Abstract: medRxiv preprint doi: https://doi.org/10.1101/2021.01.28.21250706; this version posted February 1, 2021. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.
Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and
Reduced Mortality Among Nursing Home Residents
Paul E Alexander MSc, PhD, Robin Armstrong, MD, George Fareed, MD, Kulvinder K.
Gill, MD, John Lotus, BS, Ramin Oskoui, MD, Chad Prodromos, MD, Harvey A. Risch,
MD, PhD, Howard C Tenenbaum, DDS, PhD, Craig M. Wax, DO, Peter A. McCullough,
MD, MPH
Paul E Alexander MSc PhD, McMaster University and GUIDE Research Methods
Group, Hamilton, Ontario, Canada elias98_99@yahoo.com
Robin Armstrong, MD, The Resort at Texas City Nursing Home, Texas City, TX, USA
robarmstr@hotmail.com
George Fareed, MD, Pioneers Health Center, Brawley, CA, USA gfareed@gmail.com
Kulvinder K. Gill, MD, Concerned Ontario Doctors, Toronto, Ontario, Canada
John Lotus, BS, The Foundation for Orthopaedics and Regenerative Medicine
(FOReM), Chicago, IL, USA jlotus21@uchicago.edu
Ramin Oskoui, MD, CEO, Foxhall Cardiology, PC, Washington, DC
oskouimd@gmail.com
Chad Podromomos, MD, The Foundation for Orthopaedics and Regenerative Medicine
(FOReM), Chicago, IL USA chadprodromos@gmail.com
Harvey A. Risch, MD, PhD, Yale School of Public Health, New Haven, CT USA
harvey.risch@yale.edu
Howard C. Tenenbaum DDS, Dip. Perio., PhD, FRCD(C) Centre for Advanced Dental
Research and Care, Mount Sinai Hospital, and Faculties of Medicine and Dentistry,
University of Toronto, Toronto, ON, Canada
howard.tenenbaum@sinaihealth.ca
Craig M. Wax, DO, Family Physician, Independent Physicians for Patient
Independence, New Jersey, AAPS board of Directors
physician1@comcast.net
Peter A. McCullough, MD, MPH, Baylor University Medical Center, Baylor Heart and
Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas,
TX, USA peteramccullough@gmail.com
Address for Correspondence
1
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
medRxiv preprint doi: https://doi.org/10.1101/2021.01.28.21250706; this version posted February 1, 2021. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.
Paul E Alexander MSc PhD, McMaster University and GUIDE Research Methods
Group, Hamilton, Ontario, Canada elias98_99@yahoo.com
Word Count 5546
Funding source(s): none related
Conflict of interest statement for author and co-authors: nothing to disclose
Authors had access to the data and wrote the manuscript
Views and opinions expressed are only of the authors listed and not of their
organizations of employment
Running head: Early Multidrug Regimen for COVID-19 in Nursing Homes
Acknowledgement: We thank Mr. Erik Sass, editor-in-chief of The Economic Standard
for his oversight and input.
Key words: SARS-CoV-2; COVID-19; nursing home; elderly; hospitalization; mortality;
ambulatory treatment; anti-infective; anti-inflammatory; antiviral; corticosteroid;
antiplatelet agent; anticoagulant
2
medRxiv preprint doi: https://doi.org/10.1101/2021.01.28.21250706; this version posted February..
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'abstract': '<jats:title>Abstract</jats:title><jats:p>The outbreak of COVID-19 from severe acute '
'respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous '
'morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted '
'nature of the illness including viral replication, cytokine storm, and endothelial injury '
'with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing '
'home patients. Multi-drug therapy including hydroxychloroquine with one or more '
'anti-infectives, corticosteroids, and antithrombotic agents can be extended to seniors in the '
'nursing home setting without hospitalization. Data from nine studies found multidrug regimens '
'relying on the use of hydroxychloroquine as well as other agents including doxycycline were '
'associated with a statistically significant and >60% reductions in mortality. Going '
'forward, we theorize and based on the evidence, that early empiric treatment for the elderly '
'with COVID-19 in the nursing home setting (or similar congregated settings with elderly '
'residents/patients) has a genuine probability of success and acceptable safety. This group '
'remains our highest at-risk group and warrants acute treatment focus that will prevent the '
'development and/or worsening of problems associated with COVID-19, most particularly '
'isolation, hospitalization, and death. In fact, with the rapidity and severity of SARS-CoV-2 '
'outbreaks in nursing homes, in-center treatment of patients with acute COVID-19 is possibly '
'the most rational and importantly <jats:italic>feasible</jats:italic> strategy to reduce the '
'risks of hospitalization and death. If the approach remains ‘wait-and-see’ and elderly '
'high-risk patients in such congregated nursing room type settings are allowed to worsen with '
'no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics '
'and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. '
'We put forth the notion that the most important factor in this regard, is making available '
'early therapeutic intervention as described here. These drugs include and under supervision '
'by skilled doctors, combination/sequenced ivermectin, hydroxychloroquine, colchicine, '
'azithromycin, doxycycline, bromhexine hydrochloride, and favipiravir (outside the US), along '
'with inhaled steroids such as budesonide and oral steroids including dexamethasone and '
'prednisone, and anti-thrombotic anti-clotting drugs such as heparin). As the clinical trials '
'data on treatments for COVID-19 mature, this early treatment therapeutic option deserves '
'serious, urgent, and sober consideration by the medical establishment and respective '
'decision-makers.</jats:p>',
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