Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)

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

Early ambulatory outpatient sequenced antiviral multidrug COVID-19 treatment (including for Delta or similar variants) for high-risk children and adolescents

During the past 19 months the global spread of the Severe Acute Respiratory Syndrome, Coronavirus2 (SARS-CoV-2 or COVID-19) has led to acute hospitalizations and death in primarily high-risk elderly and younger age groups who often present with comorbidities associated with increased risk. Otherwise, the virus is largely self-limiting in those infected outside of high-risk groups. Presently, the global community is confronting a predominant Delta variant of the virus, distinct from the initial variants, highly contagious and less virulent. The good news for high-risk populations is that early drug treatment (sequenced multi-drug treatment/SMDT) for all variants, has been shown to reduce the risk of hospitalization and death by as much as 85%. This paper is a combination of scientific research including clinical expert opinion of front-line doctors treating patients with COVID-19 and focuses on early treatments in children. The authors however, in support of the scientific literature recognize the risk of severe illness or death in the pediatric population is significantly low (statistical zero). Outlined are some of the key issues and pathophysiological principles that relate to the pediatric population with early infection. Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral anti-infective ‘repurposed’ therapy, 3) immunomodulation via oral/inhaled corticosteroids, 4) antiplatelet/antithrombotic/anticlotting therapy, and 5) administration of oxygen, monitoring, and telemedicine as needed. The key message is that as with adults, high-risk persons of any age, including the pediatric population, should not be left in a ‘wait-and-see’ mode whereby there is the potential for clinical decline; this, while effective, affordable, accessible, and safe treatments exist that could be administered in the pre-hospital phase. This paper should not in any way be taken as an indication or endorsement of elevated COVID-19 risk to pediatric populations, but rather as a proactive position in the rare instance a young child requires treatment. Future comparative effectiveness research comprised of high-quality and trustworthy observational study research and randomized controlled trials (especially study involving multiple therapeutic combinations/SMDT) will undoubtedly refine and clarify our clinical observations