India recently reported over 330,000 new COVID cases in a single day, a new world record.
There is a way to dramatically reduce these numbers.
The problem is that India, like most countries, has been following the advice recommended by the recognized authorities (NIH, CDC, WHO, and EMA) for how to prevent and treat COVID. This advice is based on evidence-based medicine (EBM), which takes a relatively long time to discover and rigorously validate effective treatments.
Today, India doesn’t have the luxury of time. Hospitals are so overloaded now that extremely sick people cannot get in.
It’s clear that it is time for India to forego the EBM-based recommendations and start considering all the evidence (including moderate and lower quality evidence as well as anecdotal evidence) in decision making. Then always select the option that is more likely to produce a superior outcome.
India has recently started to do this with the new AIIMS Interim Clinic Guidance for Management of COVID-19. This is a step in the right direction, but I do not believe that these new guidelines go far enough; they are simply not commensurate with the problem at hand.
Here are some ideas that I believe have the potential to drastically reduce the infection, hospitalization, death, and long-haul COVID rates.
Prevention
Prevention is the most important thing right now. “An ounce of prevention is worth a pound of cure,” and that is true in spades here since all your downstream systems are overloaded.
Short of mass vaccination, the next best scalable way to prevent people from getting COVID is ivermectin. There are 14 clinical trials that support this recommendation. Of course, if you find a drug with more trials and a bigger minimum effect size and better anecdotal data, you should use that drug instead.
People should take a dose of at least .2mg/kg once per week. It won’t prevent all COVID infections, but it should cut the number of COVID infections that need to be treated by a factor of at least 4.
Note that this dose is double the amount normally typically recommended for prophylaxis against COVID. The higher recommendation is because the virus variant prevalent in India today is particularly aggressive. You may need to go higher at .3mg/kg once a week if you aren’t seeing at least a 4x drop in cases at that dose.
There is a lot of anecdotal evidence that this works. And it makes sense intuitively as well. If you have a small fire, a small bucket of water is sufficient to extinguish it. If you have a very large fire (like the double mutant variant), it’s unlikely that the small bucket of water is going to work nearly as well.
Post-infection treatment
If someone gets infected with COVID, the most important thing is to remember what David Ho taught us about HIV: hit it fast and hard.
Check out www.c19early.com. Note that fluvoxamine and ivermectin are two widely available drugs that are extremely safe and have the greatest effect sizes.
Why not give patients both of these drugs together fast and hard? Is there a better option that is more effective?
“Fast” means you deploy these drugs as early as possible. In particular, this means do not wait for symptoms before treating. Viruses are always best treated early. There are no exceptions to this rule. A virus is like a fire. Would you wait until the entire house is on fire before you called the fire department? Of course, not! Yet that’s effectively what you are doing if you wait for symptoms. Once you’ve lost your sense of smell or taste, it can be difficult to impossible to get it back
Treating upon confirmation of infection goes against the intuition of doctors who normally want to delay treating patients until they have symptoms. That can be a fatal mistake for this virus.
“Hard” means going beyond standard dosing and treating with a combination of at least one antiviral and one anti-inflammatory.
The normal dose of ivermectin for COVID is .2mg/kg for 3 to 5 days. That’s not hard enough or long enough for the variant you have. You need to up the dose by 2X to 3X and treat for at least 5 days as long as there are no symptoms. Don’t worry. Ivermectin is safe at that dose. I’d love to suggest you use a lower dose and I would if it worked, but it doesn’t so I didn’t.
An effective dose for fluvoxamine for COVID is 50mg twice a day. Even with the variant you have, this dose has proven to be extremely effective and has a very low side effect profile (fewer than 3% of patients discontinue the drug due to side effects). But if it isn’t lowering the CRP to normal in 5 days in patients, you can up the dose as tolerated, up to double that. Fluvoxamine should be used for 14 days.
You don’t have to take my word for it. Talk to Amol Kothalkar. He’s a cardiologist in Buldhana, India, that has been treating COVID patients with both ivermectin and fluvoxamine. He’s treated over 100 patients with ivermectin and fluvoxamine and only one patient had to be hospitalized for respiratory distress due to COVID.
Finally, if you treat people early enough, and hit the virus hard enough, you will likely be able to eliminate all long-haul COVID (aka PACS) cases. That will save everyone a lot of pain and suffering, perhaps for the rest of their lives.
If fluvoxamine is in short supply or becomes too costly, a viable substitute is to use 20mg of fluoxetine daily for 14 days. The mechanisms of action are identical between the drugs. The only reason the clinical trial used fluvoxamine is it had stronger sigma-1 activation than fluoxetine. However, the differences are relatively minor and the overall COVID hospitalization stats for people on either drug are comparable (fluoxetine actually has a slight advantage).
Post-infection treatment
Finally, there will always be patients who will decline and have to be admitted to the hospital.
The good news is that there are at least 6 methods that can be used to reduce their chance of death by 80% or more. One of these methods (inhaled adenosine) has remarkable effects in as little as 10 minutes. Another method has been able to extricate patients from the ICU in as little as 48 hours.
The bad news is that few people know about these techniques.
I created a video and slide presentation describing each technique where the pioneers of each technique detail the technique and how to use it.
Summary
Based on everything we know, the above suggestions should make a profound difference in the situation in India if they are widely adopted.
One thing we do know is that doing the same thing over and over and expecting a different result is illogical.
As a world, our biggest challenge is no longer the virus. It is changing our thinking to adopt methods that are more likely to save lives than following the official protocols. The new AIIMS guidelines are a step in the right direction, but they simply aren’t aggressive enough to mitigate the problem.
