Early Covid Treatment

A Guide to Early Treatment of COVID-19

Early treatment is critical and the most important factor in managing this disease. COVID-19 is a clinical diagnosis; a confirmed antigen or PCR test is not required. Treatment should be initiated immediately after the onset of flu-like symptoms. The multiple therapies and drugs in this protocol have different mechanisms of action and work synergistically during various phases of the disease.

About this Protocol

The information in this document is our recommended approach to COVID-19 based on the best (and most recent) literature. It is provided as guidance to healthcare providers worldwide on the early treatment of COVID-19. Patients should always consult with their provider before starting any medical treatment.

New medications may be added and/or changes made to doses of existing medications as further evidence emerges. Please be sure you are using the latest version of this protocol.

A note about anesthesia and surgery:

Please notify your anesthesia team if you are using the following medications and/or nutraceuticals as they can increase the risk of Serotonin Syndrome — a life-threatening condition — when opioids are administered:

  • Methylene blue
  • Curcumin
  • Nigella Sativa
  • Selective Serotonin Reuptake Inhibitors (SSRIs)

For more information on nutritional therapeutics and how they can help with COVID-19, visit our guide to Nutritional Therapeutics.

For more information on vitamins and nutraceuticals during pregnancy, visit our guide to Vitamins and Nutraceuticals During Pregnancy.

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.

  • 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.

  • Mouthwash: 3 times a day.
    Gargle three times a day (do not swallow) with an antiseptic-antimicrobial mouthwash containing chlorhexidine, cetylpyridinium chloride; a combination of eucalyptus, menthol, and thymol; or 1% povidone-iodine. Some mouthwashes may contribute to temporary tooth staining in certain individuals. Discontinue use and try a different product if this problem arises.

  • 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 (see box) and apply 4-5 drops to each nostril every 4 hours.

    • Pour 1 ½ tablespoons (25 ml) of 10% povidone-iodine solution into a 250 ml nasal irrigation bottle.
    • Fill bottle to top with distilled, sterile, or previously boiled water.
    • To use: tilt head back, apply 4-5 drops to each nostril. Keep head tilted for a few minutes, then let drain.
  • Quercetin (or a mixed flavonoid supplement): 250-500 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.) 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).

  • 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).

  • Probenecid: 1000 mg twice daily for 5 days.
    Probenecid is an FDA-approved drug
    with a well-documented (>7 decades) safety profile for treating gout and hypertension. (56) It is a nonspecific inhibitor of organic acid transporters and has been demonstrated to be effective in limiting influenza, SARS-CoV-2, and RSV replication. (56-60) In a randomized, placebo controlled, single-blind, study in non-hospitalized patients with symptomatic mild-to-moderate COVID-19, probenecid 1000 mg twice daily for 5 days
    reduced the median time to viral clearance (7 days vs. 11 days, p < 0.0001). (55) Furthermore, on day 10 a greater proportion of patients receiving probenecid reported complete resolution of symptoms compared to placebo (68% vs. 20%, respectively; p =0.0006).
  • Aspirin: 325 mg daily (unless contraindicated).

  • Kefir and/or Bifidobacterium Probiotics.
    NOTE: Depending on the brand, these products can be very high in sugar, which promotes inflammation. Look for brands without added sugar or fruit jellies and choose products with more than one strain of lactobacillus and bifidobacteria. Try to choose probiotics that are also gluten-free, casein-free and soy-free.

  • Vitamin C: 500-1000 mg twice a day.

  • Metformin: 500 mg on day 1, 500 mg twice daily on days 2 through 5, then 500 mg in the morning and 1000 mg in the evening up to day 14.

  • 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. (See box for further guidance.)

    • Only accept values associated with a strong pulse signal
    • Observe readings for 30–60 seconds to identify the most common value
    • Warm up extremities prior to taking a measurement
    • Use the middle or ring finger
    • Remove nail polish from the finger on which measurements are made
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).