Dr Brownstein A Novel Approach to Treating COVID-19 Using Nutritional and Oxidative Therapies

 

Science, Public Health Policy,

and The Law

Volume 2:4-22

July, 2020

Clinical and Translational

Research

An Institute for Pure

and Applied Knowledge (IPAK)

Public Health Policy

Initiative (PHPI)

A Novel Approach to Treating COVID-19 Using

Nutritional and Oxidative Therapies

David Brownstein, M.D. y, Richard Ng, M.D. y, Robert Rowen, M.D. z, Jennie-Dare Drummond ,

PA y, Taylor Eason, NP y, Hailey Brownstein, D.O. x, and Jessica Brownstein {

Abstract

Objective: This report is a case series of consecutive patients diagnosed with COVID-19

treated with a nutritional and oxidative medical approach. We describe the treatment program

and report the response of the 107 COVID-19 patients.

Study Design: Observational case series consecutive.

Setting: A family practice office in a suburb of Detroit, Michigan.

Patients: All patients seen in the office from February through May 2020 diagnosed with

COVID-19 were included in the study. COVID-19 was either diagnosed via PCR or antibody

testing as well as those not tested diagnosed via symptomology.

Interventions: Oral Vitamins A, C, D, and iodine were given to 107 subjects (99%). Intravenous

solutions of hydrogen peroxide and Vitamin C were given to 32 (30%) and 37 (35%) subjects.

Thirty-seven (35%) of the cohort was treated with intramuscular ozone. A dilute, nebulized

hydrogen peroxide/saline mixture, with Lugol’s iodine, was used by 91 (85%).

Main Outcome Measures: History and physical exam were reviewed for COVID-19 symptoms

including cough, fever, shortness of breath, and gastrointestinal complaints. Laboratory

reports were examined for SARS-CoV-2 results. Symptomatic improvement after treatment

was reported for each patient consisting of first improvement, mostly better, and completely

better.

continued on next page

Copyright

c The Author – Published Under the Creative Commons License ShareAlike

(See https://creativecommons.org/licenses/)

Keywords

SARS-CoV-2, COVID-19, ozone therapy, hydrogen peroxide therapy, Vitamin A, iodine, Vitamin

C, Vitamin D, immune system, antiviral.

Clinical Assistant Professor of Family Medicine, Wayne

State University School of Medicine. Corresponding author,

[email protected]

yprivate practice West Bloomfield, MI

zprivate practice Santa Rosa, CA.

xresident physician, Providence Hospital, Southfield, MI

{4th year Michigan State College of Osteopathic Medicine

student

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

Contents

1 Introduction 6

2 Methods 7

3 Results 8

4 Discussion 10

4.1Vitamin A . . . . . . . . . . . . . . . . . . . . . . . . . 11

4.2Vitamin C (Ascorbate) . . . . . . . . . . . . . . 12

4.3Vitamin D . . . . . . . . . . . . . . . . . . . . . . . . . 12

4.4Iodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

4.5Nebulized Hydrogen Peroxide . . . . . . . 14

4.6Intravenous and Intramuscular Therapies

14

4.7IV Hydrogen Peroxide . . . . . . . . . . . . . 14

4.8IV Vitamin C (Ascorbate) . . . . . . . . . . . 15

4.9Intramuscular Ozone . . . . . . . . . . . . . . . 15

5 Conclusion 16

6 Acknowledgments 17

References 17

Abstract ( Continued from page 1 )

Results: There were a total of 107 patients

diagnosed with COVID-19. Thirtyfour

were tested for SARS-CoV-2(32%) and

twenty-seven (25%) tested positive. Three

were hospitalized (3%) with two of the three

hospitalized before instituting treatment and

only one requiring hospitalization after beginning

treatment. There were no deaths. The

most common symptoms in the cohort were

fever (81%), shortness of breath (68%), URI

which included cough (69%), and gastrointestinal

distress symptoms (27%). For the

entire cohort, first improvement was noted

in 2.4 days. The cohort reported symptoms

mostly better after 4.4 days and completely

better 6.9 days after starting the program. For

the SARS-CoV-2 test positive patients, fever

was present in 25 (93%), shortness of breath

in 20 (74%) and upper respiratory symptoms

including cough in 21 (78%) while gastrointestinal

symptoms were present in 9 (33%).

The time to improvement in the SARS-CoV-

2 test positive group was slightly longer than

the entire cohort.

Conclusion: At present, there is no published

cure, treatment, or preventive for

COVID-19 except for a recent report on dexamethasone

for seriously ill patients. A novel

treatment program combining nutritional and

oxidative therapies was shown to successfully

treat the signs and symptoms of 100%

of 107 patients diagnosed with COVID-19.

Each patient was treated with an individualized

plan consisting of a combination of oral,

IV, IM, and nebulized nutritional and oxidative

therapies which resulted in zero deaths

and recovery from COVID-19. Keywords:

SARS-CoV-2, COVID-19, ozone therapy,

hydrogen peroxie therapy, Vitamin A, iodine,

Vitamin C, Vitamin D, immune system, antiviral.

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

1. Introduction

SARS-CoV-2 is the strain of coronavirus that causes

coronavirus disease 2019 known as COVID-19.

To date, COVID-19 has infected 7,669,872 cases

worldwide and 2,090,553 cases in the US with

116,347 reported fatalities (as of 6.13.2020).[1]

COVID-19 is a pandemic that is unparalleled in

the modern world and the global response to SARSCoV-

2 has no parallel in history. Coronaviruses are

found in many bat and bird species, which are believed

to be natural hosts.[2] It is estimated that

coronaviruses have been around from 10,000 to

millions of years. Coronaviruses are pathogenic

viruses native to birds and mammals. They are classified

into four subspecies: alpha-, beta-, gamma-,

and delta- coronavirus.[3] Alpha- and beta- coronaviruses

are found exclusively in mammals and

gamma- and delta-coronavirus primarily infect birds.

[4] Coronaviruses include a family of viruses that

contain an RNA genome. Some of these viruses

have been shown to cause illness in animals and

humans.

SARS (severe acute respiratory syndrome) was

discovered in 2003.[5] It was described as an outbreak

of atypical pneumonia in Guangdong Province,

Peoples Republic of China. SARS, which occurred

during 2002-2003 infected approximately 8,098

and resulted in 774 deaths. The outbreak was primarily

concentrated in Southeast Asia and Toronto,

Canada although the outbreak spread to more than

24 countries. SARS was found to be caused by

a strain of coronavirus that infects the epithelial

lining within the lungs.[6] Prior to the SARS outbreak,

coronaviruses were only thought to cause

mild influenza-like illnesses in humans.

The second major human outbreak of coronavirus

was in 2012 in Saudi Arabia. It was referred

to as MERS (Middle East Respiratory Syndrome).

It spread to several countries including the US. Most

people infected with MERS suffered with respiratory

problems including cough and shortness of

breath. The World Health Organization confirmed

2,519 cases of MERS as of January, 2020.[7]

SARS-CoV-2 is a new strain of coronavirus that

has not been known to previously infect humans.

COVID-19 was first identified in Wuhan, China

in December 2019. China informed the WHO

that a novel strain of coronavirus was causing severe

illness. It was named SARS-CoV-2 as the

cause of COVID-19. The virus was sequenced and

found to most resemble viruses found in bats and

pangolins.[8] SARS-CoV-2 was found to be highly

transmissible between humans. SARS-CoV-2 can

be diagnosed via nasal swab PCR testing. According

the Centers for Disease Control and Prevention,

people with COVID-19 have a wide range of

symptoms reported from mild symptoms to severe

illness.[9] People with these symptoms may have

COVID-19:

Cough

Shortness of Breath or difficulty breathing

Or at least two of these symptoms:

Fever

Chills

Repeated shaking with chills

Muscle pain

Headache

Sore throat

New loss of taste or smell

The CDC further states, that this list is not inclusive.

According the CDC, the signs and symptoms

of COVID-19 present at illness vary, but over the

course of the disease, most persons with COVID-

19 will experience the following:[10]

Fever (83-99%)

Cough (59-82%)

Shortness of breath (31-40%)

Sputum production (28-33%)

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

Our patients’ symptomology correlated well

with the percentages reported by the CDC.

We will present data on clinical presentation

and treatment provided to help patients recover

from COVID-19 symptoms. This treatment program

has been utilized for over 20 years (with some

variations) in treating patients suffering from viral

illnesses such as influenza-like disease. This

treatment program was not designed to cure a viral

illness rather its purpose is to provide a therapeutic

regimen designed to support the immune system

when it is challenged with a viral infection.

2. Methods

The setting for this retrospective review is an outpatient

medical office (referred to as CHM) consisting

of five practitioners. The office is in the

metropolitan Detroit area, which was one of the

hot spots for COVID-19. The practitioners include

three medical doctors as well as a nurse practitioner

and a physician’s assistant. For the calendar year of

2020, charts were retrospectively reviewed for the

presence of COVID-19 diagnosis occurring from

February 2020 through May 2020. The charts were

analyzed for clinical symptoms, physical findings,

imaging and coronavirus testing results. Additionally,

the charts were analyzed for interventions provided

and duration to relief of symptoms. Three

endpoints were taken from the charts – hospitalization,

death, and time to improvement.

All patients gave fully informed consent for integrative

medical management of their condition.

Historical information from the charts included age,

sex, birthdate, initial date of service, care provider,

past medical history, medications, and nutritional

supplements. The number of days of illness prior to

being seen by a provider was documented as well.

For x-ray imaging we used the report provided

by the radiologist. Coronavirus testing was done

through outpatient and inpatient laboratories. Coronavirus

was diagnosed by PCR nasal swab testing.

The interventions provided at the outpatient

medical office included oral supplementation of

iodine, Vitamins A, C and D, intravenous hydrogen

peroxide and Vitamin C, intramuscular ozone injections,

and a nebulized solution of dilute hydrogen

peroxide and iodine.

Oral dosing consisted of taking the following

supplements for four days at the first sign of symptoms

or at the direction of the practitioner. The

supplements consisted of:

Vitamin A: 100,000 IU/day*** in the

form of emulsified Vitamin A palmitate

Vitamin C: 1,000 mg/hour while awake in the

form of ascorbic acid until bowel tolerance

(loose stools) was reached

Vitamin D3: 50,000 IU/day in an emulsified

form

Iodine: 25 mg/day in the form of Lugol’s

solution or tableted Lugol’s solution

Most patients were instructed to nebulize a dilute

solution of 0.04% hydrogen peroxide in normal

saline. The solution was mixed for the patient in

the office. A sterile 250 cc bag of normal saline was

injected with 3 cc of 3% food grade hydrogen peroxide

and 1 cc of magnesium sulfate. The patient

was instructed to draw off 3 cc of the dilute solution

and nebulize it hourly until symptoms improve. Additionally,

the patient was instructed to add in one

drop of 5% Lugol’s solution to the dilute hydrogen

peroxide mixture. As the symptoms improved, the

frequency of nebulizing could be reduced by the

patient.

If symptoms worsened or there was a concern

that the patient was suffering from a more severe

case, the patient was advised to come to the office

and receive intravenous injections of Vitamin C

and hydrogen peroxide along with intramuscular

injections of ozone. The dosing of these items is

shown below:

Vitamin C: 2.5 grams of sodium ascorbate

(5 cc of a 500 mg/cc ascorbic acid solution)

mixed with an equal amount of sterile water

given as an intravenous push over 2-3 minutes.

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

Figure 1. Patient Age distribution

Hydrogen peroxide: 30 cc of a 0.03% solution

of dilute hydrogen peroxide given as an

intravenous push over 2-3 minutes

Ozone: 20 cc of 18 mcg/cc ozone (as an oxygen/

ozone gas mixture) given in each buttock

as an intramuscular injection

3. Results

There were 107 patients identified in our chart review

among five practitioners. Table I outlines the

patient characteristics of the sample. The age of

patients ranges from 2-85 years old with an average

age of 54.2 and median age of 56.5. 80 patients

were female (75%) and 27 were male (25%).

The major comorbid conditions of the sample include

hypothyroidism (18%), hypertension (10%),

asthma (8%), Lyme disease (6%), Hashimoto’s disease

(5%), cigarette smoking (3%), Grave’s disease

(2%), chronic sinusitis (2%), diabetes (2%) and

cancer (2%).

Figure 1 exemplifies the age distribution of the

107-patient population at the practice. The majority

of the patients were between 51-75 years old (59%).

The second highest cohort was between 26-50 years

old (31%). Followed by those 76 years old and older

(10%) and those aged 2-25 (7%).

Table II illustrates the patient symptoms of the

total cohort. The most common patient symptom

was fever (81%), shortness of breath (68%), URI

(69%) and GI symptoms (27%).

Table 1. Patient Characteristics

N(%)

Total patients 107(100)

Age

Range 2-85

Average 54.2

Median 56.5

Sex

Male 27 (25)

Female 80 (75)

Comorbid Conditions

Hypothyroidism 19 (18)

Hypertension 11 (10)

Asthma 9 (8)

Lyme Disease 6 (6)

Hashimoto’s disease 5 (5)

Smokers 3 (3)

Grave’s disease 2 (2)

Chronic sinusitis 2 (2)

Diabetes 2 (2)

Cancer 2 (2)

Table 2. Patient Symptoms ’Total Cohort’

N (%)

Fever 87 (81)

Shortness of breath 73 (68)

URI (symptoms including cough) 74 (69)

GI (diarrhea, loose stools, pain) 29 (27)

Total patients 107 (100)**

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

Table 3 demonstrates the interventions that the

patients received from CHM (total cohort). The

most common intervention was a protocol of oral

supplements, including Vitamin A, Vitamin D, Vitamin

C, and iodine. 106 patients of the 107 total

patients were taking oral supplements (99%). The

other interventions at CHM include 32 patients receiving

IV hydrogen peroxide (30%), 37 patients

receiving IV Vitamin C (35%), 37 patients receiving

intramuscular ozone injections (35%), 91 patients

receiving a nebulized solution of normal saline and

dilute hydrogen peroxide (85%), and 91 patients

receiving nebulized iodine (85%).

Figure 2 shows the average number of days

that patient reported symptomatic improvement after

CHM interventions (for total cohort). On average,

patients reported their first improvement by

2.4 days following CHM interventions. Patients reported

feeling mostly better by 4.4 days following

interventions. Patients reported feeling completely

better after 6.9 days following CHM interventions.

Table 4 illustrates the disease course in the total

cohort. 34 of the 107 total patients (32%) were

tested for COVID-19. Of those 34 tested, 27 patients

tested positive for COVID-19 (79%). Therefore,

25% of the entire cohort (107 patients) had

tested positive for COVID-19.1 Of the total 107

patients, 0 died (0%).

Table 5 illustrates the symptoms of the COVID-

19 cohort which was similar to Table 2 for the entire

cohort.2 Figure 3 shows the symptomatic improvement

after intervention in the SARS-CoV-2

laboratory positive cohort. Compared to the entire

cohort (Figure 2), there was approximately a one

day longer time period to feeling mostly better and

completely better for those who tested positive for

SARS-CoV-2 as reported by the patients.

1Of the 107 total patients, three were hospitalized (3%)

with two of the three hospitalized before beginning treatment.

2Two patients in the SARS-CoV-2 positive cohort reported

a return of mild symptoms after reporting a resolution

of major symptoms. One patient reported feeling foggy in his

head and another reported a fast heart (90-100 bpm) along

with mild shortness of breath with any mild exertional activity.

A workup onboth failed to find a cause for the symptoms.

Table 3. Patient Interventions

INTERVENTION total (cohort)

N (%)

Total patients 107 (100)**

Oral supplements 106 (99)

IV H202 32 (30)

IV Vitamin C 37 (35)

IM Ozone 37 (35)

Nebulized NS/H202 91 (85)

Nebulized Iodine 91 (85)

Table 4. Disease Course

N (%)

Total cohort 107 (100)

Tested for COVID-19 34 (32)

Tested positive for COVID-19 27 (25)

Hospitalized 3 (3)

Death 0 (0)

Of the three patients hospitalized, two

were hospitalized before instituting treatment

One was hospitalized on the oral Vitamin

regimen of Vitamins A, C, D, and iodine. All

three made a full recovery and were treated

with nebulized hydrogen peroxide and iodine.

Table 5. Symptoms of COVID-19 Positive Cohort

N (%)

COVID positive patients 27 (100)

Fever 25 (93)

Shortness of breath 20 (74)

URI (includes cough) 21 (78)

GI 9 (33)

Two patients in the SARS-CoV-2 positive

cohort reported a return of mild symptoms after

reporting a resolution of major symptoms.

One patient reported feeling foggy in his head

and another reported a fast heart (90-100 bpm)

along with mild shortness of breath with any mild

exertional activity. A workup on both failed to

find a cause for the symptoms.

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

Figure 2. Intervention Results

4. Discussion

COVID-19 is a worldwide pandemic caused by

coronavirus. Currently, there is no vaccine or cure

for COVID-19. Dexamethasone has been reported

to reduce hospitalized case mortality.[11] Those

who have recovered from COVID-19 have done

so because their immune system was successful

in fighting off the illness. Therefore, a successful

treatment for COVID-19 will have to either have

viricidal activity or work by aiding the immune system’s

response in fighting the pathogen. Many feel

COVID-19 will come back during the next flu season—

fall/winter of 2020-2021. Therefore, there is

an urgent need for any therapy that supports the

host’s immune system and allows for an uneventful

recovery from the illness.

This cohort study consisted of a retrospective

review of 107 patients who were either diagnosed as

COVID-19 positive by PCR nasal swab testing or

presumed to have COVID-19 due to symptomatology.

The most common symptom in our cohort was

fever. The fever was reported as fluctuating varying

between 99-102 degrees Fahrenheit for most subjects.

The next most common symptom included

upper respiratory symptoms which included a rhinorrhea,

drippy eyes, cough, and congestion. Shortness

of breath was the third most common complaint.

Gastrointestinal distress, though common,

was lower on the symptom list. Although symptoms

varied between patients, all patients exhibited symptoms

that could be consistent with a viral pathology.

Treatments of the cohort consisted of first using

oral nutrient therapies. The vast majority—91

(88%) started taking vitamins A, C, D3 and iodine

at the first sign of a viral illness such as a cough,

runny nose, sore throat, etc., All subjects (100%)

took vitamin C in suggested doses of at least 3-

5,000 mg/day of ascorbic acid. Three patients took

vitamins C and D only.

There were three hospitalizations in the cohort

group. One patient was taking the oral protocol of

vitamins A, C, D and iodine when he became ill

with a cough and fever. His condition worsened

over the next seven days and was admitted to the

hospital where he was diagnosed with pneumonia.

He was treated with antibiotics. He phoned the

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

Figure 3. Two patients in the SARS-CoV-2 positive cohort reported a return of mild symptoms after

reporting a resolution of major symptoms. One patient reported feeling foggy in his head and another

reported a fast heart (90-100 bpm) along with mild shortness of breath with any mild exertional activity. A

workup on both failed to find a cause for the symptoms.

office after he was discharged from the hospital

because he was having breathing difficulties. He

started nebulizing hydrogen peroxide and felt an immediate

improvement in his breathing difficulties

from this therapy. By the third nebulized therapy

he reported to being 80% improved. He stated his

breathing difficulties began to return to normal after

day two of nebulizing every 2 hours while awake.

The other two patients started our protocol after

being hospitalized for COVID-19. One of the two

was recently diagnosed with acute myelogenous

leukemia and recently received chemotherapy. Both

were discharged still symptomatic with breathing

difficulties and a severe cough. Both patients were

treated with nebulized hydrogen peroxide and iodine

as well as the oral protocol of vitamins A, C,

D, and iodine. All three patients fully recovered.

4.1 Vitamin A

Vitamin A consists of a group of retinoid compounds

that have a wide range of physiological

effects including the support of immune system

functioning. Vitamin A deficiency is a worldwide

problem affecting 250 million preschool children

and half of all countries.[12] In children, vitamin

A supplementation has been shown to dramatically

decrease the mortality from the viral illnesses such

as measles and diarrheal infections.[13]

Over 100 years ago, — before the chemical

structure was elucidated — studies of vitamin A

pointed to its important role in immune system functioning.

Fat in butter, a good source of vitamin A,

improved the outcome of infections in malnourished

animals and humans.[14] Rats were shown to

be more susceptible to infections when they were

vitamin A deficient.[15] Vitamin A is fundamental

in maintaining the integrity of the epithelium.[16]

Vitamin A deficiency has been associated with dis-

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

ruptions in normal epithelium of the respiratory

tract[17][18] and gastrointestinal tissue.[19][20] Vitamin

A has been shown to be an important regulator

of monocyte differentiation and function.[21]

COVID-19 is characterized by cytokine storm

in the severely ill.[22] Therapies that lower cytokine

formation are being investigated. Retinoic

acid, when added to monocytic, myelomonocytic,

or dendritic cell line cultures promotes cellular differentiation

and influences the secretion of key cytokines

produced by macrophages including TNF-

a, IL-1b, Il-6, and IL-12. It has been hypothesized

that supplementation with preformed vitamin

A may down-regulate the secretion of specific proinflammatory

cytokines such as TNF- a and Il-6 by

macrophages.[23]

Acute respiratory distress syndrome (ARDS)

accompanied by respiratory failure is a major cause

of death from COVID-19.[24][25] Treatments to

combat respiratory failure are urgently needed.

In vitro and in vivo studies have found that IgA

antibodies can neutralize intracellular pathogens

including viruses by inhibiting or blocking their

attachment to epithelial cells.[26][27][28] Researchers

studying the acute humoral response to

SARS-CoV-2 in serum and bronchoalveolar fluid

of 145 patients with COVID-19 reported that early

SARS-CoV-2 specific humoral responses were

found to be typically dominated by antibodies of

the IgA isotype.[29] Furthermore, the subjects who

had the highest levels of IgA against the spike protein

for SARS-CoV-2 were the ones who had the

greatest ability to neutralize the virus. Vitamin A

deficiency has been shown to inhibit the production

of influenza-specific IgA in mice.[30] Furthermore,

vitamin A supplementation has been shown to increase

IgA levels.[31]

4.2 Vitamin C (Ascorbate)

A Chinese report of intravenous vitamin C (IVC)

infusion for 50 moderate to severe COVID-19 subjects

found all patients eventually recovered and

discharged from the hospital. The subjects were

given between 10 and 20 g of IVC per day over a

period of 8-10 hours.[32] In 2017, Paul Marik, M.D.

developed a protocol for treating septic patients

with IV vitamin C, thiamine, and hydrocortisone.

The early use of vitamin C along with thiamine

and hydrocortisone were found to be effective at

preventing progressive organ dysfunction including

kidney injury and in reducing mortality of patients

with severe sepsis and septic shock. In CITRIS-ALI

researchers reported a trial where ARDS patients

were randomized to receive IV ascorbic acid or

placebo every six hours for 4 days. Patients had

to develop ARDS within 24 hours of I CU admission.

The authors reported a reduction in 28-day

all-cause mortality rate in those receiving IV vitamin

C: 29.8% mortality in the treatment group

versus 46.3% mortality in the placebo group.[33]

COVID-19 patients are characterized by elevated

levels of inflammatory markers and oxidative stress

such as hsCRP.[34] Vitamin C is known to have

anti-oxidant and anti-inflammatory effects. Erythrocytes

(red blood cells) can deliver oxygen to

bodily tissues because they carry iron-containing

hemoglobin which reversibly binds oxygen. Oxidative

damage to red blood cells can impair the

ability to deliver oxygen to tissues.[35] The management

(and possibly the prevention of) oxidative

stress in COVID-19 may be addressed with the use

of anti-oxidant therapies. High-dose IV vitamin C

was found to have an antioxidant effect for lung

epithelial cells.[36] Vitamin C has also been shown

to prevent the oxidation of iron from its reduced

ferrous state to the oxidized ferric form.[37] Intravenous

(but not oral) ascorbate has been shown to

act as a pro-drug for hydrogen peroxide creation in

interstitial fluids in animal studies (see hydrogen

peroxide discussion below).[38]

4.3 Vitamin D

Vitamin D is being researched as an effective treatment

option for COVID-19 patients. Researchers

used 25-hydroxyVitamin D [25(OH)D] levels as a

marker to predict clinical outcomes of COVID-19

subjects.[39] Of 212 cases of COVID-19, serum

25(OH)D level was lowest in critical cases but highest

in mild cases. The authors reported vitamin D is

significantly associated with clinical outcomes. A

logistic regression analysis reported that for each

standard deviation increase in serum 25(OH)D, the

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Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

odds of having a mild clinical outcome rather than

a severe outcome were approximately 7.94 times

(OR=0.126, p<0.001) while interestingly, the odds

of having a mild clinical outcome rather than a

critical outcome were approximately 19.61 times

(OR=0.051, p<0.001). The results suggest that an

increase in serum 25(OH)D level in the body could

either improve clinical outcomes or mitigate worst

(severe to critical) outcomes, while a decrease in

serum 25(OH)D level in the body could worsen

clinical outcomes of COVID-2019 patients.

There are several mechanisms by which vitamin

D could reduce the risk of influenza-like infections

and death. Viral infections have been shown to

disrupt airway epithelial cell junctions.[40] Vitamin

D has been shown to maintain tight epithelial

junctions and adherens junctions.[41]

Vitamin D has been shown to modulate cellular

immunity and reduce cytokine storm by reducing

the production of proinflammatory cytokines

including TNF-a and interferon-g as well as increasing

the anti-inflammatory cytokines produced

by macrophages.[42] A study comparing deceased

rates for patients with COVID-19 from countries

with a large number of confirmed patients (including

Germany, S. Korea, China, Switzerland, Iran,

UK, US, France, Spain, and Italy) found a risk of

severe COVID-19 cases among patients with very

low vitamin D levels is 17.3%, while the equivalent

figure for patients with normal vitamin D levels is

14.6%–a reduction of 15.6%.

The authors hypothesized that vitamin D may

reduce symptoms of COVID-19 by suppressing cytokine

storm in COVID-19 patients.[43]

Vitamin D is produced in the bone, skin, lungs,

colon, parathyroid glands, and immune system cells.

Activation of vitamin D in response to viral infection

has been described.[44] A deficiency of vitamin

D could impair this response in the lung.[45]

4.4 Iodine

Iodine is an essential element; therefore it must

be obtained from the diet or via supplementation.

For over 40 years, US iodine levels have fallen

in the National Health and Nutrition Examination

Survey (NHANES).[46] Nearly 60% of women

of childbearing age are deficient in iodine.[47] In

fact, the mean urinary iodine concentration among

pregnant US women is 134 ug/L which signifies

deficiency.[48] We have tested over 6,000 patients

and found the vast majority—over 97%– are deficient

in iodine.

Iodine is needed for proper immune system

functioning. Iodine supplementation has

been shown to increased IgG synthesis in human

lymphocytes.[49] Iodine deficiency is associated

with decreased phagocytic activity of blood

neutrophils.[50] This was associated with a decrease

in peroxidases in neutrophils. Iodine has

been shown to increase the ability of granulocytes

to kill infectious organisms.[51] Iodine is used as an

antiseptic throughout the US because it has antiviral

and antibacterial properties. Two of us (DB and RN)

have used iodine successfully as an antimicrobial

agent for over two decades.

In order to reduce transmission of viruses, antisepsis

of human and non-human surfaces must

be identified. Researchers reported an in-vitro

study where SARS-2-CoV was exposed to iodine

(povidone-iodine) at 1-5% concentrations as a nasal

antiseptic formulation and an oral rinse. The iodine

solutions effectively inactivated SARS-CoV-2 after

exposure times of 60 seconds.[52] In vitro studies

of 0.23% PVP-I mouthwash (1:30 dilution) was

shown to inactivate both SARS-CoV and MERSCoV

following a 15-second exposure.[53]

Japan has one of the lowest rates of COVID-19

illnesses in the Western world even in a crowded

city such as Tokyo. Furthermore, Japan has not

gone on a total lockdown. The Japanese are known

to have a much higher iodine intake through their

diet when compared to other Western countries. It

is estimated that the Mainland Japanese ingest over

100x the RDA as compared to US citizens.[54] Perhaps

Tokyo and Japan itself has had less serious

COVID-19 illness because of their iodine intake.

The full oral supplementation regimen (vitamins

A, C, D, and iodine) in COVID-19 subjects

was used in 91 out of 104 subjects in the cohort. The

subjects were instructed to take the supplements for

four days. Some were treated with vitamin C (1),

vitamins C and D (2) and vitamins C, D, and io-

13

Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

dine (1). All of these patients recovered without

sequalae.

4.5 Nebulized Hydrogen Peroxide

If there were more serious problems or the oral supplementation

regimen failed to fully help alleviate

the symptoms of COVID-19, the next step was to

initiate the use of a combination of nebulized hydrogen

peroxide and iodine. A solution of 250 cc of

normal saline was mixed with 3 cc of 3% hydrogen

peroxide providing a final concentration of 0.04%

hydrogen peroxide. (Note, the hydrogen peroxide

used was initially a 35% food grade source then

diluted to 3% using a 10:1 mixture of sterile water

to 35% hydrogen peroxide.) Additionally, 1 cc of

magnesium chloride (200 mg/ml) was added to the

250 cc saline/hydrogen peroxide bag. (This was

mixed in the office for the patients.)

Patients were instructed to nebulize 3 cc of the

mixture three times per day or more often if there

were breathing problems. Usually one or two nebulizer

treatments were reported to improve breathing

problems.

A total of 91 COVID-19 subjects (85%) utilized

the nebulized solution. They reported no adverse

effects. One We have been using nebulized

saline/hydrogen peroxide at this concentration for

over two decades in his practice.

Hydrogen peroxide is continually produced in

the human body with substantial amounts produced

in the mitochondria.[55] Every cell in the body is exposed

to some level of hydrogen peroxide.[56] The

lungs are known to produce hydrogen peroxide.[57]

Nebulized hydrogen peroxide has been shown to

have antiviral activities.[58] Hydrogen peroxide can

activate lymphocytes[59] which are known to be depleted

in COVID-19.

4.6 Intravenous and Intramuscular Therapies

If COVID-19 patients continued to have symptoms

such as shortness of breath, fever, or cough, they

were offered intravenous injections of hydrogen peroxide,

Vitamin C and intramuscular injections of

ozone.

4.7 IV Hydrogen Peroxide

A dilute IV solution of hydrogen peroxide was

given in either an IV drip over 30 minutes or a rapid

infusion as an IV push over 2-3 minutes. One of

the earliest known uses of hydrogen peroxide was

used by Dr. T.H. Oliver in 1920. Dr. Oliver used

IV hydrogen peroxide to treat Indian troops who

were suffering from an influenza and pneumonia

epidemic. The death rate was reported to be over

80% at that time. Dr. Oliver’s results showed his

IV hydrogen peroxide-treated cohort of 24 soldiers

had a mortality rate of 48% compared to the 80%

death rate from those treated with the usual care at

that time.[60] In the article published by Dr. Oliver,

he stated that the low oxygen symptoms his patients

suffered from were markedly benefited by the use

of intravenous hydrogen peroxide. Furthermore, he

reported that the ‘toxemia’ (spread of bacterial products

in the blood stream) appears to be overcome in

many cases. Poor oxygenation and sepsis are both

conditions experienced by COVID-19 subjects.

When H202 is produced extracellularly or

added to a cell culture system, a gradient of

H202 is quickly established across the plasma

membrane.[61] Researchers reported that the gradient

is the result of H202-scavanging enzymes including

catalase and GSH-peroxidase that maintains a

steady-state intracellular H202 concentration being

10x less than the extracellular concentration.[62]

As Bocci states, “This result is important because

the intravenous (IV) infusion of a low and calculated

concentration of H202 results in a marked

dilution in the plasma pool with partial inactivation

and in intracellular levels able to exert biological

effects on blood and endothelial cells without

aggravating the concomitant oxidative stress.”[63]

COVID-19 is known to cause oxidative stress

which may be the cause of multi organ failure and

hypoxemia.[64][65][66] H202 is known to activate

glycolysis, ATP and 2,3-DPG in red blood cells

which can lead to improved oxygen delivery to ischemic

tissues.[67][68] H202 has also been shown

to increase the production of NO which can aid in

vasodilation and tissue oxygenation.[69][70]

Researchers studying the effects of intravenous

H202 therapy reported that it barely increases the

14

Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

plasma level of peroxidation end-products (lipid

oxygenation products). This stimulates the production

of antioxidants which act as reducing agents.

The scientists report similar effects with ozone therapy.

This results in an up-regulation of antioxidant

enzymes (SOD, GSH-peroxidase, G-6PD) in erythrocytes

which has been demonstrated in-vivo.[71]

Coronaviruses have been shown to be sensitive to

oxidizing disinfectants such as a 0.5% hydrogen peroxide

solution used as a surface disinfectant.[72] It

is well accepted that the response of the immune

system is the production of pro-oxidants which are

known to disinfect pathogens.[73]

4.8 IV Vitamin C (Ascorbate)

Intravenous use of vitamin C has been used in hospitals

and outpatient settings for COVID-19 patients

after a report from China showed improvement in

those treated with it.[74] IV ascorbic acid was introduced

to moderately to severely sick COVID-

19 patients in Chinese hospitals. The researchers

reported that intravenous ascorbic acid provided

safe and effective adjunctive care of hospitalized

COVID-19 patients. There was no mortality, no

reported side effects and shorter hospital stays universally.

The Shanghai expert group recommends

intravenous ascorbic acid use in extremely critical

settings within COVID-19 patients. In the US, multiple

hospital centers utilized IV vitamin C to treat

COVID-19 patients.

We have been successfully utilizing IV vitamin

C therapies for over two decades in order to aid

the immune system in its ability to fight pathogens.

For this study, we administered 2.5 gm of sodium

ascorbate mixed with 5 cc of sterile water as an

intravenous push over 1-2 minutes. There were no

adverse effects from this regimen.

4.9 Intramuscular Ozone

Ozone is a colorless gas with a pungent odor. It

is a natural molecule made up of three atoms of

oxygen. Ozone is produced by an ozone generator

where oxygen (O2) gas is exposed to an electrical

discharge combining O2 molecules into a mixture

of up to 5% O3 and 95% O2. Ozone therapy has

been used for over 100 years and is widely used in

Europe and Cuba and in outpatient offices in the

United States. Ozone has been used to treat infections

and wounds as well as other illnesses over

this time period. Ozone therapy can be administered

by many different methods including intravenously

and intramuscularly. Intramuscular ozone

was given in these cases to reduce transmission risk.

Since we were only treating COVID-19 patients

outside the office in the parking lot, intramuscular

injections of ozone were deemed the easiest and

safest modality.

IM ozone was provided to 37 patients (35%).

Of these, a single ozone injection was given to 31

(82%). Seven (18%) required more than one IM

injection. Five received two ozone shots, one patient

had four and another had six. The patients

who required four and six injections had been ill

for a longer time period (over 10 days) before

instituting therapy. Both recovered uneventfully.

In viral infections, ozone has been shown to improve

both the innate and adaptive immune systems

while also reducing cytokine storm. Ozone

improves neutrophil counts in children with compromised

phagocyte cell-mediated immunity.[75]

Antibodies have been shown to kill pathogens by

producing ozone gas.[76] Ozone has been shown

to have direct viricidal effects by disrupting the

lipid envelope of a virus at sites of double bonds.

When the lipid envelope is fragmented, its DNA or

RNA cannot survive. SARS-CoV-2 is an enveloped

virus which would make it an excellent candidate

for treatment with ozone.[77] Furthermore, SARSCoV-

2, as well as other coronaviruses, have abundant

cysteine–a thiol containing amino acid– in their

spike proteins. Rowen has hypothesized that ozone

is the ideal therapy for viruses.[78] In order to successfully

penetrate cell membranes, many viruses

require membrane glycoproteins to be in the R-SH

reduced form as opposed to the oxidized—RS-

S-R– form. If virus thiol groups are oxidized

they lose infectivity.[79] Rowen states, “Creating

a more “oxidized” environment may allow ozone

therapy. . . to assist the body in inactivating thiols

in viruses in blood and tissues.” SARS-CoV-2 cell

entry spike proteins are particularly rich in both

cysteine and tryptophan the two most vulnerable

15

Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

amino acids to alteration by ozone.[80][81] The

thiol group of cysteine is easily oxidized reversibly

to disulfide which is widely accepted to neutralize

the function of its protein/enzyme. Effectively,

it is an “on-off” switch. Potent oxidants, such as

hydrogen peroxide or ozone, can irreversibly oxidize

the thiol. Regardless, viruses have no means

to self-repair even when in the disulfide oxidation

state. Regarding tryptophan, its electron rich indole

group is very vulnerable to irreversible oxidation,

even by hydrogen peroxide.[82] Ozone,

like ascorbate, has been shown to increase the production

of hydrogen peroxide.[83][84] This viral

redox vulnerability theory was verified with the

use of ozone rapidly remitting 100% of 5 cases of

Ebola in 2014. The Ebola virus similarly has a

large quantity of cysteine in its membrane glycoproteins.

57 COVID-19 is associated with microthrombotic

events and, often, a cytokine storm of inflammation.

Ozone could be particularly useful as it improves

the prostacyclin:thromboxane ratio and enhances

nitric oxide production.[85] Ozone has been

shown to reduce production of TNF-a[86] as effectively

as steroids do and increases the production

of the anti-inflammatory enzyme heme oxygenase-

1.[87] Ozone treatment also induces Nrf 2 phosphorylation,

which has been reported to reduce oxidative

stress and proinflammatory cytokines in multiple

sclerosis patients, and, in low doses.[88] Nrf

2 is a regulator of genes related to antioxidant

responses.[89] The limitations of this study include

that most patients were taking nutritional supplements

before they became ill. Therefore, they may

have had fewer nutritional deficiencies compared to

the average American. Furthermore, the majority

of the subjects in this study, which mirrored the

practice, were women. As compared to women,

more men die of COVID-19.[90] Hypertension, diabetes,

and obesity are known co-morbidities with

COVID-19.[91] Our patient population had lower

rates of these illnesses when compared to US averages.

Since this was not a randomized, doubleblind,

placebo-controlled study, the therapies provided

here cannot be proven to cure the symptoms

of COVID-19. The observations of the positive

outcomes are supported by this consecutive case

series even without a control group. During the

COVID-19 pandemic, we felt that it was not ethical

to use a control group and withhold treatment

from ill COVID-19 patients.

Case control series have been shown to play an

important role in evidence generation and in clinical

practice.[92] The author of the fore worded

report, Cynthia Jackevicius states, “Who better than

clinicians—who are the first to see how new therapies

are being used and how patients respond to

the new therapies—to share their valuable insights

and experience in the medical literature through

the use of case reports? A fundamental tenet of

evidence-based clinical practice is to use the best

available clinical evidence, and at times, a case report

or case series is the best available evidence to

guide decision-making.”

Additionally, the results of this study offer a

new consideration for the current medical study

paradigm, which generally evaluates a single agent

(or occasionally more) against a disease or pathogen.

Considering the very favorable outcome of our consecutive

case cohort (no deaths, only one hospitalization

in patients treated prior to admission, and

rapid recovery), this work supports an alternate

paradigm for infection and medical challenges: providing

support of the body’s biochemical/nutritional

needs and augmenting its innate physiological defense

responses. Every substance used in our cohort

is either an essential nutrient or an oxidant mediator

actually manufactured by the body. Nothing foreign

to the body was used, nor anything patentable. The

disparity in the health outcomes under our treatment

protocol and the outcomes in the rates of serious

and critical illness and death under other protocols

is stark and demands further investigation.

5. Conclusion

In summary, we treated 107 COVID-19 patients,

solely with biological therapies, who all recovered.

Only three were hospitalized. Of the three hospitalizations,

two were hospitalized before beginning

our treatment and sought our care post hospitalization.

One was hospitalized while solely taking the

oral regimen of Vitamins A, C, D, and iodine, and

16

Sci, Pub Health Pol, & Law COVID19 Therapy Case Series- July 7, 2020

not the oxidative therapies. All recovered uneventfully.

There were no deaths.

In the state of Michigan, as of 6/21/20, the case

fatality rate was 9.0% (6,067 deaths and 67,097

positive cases of SARS-CoV-2). [92] Therefore,

out of our 107 COVID-19 patients, 10 deaths could

be predicted. At the very least, with 25 patients

testing positive for the virus, we should have expected

two deaths, but in reality, we should have

seen significantly more morbidity considering we

only had 33 tests performed on the 107 patients (all

symptomatic), a median age of 56, and comorbid

conditions. Of the 107 patients total, we should

have experienced at least eight hospitalizations considering

the median age, according to a published

analysis. [93]

As of this publication, no cure, treatment, or

preventive for SARS-CoV-2 has yet been proven

effective in a randomized study, except for

dexamethasone (a potent steroid) use in severely

ill, hospitalized patients. In this study a novel

treatment program, which is hypothesized to aid

and support the immune system, was highly

effective in the re-covery of 100% of 107 patients.

This case review points out that specific and

relatively inexpensive nutritional support along

with oxidative intravenous as well as

intramuscular, and nebulized oxidative solutions

may be helpful for COVID-19 patients. Future,

randomized studies are needed to elucidate the

effectiveness of this or similar regimens.

6. Acknowledgments

The authors would like to acknowledgment Mark

Rosner M.D. for his encouragement and help with

the design of the study.

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***Editor’s Erratum Note, 7/9/2020, 8:20PM

Due to a typographical error, the amount of

Vitamin A in the protocol was originally

reported as 10,000 IU/day. The correct

value should have been 100,000 IU/day.

22