COVID 19 Protocols for Prevention and Treatment

The best protection against severe disease from Sars-CoV-2 is immunizations.  However, not everyone is a candidate for the vaccine and the vaccine does not guarantee you will not get COVID-19.  These protocols cover most variables and combinations of our clients.

Prophylaxis and have not completed a vaccine series for Sars-CoV-2

    Nutraceutical combination recommended for daily use.

• Vitamin D3 2,000-4,000 IU/day
• Zinc: Read the note below for the recommended dose
• Quercetin 500 mg per day.  Take at least 4 hours apart from your Zinc since the two compete for absorption.
• Melatonin (tablet): Begin with 1 mg and increase as tolerated to 3 mg taken thirty to sixty minutes before bed. This supplement makes some people groggy in the morning. If this is the case, take the supplement before bed or not take it.
• Vitamin C 500 mg: 1 each morning and one each evening: Vitamin C is good for prevention only.
• Flu shot unless contraindicated.

Prophylaxis and have completed a vaccine series for Sars-CoV-2

     Streamlined Nutraceutical Combination

• Vitamin D3: 2,000-4,0000 IU/day
• Melatonin (tablet): 1 mg – 3 mg taken thirty to sixty minutes before bed as tolerated.
• Flu shot unless contraindicated.
• NOTE: I recommend stopping Zinc, Quercetin, and Vitamin C once you get your vaccine. (You get a better boost to your immune system when you start taking a supplement versus taking it long-term. Speak to your provider about the long-term use of vitamins and minerals.)

Post Exposure until tested. The optimum time to test is 3-5 days after exposure. (The Omicron variant seems to take a little longer to trigger a positive test.)

    Max nutraceutical combination (Should only be taken as directed by your healthcare professional)

• Increase Vitamin D3 to 50,000 (fifty thousand) IU/day x 7 days, then drop to the usual recommended dosing (2,000 – 4,000 IU/day).
• Zinc Sulfate: 50 mg (as elemental Zinc) per day (This can be hard to find, so we often give it as a prescription. Many pharmacists refuse to dispense Zinc since it can be found over the counter). Do your best to find Zinc, including multivitamins and other supplements.
• Vitamin C 3000 mg per day x 7 days.
• Continue Melatonin at a max of 3 mg taken thirty to sixty minutes before bed.

Positive for COVID -19 in a patient UNDER the age of 50 and NO comorbid conditions (with no to mild symptoms)

Adults under the age of 50 (18-49) are at low risk (not no risk) of complications from SARS-CoV-2. The nutraceutical combination below has been adequate for the majority of our patients.

Comorbid conditions include BMI over 30, Pulmonary Disease, Diabetes, Coronary Vascular Disease, Chronic Kidney Disease, or Cancer.

     Start/Complete Nutraceutical combination (Should only be taken as directed by your healthcare professional).

• Increase Vitamin D3 to 50,000 (fifty thousand) IU per day x 7 days, then drop to the usual recommended dosing (2,000 – 4,000 IU/day).
• Zinc Sulfate 50 mg (dose expressed as elemental Zinc) per day (prescription can be provided).
• Increase Melatonin 6 mg at night (the optimal dose is unknown).
• Monitor home pulse oximetry if available (notify your physician if saturations drop below 94%).
• If symptoms worsen or oxygen saturations are sustained under 94% – add an antibiotic regimen and inhaled budesonide.
• Emergency room evaluation is recommended if oxygen saturations drop below 90% on room air for more than 2 hours.

Positive COVID-19 in a patient UNDER the age of 50 with at least one comorbid condition or

Positive COVID-19 in a patient over the age of 50 with NO comorbid conditions or if unvaccinated

Comorbid conditions include BMI over 30, Pulmonary Disease, Diabetes, Coronary Vascular Disease, Chronic Kidney Disease, or Cancer.

• Start/Complete the nutraceutical combination above.
•  
• If you qualify, pharmacies now carry an oral treatment called Paxlovid made by Pfizer.  The treatment is two medications taken twice a day for five days.  Talk to your healthcare provider if you feel you qualify to take the oral medications.  Note, it must be started within 5 days of developing symptoms to be effective:  Here are the qualifications: 
• You have a positive COVID-19 test.
• You have had symptoms for less than five days.
• You are 16 years or older.
• You have one of the following high-risk medical conditions or possible risk factors (comorbidities that have been associated with severe COVID-19 in at least 1 meta-analysis or systematic review, in observational studies, or in case series):
  
  • Age ≥65 years^¶
  • Asthma
  • Cancer
  • Cerebrovascular disease
  • Children with certain underlying conditions^Δ
  • Chronic kidney disease
  • Chronic lung disease (interstitial lung disease, pulmonary embolism, pulmonary hypertension, bronchiectasis, COPD)
  • Chronic liver disease (cirrhosis, non-alcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis)
  • Cystic fibrosis
  • Diabetes mellitus, type 1 and type 2
  • Disabilities (eg, ADHD, cerebral palsy, congenital malformations, limitations with self-care or activities of daily living, intellectual and developmental disabilities, learning disabilities, spinal cord injuries)
  • Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
  • HIV
  • Mental health disorders (mood disorders including depression, schizophrenia spectrum disorders)
  • Neurologic conditions (dementia)
  • Obesity (BMI ≥30 kg/m²) and overweight (BMI 25 to 29 kg/m²), or ≥95^th percentile in children
  • Physical inactivity
  • Pregnancy or recent pregnancy
  • Primary immunodeficiencies
  • Smoking (current and former)
  • Sickle cell disease or thalassemia
  • Solid organ or blood stem cell transplantation
  • Substance use disorders
  • Tuberculosis
  • Use of corticosteroids or other immunosuppressive medications
• • NOTE: I no longer recommend/prescribe Ivermectin, Hydroxychloroquine, or Zithromax due to a lack of evidence in peer-reviewed articles and better options that are now available.

If respiratory symptoms develop (Shortness of breath at rest or pulse oximeter under 94%)

• Add inhaled budesonide one mg/2 mL nebulization’s bid x 7 days.
• If the patient does not have a nebulizer, substitute Dexamethasone 6 mg IM x 1 or Prednisone 1mg/kg x 5 days, then taper at 50% q 3 days until you reach 10 mg.

If the patient has an underlying serious medical condition, increased risk of venous thromboembolism, or if the patient is suspected of micro or overt thrombosis

• Add Aspirin 325 mg PO daily or low-molecular-weight heparin or oral substitute.

Positive COVID-19 in a patient over the age of 50 with at least one comorbid condition

Comorbid conditions include BMI over 30, Pulmonary Disease, Diabetes, Coronary Vascular Disease, Chronic Kidney Disease, or Cancer.

• Start/Complete the nutraceutical combination above.
• Start/Complete the nutraceutical combination above 
• All positive COVID-19 patients over the age of 50 should add Aspirin 325 mg per day x 30 days.
•  
• If you qualify, pharmacies now carry an oral treatment called Paxlovid made by Pfizer.  The treatment is two medications taken twice a day for five days.  Talk to your healthcare provider if you feel you qualify to take the oral medications.  Note, it must be started within 5 days of developing symptoms to be effective:  Here are the qualifications: 
• You have a positive COVID-19 test.
• You have had symptoms for less than five days.
• You are 16 years or older.
• You have one of the following high-risk medical concerns:
  • Established, probable, and possible risk factors (comorbidities that have been associated with severe COVID-19 in at least 1 meta-analysis or systematic review, in observational studies, or in case series):
    
    • Age ≥65 years^¶
    • Asthma
    • Cancer
    • Cerebrovascular disease
    • Children with certain underlying conditions^Δ
    • Chronic kidney disease
    • Chronic lung disease (interstitial lung disease, pulmonary embolism, pulmonary hypertension, bronchiectasis, COPD)
    • Chronic liver disease (cirrhosis, non-alcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis)
    • Cystic fibrosis
    • Diabetes mellitus, type 1 and type 2
    • Disabilities (eg, ADHD, cerebral palsy, congenital malformations, limitations with self-care or activities of daily living, intellectual and developmental disabilities, learning disabilities, spinal cord injuries)
    • Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
    • HIV
    • Mental health disorders (mood disorders including depression, schizophrenia spectrum disorders)
    • Neurologic conditions (dementia)
    • Obesity (BMI ≥30 kg/m²) and overweight (BMI 25 to 29 kg/m²), or ≥95^th percentile in children
    • Physical inactivity
    • Pregnancy or recent pregnancy
    • Primary immunodeficiencies
    • Smoking (current and former)
    • Sickle cell disease or thalassemia
    • Solid organ or blood stem cell transplantation
    • Substance use disorders
    • Tuberculosis
    • Use of corticosteroids or other immunosuppressive medications
  • NOTE: I no longer recommend/prescribe Ivermectin, Hydroxychloroquine, or Zithromax due to a lack of evidence in peer-reviewed articles and better options.
  • If the patient is feeling short of breath, add a budesonide nebulizer solution. Nebulizers can be purchased at McKinney Pharmacy or Allen Family Drug if the patient does not already have one. If the nebulizer is not feasible, do not add IM or PO steroids unless the patient has pulse ox levels under 94%.
• • •  

If inhaled steroids were not used and respiratory symptoms develop or the pulse oximeter shows a level of under 94%, add Dexamethasone 6 mg IM x 1 or Prednisone as prescribed above.

Pulse oximeter levels of under 90% should be considered high risk, and emergency room evaluation should be recommended