Updated: October 28, 2020;
Immunological and serological studies show that most people develop only mild or moderate symptoms when infected with the new coronavirus, while some people may experience a more pronounced or critical course of the disease (read more).
Based on the available scientific evidence and current clinical experience, the SPR Collaboration recommends that physicians and authorities consider the following covid-19 treatment protocol for the early treatment of people at high risk or high exposure (see references below).
Note: Patients are asked to consult a doctor.
- Zinc (50mg to 100mg per day)
- Quercetin (500mg to 1000mg per day)
- Bromhexine (25mg to 50mg per day)
- Vitamins C (1000mg) and D (2000 u/d)
- Zinc (75mg to 150mg per day)
- Quercetin (500mg to 1500mg per day)
- Bromhexine (50mg to 75mg per day)
- Vitamins C (1000mg) and D (5000 u/d)
- Aspirin (162mg to 325mg per day)
- Hydroxychloroquine (400mg per day)
- High-dose vitamin D (up to 100,000 IU)
- Azithromycin (up to 500mg per day)
- Prednisone (60mg to 80mg per day)
- Heparin LMW (usual dosage)
Note: Contraindications for HCQ (e.g. favism or heart disease) must be observed; however, a study by the European Society of Cardiology confirmed that correctly dosed HCQ is safe for covid patients in any clinical setting. Prednisone is to be used if respiratory and pulmonary symptoms develop.
For more results, see the full scientific references at the bottom of this page.
- US physicians reported an 84% decrease in hospitalizations, a 50% decrease in mortality among already hospitalized patients (if treated early), and an improvement in the condition of patients within 8 to 12 hours based on Zinc/HCQ/AZ early treatment.
- Italian hospital doctors reported a decrease in deaths of 66% based on HCQ treatment.
- A Spanish study found that low plasma zinc levels (below 50mcg/dl) increased the risk of in-hospital death of covid patients by 130%.
- US physicians moreover reported a 45% reduction in mortality of hospitalized patients by adding zinc to HCQ and azithromycin.
- Another US study reported a rapid resolution (within hours) of covid symptoms, such as shortness of breath, based on early outpatient treatment with high-dose zinc.
- A Dutch study on HCQ published in the International Journal of Infectious Diseases found a 53% risk reduction in terms of ICU admission and ventilation of covid patients.
- Australian Professor Thomas Borody reported an improvement in the condition of covid patients often within hours after treatment with zinc, ivermectin and azithromycin.
- See also: An overview of more than 100 international HCQ studies.
- Iranian doctors reported in a study with 78 patients a decrease in intensive care treatments of 82%, a decrease in intubations of 89%, and a decrease in deaths of 100%.
- Chinese doctors reported a 50% reduction in intubations due to bromhexine treatment.
- A German study discusses the efficacy of bromhexine based on biochemical properties.
- In a Spanish randomized controlled trial (RCT), high-dose vitamin D (100,000 IU) reduced the risk of requiring intensive care by 96%.
- A study in a French nursing home found a 89% decrease in mortality in residents who had received high-dose vitamin D either shortly before or during covid-19 disease.
- A large Israeli study found a strong link between vitamin D deficiency and covid-19 severity.
- A 2017 meta-study found a positive effect of vitamin D on respiratory tract infections.
- A US study showed that aspirin has a strong antiplatelet and anticoagulant effect in covid patients, which could help prevent infection-related thrombosis, embolism and stroke.
Modes of action
- Zinc inhibits RNA polymerase activity of coronaviruses and thus blocks virus replication, as first discovered by world-leading SARS virologist Ralph Baric in 2010.
- Hydroxychloroquine and quercetin support the cellular absorption of zinc and have additional anti-viral properties, as first discovered during the SARS-1 epidemic in 2003.
- Bromhexine, a mucolytic cough medication, inhibits the expression of cellular TMPRSS2 protease and thus the entry of the virus into the cell, as first described in 2017.
- Vitamins C and D improve the immune system response.
- Azithromycin (an antibiotic) prevents bacterial superinfections of the lung.
- Prednisone (a corticosteroid) reduces covid-related systemic inflammation.
- Aspirin may help prevent infection-related thrombosis and embolisms in patients at risk.
See also: An illustration of the mechanisms of action of HCQ, quercetin and bromhexine.
The early treatment of patients as soon as the first typical symptoms appear and even without a PCR test is essential to prevent progression of the disease. Zinc, HCQ, quercetin, bromhexin and aspirin may also be used prophylactically for people at high risk or high exposure.
In contrast, isolating infected high-risk patients at home and without early treatment until they develop serious respiratory problems, as often happened during lockdowns, may be detrimental.
The alleged or actual negative results with hydroxychloroquine in some studies were based on delayed use (intensive care patients), excessive doses (up to 2400mg per day), manipulated data sets (the Surgisphere scandal), or ignored contraindications (e.g., favism or heart disease).
In fact, a comprehensive study by the European Society of Cardiology confirmed that correctly dosed HCQ is safe for covid patients in all clinical settings (i.e. from ambulatory to intensive care). HCQ has beneficial anti-viral, anti-platelet, anti-thrombotic and immunomodulatory effects (read more).
People at high risk living in an epidemically active area should consider prophylactic treatment(see above) together with their doctor. The reason for this is the long incubation period of covid-19 (up to 14 days): when patients first notice that they contracted the disease, the viral load is already at a maximum and there are often only a few days left to react with an early treatment intervention.
Early treatment based on the above protocol is intended to avoid hospitalization. If hospitalization nevertheless becomes necessary, experienced ICU doctors recommend avoiding invasive ventilation (intubation) whenever possible and using oxygen therapy (HFNC) instead.
It is conceivable that the above treatment protocol, which is simple, safe and inexpensive, could render more complex medications, vaccinations, and other measures largely obsolete.
- EVMS Critical Care Covid-19 Management Protocol (Paul Marik, MD, June 2020)
- Video: Ambulatory Treatment of COVID-19 (Dr. Peter McCullough, October 2020)
- Early Outpatient Treatment of COVID-19 (McCullough et al., AmJM, October 2020)
- Study: Low zinc levels at clinical admission associates with poor outcomes in COVID-19 (Vogel et al., medRxiv, October 2020)
- Study: Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients (Carlucci et al., MedRxiv, May 2020)
- Study: Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients (Eric Finzi, International Journal of Infectious Diseases, June 2020)
- Study: Zinc Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture (Velthuis et al, PLOS Path, 2010)
- Study: Effect of Zinc Salts on Respiratory Syncytial Virus Replication (Suara & Crowe, AAC, 2004)
- Study: Zinc for the common cold (Cochrane Systematic Review, 2013)
- Review: Zinc supplementation to improve treatment outcomes among children diagnosed with respiratory infections (WHO, Technical Report, 2011)
- Article: Can Zinc Lozenges Help with Coronavirus Infections? (McGill University, March 2020)
- Study: Small molecules blocking the entry of severe acute respiratory syndrome coronavirus into host cells (Ling Yi et al., Journal of Virology, 2004)
- Study: Zinc Ionophore Activity of Quercetin and Epigallocatechin-gallate: From Hepa 1-6 Cells to a Liposome Model (Dabbagh et al., JAFC, 2014)
- Study: Quercetin as an Antiviral Agent Inhibits Influenza A Virus Entry (Wu et al, Viruses, 2016)
- Study: Quercetin and Vitamin C: An Experimental, Synergistic Therapy for the Prevention and Treatment of SARS-CoV-2 Related Disease (Biancatelli et al, Front. in Immun., June 2020)
- Report: EVMS Critical Care Covid-19 Management Protocol (Paul Marik, MD, June 2020)
- Study: TMPRSS2: A potential target for treatment of influenza virus and coronavirus infections (Wen Shen et al., Biochimie Journal, 2017)
- Letter: Repurposing the mucolytic cough suppressant and TMPRSS2 protease inhibitor bromhexine for the prevention and management of SARS-CoV-2 infection (Maggio and Corsini, Pharmacological Research, April 2020)
- Study: Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy? (Depfenhart et al., Internal and Emergency Medicine, May 2020)
- Study: Bromhexine Hydrochloride: Potential Approach to Prevent or Treat Early Stage COVID-19 (Stepanov and Lierz, Journal of Infectious Diseases and Epidemiology, June 2020)
- Study: TMPRSS2 inhibitors, Bromhexine, Aprotinin, Camostat and Nafamostat as potential treatments for COVID-19 (Arsalan Azimi, Drug Target Review, June 2020)
- Trial: Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial (Ansarin et al., BioImpacts, July 2020): “There was a significant reduction in ICU admissions (2 out of 39 vs. 11 out of 39), intubation (1 out of 39 vs. 9 out of 39) and death (0 vs. 5) in the bromhexine treated group compared to the standard group.”
- Studies: Overview of more than 100 international HCQ studies (C19Study.com)
- Study: Chloroquine is a potent inhibitor of SARS coronavirus infection and spread (Vincent et al., Virology Journal, 2005)
- Study: Chloroquine Is a Zinc Ionophore (Xue et al, PLOS One, 2014)
- Study: Physicians work out treatment guidelines for coronavirus (Korean Biomedical Review, February 2020)
- Study: Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia (Guangdong Health Commission, February 2020)
- Study: Clinical Efficacy of Chloroquine derivatives in COVID-19 Infection: Comparative meta-analysis between the Big data and the real world (Million et al, NMNI, June 2020)
- Study: Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19 (Arshad et al, Int. Journal of Infect. Diseases, July 2020)
- Study: COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin (Scholz et al., Preprints, July 2020)
- Study: Effectiveness of HCQ in COVID-19 disease (Monforte et al., IJID, July 2020)
- Meta-study: Randomized Controlled Trials of Early Ambulatory HCQ in the Prevention of COVID-19 Infection, Hospitalization, and Death (Ladapo et al., MedRxiv, September 2020)
Aspirin and heparin
- Study: Anticoagulant Treatment Is Associated With Decreased Mortality in Severe Coronavirus Disease 2019 Patients With Coagulopathy (Tang et al, JTH, May 2020)
- Study: Autopsy Findings and Venous Thromboembolism in Patients With COVID-19 (Wichmann et al., Annals of Internal Medicine, May 2020)
- Review: Anticoagulation Guidance Emerging for Severe COVID-19 (Medpage Today)
- Study: Platelet gene expression and function in patients with COVID-19 (Manne et al., ASH Blood, September 2020)
- Review: Should aspirin be used for prophylaxis of COVID-19-induced coagulopathy? (Hussein et al., Medical Hypotheses, November 2020)