Immune Support: Quercetin, Vitamin C, Zinc, Vitamin D3 and FLCCC Protocol (July 2021)

Doctors and pharmacists have been overwhelmed with questions about the use of supplements, OTC (Over The Counter) medications, and prescription drugs in the battle against the virus that causes COVID-19. While the best evidence continues to support behaviors like maintaining a physical distance of 6 feet, wearing a mask, and washing hands frequently and thoroughly—some research indicates that certain supplements and common OTC medications could reduce the risk of infection or mitigate the seriousness of symptoms.

The Front Line COVID-19 Critical Care Alliance (FLCCC) and other healthcare organizations have incorporated a mix of readily available agents into their management protocol for COVID-19.

Quercetin and COVID-19

Quercetin was initially found to provide broad-spectrum protection against SARS coronavirus in the aftermath of the SARS epidemic that broke out across 26 countries in 2003. Now, some doctors are advocating its use against SARS-CoV-2, in combination with vitamin C, noting that the two have synergistic effects.


Quercetin

Incidentally, ascorbic acid (vitamin C) and the bioflavonoid quercetin (originally labeled vitamin P) were both discovered by the same scientist — Nobel prize winner Albert Szent-Györgyi. Quercetin’s antiviral capacity has been attributed to five main mechanisms of action:
  1. Inhibiting the virus’ ability to infect cells by transporting zinc across cellular membranes
  2. Inhibiting replication of already infected cells
  3. Reducing infected cells’ resistance to treatment with antiviral medication
  4. Inhibiting platelet aggregation — and many COVID-19 patients suffer abnormal blood clotting
  5. Promoting SIRT2, thereby inhibiting the NLRP3 inflammasome assembly involved with COVID-19 infection
Similarly, vitamin C at extremely high doses also acts as an antiviral drug, effectively inactivating viruses. 

Quercetin, Vitamin C, Zinc and Vitamin D3

The initial MATH+ protocol was released in April 2020. In early July and August, it was updated to include quercetin and a number of optional nutrients and drugs, not only for critical care but also for prophylaxis and mild disease being treated at home.

There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immunomodulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy.

For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) I-MASK+ protocol recommends (updated June 30, 2021):
  • Vitamin D3: 1000–3000 IU/day. Note RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese. (Amazon)
  • Vitamin C: 500 - 1,000 mg BID (twice daily) 
  • Quercetin: 250 mg daily. It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored. (Amazon)
  • Melatonin: 6 mg before bedtime (causes drowsiness). (Amazon)
  • Zinc: 30 - 40 mg/day (elemental zinc). Zinc lozenges are preferred. (Amazon)
  • Ivermectin prophylaxis dosage (dose for prophylactic ivermectin):
    • prevention for high-risk individuals: 0.2 mg/kg per dose (take with or after meals) — one dose today, repeat after 48 hours, then one dose weekly. 
    • Post COVID-19 exposure prevention: 0.2 mg/kg per dose (take with or after meals)  — one dose today, repeat after 48 hours. (Find a Doctor). 
High risk Individuals: > 60 years with co-morbidities (hypertension, diabetes, chronic lung disease, chronic kidney disease), obesity, long term care facilities, etc.

Post COVID-19 exposure: To use if a household member is COVID-19 positive, or you have prolonged exposure to a COVID-19 positive patient without wearing a mask.

Precautionary Note: Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs. 

Due to the possible drug interaction between quercetin and ivermectin (may increase ivermectin levels), these drugs should not be taken simultaneously (i.e. should be staggered morning and night). 

Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.

Related: List of Doctors that will prescribe Ivermectin

For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC I-MASK+ protocol recommends (updated June 30, 2021):
  • Ivermectin: 0.2–0.4 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if:  1) in regions with more aggressive variants; 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors.
  • Fluvoxamine: 50 mg twice daily for 10–14 days. Add to ivermectin if: 1) minimal response after 2 days of ivermectin; 2) in regions with more aggressive variants; 3) treatment started on or after day 5 of symptoms or in pulmonary phase; or 4) numerous co-morbidities/risk factors. Avoid if patient is already on an SSRI (selective serotonin reuptake inhibitor).
  • Vitamin D3: 4000 IU/day. (Amazon)
  • Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon)
  • Quercetin: 250 mg twice a day. (Amazon)
  • Melatonin: 10 mg before bedtime (causes drowsiness). (Amazon)
  • Zinc: 100 mg/day. Zinc lozenges are preferred. (Amazon)
  • Nasopharyngeal Sanitation: Steamed essential oil inhalation 3 times a day (i.e. vapo-rub) and/or chlorhexidine/benzydamine mouthwash gargles (Amazon) and Betadine nasal spray 2–3 times a day (Amazon).
  • Aspirin: 325 mg/day unless contraindicated. (Amazon)
  • Pulse Oximeter: FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%. (Amazon)
Editor's Notes: 
  • Optional: Curcumin: 500 mg twice a day (Ref) (Amazon)
  • Duration for supplements: Most supplements (e.g. vitamin D, zinc, quercetin) for early treatment are given for 5 - 10 days. To continue for preventive purposes, dosages will need to be reduced as per the prevention or prophylaxis protocol.
  • If you can’t get fluvoxamine (Luvox), using 30mg once a day of fluoxetine (Prozac) is equally effective (equivalent to 50mg twice a day of fluvoxamine).
  • Optional: Azithromycin 250 mg twice a day. (Find a Doctor). 
The medical evidence to support each drug and nutrient can be found under “Medical Evidence” on the FLCCC’s website.


FLCCC Alliance

FLCCC

The Front Line COVID-19 Critical Care (FLCCC) Alliance was initially formed as a working group under “emergency” conditions of the early COVID-19 pandemic in response to multiple early reports of COVID patients with an inexplicably high need for prolonged mechanical ventilation and an excessive mortality associated with the prevailing “supportive care only” recommendations disseminated by the majority of national and international health care organizations.

As a group of highly published leaders in critical care with expertise in therapies directed at severe infections, in particular “HAT” therapy first developed by Dr. Paul Marik for the treatment of bacterial sepsis, and along with published high patient survival rates from our centers, we were contacted by equally concerned and motivated colleagues from other specialties.

With the increasing publications in addition to our rapidly accumulating personal clinical experiences and investigations into the pathophysiology of COVID-19 patients, we formulated the MATH+ Hospital Treatment Protocol in March 2020. On August 5, 2020, we published our findings in the rationale paper Scientific Review of COVID-19 and MATH+.

In October 2020, the FLCCC Alliance identified, based on a review of the recent and rapidly emerging clinical trials evidence, that ivermectin, an anti-parasitic medicine, has highly potent real-world, anti-viral, and anti-inflammatory properties against SARS-CoV-2 and COVID-19. This conclusion is based not only from multiple in-vitro and animal models, but from numerous clinical trials from centers and countries around the world showing repeated, consistent, large magnitude improvements in clinical outcomes when ivermectin is used not only as a prophylactic agent but also in mild, moderate, and even severe disease states. Further, data from large “natural experiments” that appear to have occurred when various regional health ministries and govern­mental authorities within South American countries initiated “ivermectin distribution” campaigns which then led to temporally associated decreases in case counts and case fatality rates.

Based on these findings, the FLCCC team has developed the I-MASK+ protocol for prophylaxis and at home treatment of early stage disease. 

A more detailed story of the inception and evolution of the FLCCC Alliance can be read here.


Related: 

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Supplements you can purchase from Amazon for COVID-19 prevention. Inspired by the FLCCC prevention protocol >

 

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