Given both the current health crisis and that which will accompany high unemployment rates and the loss of small businesses, plus resulting reductions in state and federal services, it is important that we think outside the box as we navigate this crisis.
The COVID-19 Critical Care Working Group, comprising seven pulmonologists and emergency room doctors — critical care doctors who run ICU teams in different parts of the country — developed a protocol they have been using to successfully treat all of their COVID-19 patients since early March; even challenging cases, such as an 87-year old patient already on oxygen.
Initially developed by Dr. Paul Marik, MD, Chief of Pulmonology and Critical Care at Eastern Virginia Medical School in Norfolk, VA (EVMS), Marik’s protocol additionally includes early oral dosing with vitamins C and D and notes that ventilators may be part of the problem. The ICU protocol, which includes IV vitamin C along with aggressive treatment, can be found on the EVMS website.
Doctors on the cutting edge use IV vitamin C at high doses to successfully treat patients in critical care situations. These same doctors cite extensive research — including studies designed to fail — plus their experience in maintaining baseline levels of vitamins C, D, B and dosing additionally with vitamin C (5,000-10,000 mg) to treat viral illness; keeping patients out of the ICU to start. They note that optimal blood serum levels of vitamin D are 70ng/mL-100ng/mL for protection against viral illness, and also cancer and neurodegenerative disease.
We know the expression of illness is based on underlying factors in a given population. African Americans, followed by Latinos, are generally deficient in vitamin D. Cold and flu season tracks the annual movement indoors in northern climates—and resulting lower blood serum levels of vitamin D. This could be an important link to understand in terms of how vitamin D might help fight this illness. With an outdoor lifestyle, Hawaii residents would have higher levels of vitamin D to start.
While this protocol was developed by critical care physicians on the front line, a comparative study could look at the COVID-19 statistics from these seven ICUs relative to statistics from other ICUs in the same cities during the same time, to establish controls. A comparative analysis study such as this would be the ethical way to establish a control, so as not to intentionally delay or withhold a potentially lifesaving treatment in a critical care situation, particularly one that is being successfully used.
In addition to implementing this working protocol, it is important to begin widespread antibody testing to understand how many people have had COVID-19 already. Because test kits were not available until late March, a few months into the outbreak, the data we have is limited. A flu-like respiratory virus swept the island from mid-January through early February. Given constant travel Hawaii-China-Japan — tourist, business and family related — the virus logically would have arrived here at least as early as in Italy.
Having had a virus strengthens the immune system and a population; providing more complete and lasting protection via learned immunity than a vaccine, which is based on the same concept. Were we to understand that more people have had COVID-19 already on island, it would both help to understand and be good news in terms of what it would mean for our population. While the live-virus test was quickly developed, without time for testing, and is raising questions regarding reliability—as doctors are finding patients testing both positive and negative in a single day—there are now three FDA-approved antibody tests. These tests have undergone rigorous scrutiny, with more time for development, and can now provide a reliable understanding of who has had the virus already.
The fact that doctors are seeing unreliable and conflicting results from the live virus tests, means that we are seeing both false-positive and false-negative results, which may account for some of the stories that don’t make sense. The antibody tests will provide a more reliable way to understand the numbers; at least, if we test in time. As making sound policy requires good data, these tests provide a way to build a better foundation of understanding moving forward.
After extensive research and correlating testing, Clinical Labs has selected the recently FDA-approved test by Abbot, which is now available for $43. As other locations are charging $130 for this same test, this is a wonderful price for Clinical Labs to offer the test for in Hawaii. Other good FDA-approved antibody tests include one by Chembio.
Fear and stress themselves take a toll on the immune system and feeding a family is a real concern. Taking positive steps forward — adopting a working treatment protocol and initiating antibody testing on island — is essential, not only for COVID-19 patients and health care providers, but for everyone on the island.
Tania Howard is a resident of Waimea.