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.
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Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)
Peter A. McCullough1,*, Paul E. Alexander2, Robin Armstrong3, Cristian Arvinte4, Alan F. Bain5, Richard P. Bartlett6, Robert L. Berkowitz7, Andrew C. Berry8, Thomas J. Borody9, Joseph H. Brewer10, Adam M. Brufsky11, Teryn Clarke12, Roland Derwand13, Alieta Eck14, John Eck14, Richard A. Eisner15, George C. Fareed16, Angelina Farella17, Silvia N. S. Fonseca18, Charles E. Geyer, Jr.19, Russell S. Gonnering20, Karladine E. Graves21, Kenneth B. V. Gross22, Sabine Hazan23, Kristin S. Held24, H. Thomas Hight25, Stella Immanuel26, Michael M. Jacobs27, Joseph A. Ladapo28, Lionel H. Lee29, John Littell30, Ivette Lozano31, Harpal S. Mangat32, Ben Marble33, John E. McKinnon34, Lee D. Merritt35, Jane M. Orient36, Ramin Oskoui37, Donald C. Pompan38, Brian C. Procter39, Chad Prodromos40, Juliana Cepelowicz Rajter41, Jean-Jacques Rajter41, C. Venkata S. Ram42, Salete S. Rios43, Harvey A. Risch44, Michael J. A. Robb45, Molly Rutherford46, Martin Scholz47, Marilyn M. Singleton48, James A. Tumlin49, Brian M. Tyson50, Richard G. Urso51, Kelly Victory52, Elizabeth Lee Vliet53, Craig M. Wax54, Alexandre G. Wolkoff55, Vicki Wooll56, Vladimir Zelenko57
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1
Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, 75226, TX, USA
2
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, L8S 4L8, Ontario, Canada
3
Armstrong Medical Group, Texas City, 75510, TX, USA
4
North Suburban Medical Center and Vibra Hospital, Thornton, 80229, Colorado, USA
5
Chicago Health and Wellness Alliance, Chicago, 60603, IL, USA
6
Recipient of the Texas HHS Meritorious Service Award, 78751, Texas, USA
7
PianoPsych, LLC, Natick, 01760, MA, USA
8
Division of Gastroenterology, Department of Medicine, Larkin Community Hospital, S. Miami, 33143, FL, USA
9
Centre for Digestive Diseases, Five Dock, 2046, NSW, Australia
10
Infectious Diseases, St. Luke’s Hospital, Kansas City, 64111, MO, USA
11
University of Pittsburgh, Department of Medicine, Pittsburgh, 15213, PA, USA
12
Clarke Neurology, Newport Beach, 92660, CA, USA
13
Alexion Pharma Germany GmbH, 80687, Munich, Germany
14
Affordable Health, Inc., Piscataway, 08854, NJ, USA
15
Eisner Laser Center, Macon, 31210, GA, USA
16
Pioneers Medical Center, Brawley, 92227, CA, USA
17
Privia Medical Group, Webster, 24510, TX, USA
18
Hapvida HMO, Ribeirão Preto,14015-130, SP, Brazil
19
Houston Methodist Cancer Center, Houston, 77030, TX, USA
20
The Medical College Of Wisconsin, Milwaukee, 53226, WI, USA
21
Personal Healthcare Network, Kansas City, 64116, MO, USA
22
Fusion Clinical Multimedia, Inc., Philadelphia, 19019, PA, USA
23
Ventura Clinical Trials, PROGENABIOME, Malibu Specialty Center, Ventura, 93003, CA, USA
24
Stone Oak Ophthalmology, Immediate Past President, Association of American Physicians and Surgeons, San Antonio, 78258, TX , USA
25
Cardiosound, Atlanta, 30342, GA, USA
26
Rehoboth Medical Center, Houston, 77083, TX, USA
27
Complex Primary Care Medicine, Pensacola, 32507, FL, USA
28
University of California Los Angeles, Los Angeles, 90095, CA, USA
29
Emergency Medicine, Phoenix, 85016, AZ, USA
30
Family Medicine, Kissimmee, 34741, FL, USA
31
Lozano Medical Clinic, Dallas, 75218, TX, USA
32
Howard University College of Medicine, Mangat and Kaur, Inc., Germantown, 20876, MD, USA
33
President, MyFreeDoctor.com Pensacola Beach, 3256, FL, USA
34
Department of Medicine, Henry Ford Hospital, Wayne State University School of Medicine, Detroit, 48202, MI, USA
35
Orthopaedic and Spinal Surgery, Private Practice, Omaha, 68135, NE, USA
36
Internal Medicine, Executive Director, Association of American Physicians and Surgeons, Tucson, 85716, AZ, USA
37
Foxhall Cardiology, PC, Washington, 20016, DC, USA
38
Orthopedic Surgery, Salinas, 93907, CA, USA
39
McKinney Family Medicine, McKinney, 75070, TX, USA
40
Illinois Sports Medicine and Orthopaedic Center, Glenville, 60025, IL, USA
41
Pulmonary and Sleep Consultants, Ft. Lauderdale, 33316, FL, USA
42
MediCiti Medical College, 500005, Hyderabad, India
43
University of Brasília, Brasilia , 70910-900, DF, Brazil
44
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06510, CT, USA
45
Robb Oto-Neurology Clinic, Phoenix, 85012, AZ, USA
46
Bluegrass Family Wellness, Crestwood, 40014, KY, USA
47
Heinrich Heine University, Düsseldorf, 40225, Germany
48
Past Pres. Association of American Physicians and Surgeons, Tucson, 85716, AZ, USA
49
NephroNet Clinical Trials Consortium, Buford, 30518, GA, USA
50
All Valley Urgent Care, El Centro, 92243, CA, USA
51
Houston Eye Associates, Houston, 77025, TX, USA
52
Victory Health, LLC., 80487, Colorado, USA
53
Vive Life Center, 85728, Arizona & Texas, USA
54
Family Medicine, Mullica Hill, 08062, NJ, USA
55
CMO Emergency Hapvida Saude, HMO, Fortaleza, 60140-061, CE, Brazil
56
National Healthcare Coalition, Family Medicine, Eagle, 83616, ID, USA
57
Affiliate Physician, Columbia University Irving Medical Center, New York City, 10032, NY, USA
*Correspondence: peteramccullough@gmail.com (Peter A. McCullough)
Rev. Cardiovasc. Med. 2020, 21(4), 517–530;
https://doi.org/10.31083/j.rcm.2020.04.264
Submitted: 28 November 2020 | Revised: 8 December 2020 | Accepted: 15 December 2020 | Published: 30 December 2020
(This article belongs to the Special Issue Utilizing Technology in the COVID 19 era)
Copyright: © 2020 McCullough et al. Published by IMR Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Abstract
Keywords
SARS-CoV-2
COVID-19
hospitalization
mortality
ambulatory treatment
anti-infective
anti-inflammatory
antiviral
corticosteroid
antiplatelet agent
anticoagulant
sequenced multidrug therapy
Figures
Fig. 1.