IMR Press / RCM / Volume 21 / Issue 4 / DOI: 10.31083/j.rcm.2020.04.264
Open Access Review
Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)
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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, 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: (Peter A. McCullough)
Rev. Cardiovasc. Med. 2020, 21(4), 517–530;
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 (

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.

ambulatory treatment
antiplatelet agent
sequenced multidrug therapy
Fig. 1.
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