We will discuss over the counter available medication, supplements and immune boosters in five sections.
Part 1. Immune boosting in low risk individuals
Part 2: Immune boosting in a high risk individual due to contact, premorbid conditions or occupation.
Part 3: Early treatment of mild COVID19 in asymptomatic or minimally symptomatic individuals.
Part 4: Treatment of mild to moderate COVID19 in patients with more significant symptoms such as fever, body pain, chills and headaches.
Part 5: Monitoring and hospitalisation.
It is important to treat this pathway as a continuum. If a patient transitions from Part 2 to Part 3 for instance, the Rx being taken in the previous part needs to be continued and the recommendations in Part 3 will be an ADD ON to previous Rx. Same applies if the patient then transitions to Part 4. The recommendations there would be ADD ON to what was being taken for Parts 2 & 3.
Part 1. Immune boosting in low risk individuals: Aim here is to keep immune system healthy and prevent common vitamin deficiencies
1. 50 plus ‘One a day’ Multivitamin or suitable alternative with at least 24 mg of Zinc and 1000 IU of Vitamin D3 along with other vitamins and minerals.
2. Vitamin D3 1000 IU additional on top to the Multivitamin.
3. If vegetarian, Vitamin B12 / Cyanocobalamin 500 mcg sublingual once a day additional.
In addition to this it is important to sleep well, keep an ideal weight, stay active, keep stress down and follow a healthy and varied diet.
Part 2: Immune boosting in a high risk individual due to contact, premorbid conditions or occupation: Aim here is to reduce pre-existing inflammation within the body related to Metabolic Syndrome
In ADDITION to Part 1,
4. Vitamin C 1000 mg a day
5. Omega – 3 – Fatty Acids 1000 mg a day, if cardiovascular / metabolic syndrome risk factors such as age above 60, obesity, heart disease, diabetes, hypertension, kidney disease etc:
Part 3: Early treatment of mild COVID19 in asymptomatic or minimally symptomatic individuals with localised symptoms: Aim here is to reduce replication of virus.
In ADDITION to Part 1 & 2
6. Quercetin ( with Bromelain ) 400 mg twice a day ( Bromhexine 8 mg three times a day in Indian Subcontinent )
7. Zinc 50 mg once a day
Part 4: Treatment of mild to moderate COVID19 in patients with more significant generalised symptoms such as fever, body pain, chills and headaches: Aim here is to reduce oxidative stress related to systemic infection and reduce blood clotting tendency.
In ADDITION to Part 1, 2 & 3
8. NAC / N- Acetyl- Cysteine 600 mg twice a day
9 & 10. Melatonin 3mg with Magnesium 150 mg one tab at night
11. Famotidine 20 mg twice a day
12. Aspirin 81 mg EC tab once a day with heaviest meal.
Part 5: Monitoring and hospitalisation.
While patients with early breathing difficulty may try breathing exercises and lying prone in bed, it is important these patients monitor their Oxygen saturations closely at least four to six times a day. Patients with Oxygen Saturations below 94 % must present to hospital so that effective treatments such as anti-inflammatory steroids and high dose blood thinners can be administered. IV antiviral agents can also be considered at this stage. Patients experiencing chest pain , leg swelling or neurological symptoms at any stage should call an ambulance, as this may be due to a blood clot.
It should be stressed that this prescription is a general recommendation. Patients should only consume medication or health supplements after consulting with a Physician / Pharmacist to ensure that this is safe for them and that they do not have any pre-existing conditions which are a contraindication to taking these. Also, the science around this is changing everyday, and this my best recommendation as of publication date, but may well be superseded as as more becomes known about this disease.
It is crucial that COVID19 is detected early, so that treatments which reduce viral replication, improve immune response, reduce oxidative stress and reduce blood clotting tendencies can be initiated early. Rapid testing including paper strip antigen testing has an important role to enable this, despite lesser sensitivity vs a standard rtPCR test nasal swab.
It is important to stress that the prevention is the best form of treatment. Maintaining a small social bubble, physical distancing, wearing face covering when in close proximity to those outside your social bubble and hand hygiene are the best way to prevent this disease. Ultimately a vaccine ( and SARSCOV2 specific monoclonal antibody ) will lead to the end of this Pandemic. Hospital treatment with anti-inflammatory steroids, blood thinning agents and prone positioning to delay intubation is reducing hospital mortality rates already.
