An overview of the MATH+, I-MASK+ and I-RECOVER Protocols A Guide to the Management of COVID-19
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Updated as of February 22, 2022)
Developed and updated by Paul Marik, MD, FCP (SA), FRCP (C), FCCP, FCCM for the Front Line COVID-19 Critical Care Alliance (FLCCC)
This is our recommended approach to COVID-19 based on the best (and most recent) literature. This is a highly dynamic topic; therefore, we will be updating the guidelines as new information emerges. Please check on the FLCCC Alliance website (www.flccc.net) for updated versions of this protocol.
Disclaimer: The information in this document is provided as guidance to physicians worldwide on the prevention and treatment of COVID- 19. Our guidance should only be used by medical professionals in formulating their approach to COVID-19. Patients should always consult with their physician before starting any medical treatment.
The FLCCC AllianceTM is registered as a 501(c)(3) non-profit organization.
Updates in this version:
Typographical corrections
Minor changes to the I-RECOVER protocol
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Introduction
1.1 The Vacuum of Truth 3 1.2 The Use of “Off-Label” Drugs 3 1.3 An Overview of the Treatment of COVID-19 3 Pre- and Postexposure Prophylaxis (I-MASK+ protocol)
2.1 Core Components of the I-MASK+ Prophylactic Protocol 11 2.2 Nutritional Supplements 13 2.3 Prevention Protocol in Children and Adolescents 15
Symptomatic Patients at Home (I-MASK+ Early Treatment Protocol)
3.1. First Line Treatments 19 3.2. Second Line Treatments 20 3.3. Optional Treatments (and those of uncertain benefit) 22 3.4. Post Covid (Omicron) treatment 23 3.5. Management of Pediatric Patients (CHILD CARE) 24
Mildly Symptomatic Patients (On floor/ward in hospital)
4.1 First Line Therapies 28 4.2 Second Line and Optional Treatments 29
5. MATH+ PROTOCOL (For Patients Admitted to the ICU)
5.1 Core Components 33
5.2 Additional Treatment Components 34 5.3 Second Line Treatments 35 5.4 Optional Treatments (and those of uncertain benefit) 35
An Approach to the Patient with Severe Life-Threatening COVID-19 39 The “Full Monty” for Severe COVID Pulmonary Disease 40 Salvage Treatments 41 Salvage Treatments of Unproven/No Benefit 41 Treatment of Macrophage Activation Syndrome (MAS) 42 Approach to the DELTA/P1 Variant 42 Approach to the Omicron Variant 42 Monitoring 43 Post ICU Management 43 Post Hospital Discharge Management 44 Pathophysiology of COVID-19 44
The Long Haul COVID syndrome (post-COVID syndrome)
17.1 Approach to Treatment 47 17.2 The I-RECOVER Protocol 48 17.3 First Line Therapies 48 17.4 Second Line Therapies 49 17.5 Third Line Therapies 49 17.6 Optional Adjunctive Therapies 49 Key Concepts of the I-MASK+ and MATH+ Treatment Protocols 50 References 54
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1. Introduction
1.1. The Vacuum of Truth
“The first step is to give up the illusion that the primary purpose of modern medical research is to improve Americans’ health most effectively and efficiently. In our opinion, the primary purpose of commercially funded clinical research is to maximize financial return on investment, not health.”
—John Abramson, M.D., Harvard Medical School
We are living through a period of time characterized by a “Vacuum of Truth,” with misinformation, disinformation, blatant lies, censorship, and nefarious intentions being the order of the day. It is difficult to dissect out the actual truth and discern whom to trust. Furthermore, it is no longer controversial to acknowledge that drug makers rigorously control medical publishing and that The Lancet, New England Journal of Medicine (NEJM), and Journal of the American Medical Association (JAMA) are utterly corrupted instruments of Big Pharma.
The Lancet editor, Richard Horton has stated, [1] “Journals have devolved into information laundering operations for the pharmaceutical industry.” Dr. Marcia Angell, who served as an NEJM editor for 20 years, says journals are “primarily a marketing machine.” [2] Pharma, she says, has co-opted “every institution that might stand in its way. Complex scientific and moral problems are not resolved through censorship of dissenting opinions, deleting content from the Internet, or defaming scientists and authors who present information challenging to those in power. Censorship leads instead to greater distrust of both government institutions and large corporations. [3]
1.2 The Use of “Off Label” Drugs
Once the FDA approves a prescription medication, federal laws allow any U.S. physician to prescribe the duly approved drug for any reason. [4] Thirty percent of all prescriptions written by American doctors, exercising their medical judgment, are for off-label uses. The Attorney General of Nevada,[5] as well as many other states have asserted the right of physicians to prescribe “off label” drugs such as ivermectin and hydroxychloroquine for the treatment of COVID-19. The office of Nebraska Attorney General Doug Peterson released a legal opinion on October 15 2021 saying it didn’t see data to justify legal action against health care professionals who prescribe ivermectin or hydroxychloroquine. [5]
1.3. An Overview of the Treatment of COVID-19
While there is no cure or “magic bullet” for COVID-19, recently, a number of therapeutic agents have shown great promise for both the prevention and treatment of this disease. These include ivermectin, Vitamin D, quercetin, melatonin, fluvoxamine, spironolactone, corticosteroids, curcumin (turmeric), Nigella sativa and antiandrogen therapy. It is critical to recognize that infection with SARS-CoV-2 progresses through a number of stages/phases and that treatment is highly stage-specific (see Figures 1- 4 and Table 1). It is likely that no single drug will be effective in treating this complex disease and that multiple drugs with different mechanisms of action used in specific phases of the disease will be required. A growing body of evidence suggests that many of these agents may act synergistically in various phases of the disease. [6-8] Furthermore, an understanding of the structure of SARS-CoV-2 (see Figure 5) as well as the pathophysiology/pathogenesis of COVID-19 is critical in treating the disease. [9]
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Finally, the relentless malpractice of deliberately withholding effective early COVID treatments, and of forcing the use of toxic remdesivir in hospitalized patients, may have unnecessarily killed up to 500,000 Americans (see Figures 6a-c). [3]
As the pandemic has played out over the last year, over four million patients have died worldwide, and the pandemic shows no signs of abating. Most countries across the globe have limited resources to manage this humanitarian crisis. We developed the MATH+ protocol to provide guidance for the treatment of the pulmonary phase of this disease with the goal of reducing hospital mortality from this devastating disease.
However, it soon became obvious that our emphasis needed to shift to the prevention and early (home) treatment to prevent patients progressing to the pulmonary phase and requiring hospitalization (see Figure 5). Hence, we developed the I-MASK+ protocol. While we strongly believe that such an approach can mitigate the development and progression of this disease, limit deaths, and allow the economy to re-open, so-called “health care authorities” across the globe have been silent in this regard, including the WHO, CDC, NIH, and others (see NIH Guidance, Figure 6a and 6b).
While vaccination may be part of the solution to the COVID-19 pandemic, it will take many months — if not years — to vaccinate the 70-85 percent of the world’s population required for “herd immunity.” Mutant strains of SARS-CoV-2 have recently appeared, demonstrating increased transmissibility. [10-13] Many of these mutations involve the spike protein (which almost all of the vaccines have targeted), raising the real possibility that the vaccines may become less effective (or ineffective) against the mutating strains. [10,11,14-19] Indeed, the protective immunity of the vaccines against both the Delta and Omicron variants has come into question. [16-20] We believe that the I-MASK+ protocol provides both a bridge and an alternative to universal vaccination.
And, finally the post-COVID syndrome or “long-hauler syndrome” has emerged as a common and disabling disorder, and its pathophysiology is poorly understood. We offer the I-RECOVER protocol to help treat this disabling disorder. Recently, post-vaccination syndrome has emerged as a problematic entity; we believe the I-RECOVER protocol has utility in treating this syndrome as well.
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