COVID-19 Prevention: Evidence Review and Tracker (August 2021)

By Dr. Frank Yap, MD -
Some doctors and media channels argue that there is very little evidence to support the use of drugs and dietary supplements to prevent or treat COVID-19. As of August 2021, there are more than 5,500 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, track and summarise relevant information in one place. 

This guide is based on dynamic review of various references to scientific literature and hopefully, can help you make sense of the options and to separate the facts from fiction. Below, we look at the most studied and most watched categories for COVID-19 prevention.

McCullough et al. Reviews in Cardiovascular Medicine, 2020
Note: This is a highly dynamic topic; therefore, we will be updating this article as new information or evidence emerges. 

Drugs and supplements do not replace vaccines and other measures. All practical, effective, and safe means should be used. Elimination of COVID-19 is a race against viral evolution. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. Denying the efficacy of any method increases the risk of COVID-19 becoming endemic; and increases death rate, morbidity, and collateral damage.

For prevention protocols, please check out FLCCC I-MASK+ Prophylaxis protocol and Zelenko Prophylaxis Protocol.


Vaccine

Vaccine is a preventive strategy to boost your immune system and reduce the risk of getting COVID-19.

As of August 2021, researchers are currently testing more than 90 vaccines in clinical trials on humans. The vaccine remains a popular agent for COVID-19 protection, and the published reports of the candidate vaccines showcase some encouraging results.

For COVID-19 vaccine tracker, check out New York Times - Coronavirus Tracker (constantly updated).

Note: The mRNA and vector-based therapies are not really new technologies. MRNA and vector-based therapies have been in use since 2012 to treat patients with cancers, inherited immunodeficiencies, metabolic, eye, neuro-muscular diseases, even hypercholesterolemia.

Ivermectin

Some doctors and media channels argue that there is very little evidence to support the use of ivermectin to prevent or treat COVID-19. However, you can find a summary of more than 60 studies on ivermectin done by more than 500 authors from c19ivermectin.com (constantly updated).

As of August 2021, there are more than 80 on-going trials globally on Ivermectin for treatment and prevention of COVID-19 on covid-nma.com.

The Critical Care physicians of the FLCCC Alliance conducted a comprehensive review of the rapidly emerging scientific evidence on Ivermectin from studies conducted around the world. The link to their review that has been published in a peer-reviewed journal is HERE. This review led the team to develop the I-Mask+ Protocol and to call for its urgent adoption by health authorities — who could subsequently issue immediate guidance for the nation’s prescribing physicians.


Dietary Supplements (Vitamin D, C, Zinc, Quercetin) 

As of August 2021, there are more than 60 publications related to dietary supplements and COVID-19.

There are more than 80 types of supplements that are being studied for COVID-19. Vitamin D remains the most studied vitamin with the most evidence followed by zinc and vitamin C, for COVID-19. You can review the details of these trials on clinicaltrials.gov. 

Quercetin, EGCG and Zinc are among the handful of COVID-19 supplements that are being studied as potential candidates that might influence the outcome in the prevention and management of COVID-19. Hydroxychloroquine, Quercetin and EGCG (EpiGalloCatechin Gallate) are all zinc ionophores. Meaning they all transport zinc into the cells.

For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) recommends (updated June 30, 2021):
  • Vitamin D3: 1000–3000 IU/day. Note 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. (Amazon)
  • Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon)
  • Quercetin: 250 mg daily. 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. (Amazon)
  • Melatonin: 6 mg before bedtime (causes drowsiness). (Amazon)
  • Zinc: 30 - 40 mg/day (elemental zinc). Zinc lozenges are preferred. (Amazon)
  • Ivermectin for 
    • prevention in high-risk individuals (> 60 years with co-morbidities, morbid obesity, long term care facilities, etc): 0.2 mg/kg per dose (take with or after meals) — one dose today, repeat after 48 hours, then one dose weekly. 
    • Post COVID-19 exposure prevention: 0.2 mg/kg per dose (take with or after meals)  — one dose today, repeat after 48 hours.
The IMASK + protocol MUST be part of an overall strategy which includes common sense public health measures, i.e., masks, social distancing, and avoidance of large groups of people.

Antiseptic Mouthwashes and Throat Rinses

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.

Antiseptic mouthwashes/throat rinses (chlorhexidine, povidone-iodine, cetylpyridinium chloride) and/or povidone-iodine (Betadine) nasal spray/antiseptic applied 2 times per day. A mouth wash containing cetylpyridinium chloride (CPC) has broad antimicrobial properties and has been shown to be effective in controlling gingivitis and gingival plaque. 

An in-vitro study demonstrated that CPC was highly viricidal against 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.

Oropharyngeal and nasal sanitization will likely reduce the viral load in the upper airways, thereby reducing the risk of symptomatic disease and likely reducing disease severity. This may be particularly important with the Delta variant which replicates to achieve viral high loads in the nasopharynx/ oropharynx. (Ref, Page 13)

Others

Aside from supplements, drugs and vaccine, there are other ways that may help improve immune response and to prevent you from catching the coronavirus.
  • Wear protective face mask. This is to protect not only yourself but others.
  • Abundant evidence suggests that eating whole in fruits, vegetables and whole grains—all rich in networks of naturally occurring antioxidants and their helper molecules—provides protection against free radicals.
  • Getting Enough Sleep
  • Avoid sugar, red meat, processed foods and vegetable oil (linoleic acid).
  • Don't smoke.
  • Take steps to avoid infection, such as washing your hands frequently, using hand sanitizer and cooking meats thoroughly.
  • Try to minimize stress.
  • Drink enough water to keep your body hydrated.
  • Avoid excess alcohol.
  • Avoid crowded areas.
  • Regular physical activity (outdoor activities may not be allowed in countries with 'lock-down'). Those with active lifestyle has lower risk if hospitalised as compared to those with sedentary lifestyle (Infectious Diseases and Therapy, 2021)
  • Consult your nearest local healthcare provider if you have any doubt.

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