As an independent organization we decided to evaluate different approaches in the prophylaxis and prevention of COVID-19.

Different levels of prevention and control of COVID-19 show that it is possible to take measures to control the evolution of the disease.

After 14 months of living with the pandemic induced by the presence of COVID-19, several approaches and procedures were used in order to control the evolution of the disease, all under the concept of evidence-based medicine, where biochemical and pharmacological reasons were the basis of fundamentals, remembering that the treatment in general aims to improve the patient’s response to the aggression of the infection, as well as the response to the second phase involving the inflammatory concept.

This review aims to show that many behaviors that seem contradictory may have a place in the prophylaxis as well as in the treatment of patients with COVID-19 and should be analyzed to deal with the current situation, as well as for us to prepare for similar situations in the coming future.

Two hundred eighty-two patients diagnosed with positive rt-PCR COVID-19 were analyzed during this period, either in person or by telemedicine¹: 36 patients from Bolivia, 26 from Peru, 18 from Ecuador, 3 from Argentina, 2 from Chile, 4 from Paraguay, and 193 from Brazil. Of the total, 206 (73%) were men and 76 (27%) were women.

Three patients (0.5%) ultimately died from the disease, but help was requested by two of them during the final phase of the patient’s treatment. One obese muscular patient with high comorbidity was treated in the severe phase of intubation and responded favorably to the classic treatment associated with intravenous vitamin C in antioxidant doses, and was discharged after two months of hospitalization, refusing to be monitored, having high levels of dimer, and did not take anticoagulants. The patient had a fatal myocardial infarction two months after leaving the hospital.

Twelve (4.5%) (patients were hospitalized; no patient was intubated.

Two hundred twenty-six (80%) patients with little symptoms (low-grade fever, pain, minimal discomfort, eventual anosmia) were treated symptomatically with analgesics and antipyretics.

Forty-two (15%) patients with severe symptomatology, (fever, pain, malaise, cough, shortness of breath and pulmonary impairment above 25%, increased ferritin, and D-dimer, along with elevated CRP) took immediate treatment that included^2-4 hydroxychloroquine,⁵ azithromycin,⁶ prednisone,⁷and 14 anticoagulants and two all of the above combined with colchicine.⁶

Intravenous vitamin C with pro-oxidative properties was administered in the first five days and with antioxidant properties if necessary; during the inflammatory phase after the 5th day of clinical evolution we used vitamin C as an antioxidant in lower doses, below 10 grams a day. Of this total, 12 patients were maintained on anticoagulants for an average of two months until reaching an adequate level of D-dimer, two other patients maintained the modulation of inflammation, and regulation of thromboxane synthetase via omega-3 based on the amount of resolvins and protectins produced by omega-3 administration.^8,9

Protocols for Doctors and Health Professionals

The protocols are based on the principles of hydroxychloroquine interference in hemoglobin iron competing effect with COVID-19 increasing ferritin in lab tests, a pharmacological mechanism already known in the prophylaxis of patients traveling to malaria-prone regions, where administering the medication for five days provides protection for a 60-day period, as it is a delayed-action immunomodulator in the control of pro-inflammatory cytokines. During a virtual meeting it was suggested that everyone who considers themselves to be at risk—either due to the day-to-day contact with infected patients or due to diseases associated with taking a protocol in hydroxychloroquine—the usual dose of 400 mg daily for five days each month, associated with the treatment to restore the immune function of T lymphocytes and B lymphocytes, was administered. Aside from this, the following were also given¹⁰: 1 gram of vitamin C every 12 hours; vitamin D (50,000 UI per month)¹¹; zinc, 50 mg per day, combined with copper after a month of administration equivalent to 3 mg^12,13; and beta glucan, 100 mg a day.

Of 103 colleagues initially included in the study, which concluded in December 2020, 83 patients (80.5%) were continually treated with the hydroxychloroquine, presenting no case of covid 19 within this group of patients (physicians). We have no concrete information about the group that did not take it continuously, as they were separated from the study group.

Patients in Continuous Use of Hydroxychloroquine with Collagenopathy Treatment. We are continually and routinely monitoring 23 patients with collagen disorders up to the present day, in continuous use of 400 mg hydroxychloroquine. None of these subjects presented complications with their ophthalmological evaluation performed every 12 to 18 months. Without needing to suspend the medication, 16 of these patients maintained social isolation, seven kept distance, and none of them developed the viral disease during the entire follow-up period. These patients continue with their usual treatment, and immune stimulus supplementation was not included.

Until today, after four decades of use of chloroquine in the form of hydroxychloroquine, we have never had the need for a cardiological evaluation, only ophthalmological, where we have seen a less than 1% incidence of maculopathy, a much higher number if we use chloroquine diphosphate.

Hydroxychloroquine is a slow cytokine immunomodulator that controls inflammation through modulation of IL-1, IL-6 and TNF-alpha.^8,14

Vitamin C and COVID-19

Several studies have been published in China regarding the use of vitamin C in supportive treatment in patients with COVID-19, with the purpose of controlling the viral evolution, by activating the respiratory burst system where macrophages release pseudopods that carry the virus and inhibit by the myeloperoxidase enzyme, by converting ascorbate to ascorbate peroxide as respiratory burst usually do. In these cases, the doses used were above 35 grams (400-500 mg/kilo body weight) in intravenous infusion. However, in the inflammatory phase, much smaller doses (below 10 grams) were recommended to control oxidative stress via the release of pro inflammatory cytokines. In general, a portable glucometer can be used to identify pro and antioxidant levels when using intravenous vitamin C, since the vitamin C molecule is equal to glucose and the glucometer cannot differentiate it from hexose.^15,16

Conclusions

The experience in closed circuit and without a large universe of patients has shown that it is totally possible to control the evolution of the disease once it has begun its process, considering the violent evolution of the disease in the last 14 months with a high number of infected population and proportional deaths worldwide. Despite not having an expressly significant number of patients involved, the results are gratifying to the point that it is time to discuss science and protocols in the different stages of the disease, to define the proper pathway for the use of drugs or nutrients for the benefit of patients, eliminating clarifications and guesswork.

Note: This is a work of guidance and does not aim to be a model of treatment, but rather to open the possibility of scientific discussions, which allow us to offer possibilities to patients in a time of difficulty with changes, pre-, during, and post-COVID.

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