FLCCC I-MASK+ Protocol for COVID-19 (December 2022)

FLCCC (Front Line COVID-19 Critical Care) I-MASK+ Protocol


I-MASK+ Prevention & Early Outpatient Treatment Protocol for COVID-19 was designed for use as a prevention and in early outpatient treatment, for those who test positive for COVID-19. Component nutrients include vitamin D, C, melatonin, quercetin and zinc.

All the component medicines are FDA-approved (except ivermectin), inexpensive, readily available and have been used for decades with well-established safety profiles.

Please take note that I-MASK+ protocols are now:

PREVENTION PROTOCOL

The I-Prevent protocol latest version (version 1: November 30, 2022).

I-PREVENT Protocol

As rates of infection with influenza and RSV rose in fall/winter 2022, FLCCC adapted the I-PREVENT protocol to include prevention against these viruses. The interventions recommended are likely to reduce the risk and severity of infection with COVID-19, influenza, and RSV infections as well as the common cold. It should be noted that the medications included in the I-PREVENT protocol are inexpensive, safe, and widely available. This protocol includes a section for pre-exposure (long-term) as well as a post-exposure (acute, short-term).

Pre-Exposure Prevention

  • Antiseptic antimicrobial mouthwash: gargle twice daily (do not swallow). Choose mouthwashes containing chlorhexidine, povidone-iodine, cetylpyridinium chloride, or the combination of eucalyptus, menthol, and thymol.
  • Vitamin D: dosing varies; optimal target is greater than 50 ng/ml. Table 1 presents a safe and practical treatment schedule for raising serum concentrations in non-urgent situations. The dosing schedule illustrated in Table 2 should be used when recent serum concentration levels are unavailable.
  • Vitamin C: 500 mg twice daily
  • Zinc: 20-50 mg/day (e.g., zinc citrate and zinc gluconate). Commercial zinc supplements are commonly formulated as zinc oxide or salts with acetate, gluconate, and sulfate.
  • Melatonin: 1-6 mg nightly (slow/extended). Begin with 1 mg and increase as tolerated to 6 mg at night. Causes drowsiness. Some patients are intolerant to melatonin, having very disturbing and vivid dreams; in these patients, it may be best to start with a 0.3 mg slow-release tablet and increase slowly, as tolerated.
  • Elderberry syrup, supplements or gummies: follow manufacturer’s dosing recommendations. Take during periods of high transmission of COVID-19, influenza, and RSV. A triple combination containing elderberry, Vitamin C, and zinc may be a convenient approach. Patients with autoimmune disease should take for 2 weeks or less and monitor their symptoms closely.
  • Resveratrol/Quercetin/Pterostilbene Combination Flavonoid supplement: 400-500 mg daily. The safety of these phytochemicals has not been determined in pregnancy and they should therefore be avoided. Due to the possible drug interaction between quercetin and ivermectin, these drugs should not be taken simultaneously (i.e., should be staggered morning and night).
  • Ivermectin: In the current situation of abundant natural immunity along with the recent circulation of less severe and more highly transmissible variants, chronic weekly or bi-weekly ivermectin prophylaxis is no longer applicable to most people. The following prophylaxis approaches with ivermectin can be considered and applied based on patient preference, comorbid status, immune status, and in discussion with their provider:
    • Bi-weekly ivermectin at 0.2mg/kg; can be considered in those with significant comorbidity and lack of natural immunity or immunosuppressive states or those with long COVID or post-vaccine syndrome who are not already on ivermectin as treatment
    • Daily ivermectin just prior to and during periods of high possible exposure such as travel, weddings, conferences, etc.
    • Immediate initiation of daily ivermectin at treatment doses (0.4mg/kg) upon first symptoms of a viral syndrome

Table 1. Guidance on Upfront Loading Dose Regimens to Replenish Vitamin D Stores in the Body

When serum vitamin D levels are available, the doses provided in this table can be used for the longer-term maintenance of serum 25(OH)D concentration above 50 ng/mL (125 nmol/L). The table provides the initial bolus dose, weekly dose, frequency, and the duration of administration of oral vitamin D in non-emergency situations, in a non-obese, 70 kg adult. *



* A suitable daily or weekly maintenance dose to be started after completing the loading-dose schedule. The dose should be adjusted for those who are overweight (higher) or underweight (lower).
** To convert ng/mL to nmol/L, multiply the amount in ng by 2.5; One µg = 40 IU.
$ Mentioned replacement doses can be taken as single, cumulative doses, two to three times a week spread out over a few weeks.
$$ From the day one of week two onwards.
# Estimated total Vitamin D dose needed to replenish the body stores (i.e., the deficit) is provided in the last column.

(Table adapted with permission from S.J. Wimalawansa)

Table 2. Vitamin D Dosing in the Absence of a Baseline Vitamin D Level

Longer-term maintenance schedules of oral vitamin D based on body weight to maintain the levels above 50 ng/mL (125 nmol/L) when the serum 25(OH)D concentrations are unknown.



* Example of a daily or once-a-week dose range for adults with specific body types (based on BMI for white Caucasians and body weight for other ethnic groups). Appropriate dose reductions are necessary for children.

# For those with chronic comorbid conditions, such as hypertension, diabetes, asthma, COPD, CKD, depression, and osteoporosis, and to reduce all-cause mortality, higher doses of vitamin D are needed. For them, one can use the doses that are recommended for persons with obesity (BMI, 30–39: the third row).

$ Those with multiple sclerosis, cancer, migraine headaches, and psoriasis, and those routinely taking medications such as anti-epileptic and anti-retroviral agents that significantly increase the catabolism of vitamin D should consider taking age-appropriate doses recommended for those with morbid obesity (BMI ≥ 40; the higher end of the daily doses in the fourth row).

(Table adapted with permission from S.J. Wimalawansa)

Post-Exposure Prevention

  • Naso-Oropharyngeal hygiene (Nasal Spray and Mouthwash): 2-3 times daily. The combination of nasal antiseptic sprays and oropharyngeal mouthwashes is strongly suggested. Choose a nasal spray with 1% povidone-iodine (for example Immune Mist™, CoFixRx™, Ionovo™ or Betadine® Antiseptic Sore Throat Gargle™).) and a mouthwash containing chlorhexidine, povidone-iodine, cetylpyridinium chloride (e.g., Scope™, Act™, Crest™), or the combination of eucalyptus, menthol, and thymol (Listerine™).
  • Elderberry: four times daily as per manufacturer’s directions for 1 week (gummy, supplement, or syrup)
  • Vitamin C: 500-1000 mg four times daily for 1 week
  • Elemental Zinc: 50-90 mg daily for 1 week
  • Melatonin: 2-5 mg at night (slow/extended release)
  • Resveratrol/Combination Flavonoid supplement: 500 mg twice daily. A flavonoid combination containing resveratrol, quercetin and pterostilbene is recommended.
Optional with documented exposure to COVID-19 (positive test):
  • Ivermectin: 0.4 mg/kg immediately, then repeat second dose in 24 hours;
  • AND
  • Hydroxychloroquine (HCQ): 200 mg twice a day for 5 days.
  • OR
  • Nitazoxanide: 500-600 mg twice daily for 5 days
Table 3. How to calculate ivermectin dose

Note that ivermectin is available in different strengths (e.g., 3, 6 or 12 mg) and administration forms (tablets, capsules, drops, etc.). Note that tablets can be halved for more accurate dosing, while capsules cannot.



Notes:
  • High risk Individuals: > 60 years with co-morbidities (hypertension, diabetes, chronic lung disease, chronic kidney disease), obesity, long term care facilities, etc.
  • Post COVID-19 exposure: To use if a household member is COVID-19 positive, or you have prolonged exposure to a COVID-19 positive patient without wearing a mask.
  • Precautionary Note: Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs. 
  • Precautionary Note: Hydroxychloroquine - Animal studies have revealed evidence of teratogenic effects (fetal harm; embryonic deaths and malformations of anophthalmia and microphthalmia) have been observed in the offspring of pregnant rats who were administered large doses of chloroquine. This drug crosses the placenta - Drugs.com.
  • Due to the possible drug interaction between quercetin and ivermectin (may increase ivermectin levels), these drugs should not be taken simultaneously (i.e. should be staggered morning and night). 
  • Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.
  • Vitamin D3 RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese.
  • When Is the Best Time to Take Vitamin D? Morning or Night? It is possible that increasing vitamin D levels during the day may act, in part, as a signal that suppresses melatonin generation (source). Therefore, it's better to take vitamin D (with meal) during the day and melatonin to be taken just before bedtime.
  • It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored.
  • Please consult with a qualified doctor and only use human ivermectin. Ivermectin for animals contain excipients (binding and storage compounds such as polyethylene glycol (PEG)) that are known to cause liver failure in high doses. 
  • There have been reports of visual problems associated with ivermectin. However, the effect is minor and transient.
Related: 

EARLY TREATMENT PROTOCOL

The I-Care protocol has been updated several times and below is their latest version (version 4: November 30, 2022).


FIRST LINE THERAPIES (In order of priority; not all required)
  • Ivermectin: 0.4 to 0.6 mg/kg – one dose daily for at least 5 days or until symptoms resolve. If symptoms persist longer than 5 days, consult a healthcare provider. See Table 1 for help with calculating correct dose. Due to a possible interaction between quercetin and ivermectin, these drugs should be staggered throughout the day (see Table 2). For COVID treatment, ivermectin is best taken with a meal or just following a meal, for greater absorption. (Find a Provider)
  • Hydroxychloroquine (HCQ): 200 mg twice a day for 5 to 10 days. Best taken with zinc. HCQ may be taken in place of, or together with, ivermectin. While ivermectin should be avoided in pregnancy, the FDA considers HCQ safe in pregnancy. Given the pathway used by the Omicron variant to gain cell entry, HCQ may be the preferred drug for this variant. (Find a Provider)
  • Mouthwash: three times a day. Gargle three times a day (do not swallow) with an antiseptic-antimicrobial mouthwash containing chlorhexidine, cetylpyridinium chloride (e.g., Scope™, Act™, Crest™) or povidone-iodine (e.g. Betadine® Antiseptic Sore Throat Gargle™).
  • Nasal spray with 1% povidone-iodine: 2-3 times a day. Do not use for more than 5 days in pregnancy. If 1% product is not available, dilute the more widely available 10% solution and apply 4-5 drops to each nostril every 4 hours. (Povidone Iodine Nasal Spray)
  • Quercetin (or a mixed flavonoid supplement): 250 mg twice a day. Due to a possible interaction between quercetin and ivermectin, these drugs should not be taken simultaneously (i.e., should be staggered at different times of day – see Table 2). As supplemental quercetin has poor solubility and low oral absorption, lecithin-based and nanoparticle formulations are preferred.
  • Nigella sativa: If using seeds, take 80 mg/kg once a day (or 400 to 500 mg of encapsulated oil twice a day). 
  • Honey: 1 g/kg one to two times a day
  • Melatonin: 5-10 mg before bedtime (causes drowsiness). Slow or extended-release formulations preferred. 
  • Curcumin (turmeric): 500 mg twice a day. Curcumin has low solubility in water and is poorly absorbed by the body; consequently, it is traditionally taken with full fat milk and black pepper, which enhance its absorption. 
  • Zinc: 75-100 mg daily. Take with HCQ. Zinc supplements come in various forms (e.g., zinc sulfate, zinc citrate and zinc gluconate). 
  • Aspirin: 325 mg daily (unless contraindicated). 
  • Kefir and/or Bifidobacterium Probiotics. Low levels of Bifidobacterium may predispose a person to COVID-19 and increase disease severity. Likewise, COVID-19 depletes the microbiome of Bifidobacterium, which may then increase the severity and duration of symptoms. Kefir (a fermented milk drink) is high in Bifidobacterium and other probiotics that have demonstrated health benefits. Suggested probiotic supplements include Megasporebiotic (Microbiome labs), TrueBifidoPro (US Enzymes) and yourgutplus+.
  • Vitamin C: 500-1000 mg twice a day.
  • Home pulse oximeter: Monitoring of oxygen saturation is recommended in symptomatic patients, due to asymptomatic hypoxia. Take multiple readings over the course of the day and regard any downward trend as ominous. Baseline or ambulatory desaturation under 94% should prompt consultation with primary or telehealth provider, or evaluation in an emergency room.
Note: Most of the first line therapies are inexpensive and easily purchased over the counter.


SECOND LINE THERAPIES (In order of priority/importance)

Add to first line therapies above if: 
1) more than 5 days of symptoms; 
2) poor response to first line agents; 
3) significant comorbidities.
  • Nitazoxanide (NTZ): 600 mg twice a day for 5 days. (Find a Provider)
  • Vitamin D3: 10,000 IU daily (two 5,000 IU capsules) for two weeks. 
  • B complex vitamins
  • Fluvoxamine: 25-50 mg twice a day. Can substitute fluoxetine (Prozac; 20-40mg daily) if fluvoxamine not available. (Find a Provider)
  • N-acetyl cysteine (NAC): 600-1200 mg orally twice a day. 
  • Omega-3 fatty acids: 4 g daily. Vascepa (Ethyl eicosapentaenoic acid); Lovaza (EPA/DHA); or alternative DHA/EPA. Vascepa and Lovaza tablets must be swallowed and cannot be crushed, dissolved, or chewed.
Table 1. How to calculate ivermectin dose

Note that ivermectin is available in different strengths (e.g., 3, 6 or 12 mg) and administration forms (tablets, capsules, drops, etc.). Note that tablets can be halved for more accurate dosing, while capsules cannot.



Table 2. Proposed medication schedule for first line treatments


Table 3. A Single-Dose Regimen of Calcifediol to Rapidly Raise Serum 25(OH)D above 50 ng/mL


Treatment of Omicron BA.4 / BA.5 / BQ.1.1 and XBB1 Variants

The following protocol should be used where BA.4/BA.5/BQ.1.1 and XBB1 are the predominant circulating strains.
  • Hydroxychloroquine: (200 mg twice daily or 400 mg daily for 5 days) AND 
  • Ivermectin (0.4-0.6 mg/kg once daily for 5 days taken with a fatty meal). Alternative to ivermectin: Nitazoxanide (500 mg three times a day for 5 days taken with a fatty meal).  (Find a Provider)
  • Zinc: (75-100 mg for 5 days). (e.g., zinc citrate or zinc gluconate). 
  • Antiseptic/antimicrobial mouthwash: (3 times daily). 
  • Nasal spray with 1% povidone-iodine, Carrageenan, Nitric Oxide, or nasal irrigations with saline or neutral electrolyzed water: 2-3 times daily. (Povidone Iodine Nasal Spray)
  • Quercetin: 250-500 mg twice daily. (lecithin-based and nanoparticle formulations are preferred).
  • Melatonin: (5-10 mg at night — slow-release formulation preferred). (Amazon)
  • Nigella sativa: (seeds 80 mg/kg once a day or encapsulated oil 400-500 mg twice a day) taken with honey (1 g/kg one to two times a day). (Amazon)
  • Aspirin: 325 mg daily unless contraindicated. (Amazon)
  • Home pulse oximeter.
High-risk patients (aged over 60, comorbidities, poorly ambulatory), delayed treatment, high D-dimer, recently vaccinated, or severe symptoms, should add: 
  • Apixaban: (5 mg daily for 15 days) OR Rivaroxaban (10 mg daily for 15 days). 
  • Spironolactone: (200 mg once daily for 7 days — avoid in patients with impaired renal function).
If symptoms have not markedly improved by day 3 of treatment, the following medications should be started. [NOTE: physicians should provide prescriptions for these medications at first visit.]
  • Prednisolone: (60 mg daily for 5 days).
  • Oral antibiotic: Doxycycline (100 mg twice daily for 5 days) (Doxycycline may act synergistically with ivermectin and may be the antibiotic of first choice) OR Azithromycin (Z-pack) (500 mg day 1, then 250 mg daily for 4 days) OR Amoxicillin/ Clavulanate (Augmentin) (500 mg/125 mg tablet twice daily for 7 days). 

Ordinary Vitamin D3 Does not work in Acute Illness

According to this webinar (below) by Dr Pierre Kory and Dr. Keith Berkowitz:


Video time from 11:30 - 12:30: 

Vitamin D3 (ordinary form) does not work in acute illness. It doesn't become active for at least a week... Vitamin D3 is for prevention and you should continue to take it if your levels are below 50 ng/ml...

There is only one form of vitamin D that will have an acute impact and that is calcifediol (vitamin D3 analog). 

About FLCCC Alliance

The Front Line COVID-19 Critical Care (FLCCC) Alliance was initially formed as a working group under “emergency” conditions of the early COVID-19 pandemic in response to multiple early reports of COVID patients with an inexplicably high need for prolonged mechanical ventilation and an excessive mortality associated with the prevailing “supportive care only” recommendations disseminated by the majority of national and international health care organizations.

As a group of highly published leaders in critical care with expertise in therapies directed at severe infections, in particular “HAT” therapy first developed by Dr. Paul Marik for the treatment of bacterial sepsis, and along with published high patient survival rates from our centers, we were contacted by equally concerned and motivated colleagues from other specialties.

With the increasing publications in addition to our rapidly accumulating personal clinical experiences and investigations into the pathophysiology of COVID-19 patients, we formulated the MATH+ Hospital Treatment Protocol in March 2020. On August 5, 2020, FLCCC published our findings in the rationale paper Scientific Review of COVID-19 and MATH+.

In October 2020, the FLCCC Alliance identified, based on a review of the recent and rapidly emerging clinical trials evidence, that ivermectin, an anti-parasitic medicine, has highly potent real-world, anti-viral, and anti-inflammatory properties against SARS-CoV-2 and COVID-19. This conclusion is based not only from multiple in-vitro and animal models, but from numerous clinical trials from centers and countries around the world showing repeated, consistent, large magnitude improvements in clinical outcomes when ivermectin is used not only as a prophylactic agent but also in mild, moderate, and even severe disease states. Further, data from large “natural experiments” that appear to have occurred when various regional health ministries and governmental authorities within South American countries initiated “ivermectin distribution” campaigns which then led to temporally associated decreases in case counts and case fatality rates.

Other Potential Treatments

For other potential treatments for COVID-19, check out c19early.com (constantly updated).

Conclusion and Key Takeaway

If you are an average layperson, you will likely find this protocol overwhelming. This is a guide and may need to be personalized according to your unique situation. Always see or talk to your doctor before taking these drugs, supplements and over the counter products. 

Be aware that most of the 'treatment' doses for supplements are above the recommended dietary allowance (RDA) and therefore such doses should not be maintained on a long term basis. 

This guide may not be the answer to everything but it could be everything to you or your loved ones.

Notes:

  • Dosages for supplements: Be aware that most supplements have two categories of doses i.e. treatment (therapeutic dosages are normally higher than the RDA dosages) and 'maintenance' or 'preventive' doses that are based on the recommended daily value.
  • Duration for supplements: Most supplements (e.g. vitamin D, zinc, quercetin) for early treatment are given for 5 - 10 days. To continue for preventive purposes, dosages will need to be reduced as per the prevention or prophylaxis protocol.
  • You should ideally supplement your micro-nutrients from healthy and wholesome foods, fruits and vegetables.
  • Although ivermectin and hydroxychloroquine are relatively safe drugs, they are still synthetic chemicals that can have side effects. Vitamin D, C, Zinc and Quercetin are nutrients that your body require for optimal health. Nutrients are safer alternatives especially if your risk is low e.g. age below 50 and no other chronic illness. Discuss with your doctor on the benefit vs risk for each treatment. If you are on multiple medications, be aware of supplement-drug interactions that might enhance the possibilities of adverse effects.
  • Nutritional supplements are meant to tip the scales in favour of you in terms of your immune system and to improve your probability of a smooth recovery, if at all you do get COVID-19. 
Disclaimers: 
  • Please do not consider these protocols as personal medical advice, but as a recommendation for use by professional providers. Consult with your doctor, share the information on this website and discuss with her/him.
  • We are fans and affiliates of FLCCC. We do not represent FLCCC. Any opinions are our own.
  • Always see or talk to your doctor before taking these drugs, supplements and over the counter products. Be aware that most of the 'treatment' dosages are above the recommended dietary allowance (RDA) and therefore such dosages should not be maintained on a long term basis. 
  • Our aim here isn't to replace your doctors' advice. It is intended as a sharing of knowledge and information. Do take note that supplements are not 100% protective or curative against COVID-19.
  • The I-MASK+ protocol is a bridge to vaccines and a safety net for those who cannot or have not been vaccinated; or are vaccinated and have concerns regarding declining protection against emerging variants. Vaccines have shown efficacy in preventing the most severe outcomes of COVID-19 and are an important part of a multi-modal strategy that must also include early treatment. The decision to get a vaccine should be made in consultation with your health care provider. 
  • You still need to follow the advice given by CDC, WHO and your local authority in terms of local guidelines such as mask wearing, social distancing, vaccination and avoiding crowds. It's better to combine multiple strategies in order to defend yourself against this virus.
  • According to US NIH: "...Guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient and their provider."


Z-Stack Supplement

In an effort to make it easier for patients, Dr Zelenko has developed an oral supplement that contains all four key ingredients: vitamin C, quercetin, vitamin D3 and zinc. It’s referred to as 'Z-Stack Supplement.
Z-Stack Vitamin cocktail provides key ingredients needed in order to help your body fight off this deadly invader. The Z-Stack Vitamins are Kosher certified, GMP certified and made in the USA.

The cost of the Z-STACK vitamin cocktail is $55 per bottle for a one month supply.

Where to buy Z-Stack: Z-stack is available on Dr Zelenko's website. Here is the link: Z Stack Supplement.

Note: To get 5% OFF, please use this coupon code: DRFRANCIS

Comments

  1. I'm so encouraged by the stand more doctors are taking to prevent and treat COVID-19 the way they swore an oath to do, instead of insisting that only a vaccine can end the pandemic and prevent deaths. It's baffling to me why all doctors are not on board demanding the NIH, WHO and CDC end their irrational, non-health-oriented approach to COVID-19 protocols. It seems they are controlled by the pharmaceutical industry. I hope even more doctors will wake up and let their own knowledge and experience and desire to heal guide them. I hope a huge contingent of healthcare practitioners will march on Washington and demand changes in those organizations. Thank you all who prescribe known safe medications for prevention and treatment for standing up to them so fewer people die going forward.

    ReplyDelete
  2. Why are you promoting masks and social distancing? In your press conference, Frontline dr.s compared throwing sand at a chain link fence to wearing masks. Also some of those brands have fillers that are not beneficial, do not state tested by 3rd party for contaminates, nor non gmo, like most corn and soy....rice. Why haven't you come together to sue the CDC, FDA, hospitals, nih, government... any one? In some states they're masking our kids, mandating vaccines, not allowing us to choose. Frontline Dr.s... We need you to start suing. Also , please consider adding NAC to some of the natural protocols... consider what steroids may do to some and some herbals, like elderberry contribute to cytokine storm of its own.

    ReplyDelete
  3. A resounding THANK YOU!!!
    The medical industry in the US is acting negligent at least in suppressing your information.

    ReplyDelete
  4. What is safe for high fevers 103 plus for 14 year old

    ReplyDelete

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