Peter A McCullough, Paul E Alexander, Robin Armstrong, Cristian Arvinte, Alan F Bain, Richard P Bartlett, Robert L Berkowitz, Andrew C Berry, Thomas J Borody, Joseph H Brewer, Adam M Brufsky, Teryn Clarke, Roland Derwand, Alieta Eck, John Eck, Richard A Eisner, George C Fareed, Angelina Farella, Silvia N S Fonseca, Charles E Geyer Jr, Russell S Gonnering, Karladine E Graves, Kenneth B V Gross, Sabine Hazan, Kristin S Held, H Thomas Hight, Stella Immanuel, Michael M Jacobs, Joseph A Ladapo, Lionel H Lee, John Littell, Ivette Lozano, Harpal S Mangat, Ben Marble, John E McKinnon, Lee D Merritt, Jane M Orient, Ramin Oskoui, Donald C Pompan, Brian C Procter, Chad Prodromos, Juliana Cepelowicz Rajter, Jean-Jacques Rajter, C Venkata S Ram, Salete S Rios, Harvey A Risch, Michael J A Robb, Molly Rutherford, Martin Scholz, Marilyn M Singleton, James A Tumlin, Brian M Tyson, Richard G Urso, Kelly Victory, Elizabeth Lee Vliet, Craig M Wax, Alexandre G Wolkoff, Vicki Wooll, Vladimir Zelenko

PMID: 33387997 DOI: 10.31083/j.rcm.2020.04.264


The SARS-CoV-2 virus spreading across the world has led to surges of COVID-19 illness, hospitalizations, and death. The complex and multifaceted pathophysiology of life-threatening COVID-19 illness including viral mediated organ damage, cytokine storm, and thrombosis warrants early interventions to address all components of the devastating illness. In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death. Prompt early initiation of sequenced multidrug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. A multipronged therapeutic approach includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine. Randomized trials of individual, novel oral therapies have not delivered tools for physicians to combat the pandemic in practice. No single therapeutic option thus far has been entirely effective and therefore a combination is required at this time. An urgent immediate pivot from single drug to SMDT regimens should be employed as a critical strategy to deal with the large numbers of acute COVID-19 patients with the aim of reducing the intensity and duration of symptoms and avoiding hospitalization and death.

Keywords: COVID-19; SARS-CoV-2; ambulatory treatment; anti-infective; anti-inflammatory; anticoagulant; antiplatelet agent; antiviral; corticosteroid; hospitalization; mortality; sequenced multidrug therapy.