I have received many emails asking me how I would treat myself if I developed COVID-19.
If I had COVID-19 and was not very sick, I do not know if I would take anything. Today there are no drugs or treatments proven to prevent or cure COVID-19, and the U.S. Food and Drug Administration (FDA) has not licensed any treatment specifically for the virus, but has allowed emergency use for some treatments. Since a successful drug will bring billions of dollars to the company that develops it, you have to be very cautious about many of the press releases put out by companies racing to find treatments. If I had only mild symptoms, I would probably just take it easy (as I would with the flu or a bad cold) and not take any drugs. However, new controlled studies are being reported daily so my opinion may change at any time. People with heart disease, lung disease, diabetes, auto-immune disease, cancer or obesity and those over 65 are at increased risk for complications, so their doctors may elect to prescribe some of the treatments listed below.
If I was very sick: COVID-19 kills people by 1) forming clots throughout their bodies, particularly in their lungs and heart, and 2) creating a “cytokine storm,” an overactive immune system that uses the same cells and proteins that kill germs to turn around and attack the person’s own body. The treatment for very sick COVID-19 patients should include drugs to dampen down an overactive immune system and possibly drugs to prevent clots. If I was very sick with COVID-19, I would probably request:
- Vasoactive Intestinal Polypeptide (VIP, brand name Aviptadil). The FDA and the National Institutes of Health (NIH) have fast tracked an old drug called VIP for further studies because it has been around for more than 20 years, appears to be safe, is not too expensive, and may be effective in treating COVID-19. COVID-19-related death is usually caused by lung failure, and more than 100 studies over more than 20 years have shown that VIP is very safe for humans suffering from lung diseases such as sarcoidosis, pulmonary fibrosis, asthma, and pulmonary hypertension. Patients who survived being on ventilators for COVID-19 have had much higher levels of VIP in their blood than those who died of respiratory failure. VIP dampens down inflammation, an overactive immune system called “cytokine storm.” VIP has caused critically-ill COVID-19 patients to gain: 1) rapid clearing of pneumonia on X rays, 2) a marked improvement in blood oxygen saturation, and 3) a more than 50 percent decrease in laboratory test markers of inflammation. VIP inhibits the growth of SARS-CoV-2 (the virus that causes COVID-19) in human lung cells and in monocytes that help to regulate immunity.
- Dexamethasone or other corticosteroids, or other immune suppressants. Data show that these drugs help to stop the body from attacking itself (“cytokine storm”) so patients who are close to dying can recover from COVID-19. They help to shut down an overactive immune system, but can harm you if they dampen your immune system too much and allow the virus to spread further through your body.
- Remdesivir, a drug that has been reported to prevent some viruses from reproducing in humans. One study showed that remdesivir shortened hospital stays from 15 to 11 days in very sick COVID-19 patients (N Engl J Med, May 22, 2020).
- Convalescent plasma, serum taken from the blood of people who have recovered from COVID-19, because it has antibodies specific to kill the virus that causes COVID-19, has been given to thousands of patients with diseases other than COVID-19, and may have helped patients with serious influenza symptoms. Antibodies taken from the blood of recovered patients have been used for more than 100 years to treat more than 80 diseases, including AIDS, and appear to be safe. Many companies are working to show that blood from recovered COVID-19 patients will help to treat the disease. We do not yet have any controlled studies to show that convalescent plasma is effective for COVID-19; I will continue to watch for study results.
- Interferons are produced normally by your immune system when you have an infection, and SARS-CoV-2 somehow reduces your body’s production of interferons. They have been shown to prevent infections in both animals and humans and have been given to many hundreds of thousands of people with various other infections, but we have very few controlled studies in COVID-19 patients. One British study showed that inhaled interferon helped hospitalized patients recover from COVID-19.
- Anticlotting drugs: Clotting is a major cause of death in COVID-19 and there is no doubt that anticlotting agents can save lives. However, a serious concern is that they can also cause bleeding, so we do not know how safe anticlotting agents are in treating COVID-19.
Other Treatment Options for Very Sick COVID-19 Patients
• Blood filtration systems: The FDA has granted emergency use for several devices that filter the immune chemicals called cytokines from the bloodstream.
• Ventilators: These are machines that help people breathe in more oxygen.
The following treatments may have some potential, but I would probably not take them because so far there is no strong data to show benefits.
• Favipiravir has been shown to be of some benefit in treating serious cases of influenza, but I know of only one small study to show benefit in treating COVID-19.
• Recombinant ACE-2 helps to prevent the virus from getting into human cells in tissue cultures, but I know of no published human studies.
• Lopinavir, Leronlimab and Ritonavir are HIV drugs that stop tissue culture growth of the coronavirus, but I have not found any controlled studies that show that they are effective in treating COVID-19.
• Ivermectin helps to rid humans of parasitic worms and blocks the coronavirus from growing in tissue cultures. I can find no controlled human COVID-19 studies. It has lots of side effects.
• Hydroxychloroquine and chloroquine have been around for more than 60 years to treat malaria and some auto-immune diseases. They have been shown to stop SARS-CoV-2 from reproducing in tissue culture, but so far no controlled studies have shown that they help to treat COVID-19 in humans, seven controlled studies showed that they are not effective, and at least one study failed to show that they are effective in treating COVID-19 in monkeys. The FDA has cautioned that hydroxychloroquine or chloroquine, alone or with the antibiotic azithromycin, should not be used outside a hospital or clinical trial because of the risk of irregular heartbeats that can be fatal.
• Oleandrin is an extract of the oleander plant, a common garden shrub that is highly poisonous. It can cause irregular heartbeats and kill you. I have found no controlled studies on humans showing that it is safe or effective. This deadly plant should definitely not be used for self-medication.
My Recommendations Are Likely to Change
Since the virus first showed up in significant numbers in January 2020, companies all over the world have mobilized at an incredibly fast rate to be the first to produce studies to show that their drugs are effective. The rewards for success are huge, so we should expect successful treatments soon. Even more important for ending the pandemic will be the vaccines that are currently being tested.