New outpatient protocol for COVID-19?

With the rising number of COVID-19 cases in Illinois, a group of more than 750 doctors has piloted a COVID-19 protocol that the group feels is promising.

In mid-October, the DuPage Medical Group began using aspirin, Pepcid, zinc, iron and vitamins C and D for its patients who have tested positive for COVID-19, according to Dr. Mathew Philip, internal medicine physician and medical director of clinical innovation at DMG.

“We’ve been keeping in touch with the latest research since the pandemic began,” Philip said. “What I was noticing was that a lot of the research tends to focus on the people who are hospitalized. But the vast majority, greater than 90%, are treated outpatient. But there’s not one treatment for patients who are hospitalized.”

Philip said he works in a high-risk clinic, so he typically sees patients with emphysema, heart failure, kidney disease and diabetes – patients at higher risk for severe COVID-19.

Philip said the main factors contributing to severe illness were blood clots and inflammation. Inpatient treatment has included aspirin and other blood thinners and dexamethasone, a powerful steroid, he said.

So Philip said he worked with a infectious disease specialist, two pulmonary and critical doctors, and two emergency department doctors to develop the new outpatient therapeutic consideration protocol to support COVID-19 patients early in their illness.

“The very first patient we used this on had underlying medical conditions,” Philip said.

In addition to fatigue and fevers, this patient and her husband had gastrointestinal and respiratory symptoms, he said. So he suggested they follow the protocol.

“They were doing better by the next day,” Philip said.

Philip said the couple continued to progress and made a full recovery. Out of the first 20 patients who used the protocol, only one was hospitalized, he said. And these were all high-risk patients.

“And she was 40,” Philip said of the one who was hospitalized. “She was hospitalized with blood clots and made a full recovery.

“Since then, DMG doctors have used the protocol with hundreds of normal-risk patients, including those in the Joliet area, and all patients have done well.”

“I have not heard of any hospitalizations,” he said.

Philip said some patients’ symptoms have been so mild while using this protocol, they find it hard to believe they have COVID-19.

But DMG doctors received confirmation through testing for the presence of the virus and then later followed up with antibody tests, he said.

“Using this outpatient strategy allows us to support our COVID-19 patients early in their illness, before they require hospitalization,” Dr. Mia Taormina, chair of the infectious disease department at DMG, said in a news release from DMG. “We have seen success using these therapeutic strategies among our highest risk COVID-19 patients and look forward to standardizing this approach organization-wide in the coming days.”

Philip cited a recent study from the University of Maryland School that researchers said provided "cautious optimism" in the use of aspirin in the treatment of COVID-19 patients.

In the study, researchers looked through the medical records of 412 COVID-19 patients, who were hospitalized because of the virus. About a fourth of the patients were taking low-dose aspirin to manage cardiovascular disease.

Researchers found patients on aspirin therapy were 44% less like to be placed on a ventilator, 43% less likely to be admitted to an intensive care unit and 47% less likely to die in the hospital.

Earlier this month, it was announced that the world's largest clinical trial (6,000 patients and 176 hospital sites in the United Kingdom) of treatments for patients hospitalized with COVID-19 will now investigate aspirin, too.

What about the vitamin supplements?

Cleveland Clinic Journal of Medicine said that, although a number of studies suggest zinc and vitamins C and D "may have biologic plausibility for the prevention and treatment of COVID-19," additional research is needed.

Other studies suggest low levels of vitamin D may contribute to severe COVID-19. But if, when and how to supplement are all questions that need further study.

The research on iron is controversial, with some studies exploring the relationship iron has on the disease and concern about the safety of supplementation.

However, a study from Hartford HealthCare may support the benefit of Pepcid in patients with COVID-19.

After seeing that 85 of 900 patients had taken Pepcid while hospitalized, researchers noted two things: Those taking Pepcid had a 45% reduced risk of dying in the hospital and a 48% reduced risk of needing a ventilator.

The Pepcid website said Pepcid is "not indicated for the treatment or prevention of COVID-19."

Philip stressed the DMG protocol is only for adult patients. He said patients should not supplement without talking to their doctors first. Or they may schedule a visit with a DMG doctor.

He also said the protocol is not a substitute for social distancing, wearing face masks and frequent handwashing. Philip also doesn’t want patients taking the virus lightly; he wants them to be as safe as possible during this time.

“This is only adding another layer of protection,” he said.

In addition to Philip and Taormina, the the following DMG doctors also helped develop the therapeutic consideration protocol: Dr. Jonathan Claud (immediate care), Dr. Ravi Nemivant (pulmonary medicine and critical care) and Dr. Ted Shieh (immediate care).