Three novel prevention, diagnostic, and treatment options for COVID-19 urgently necessitating controlled randomized trials
Fecha
2020Autor
Horowitz, Richard I.
Freeman, Phyllis R.
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Resumen
Purpose: Asymptomatic or minimally symptomatic infection with COVID-19 can result in silent transmission to
large numbers of individuals, resulting in expansion of the pandemic with a global increase in morbidity and
mortality. New ways of screening the general population for COVID-19 are urgently needed along with novel
effective prevention and treatment strategies.
Hypothesis: A hypothetical three-part prevention, diagnostic, and treatment approach based on an up-to-date
scientific literature review for COVID-19 is proposed. Regarding diagnosis, a validated screening questionnaire
and digital app for COVID-19 could help identify individuals who are at risk of transmitting the disease, as well
as those at highest risk for poor clinical outcomes. Global implementation and online tracking of vital signs and
scored questionnaires that are statistically validated would help health authorities properly allocate essential
health care resources to test and isolate those at highest risk for transmission and poor outcomes.
Second, regarding prevention, no validated protocols except for physical distancing, hand washing, and
isolation exist, and recently ivermectin has been published to have anti-viral properties against COVID-19. A
randomized trial of ivermectin, and/or nutraceuticals that have been published to support immune function
including glutathione, vitamin C, zinc, and immunomodulatory supplements (3,6 Beta glucan) could be beneficial in preventing transmission or lessening symptomatology but requires statistical validation.
Third, concerning treatment, COVID-19 induced inflammation and “cytokine storm syndrome” with hemophagocytic lymphohistiocytosis (HLH)/Macrophage Activation Syndrome (MAS) have resulted in extreme
morbidity and mortality in those with certain comorbidities, secondary to “acute respiratory distress syndrome”
(ARDS) and multiorgan dysfunction with disseminated intravascular coagulation (DIC). Deficiency in red blood
cell, serum and alveolar glutathione has been published in the medical literature for ARDS, as well as viral and
bacterial pneumonias, resulting from increased levels of free radical/oxidative stress. A randomized controlled
trial of blocking NF-κB and cytokine formation using glutathione precursors (N-acetyl-cysteine [NAC] and alpha
lipoic acid) and PO/IV glutathione with associated anti-viral effects should be performed, along with an evaluation of Nrf2 activators (curcumin, sulforaphane glucosinolate) which have been scientifically proven to lower
inflammation. Since high mortality rates from sepsis induced DIC due to COVID-19 infection has also been
associated with thrombotic events and elevated levels of D-dimer, randomized controlled trials of using anticoagulant therapy with heparin is urgently required. This is especially important in patients on ventilators who
have met certain sepsis induced coagulopathy (SIC) criteria. The use of acetazolamide with or without sildenafil
also needs to be explored with or without heparin, since increased oxygen delivery to vital organs through
prevention of thrombosis/pulmonary emboli along with carbonic anhydrase inhibition may help increase oxygenation and prevent adverse clinical outcomes
Palabras clave
COVID-19; Cytokine storm syndrome; Macrophage activation syndrome; Pneumonia; ARDS; DIC; N-Acetyl-cysteine; Glutathione; NF-κB; Nrf2Enlace al recurso
https://doi.org/10.1016/j.mehy.2020.109851Colecciones
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