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COVID 19: A Clinical Primer—Overview and Plaquenil/Zithromax

Jacob Teitelbaum, MD

Jacob Teitelbaum, MD, is one of the most frequently quoted integrative medical authorities in the world. He is the author of the best-selling From Fatigued to Fantastic!, Pain Free, 1,2,3!, Complete Guide to Beating Sugar Addiction, Real Cause Real Cure, The Fatigue and Fibromyalgia Solution, Diabetes Is Optional, and the popular free Smart Phone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia and chronic fatigue syndrome and a study on effective treatment of autism using Nambudripad’s Allergy Elimination Techniques (NAET). Dr Teitelbaum appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr Oz Show, Oprah & Friends, CNN, and FoxNewsHealth. Learn more at www.Vitality101.com/.

 

There has been a lot of good sense and nonsense information being put out to both physicians and the public about this virus. So I am happy to share with you what the research and common sense actually does show. Including how to decrease the viral risk for you and those you treat.

 

Should I Panic?

No. Keep calm, and carry on…

It was important for people to become aware of the coronavirus and its concerns, so that people would be aware of the importance of social distancing, while we get ahead of the virus. Unfortunately, the media is once again going into its usual pattern of making people horribly frightened and hateful of each other. Seemingly, about almost everything. I was glad to see both parties working together initially, but now the virus has gone into being politicized. And I suspect a number of industries, well beyond those selling toilet paper, have a strong financial interest in keeping people panicked.

Put simply, although the virus warrants caution, it does not warrant fear. There are simple measures you can do that will likely leave you at about the same risk as if you had a regular flu bug. It is also good to remember that in 80% of people the illness is mild.

 

Let’s start by putting things in perspective.

1 – in China, the regular flu season causes about 90 000 deaths a year. As of the date I am writing this, COVID 19 has caused 11 500 deaths in China, and a Nobel laureate has noted that the virus already seems to have peaked and is slowing down in China. So it may pass much more quickly than is currently suspected.1  So simply put, there is a significant possibility that you would be more likely to die from the regular flu that goes around each year, then from COVID 19.

The concern is that the cause of death tends to be pneumonia with ARDS (shock lung). Social distancing is being used to slow the spread of the virus, to keep the healthcare system from being overwhelmed.

2 – in the United States, 80 000 people died of the regular flu last year. As of March 26, there have been less than 1000 US deaths from COVID 19. So it’s okay to relax. Again, caution – and not panic or fear. Although we do not know what the final death toll will be, I believe the information in this article can markedly decrease the number of deaths.

3-over 80% of deaths are in people over 65. In China in one study, there were no deaths in children except for three that had severe underlying health conditions such as leukemia or a surgical abdomen. Most cases of coronavirus in children are mild.2,3 So for children, although I recommend a good child’s multivitamin and making sure they stay hydrated, I would just treat this like any other crud that’s part of their growing up.

Basically, for many if not most people, the infection is no more severe than a mild or normal flu.  Though it is fatal even in some in the 20-60 yo age group, overall it may not be a bad thing for people under 60 years of age to get it, and develop immunity. What is key is to improve their immunity to lower the risk of the infection being severe. The vitamin powder, and zinc plus vitamin C, as well likely the Plaquenil and Zithromax, discussed below can all do this.

 

Prevention and Treatment

Here is what to do to markedly decrease the risk of getting the virus and decrease the severity of the illness.

An Ounce of Prevention. – Start with nutritional support

Because of how new this virus is, it is helpful to extrapolate from studies of earlier coronaviruses. Basically, research suggests that taking a high potency multivitamin with vitamin C, vitamin A (preferably retinol), vitamin D, B complex and zinc are especially important.4 With zinc being the most important.

 

My recommendations?

  1. I recommend a high potency multinutrient powder that contains 15 mg of zinc, 500 mg of vitamin C, 2000 – 5000 units of vitamin A, and 1000 units of vitamin D. All of these can have dramatic immune benefits. The one that I use in my practice is called the Energy Revitalization System vitamin powder (by Enzymatic Therapy). I recommend people start on this now, and stay on it long term.
  2. In addition, I have people take zinc 50 mg a day for one month. I suspect that this will turn out to be the most important nutrient for COVID 19. Zinc is poison to the coronavirus, and is basically like doing spay or neuter on the virus, decreasing its ability to reproduce.5 Zinc also kills coronavirus on contact. So when I am out and about, I keep a zinc lozenge in my mouth.
  3. Although there is some debate about Elderberry, in my practice I am recommending both Elderberry and Andrographis (400 mg of a 20% extract 1-2 twice a day- still available from EuroMedica) to those who want to add additional treatment.
  4. Getting good sleep is also critical for optimizing immune function.
  5. In treating thousands of people with CFS and fibromyalgia, I find that those with adrenal fatigue have much more difficulty with viral infections. So in those who get irritable when hungry, suggestive of suboptimal adrenal function, I do give adrenal support using Adrenaplex (EuroMedica).
  6. It is important to also stay hydrated. The IgA antibodies that are our first line of defense work poorly on a dry environment.

 

The importance of social distancing, handwashing, and other routine precautions has been discussed at length elsewhere. So I will not go to into that further here.

It is also important to caution people not to take ibuprofen related medications, as they have been implicated in being associated with increased progression to pneumonia and lung failure.

 

Treatment – Hydroxychloroquine (Plaquenil) and azithromycin (Zithromax)

You may have heard a lot of arguments about whether we should be using Plaquenil (hydroxychloroquine) and Zithromax. Imho, the science and common sense very strongly recommends that these should be begun at first sign of the virus. Period. Many of the arguments against this in the media (including medical media) are coming from the illness becoming politicized.

Although the human research was done in a number of non-placebo-controlled small studies, and reported case series, they were reasonably well done, include ~ 1000 cases, and show that combining these two treatments caused 83 % of people to be virus free after three days and 100% at five days (versus 19% in the control group), instead of the usual 20 days.6,7 It also made the illness much less severe in both the French study combining Plaquenil and Zithromax 6, as well as in the Chinese Plaquenil study.8

Preliminary reports from the Chinese authorities suggests that approximately 100 infected patients treated with chloroquine experienced a more rapid improvement in fever and lung CT scan changes, and recovered more quickly than the control groups. There were no obvious serious adverse effects. A recent randomized Chinese study of 64 cases showed significant benefits as well, with faster recovery. All 4 of the patients who progressed to severe illness were in the control group.9

Because of this, the Chinese medical advisory board has suggested chloroquine inclusion in the COVID-19 treatment guidelines.

In vitro studies also suggest hydroxychloroquine (Plaquenil) to be highly effective against COVID 19.10   The entire treatment costs about $20, and is much safer than ibuprofen or acid blockers. You may be hearing scare stuff in the media about visual damage in the retina and other problems from the Plaquenil. When you see people saying this, you can know right away that they have no familiarity with the science or no interest in being accurate. For example, generally the eye changes do not occur unless one is taking it for over five years. I have seen no reported cases of significant eye changes or cardiomyopathy with a six day course of treatment. Except for occasional stomach upset, this treatment is incredibly safe. Knowing this can help you separate the sense from the nonsense in what you read.

 

Risk / benefit Analysis of Plaquenil and ZithromaxFor perspective, about 250 Americans die each day from Advil related medication.

Although the studies are small, the French study had a control group, and an objective outcome measure of the viral test being negative at day 6 in 75% of the treated group, vs 0% of the control group. This is quite significant, even in a small study. In vitro studies also show Plaquenil to be highly effective against the Coronavirus.

So doing the math for a risk benefit assessment, the risk/costs are exceedingly low vs the potential benefit. We don’t have the luxury of waiting 3-6 months for the results of a large RCT.

 

The treatment group also clinically did much better.

The pills retail for both Zithromax and Plaquenil totals less than $20. So If everyone over 20 had the option of receiving them, the cost in the US would be under
$4 billion. With the contagious period cut from an average of 20 days to 3-6 days, the effect could be powerful at cutting the lockdown time and decreasing the spread of the virus.

Although we do not have this research yet, I suspect there is a significant probability of slowing viral growth and length of infection decreasing the risk to progression to pneumonia and ARDS ( shock lung ) by 25% or more. This could easily save 250 000 lives. Used as directed, there would likely be almost zero deaths from plaquenil and about 47 arrhythmia deaths per million people using it from Zithromax 13 (largely preventable by an EKG looking for prolonged QT interval and assessing risk with the Tisdale score). These mostly in those with underlying heart disease at the highest risk of dying from Coronavirus. This compares to an estimated 10 000 to 30 000 deaths per million people who get the virus. So there only needs to be an ~0.2% likelihood of this treatment working to make it worthwhile. The data suggests a far greater than 50% probability.

 

From a financial analysis:

We are currently looking at costs of $2 trillion to blunt the initial effects of the lockdown. So a potential 25 000+% financial return on the investment. Prevention of recession has major health benefits as well.

By the time even 3 months passes waiting for large study results, and optimistically one month to increase production of the meds, we will likely have already seen most of the damage. With viral spread being logarithmic, now is the time to proceed, before the bulk of the damage is done. Even if the treatment does not pan out, imho there is little relative cost/risk vs the probability of major benefits.

 

Dosing Plaquenil and Zithromax

Although right now the pharmacies are largely sold out of the Plaquenil, major efforts are being made to make this available again. The dosing that I recommend is Plaquenil 200 mg, two tablets twice a day for the first day, and then one tablet twice a day for five days. The full treatment is a total of 14 pills over five days. The Zithromax 250 mg dosing would be two tablets the first day, and then one a day for four days (1 Z pack). It is incredibly easy, low cost, and safe. I recommend taking both of them together at first sign of having the infection.

 

IV vitamin C and glycyrrhizin

For those of you doing IV infusions, both of these I think are warranted for acute infections. Glycyrrhizin has been shown to be active against coronavirus, including SARS.11-12  The IV Vitamin C dose regimen recommended by Dr. Klinghardt is 7.5-50 gm IV daily for 3 days.

So this is a time for caution rather than fear. Follow the recommendations for social distancing, handwashing, etc. Then turn off the “news” which is giving misinformation grossly out of perspective, to scare people so they watch all day. Watching five minutes a day will be enough to learn what you need to know.

So relax, enjoy the time with yourself and your family, and do the things above to help you and those who treat stay safe. You’re going to  be OK.

 

References

  1. Los Angeles Times. 2020. Why This Nobel Laureate Predicts A Quicker Coronavirus Recovery: ‘We’re Going To Be Fine’. [online] Available at: <https://www.latimes.com/science/story/2020-03-22/coronavirus-outbreak-nobel-laureate> [Accessed 25 March 2020].
  2. Wang D, Ju XL, Xie F, et al. Zhonghua Er Ke Za Zhi. 2020;58(4):E011. doi:10.3760/cma.j.cn112140-20200225-00138
  3. Ludvigsson JF. Systematic review of COVID-19 in children show milder cases and a better prognosis than adults [published online ahead of print, 2020 Mar 23]. Acta Paediatr. 2020;10.1111/apa.15270. doi:10.1111/apa.15270
  4. Zhang, L. and Liu, Y., 2020. Potential interventions for novel coronavirus in China: A systematic review. Journal of Medical Virology, 92(5), pp.479-490.
  5. te Velthuis AJW, van den Worm SHE, Sims AC, Baric RS, Snijder EJ, et al. (2010) Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. PLOS Pathogens 6(11): e1001176. https://doi.org/10.1371/journal.ppat.1001176
  6. COVID-19: Could Hydroxychloroquine Really Be An Answer? Available at https://www.medscape.com/viewarticle/927033/.
  7. Gautret P, Lagier J, Parola P, Thuan Hoang V, Meddeb L, Mailhe M, Doudier B, Courjon J, Giordanengo V, Esteves Vieira V, Tissot Dupont H, Honoré S, Colson P, Chabrière E, La Scola B, Rolain J, Brouqui P, Raoult D. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents. 2020. doi: https://doi.org/10.1016/j.ijantimicag.2020.105949.
  8. Devaux CA, Rolain J, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? International Journal of Antimicrobial Agents. 2020. doi:https://doi.org/10.1016/j.ijantimicag.2020.105938.
  9. Xueting Yao, Fei Ye, Miao Zhang, Cheng Cui, Baoying Huang, Peihua Niu, Xu Liu, Li Zhao, Erdan Dong, Chunli Song, Siyan Zhan, Roujian Lu, Haiyan Li, Wenjie Tan, Dongyang Liu, In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clinical Infectious Diseases, , ciaa237, https://doi.org/10.1093/cid/ciaa237
  10. Fiore C, Eisenhut M, Krausse R, et al. Antiviral effects of Glycyrrhiza species. Phytother Res. 2008;22(2):141–148. doi:10.1002/ptr.2295
  11. Hoever G, Baltina L, Michaelis M, Kondratenko R, Baltina L, Tolstikov GA, Doerr HW, Cinatl Jr J. Antiviral Activity of Glycyrrhizic Acid Derivatives against SARS-Coronavirus. Med. Chem. 2005;(48):1256-1259
  12. Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the risk of cardiovascular death. N Engl J Med. 2012;366(20):1881–1890. doi:10.1056/NEJMoa1003833

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