Early Ambulatory Multidrug Therapy Reduces Hospitalization and Death in
High-Risk Patients with SARS-CoV-2 (COVID-19)
Abstract
Background. There is an emergency need for early ambulatory treatment of
COVID-19 in acutely ill patients in an attempt to reduce disease
progression and the risks of hospitalization and death. Methods and
Results. We recently reported results on 320 high-risk (age
> 50 with ≥ 1 comorbidity) COVID-19 cases and have updated
our results with 549 additional cases in period ending December 16,
2020. Our protocol utilizes at least two agents with antiviral activity
against SARS-CoV-2 (zinc, hydroxychloroquine, ivermectin) and one
antibiotic (azithromycin, doxycycline, ceftriaxone) along with inhaled
budesonide and/or intramuscular dexamethasone. Albuterol nebulizer,
inhaled budesonide, intravenous volume expansion with supplemental
parenteral thiamine 500 mg, magnesium sulfate 4 grams, folic acid 1
gram, vitamin B12 1 mg, are administered for severely ill patients who
either present or return to the clinic with severe symptoms. In period 1
(April-September, 2020) 6/320 (1.9%) and 1/320 (0.3%) patients were hospitalized and died, respectively. In period 2,
(September-December, 2020) 14/549 (2.6%) and 1/549 (0.18%) were
hospitalized and died, respectively. For comparison, we used the
Cleveland Clinic COVID-19 hospitalization calculator and based on
average age and comorbidities the expected rate of hospitalization for
both periods was 18.5%. The cumulative mortality among confirmed and
suspected COVID-19 in Collin, Dallas, Denton, and Tarrant counties was
0.76, 1.04, 0.90, and 0.97. As a result, our early ambulatory treatment
regimen was associated with estimated 87.6% and 74.9% reductions in
hospitalization and death respectively, p<0.0001. Conclusions.
We conclude that early ambulatory, multidrug therapy is associated with
substantial reductions in hospitalization and death compared to
available rates in the community. Prompt ambulatory treatment should be
offered to high-risk patients with COVID-19 instead of watchful watching
and late-stage hospitalization for salvage therapies.