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Covid-19 Protocol For Home-Care

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EVMS CRITICAL CARE

COVID-19 MANAGEMENT PROTOCOL

Developed and updated by Paul Marik, MD Chief of Pulmonary and Critical Care Medicine Eastern Virginia Medical School, Norfolk, VA June 17th, 2020

URGENT! Please circulate as widely as possible. It is crucial that every pulmonologist, every critical care doctor and nurse, every hospital administrator, every public health official receive this information immediately.

This is our recommended approach to COVID-19 based on the best (and most recent) literature. This is a very dynamic situation; therefore, we update the guideline as new information emerges. Please check the EVMS website for updated versions of this protocol.

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FLCC website: covid19criticalcare.com/

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Page 1 of 23 | EVMS Critical Care COVID-19 Management Protocol 06-17-2020 | evms.edu/covidcare

 

THIS IS A STEROID RESPONSIVE DISEASE: HOWEVER, TIMING IS CRITICAL

Page 2 of 23 | EVMS Critical Care COVID-19 Management Protocol 06-17-2020 | evms.edu/covidcare

Prophylaxis

While there is extremely limited data, the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease. This cocktail is cheap, safe, and widely available.

  • 􏰀  Vitamin C 500 mg BID and Quercetin 250-500 mg BID [1-7]
  • 􏰀  Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1month, reduce the dose to 30-50 mg/day. [1,8-12]
  • 􏰀  Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 2 mg at night [13-16]
  • 􏰀  Vitamin D3 1000-4000 u/day [17-24]
  • 􏰀  Optional: Famotidine 20-40mg/day [25]

Symptomatic patients (at home):

  • 􏰀  Vitamin C 500 mg BID and Quercetin 250-500 mg BID
  • 􏰀  Zinc 75-100 mg/day
  • 􏰀  Melatonin 6-12 mg at night (the optimal dose is unknown)
  • 􏰀  Vitamin D3 2000-4000 u/day
  • 􏰀  Optional: ASA 81 -325 mg/day
  • 􏰀  Optional: Famotidine 20-40mg/day
  • 􏰀  Optional: Ivermectin 150-200 ug/kg (single dose) [26-28]
  • 􏰀  In symptomatic patients, monitoring with home pulse oximetry is recommended. Ambulatorydesaturation < 94% should prompt hospital admission. [29]
  • 􏰀  Not recommended: chloroquine and hydroxychloroquine. The use of these agents is extremelycontroversial. Notwithstanding, the retraction of the Lancet paper,[30] there is a paucity of data to support the use of these drugs. [31-35] It is possible that the efficacy of these drugs requires the co-administration of Zinc. [36,37]
 

 


WEBSITE IS BEING CONTINUOUSLY UPDATED 10-26-2020