Integrative Antioxidant Therapy in the Treatment of a Severe Covid-19 Patient

Summary:

1. We describe a case of severe Covid-19 (a man of advanced age and multiple comorbidities including diabetes mellitus, hypertension, obesity and active chronic hepatitis B) who improved quickly upon receiving the “Integrative antioxidant” intervention” approach and was discharged from hospital 4 days after the implementation of the approach.
2. Severe/critical cases of Covid-19 cases are characterized biochemically and pathologically by cytokine storm with rapidly rising oxidative stress, leading to severe oxidative damage of biologically important macromolecules, cells, and eventually multiple organ failure and death.
3. Early, sufficient doses and integrative antioxidants administration, to block or reduce oxidative stress, cytokine storm, may be able to prevent or reduce the oxidative damages of biologically important macromolecules (especially poly-unsaturated fatty acids in bio-membranes, PUFA, lipid peroxide chain reaction) and multi-organ failure, death.
4. The optimal efficiency of our body’s antioxidant systems requires all components to be present and in sufficient amounts. Inadequate or absent of one component antioxidant may render the entire antioxidant system less efficient or dysfunctional entirely.
5. Due to the high safety and low-cost profile of antioxidant vitamins, nutrients, and the potential clinical utility of this approach, as demonstrated in the case presented here, further clinical research is clearly warranted as this may help many other patients, not only in severe Covid-19, but also other cytokine storm/oxidative stress cases caused by viral or other agents.

Case description: I recently consulted on a Manila (Philippines) Covid-19 patient: Robert, male, 60 years old, he is 176 cm in height (5’9), 90 kg, with type 2 diabetes, hypertension, and with a history of chronic hepatitis B. He developed cough, low fever, and pneumonia on chest X ray. He was admitted to the hospital on 9/1/21 and was given standard therapy. But his clinical conditions didn’t improve and instead worsened. His oxygen saturation went down to as low as 90% and inflammatory/cytokine storm markers were also rising significantly (ferritin rose from 997 on 9/1 to 2202 on 9/6; D Dimer rose from 0.27 on 9/1 to 0.99 on 9/6. His CRP was also very high at 33.97).

The family requested high dose Vit C (HDIVC), but the attending physician was hesitant due to very high levels of ferritin and also the hospital has a policy on Vit C use of up to 3,000 mg per day.

During a video consultation upon request, I pointed out that the poor health status with the comorbidities (diabetes mellitus, hypertension, obesity and active hepatitis B) and the rapidly rising levels of cytokine storm markers, make Robert at very high risk of imminent multi-organ failure and high mortality. The rapidly rising levels of cytokine storm markers suggest that Robert is on the brink of developing cytokine storm, if he is not already in one^1–5. The family and the attending are concerned about the high ferritin and the possible side effects of HDIVC. I pointed out Robert’s high ferritin levels are more of an “acute inflammatory” response in nature and a marker for cytokine storm, rather than an indicator of true high iron storage. The priority is to quickly block/control the cytokine storm, to reduce oxidative pressure, to prevent/minimize oxidative damages to the cells, tissues and organs, to prevent multi-organ failure.

I recommend immediate large doses of integrative antioxidant intervention:

1. Vit C vein 30 g/24 hours;
2. Vit E, 400iu/day 3;
3. Vit D3 (his D3 is only 28), 50,000iu, one-time, immediately.
4. Magnesium 1000mg/day;
5. Zinc 100mg/day x 7-10 days, then reducing to 30-50 mg/day;
6. Glutathione (glutathione), 1-2 g/day, intravenous or Lipo, oral
7. 3% hydrogen peroxide atomized inhalation, 15-30 minutes, 3-4 times/day (this however, wasn’t implemented due to hospital restriction);
8. Other (e.g. CoQ10, alpha lipoic acid, melatonin).

However, due to the policy restriction and other factors, my suggestions weren’t implemented immediately.  A few days later, the patient’s condition deteriorated further. Upon the 2^nd video consult, I was really worried of an imminent multi-organ failure and was literally begging the attending physician to implement my suggestions. I pointed out loudly the high safety profile of the agents that I recommended with literature references. We, the attending physician, the caring staff, the family and myself worked as a team to figure out a way to implement my suggestions.  The hospital limits the maximum amount of intravenous VCs to 3 g/24 hours, so I recommend to give HDIVC at 3 grams/24 hours, and then add liposomal VC (luckily, they were able to find Lipo-VC of LivOn Labs in Manila), 6 grams by mouth as a loading dose and followed by 2-3 grams every 6 hours by mouth. Hydrogen peroxide nebulization, however, was prohibited by the hospital and wasn’t implemented. The rest of my suggestions including Lipo-Glutathione, zinc, high dose Vit D3 were all administered as recommended.

The next day, the patient was beginning to improve, Mike (one of the patient’s brothers) told me. On the third day (September 13th), his clinical conditions as well as his chest R ray showed significant improvement and the oxygen mask was removed. Discharge was planned. On the fourth day after the antioxidants administration (September 14^th), the patient was discharged from the hospital to home.

 

 

 

 

 

 

Robert’s Chest X ray on 9/13/21 improved significantly compared with CXR on 9/10/21.

I recommended the continued the integrative antioxidants administration for a few more weeks until clinical and laboratory markers all return to normal and then be placed on a maintenance plan for his chronic disease management. The family scheduled another consultation with me is later for the management of Robert’s ongoing recovery as well as the management of his underlying chronic diseases (diabetes, hypertension and obesity).

On 14 September, the patient was discharged from the hospital and returned home for treatment.

Brief discussion:

Soon after the outbreak of Covid-19, in my paper (3/1/20)⁴ and in my NIH presentation (4/8/20) ^5,6, I (as well as others) pointed out that Cytokine storm/oxidative stress is a key pathological and biochemical feature of severe/critical Covid-19 and other acute respiratory distress syndrome and early and high dose Vit C intravenously should be implemented⁴. Cytokine storm/oxidative stress is also a common feature of severe cases of influenza⁷, viral hepatitis^8–10, viral encephalitis¹¹, AIDS/HIV¹², Ebola¹³, etc. Oxidative damage of important bio-molecules caused by cytokines storm/oxidative stress is largely responsible for various clinical symptoms of Covid-19.

https://www.researchgate.net/publication/326637077_Redox_Biology_of_Respiratory_Viral_Infections/figures?lo=1

Cytokine storm/oxidative stress results in the rapid and significant oxidative damages of bio-important molecules, especially unsaturated fatty acids on cell membranes, in a process called lipid peroxidation chain reaction^14–16. This lipid peroxide chain reaction oxidizes PUFA molecules on lipid membranes much more readily and rapidly. The dietary intake of omega-6 PUFA has increased several fold during the last several decades^17,18, setting the stage for explosive lipid peroxidation among those with a high PUFA diet. This may be partially the reason of the high morbidity and mortality seen in patients with basic chronic diseases such as diabetes and other metabolic diseases since these patients tend to have a high omega-6 PUFA intake^19,20.

There are several different types of oxidants (free radicals) and there are different antioxidant systems that neutralize or scavenge these oxidants^21,22. These antioxidants systems require each and every member of a system to be present to be effective.  For example, vitamin E is required for the termination of lipid peroxidation chain reaction. In the absence of vitamin E, vitamin C’s is ineffective in termination of lipid peroxidation²³.

 

http://www.robertbarrington.net

In conclusion, early and sufficient doses of some basic antioxidants  (such as vitamins E, C, CoQ10, glutathione, magnesium, selenium, NAD and NAD precursors) should be systematically implemented in order to prevent or to terminate cytokine storm which may lead to multi-organ failure and ultimately death. In addition to these antioxidants, other agents with natural antiviral or immune boosting effects should also be implemented including, but not limited to vitamin D3, zinc, and hydrogen peroxide nebulization²⁴.

I introduced this concept in my presentation at the 50^th Annual Conference of ISOM¹⁰.

p.s. This is one of the questions I received from the family:

“Why did Robert’s lungs suddenly improve within 2 days? (On 9/11, the pulmonologist said that Robert needed to be on oxygen for 1 month after discharge.  Then on 9/13, after a new X-ray and ABG test, the pulmonologist said he did not need to be on oxygen anymore after discharge. “

References:

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