10 Best Outpatient Treatments for COVID-19 (Updated August 2021)
Information related to the COVID-19 ('CO' stands for corona, 'VI' for virus, and 'D' for disease) pandemic has been overwhelming and confusing as well. Information is all over the place and various groups are giving conflicting statements. How do you make sense from all these fragmented information?
As of August 2021, there are more than 6,000 studies that have been launched to investigate various treatments for COVID-19. You can review the details of these trials on ClinicalTrials.gov. New ones are being added every day. The aim of this article is to organise and summarise relevant information in one place. Below, we look at the most studied categories.
|McCullough et al. Reviews in Cardiovascular Medicine, 2020|
Most doctors know the need to focus now on early treatment as the most immediate and practical way to reduce hospitalisations and death. This is your guide to help you know your options, and to use with your personal physician.
Below, we look at the best outpatient treatment categories for COVID-19 and summaries of the rationale and evidence for each category.
Based on the AAPS algorithm or flowchart below, nutraceuticals are the first line treatment for mild COVID-19 patients.
- Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if: 1) in regions with more aggressive variants; 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors.
- Fluvoxamine: 50 mg twice daily for 10–14 days. Add to ivermectin if: 1) minimal response after 2 days of ivermectin; 2) in regions with more aggressive variants; 3) treatment started on or after day 5 of symptoms or in pulmonary phase; or 4) numerous co-morbidities/risk factors. Avoid if patient is already on an SSRI (selective serotonin reuptake inhibitor).
- Vitamin D3: 4000 IU/day. (Amazon)
- Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon)
- Quercetin: 250 mg twice a day. (Amazon)
- Melatonin: 10 mg before bedtime (causes drowsiness). (Amazon)
- Zinc: 100 mg/day. Zinc lozenges are preferred. (Amazon)
- Nasal/oral rinse: 3 x daily – gargle (do not swallow) antiseptic mouthwash with cetylpyridinium chloride (e.g. Crest, Scope mouthwash™), ListerineTM with essential oils, or povidone/iodine 1 % solution as alternative (Betadine® Antiseptic Sore Throat Gargle™). (Reference, page 13)
- Aspirin: 325 mg/day unless contraindicated. (Amazon)
- Aspirin: 325 mg/day unless contraindicated. (Amazon)
- Pulse Oximeter: FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%. (Amazon)
4. Bamlanivimab plus Etesevimab, Casirivimab plus Imdevimab and Sotrovimab (Monoclonal Antibodies)
- Bamlanivimab plus etesevimab; or
- Casirivimab plus imdevimab; or
- HCQ (Hydroxychloroquine) is not effective when used very late with high dosages over a long period (RECOVERY/SOLIDARITY), effectiveness improves with earlier usage and improved dosing.
- Early treatment shows positive effects.
- Negative evaluations typically ignore treatment time, often focusing on a subset of late stage studies and did not include zinc.
6. Nasal Sprays and COVID-19
Do nasal sprays actually work against COVID-19?Below, we've listed the best nasal sprays for COVID-19. Do note that some of them are available as over-the-counter medications but some are still under clinical trial.
1. Nitric Oxide Nasal Spray
2. Iota-Carrageenan Nasal Spray
3. Povidone Iodine Nasal Spray
4. AeroNabs Nasal Spray for COVID
5. Xlear Nasal Spray
6. Taffix Nasal Spray
7. Halberd COVID-19 Preventative Nasal Spray
8. BioBlock®, a Novel Prophylactic Nasal Spray
Budesonide is a steroid sold under the trade name Pulmicort by AstraZeneca Plc and is also used for treating smoker's lung. The 28-day study of 146 patients suggested that those who inhaled budesonide reduced the risk of urgent care or hospitalization by 90 per cent when compared with usual care.
8. Povidone Iodine and Mouthwash
Due to the presence of angiotensin-converting enzyme 2 (ACE2) in the oral gingival epithelium and salivary glands, the human oral cavity may act as a reservoir for SARS-CoV-2. The ACE2 present on the host cell membrane acts as the primary entry receptor for SARS-CoV-2. Evidence indicates that the saliva of SARS-CoV-2-infected individuals contains high amounts of viral RNA and that aerosols formed from the saliva can act as a potential vector for viral transmission.
Povidone iodine (PVP-I) is an antiseptic that has been used for over 150 years. It's already proven that different concentration of PVP-I can deactivate COVID-19 virus.
In a primary prevention study in Singapore, a povidone-iodine throat spray administered three times daily proved to be highly effective in reducing the risk of laboratory confirmed SARS-CoV-2 infection.
9. Aspirin, Antiplatelet agents and antithromboticsIn addition to the obvious symptoms that COVID patients get such as fever and cough during the initial viral phase, they may also get symptoms and signs related to two distinct processes i.e. hyperinflammation (with out without cytokine storm) and a hypercoagulable state. A hypercoagulable state is the medical term for a condition in which there is an abnormally increased tendency toward blood clotting (coagulation).
Because thromboxane A2 is markedly upregulated with SARS-CoV-2 infection, early administration of aspirin 325 mg per day is advised for initial antiplatelet and anti-inflammatory effects (Chow et al., 2020; Glatthaar-Saalmüller et al., 2017; Turshudzhyan, 2020; A. Gupta et al., 2020a).
In a retrospective study of 2773 COVID-19 inpatients, 28% received anticoagulant therapy within 2 days of admission, and despite being used in more severe cases, anticoagulant administration was associated with a reduction in mortality, HR = 0.86 per day of therapy, 95% CI: 0.82-0.89; P<< 0.001. Pre-emptive use of low molecular weight heparin or novel anticoagulants have been associated with >> 50% reduction in COVID-19 mortality (Billett et al., 2020).
Finally, many acutely ill outpatients also have general indications or risk for cardioembolic/venous thromboembolic prophylaxis applicable to COVID-19 (Moores et al., 2020; Ruocco et al., 2020). There are ambulatory randomized trials of aspirin and novel oral anticoagulants underway. However, given reports of catastrophic stroke and systemic thromboembolism and the large reductions in mortality for both prophylactic and therapeutic use, administration of aspirin 325 mg po qd for all COVID-19 high-risk patients and systemic anticoagulation is prudent in patients with a history of heart, lung, kidney, or malignant disease (Yamakawa et al., 2020).
Azithromycin is a widely prescribed generic antibiotic. While it's mainly used to fight bacteria, not viruses, there is some research suggesting the drug has antiviral properties.
As of August 2021, there are more than 120 studies that have been launched to investigate the benefits of Azithromycin against COVID-19. You can review the status of these trials on clinicaltrials.gov. Several trials are testing azithromycin in combination with hydroxychloroquine.
One potential concern is serious heart side effects. Both drugs can cause abnormal changes in the rhythm of the heart. These can be fatal, particularly for susceptible patients who already have heart problems. Many studies are using EKG tests to closely monitors patients receiving this treatment combination.
While QT-prolonging medication use has been associated with increased risk of death, this risk may be smaller than the potential benefit from treatment of COVID-19 for some patients (American College of Cardiology).