for non-physicians reading this, exercise to the point of exhaustion or peak performance is not what is meant.) Leaky junctions tends to be a problem of diabetes.
COVID-19 (Revised May-26-2020 cocktail)Prescription medications
Zithromax 500 mg PO BID X 5 days. Renew another 5 as needed.
Singulair (Montelukast) 60 mg loading dose. 10 mg QD X 15 days. Renew as needed.
For patients already on Singulair, if they are having symptoms, they can double or quadruple their dose. Singulair has been tested to 900 mg in a day in humans. No toxicity reported.
For patients having very slow recovery, prescribe Singulair 10 mg/day for a year. It won't harm them. The side effect that may appear is a weepy depression. Supplements/Nutrition
Vitamin C minimum 500 mg PO 6X per day X 15 days. Maximum 5 grams 8X per day. (I have suggested 1-3 grams per hour orally to get it into people.) Vitamin D 20,000 IU PO QD X 15 days (This is a good level to maintain for most. 15 days is just the 'official' time course.)
For diagnosed patients, 500,000 IU by injection. Repeat every 5 days during hospitalization.
If someone shows clotting symptoms, deliver a shot of vitamin D, or double the oral dose for 5 days.Zinc Zulfate 220 mg PO QD X 5 days. Exercise
Try to keep patients mobile. Walking, etc. Try to let them go outside and move.
Blood flow helps maintain tight junctions between cells lining blood vessels. The pericytes are normally behind the surface cells, and pericytes have the ACE2 receptors.
Crawl if they have to, but find a way to keep blood moving normally. BID = twice a day
QD = once a day
PO = oral
