By Bob Kronemyer

Intravenous vitamin C and intravenous ozone are two simple, synergistic and low-cost adjuvant therapies that have been found to be effective for managing COVID-19 in patients who have just been hospitalized, according to an article in Revista Espanola de Anestesiologia y Reanimacion (2020 Apr 14. [Epub ahead of print]. S0034-9356(20)30075-X). There are virtually no side effects with this approach.

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“Vitamin C has a long track record,” said co-author Peter Papadakos, MD, FCCM, FAARC, the director of critical care medicine at the University of Rochester Medical Center and a professor of anesthesiology, surgery, neurosurgery and neurology at the University of Rochester, in New York. As an example, he and his colleagues have been using vitamin C for its anti-inflammatory effects and for fluid modulating purposes in severe burn patients for many years. Others have used vitamin C to treat sepsis and acute respiratory distress syndrome.

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“With the global pandemic of COVID-19, we thought vitamin C would be an ideal agent to use in these patients,” Dr. Papadakos said. “Vitamin C has immunomodulating activity and reduces alveolar epithelial water in burns. It also has a very good safety profile.”

For IV administration of vitamin C, Dr. Papadakos recommended doses typically ranging from 0.2 to 0.5 g, whereas central venous access is preferred for very high doses, sometimes over 50 g/d (Table 1).

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Table 1. Protocol for IV Vitamin C Administration for COVID-19 Infection
  • Central venous access preferable for very high doses (>50 g)
  • Check: blood count, renal function,1 electrolytes and G6PD
  • Check IL-6; ferritin levels may be a useful indicator of therapeutic response and prognosis
  • Use sterile water, PlasmaLyte or Lactated Ringer’s for mixture, or dextrose 5%-10%
  • Doses: 0.2-0.5 g vitamin C2
  • Administer daily until improvement, then every 2 days
  • Infusion rate: adjust for 0.25-0.5 g/min (usually 1 to 4 h according to dose)
  • Supplement with calcium and/or magnesium IV, if necessary
  • If possible add zinc sulfate 220 mg/24 h,3 thiamine 400 mg/d, vitamin D 5,000-10,000 IU/24 h,4 vitamin E 1600 IU/48 h oral/NG, melatonin 6 mg/24 h oral at night
1 Caution with doses and frequency of administration.
2 If patient is in critical condition, suggest dose administration twice a day (every 12 hours).
3 220 mg of zinc sulfate contains 50 mg of elemental zinc.
4 Aim for 25(OH) level of 80-90 nmol/L.
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Peter Papadakos, MD, FCCM, FAARC

Other components are added to the IV solution, if possible: zinc sulfate (200 mg over 24 hours), thiamine (400 mg daily), vitamin D (5,000-10,000 IU over 24 hours), and vitamin E (1,600 IU over 48 hours).

“All of these elements have been shown to be helpful,” Dr. Papadakos said. Treatment can also be supplemented with calcium and magnesium by IV, if necessary.

Ozone Disrupts Coronavirus

As a treatment, ozone attacks the envelope of coronaviruses, according to Dr. Papadakos. “By affecting cysteine, ozone disrupts viral proteins, lipoproteins, lipids and glycolipids in the actual virus. As a result, ozone creates a dysfunctional virus, which cannot replicate.” Ozone therapy also affects certain coagulation parameters.

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To prepare ozone for IV, the patient’s blood is saturated with ozone from a medically approved ozone machine, then the patient’s blood containing the ozone molecule is infused into the patient (Table 2).

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Table 2. Ozone Autohemotherapy Protocol For COVID-19 Infection
  • Exclusive venous access for ozone administration. Peripheral venous access is preferable on the ward; use a central line for ICU patients
  • Blood removal: 150-200 mL
  • Anticoagulant to add in the sterile bottle or bag: - Heparin sodium: 1,000 IU for each 100 mL of blood removed; or - Sodium citrate 3.13%: 10 mL for each 100 mL of blood removed; or - ACD-A (Anticoagulant Citrate Dextrose A): 14 mL for each 100 mL blood removed
  • Initial dose: 40 mcg/mL of ozone. Increasing dose is acceptable in ensuing days to a maximum of 70 mcg/mL
  • Volume of gas O2/O3 200 mL
  • Shake the bottle gently once ozone is mixed with the blood and every 2 minutes during administration
  • 2 sessions per day in non-critically ill patients and 4 sessions per day in critically ill patients until improvement
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Peripheral venous access is favored, using a butterfly infusion set or cannula. The ozone/oxygen mixture is adjusted to a 1:1 ratio, with a starting dose of 25 mcg/mL of blood, followed in subsequent days by up to 80 mcg/mL.

The combination IV therapy begins with vitamin C at an intermittent infusion time of usually one to four hours, depending on the dose, followed by one to four hours of ozone, and then repeating the protocol over a few days.

“Because many COVID-19 patients require intubation, anything we can do to prevent intubation will greatly lessen the health care burden,” Dr. Papadakos said. “Part of the surge that hospitals are experiencing is from patients being intubated, which leads to mechanical ventilation for 10 to 15 days. That ties up the technology. Thus, anything we can do to try to decrease that initial inflammatory response and prevent the patient from being intubated in the first place helps not only the patient, but mitigates the surge as well. Our proposed synergistic therapy allows COVID-19 to become a more treatable disease.”