Seven U.S. physicians have joined together to promote a controversial treatment for seriously ill COVID-19 patients. As the death toll mounts in a desperate struggle against the virus, they are urging hospitals everywhere to try their strategy — one they believe saves lives and reduces dependence on increasingly scarce ventilators.
The physicians, who jointly established the “Front Line COVID-19 Critical Care Consortium,” recommend a treatment that primarily involves the intravenous combination of vitamin C and corticosteroids. The protocol calls for the treatment to start as soon as a patient enters the emergency room and continue every six hours during the course of the illness.
Paul Marik, MD, Professor of Internal Medicine and Chief of Pulmonary and Critical Care Medicine at EVMS, conceived of the treatment as a way to battle runaway inflammation in the lungs — the real killer in most COVID-19 patients.
“It’s not the virus that’s killing the host, it’s the host’s response to the virus,” Dr. Marik says, describing the excessive levels of inflammation that result from an overly aggressive immune system.
The immune system responds to an infection by releasing proteins known as cytokines that initiate inflammation. Inflammation is a natural part of the healing process, but an overreactive immune system can trigger a “cytokine storm” that can send inflammation spiraling to dangerous levels.
When this extreme inflammation leaves patients short of breath, caregivers mistakenly attribute it to acute respiratory distress syndrome (ARDS), Dr. Marik says. The standard ARDS treatment is intubation — inserting a tube down the throat and directly into the lungs — and connecting them to a mechanical ventilator that forces air into the lungs. Unfortunately, a large majority of ventilated COVID-19 patients — in some cases more than 80 percent — are dying.
To avoid ventilation, Dr. Marik and his colleagues cool the overheated immune system with vitamin C and steroids, both strong anti-inflammatory molecules. They are particularly effective when used in combination.
Joseph Varon, MD, Professor of Acute and Continuing Care at the University of Texas Health Science Center and Chief of Staff/Chief of Critical Care at United Memorial Medical Center in Houston, Texas, has come to depend on the combination treatment.
“You start it early and patients don’t even need to be intubated,” Dr. Varon says in a YouTube video just released by the consortium. At last count, he had no deaths among 24 patients treated with vitamin C and steroids.
Dr. Marik reiterates the importance of starting the treatment early.
“If you wait for them to crash and you wait for them to end up on a ventilator, the Titanic is already sinking,” Dr. Marik says. “You have to intervene early and aggressively to prevent them from deteriorating.”
The vitamin C/steroid protocol is not widely used in the U.S. because large sectors of the medical community doubt its effectiveness, says consortium member Pierre Kory, MD, Critical Care Service Chief at the University of Wisconsin School of Medicine and Public Health in Madision, Wisconsin.
“Whenever you make a strong claim around a vitamin, I think most doctors are very conservative and skeptical of such claims,” Dr. Kory says in the video. “So, it’s very hard for most physicians to adopt the therapy fully.”
The treatment is controversial but not unconventional. Vitamin C has been used widely in China’s treatment of COVID-19 patients, and a clinical trial of high-dose vitamin C is underway there now.
Veteran emergency physician and consortium member Howard Kornfeld, MD, says standard protocols are not working in places like New York. “It’s a disaster,” he says. “And that disaster is coming to other cities.”
Consortium members believe their treatment can help thwart the disaster.
“People are dying needlessly,” Dr. Marik says. “This protocol will save lives.”
The protocol is available at EVMS.edu/Covidcare.
UPDATE: On May 6, 2020, Consortium member Pierre Kory, MD, Critical Care Chief at the University of Wisconsin School of Medicine and Public Health, testified at a hearing of the Senate Committee on Homeland Security and Governmental Affairs. The roundtable event was titled COVID-19: How New Information Should Drive Policy. Watch the testimony.