Spring 2021 Outpatient (Primary Care) COVID treatment update

There’s really only one thing to know: early outpatient treatment of COVID is a hugely important aspect of the pandemic and major progress has been made. The big strides in early, pre-hospital treatment need to be disseminated into the mainstream. It’s a bit of the forgotten pillar of the approach to the pandemic and I want to take a little time here to give you some of what I have learned.

Many of us outpatient doctors have formed the opinion that, even now in the vaccine stage, the early outpatient treatment protocols for COVID-19 are a huge key to our success. 90% of the headlines concern the vaccines, but there are still an average of 65,000 cases being reported every day on a national scale (and 30 cases daily on average locally in the county- 211 over this last seven days). While we are hopeful the future is uncertain due to the viruses ability to adapt. My main question: Are we using all the tools available to us?

Are we aware that there are effective ambulatory (pre hospital) treatments for COVID-19?

Effective treatments exist, and they really work. Two studies in peer reviewed journals demonstrate a 85% reduction in mortality and hospitalization with their use. That’s big news.

Many countries around the world are making efforts with pre hospital treatment. Treatment kits which contain a combination of different medications to treat COVID are disseminated at the time of diagnosis.

Other countries (America, Canada and the UK amongst others) have been sluggish to widely adopt protocols, and patients are sent home to isolate without treatment after a positive COVID test. Patients aren’t given anything because they or their doctors have not connected to the protocols that are proving very effective. The message of this writing is to explain the story of early outpatient treatment and to encourage early diagnosis and treatment for anyone with an elevated risk profile.

Why the struggle for the medical establishment to adopt an early ambulatory treatment protocol?

I would argue that it is an area that our government is ill-equipped to address for reasons I will outline below. This led to the nihilistic approach to the pre-hospital realm we are seeing. It has been a major missed opportunity, and it now should to come to an end.

The next time a doctor advises therapeutic nihilism to someone you know after a diagnosis of COVID-19 there ought to be a full stop and push back. There are good treatments. You will be armed with resources below.

What you need to know about the protocols for treating COVID-19:

  1. The protocols that have emerged for early outpatient treatment are highly effective, (85% reduction in mortality and hospitalizations) as we said above. Even for the highest risk groups the case mortality has been shown to be brought to below 1%, BUT THE PROTOCOLS NEED TO BE USED!
  2. Many people argue that the ambulatory treatment pillar of the pandemic is the most crucial pillar. Using these protocols before the process gets out of control is paramount. That’s easy to see. If you have less hospitalized patients you have less morbidity and mortality. Being able to use the treatment protocols if the vaccines somehow prove less effective against the variants is a critical safety net.
  3. These protocols have been formulated by doctors on the ground, not by the central agencies, hence their variable penetration. The ambulatory doctors were the only ones positioned to determine an outpatient approach to COVID. It could only come from their experience of treating sick patients. This was extremely difficult to pull together because this group of doctors isn’t traditionally organized for this task, especially the dissemination effort.
  4. Governement Agency policy is well suited to influence other areas like vaccine development, contagion control, and blockbuster drug development. That is their wheelhouse. When the central agencies tried to get involved in the early ambulatory treatment questions, they framed research questions in ways which proved detrimental to the effort and yielded misleading results, and in some cases with improper approaches and studies had to be retracted. All this led to the treatment nihilism for many doctors and the impression that there is nothing to offer. Doctors in many parts of the country were actually fearful of treating COVID due to the situation that developed. Some of these treatments were vilified due to the challenges above.
  5. Out of sheer necessity some experts in ambulatory care haven’t settled for the nihilistic approach that gripped the early outpatient care world. They studied the phases of the illness and devised a sequenced multi-drug approach using medications that had a high safety profile and signals of efficacy from relevant data from all corners of the globe and experience. They cut through the misleading single drug trials knowing that a multi-drug approach would be needed, and as mentioned above, the protocols are now yielding an 85% improvement in the rates of hospitalization and death!
  6. The approach of the grass roots effort has been to use re-purposed drugs, drugs that have been around for decades in most cases. Re-purposed drugs don’t have corporate sponsors and teams of scientists behind them. They don’t have lobbyists. The government is not equipped to invest in this type of protocol development for those reasons. So no surprise we got nothing from the central governmental agencies. Even with the published results showing great efficacy, messages of early outpatient treatment are not being disseminated from a central coordinated source. This has been the greatest failure of the pandemic and still poses the greatest challenge and opportunity. That’s all ok because the best movements are de-centralized anyhow.
  7. The protocols address the different phases of the illness. Some medicine or supplements in the multi-drug regimens are directed at viral replication (need to be used in the first 1st 5 days), some address inflammation (used after 5 days) and the last major category counters the coagulation tendency of this illness.
  8. Ambulatory setting paralysis is a travesty at any stage. It is perhaps understandable for the opening act of a pandemic but no longer.


Basic Tenets of the outpatient therapy

  1. Testing is a key — rapid testing and testing turnaround is vital. If you think you have COVID, get tested.
  2. Multiple drugs used in sequence (as laid out below) to address the multiple phases of this complex syndrome is proving to be what yields results.
  3. Ambulatory treatment carries a person through the illness and leaves them with natural immunity, both antibody and non antibody mediated. This immunity is not to be underestimated. There are still only extremely rare second cases of COVID.
  4. Everyone should have access to these protocols. Patients can drive their own care with the knowledge that they exist. If their own doctor are not able to mobilize there are networks of doctors that are willing to help.

Specifics of ambulatory treatment

Sequenced oral multi-drug therapy at the time of diagnosis is important and can save lives.

You don’t need to memorize this or even understand it, just know that early diagnosis and early initiation of the protocol is the goal. For access to a download of this algorithm, see below.

One of the leaders in the de-centralized effort to establish ambulatory protocols is Dr Peter McCullough an American cardiologist, epidemiologist and internist at Baylor University Hospital Center. He is the vice chair of the medical department there. He knows academic medicine- he is the editor of 2 medical journals and is the most published expert in his field. He knows the science of treating high risk patients.

He teamed with doctors from all over the world to author author two early outpatient COVID treatment papers. In my opinion he is the US expert in this field. He has testified before Congress on this matter and before his state legislature.McCullough helped publish “A Guide to Home-Based COVID Treatment,” by the Association of American Physicians and Surgeons. This has the above algorithm and much more. Download it for free and recommend it to others. It’s really strong work- the ultimate early outpatient approach.

We are moving through but no one can be sure if the virus will be able to adapt around the current vaccine technology. And in any case there will be cases that breakthrough the vaccine.

Another website that has compiled many other protocols from self organizing efforts to breakthrough the nihilistic status quo is here: https://c19protocols.com

I’m reminded of the spirit that formed our nation when I think of the work that these renegades have compiled.

It’s revolutionary, effective (85% improvement in the rates of hospitalization and death) and should be accessible to more people.

We know more and more about COVID. Let’s keep our approach broad.

Don’t rely on treatment of COVID to be your sole approach. That is not the point. Use the obvious strategies that we all have established and know well. Try to not get exposed, regardless of whether or not you’re vaccinated. Protect yourself with optimal ventilation, masking and distancing.

And know that if your family or friends need support and can’t find it, many of us are willing to help do whatever we can. Bear that in mind and as always, don’t hesitate to reach out with any questions or concerns.