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ABSTRACT
Introduction
COVID-19 disease progresses through a number of distinct phases. The management of each phase is unique and specific. The pulmonary phase of COVID-19 is characterized by an organizing pneumonia with profound immune dysregulation, activation of clotting, and a severe microvascular injury culminating in severe hypoxemia. The core treatment strategy to manage the pulmonary phase includes the combination of methylprednisolone, ascorbic acid, thiamine, and heparin (MATH+ protocol). The rationale for the MATH+ protocol is reviewed in this paper.
Areas covered
We provide an overview on the pathophysiological changes occurring in patients with COVID-19 respiratory failure and a treatment strategy to reverse these changes thereby preventing progressive lung injury and death.
Expert opinion
While there is no single ‘Silver Bullet’ to cure COVID-19, we believe that the severely disturbed pathological processes leading to respiratory failure in patients with COVID-19 organizing pneumonia will respond to the combination of Methylprednisone, Ascorbic acid, Thiamine, and full anticoagulation with Heparin (MATH+ protocol).We believe that it is no longer ethically acceptable to limit management to ‘supportive care’ alone, in the face of effective, safe, and inexpensive medications that can effectively treat this disease and thereby reduce the risk of complications and death.
KEYWORDS:
Article highlights
Patients infected with SARS-CoV-2 progress through a number of phases with the treatment of COVID-19 being highly specific for each phase of the disease.
The pulmonary phase of COVID-19 is characterized by the development of an organizing pneumonia, severe pro-inflammatory state, and activation of clotting with macro- and microvascular thrombosis and hypoxemia.
Supportive treatment alone is no longer acceptable during the pulmonary phase of COVID-19.
Patients who have progressed to the pulmonary phase of COVID-19 are likely to benefit from treatment with the core components of the MATH protocol, consisting of methylprednisolone, ascorbic acid, thiamine, and full anticoagulation with heparin.
The core components of the MATH protocol are safe, reasonably inexpensive, and readily available.
We postulate that the addition of melatonin, famotidine, vitamin D, elemental zinc, magnesium, and atorvastatin (MATH +) will potentiate the efficacy of the core MATH components.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.