EVMS CRITICAL CARECOVID-19 MANAGEMENT PROTOCOL (East Virginia Medical School)
Has sections on prophylaxis recommendations and mildly symptomatic patients.
Prophylaxis
While there is very limited data (and none specific for COVID-19), the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease, especially amongst the most vulnerable citizens in our community; i.e. those over the age of 60 years and those with medical comorbidities. While there is no high level evidence that this cocktail is effective; it is cheap, safe and should be readily available. So what is there to lose? •
Vitamin C 500 mg BID and Quercetin 250-500 mg BID•
Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1-2 months, reduce the dose to 30-50 mg/day. •
Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 1-2 mg at night•Vitamin D3 1000-4000 u/day (optimal dose unknown). Likely that those with baseline low 25-OH vitamin D levels and those > living at 40o latitude will benefit the most.
Mildly Symptomatic patients (on floor):•
Vitamin C 500mg BID and Quercetin 250-500 mg BID (if available)•
Zinc 75-100 mg/day•Melatonin 6-12 mg at night (the optimal dose is unknown)•
Vitamin D3 1000-4000 u/day•
Enoxaparin 40-60mg day (if not contraindicated; dose adjust with CrCl < 30ml/min)•
Optional (and if available): Chloroquine 500 mg PO BID for 5 days or hydroxychloroquine 400mg BID day 1 followed by 200mg BID for 4 days•
Observe closely. •
N/C 2L /min if required (max 4 L/min; consider early t/f to ICU for escalation of care). •
Avoid Nebulization and Respiratory treatments. Use “Spinhaler” or MDI and spacer if required. •
Avoid non-invasive ventilation• (emphasis in original)
T/f EARLY to the ICU for increasing respiratory signs/symptoms.
FWIW, among optional treatment components for ICU patients:
"Azithromycin 500 mg day 1 then 250 mg for 4 days (has immunomodulating properties including downregulating IL-6; in addition Rx of concomitant bacterial pneumonia)"
Down regulating IL-6 would help avoid a cytokine storm?
