Early Outpatient COVID Treatment – Why is There Still no Plan?

For most infections, early treatment is imperative to prevent late complications. Gangrene infection in the toe must be treated aggressively to prevent losing not only the toe but also a foot or leg if the infection is inadequately treated and spreads.

Those with cardiovascular disease are treated with statins and blood thinners as outpatients to prevent more serious disease and subsequent hospital care for stroke and heart attack with a much higher probability of disability or death.

COVID has been with us for almost two years and yet there are still no officially and medical establishment endorsed outpatient treatment protocols to keep infected individuals out of hospitals, which is where more serious problems begin, from secondary hospital infections, ventilators, and ultimately death.

Back in March of 2020, when COVID emerged on the scene, the rule of thumb was to not go to the hospital until short of breath and deathly ill. By this time, with the cytokine storm raging, hurricane-force winds were blowing most to a ventilator in the ICU where it was by the grace of God and a coin flip whether one would exit the ICU alive, whatever alive meant for those poor souls that lived through weeks in a medically induced coma.

Where are we at now? What does this same person do in early 2022, with symptoms of a bad cold or flu, regardless of vaccination status -- which makes little difference at this point in time?

Consider this scenario. After waiting for hours for a COVID nasal swab, testing which President Biden promised more of but failed to deliver on (a recurring theme of his floundering presidency), the test returns positive. The cough is worsening, along with a sore throat, fever, aches and pains, headache, and a GI tract running in high gear. Now what? What are the medical establishment’s recommendations?

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A good place to start is the NIH, specifically their “General management of non-hospitalized patients with acute COVID-19,” updated less than a month ago.

Management of non-hospitalized patients with acute COVID-19 should include providing supportive care, considering the use of COVID-19-specific therapy for patients who have a high risk for disease progression, taking steps to reduce the risk of SARS-CoV-2 transmission (including isolating the patient), and advising patients on when to contact a health care provider and seek an in-person evaluation.

Rough translation: good luck, take two aspirin and call me in the morning if you can’t breathe. And make sure your affairs are in order for your hospital trip may be one way.

Supportive care is what you find in the supermarket aisle or at home – Tylenol, Nyquil, a humidifier, Grandma’s chicken soup, stay home, and hope you get better. Specific therapy refers to monoclonal antibodies, which depending on which antibody and which COVID variant you have, may or may not be effective.  That’s assuming they are available given supply shortages. Or if you are of the wrong race, under the new paradigm of “healthcare equity”, you may be at the back of the line.

High-risk patients certainly need aggressive treatment, but what about everyone else, the vast majority? Just “supportive care”?

Otherwise, it’s “isolate,” which most would do anyway with a bad cold or the flu, staying home from school or work. And advice on when to seek evaluation, by which time the virus may have enough of head start to evade any of the newly approved therapeutics, meaning following the yellow brick road to the ICU.

What does the NIH’s sister bureaucracy, the CDC, have to say?

Current clinical management of COVID-19 consists of infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated.

Prevention? Duh. Of course, we want to do that. Isn’t that what the masks, hand sanitizers, gloves, face shields, quarantines, social distancing, school and business closures, vaccine passports, booster shots, and everything else that has brought us now to a record-setting million new cases a day in the US is supposed to prevent? How well are those measures working after two years? I am reminded of triple vaxed, masked, and face shielded Secretary of Defense Lloyd Austin, looking more like Darth Vader, coming down with COVID recently.

Other than that, the CDC recommends supportive care of oxygen and a ventilator. Great options. What are the recommendations for that critical time between staying home and needing oxygen or a ventilator? Why is that time frame conspicuously absent from treatment protocols?

There are a handful of new antivirals available under emergency use authorization, given by IV infusion generally, becoming quasi-hospital care, and some of which may have “major safety concerns.” What about the critical time between when one is sick with COVID but not sick enough for IV infusions or hospitalization?

Why after two years do we not have early outpatient treatment options for patients to keep them far away from IV lines and hospitals? Just as we do for diabetes, asthma, COPD, and a host of other diseases and conditions that are far better and cost-effectively managed at home, keeping people away from currently overcrowded hospitals.

But we do have such treatment options. Yet they are condemned and disparaged by the medical establishment and media, in favor of fighting a potentially fatal disease with a spoonful of Nyquil followed by a wing and a prayer.

I speak of several medications, deemed safe and effective by the FDA for human use, although for non-COVID indications, COVID treatment being an off-label use. This is legal, ethical, and common in medicine. Think of Avastin for macular degeneration and diabetic retinopathy, the most used therapeutic, yet off-label for this purpose. Yet in the case of Covid, these options are banned by medical authorities with punishment doled out to those who dare prescribe them.

As a necessary disclaimer, I am not offering medical advice, only commenting on the current state of COVID treatment. All such treatment decisions should be made in consultation with your health care provider.

Hydroxychloroquine and ivermectin, with decades of use, overwhelmingly safe when prescribed appropriately, are two such drugs. Then there are a host of over-the-counter supplements, including quercetin, zinc, vitamin C, vitamin D, and melatonin. There are also nasal sprays, gargles, and sinus rinses with dilute hydrogen peroxide or povidone-iodine. Most recently there have been reports about off-label Viagra and antidepressant fluvoxamine (Luvox) having potential benefit for COVID.

I won’t belabor the hysteria over hydroxy, as in Fox News’s Neil Cavuto telling his audience, “It will kill you” or ivermectin described by the FDA as horse paste, which by the same logic, means oats and corn are horse food, despite both being part of a normal human diet.

The Frontline COVID-19 Critical Care Alliance seems to be only one of a few medical organizations offering an early outpatient treatment and prevention protocol to keep people out of the hospital and morgue. Yet the writers of Time call these medical professionals “bogus”.

So where are the vaunted clinical trials of these potential therapeutics? It took two months of vaccine trials for approval yet now almost two years into this, where are the NIH-sponsored trials of these cheap and safe therapeutics?

Fortunately, others have done such trials. A meta-analysis of 73 ivermectin trials demonstrated, “Using the most serious outcome shows 66% [53‑76%] and 83% [74‑89%] improvement for early treatment and prophylaxis.”

A similar meta-analysis of 369 hydroxychloroquine studies showed,

HCQ is not effective when used very late with high dosages over a long period, effectiveness improves with earlier usage and improved dosing. Early treatment consistently shows positive effects.

Note that early studies showing harm used dosages that were too high and too late to have benefit. But early treatment was consistently positive.

This is not to argue against vaccines any more than to argue that the Air Force is the only way to win a war, excluding the Army, Navy, and Marines. With a nasty virus like COVID, it should be an all-hands-on-deck approach. Instead, we have vaccines to prevent, which are not preventing the current Omicron variant, and late-stage treatment of those already in the hospital.

The missing black hole is those millions of patients with early positive disease who are offered nothing but good luck wishes. These treatments are generally safe, and while not a cure, are effective for many, as the studies demonstrate. We should be throwing everything we can at this disease, yet we are not. Why is that?

Is it that there are no huge profits available for cheap off-label drugs, unlike for vaccines and the newly approved or EUA therapeutics? Is this incompetence or personal and corporate greed? Or is it mass formation psychosis as recently described by Dr. Robert Malone, one of the mRNA vaccine innovators?

What we are doing is the same thing over and over again, expecting different results, when reality says otherwise. What’s that the definition of?

As America approaches 1 million COVID deaths, we should by now be throwing the kitchen sink at this virus – vaccines, monoclonal antibodies, antivirals, and the cheap off-label zinc ionophores and supplements, that each plays a role in keeping Americans from getting sick and dying. It should not be an either/or option but a thoughtful use of everything available. Patients kept out of the hospital live; many of those entering the hospital are damaged or die.

Yet here we are, almost two years into this pandemic, with a dozen claims by President Biden to “shut down the virus” only to set new daily case records last week, with a gaping hole in this important phase of COVID management. How will history judge this omission?

Brian C Joondeph, MD, is a fully vaccinated physician and writer. On Twitter as @retinaldoctor

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