COVID 19 Protocols for Prevention and Treatment

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Always consult with a physician prior to taking any supplement or medication.

The protocols below were created by Nelson X. Simmons, MD

Updated June 1, 2022

JAMA article released November of 2021: Click Here

Original Source from January 2021: The American Journal of Medicine: Volume 134, issue 1, page 16-22

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.
  • Quercetin 500 mg twice per day x 14 days (Taken at least 4 hours after or before Zinc).
  • 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).
  • Quercetin 500 mg twice per day x 14 days.
  • 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

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 concerns:
    • 75 Years or Older
    • Severely Immunocompromised, including active cancer treatment, organ transplant, taking medicine to suppress the immune system, active treatment with high dose steroids, advanced or untreated HIV.
    • Chronic lung diseases, limited to Interstitial lung disease, pulmonary embolism, pulmonary hypertension, bronchiectasis, COPD (chronic obstructive pulmonary disease)
    • Cancer
    • Chronic Kidney Disease
    • Cerebrovascular Disease, including prior stroke
    • Diabetes mellitus, type 1 and type 2
    • Dementia
    • HIV
    • Pregnancy
    • Smoker, Current and Former
    • Tuberculosis
    • Heart conditions, such as Heart Failure, Coronary Artery Disease, Cardiomyopathies
    • Mental health disorders, limited to Schizophrenia spectrum disorders, Mood disorders (including diagnosis of depression)
    • Chronic liver diseases are limited to Cirrhosis, Non-alcoholic fatty liver disease, alcoholic liver disease, or autoimmune hepatitis.
    • NOTE: I no longer recommend/prescribe Ivermectin, Hydroxychloroquine, or Zithromax due to 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 suspect for 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 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:
    • 75 Years or Older
    • Severely Immunocompromised, including active cancer treatment, organ transplant, taking medicine to suppress the immune system, active treatment with high dose steroids, advanced or untreated HIV.
    • Chronic lung diseases, limited to Interstitial lung disease, pulmonary embolism, pulmonary hypertension, bronchiectasis, COPD (chronic obstructive pulmonary disease)
    • Cancer
    • Chronic Kidney Disease
    • Cerebrovascular Disease, including prior stroke
    • Diabetes mellitus, type 1 and type 2
    • Dementia
    • HIV
    • Pregnancy
    • Smoker, Current and Former
    • Tuberculosis
    • Heart conditions, such as Heart Failure, Coronary Artery Disease, Cardiomyopathies
    • Mental health disorders, limited to Schizophrenia spectrum disorders, Mood disorders (including diagnosis of depression)
    • Chronic liver diseases are limited to Cirrhosis, Non-alcoholic fatty liver disease, alcoholic liver disease, or autoimmune hepatitis.
    • 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 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.

INFORMATION ON ZINC

Zinc comes in many forms: For prevention, I recommend taking the doses below.  If exposed or positive, I recommend changing to zinc sulfate at 220 mg (can also be written as 50 mg of elemental zinc). We can provide a prescription for zinc sulfate.

NOTE: Zinc is better absorbed on an empty stomach, however, the most common side effect is nausea.  To minimize nausea, I advise taking it at least 30 minutes after a meal.  Also, note that you should not take Zinc and Quercetin together as they compete for absorption.

  • Zinc Gluconate: 50 mg per day
  • Zinc Sulfate: 10-15 mg per day
  • Zinc Picolinate: 30-50 mg per day
  • Zinc Citrate: 50 mg per day
  • Chelated Zinc: 15-30 mg per day.  Often goes by names like Zinc Acetate and Zinc Orotate.

This document is intended for Personal MD patients. If you are not our patient, note that this is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor/patient relationship is formed. The use of this information and the materials herein is at the user’s own risk. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions.