Last week we warned readers about unproven COVID-19 treatments. The FDA and the FTC cracked down on companies that were marketing essential oils, tinctures and teas to combat the coranovirus. There are no FDA-approved drugs or other treatments for this infection. That said, there are some intriguing studies suggesting that drugs like chloroquine, hydroxychloroquine and even a dietary supplement called quercetin might help control coronavirus.
Is There Real Science?
Let me introduce you to Dr. Roger Seheult. This physician has a unique ability to explain very complicated medical processes in ways that even most laymen can understand. He is an Associate Clinical Professor at the University of California, Riverside, School of Medicine.
His specialties include pulmonary medicine, internal medicine, critical care medicine, intensive care and sleep medicine. He helps medical students, physicians, nurses and many other health professionals cram for medical exams. Here is a short video that allows you to better appreciate who Dr. Seheult is and why his coronavirus information is so interesting. He is uniquely equipped to discuss ways to potentially control coronavirus.
Here is a link to his YouTube video on potential treatments that might help control coronavirus:
We warn you that this is a bit technical, but it is worth spending a few minutes watching this YouTube video. It has had over 500,000 views over the last several days. You will learn about a drug for rheumatoid arthritis, lupus and malaria called hydroxychloroquine (Plaquenil). It has been on the market since 1955. You will also learn about a dietary supplement called quercetin. Both may have antiviral activity that just might help control coronavirus.
In case you are not ready to spend a few minutes watching this video, here is the executive summary:
Next, Dr. Seheult discusses the antiviral activity of hydroxychloroquine. He mentions something called ARDS (Acute Respiratory Distress Syndrome) which is the hallmark of the COVID-19 infection and can be lethal.
“Hydroxychloroquine was found to be more potent than chloroquine to inhibit SARS-CoV-2 in vitro.”
The name SARS-CoV-2 is the official medical name for the coronavirus that causes COVID-19. He also emphasizes that this paper is all about in vitro data. In other words, in a test tube or petri dish, not in humans. He goes on to describe both prophylaxis and treatment with both hydroxychloroquine and chloroquine through in vitro testing. He mentions the dosing recommendations from the authors in the article based on the test-tube testing.
We found one statement by Seheult particularly intriguing. He tells his medical colleagues:
“So as hospitals across the country start to see this kind of infection coming in, this may be one type of treatment that you consider.”
If you really want to understand what is going on you will need to watch a somewhat more mechanistic video that explains why the malaria drug chloroquine and zinc work to interfere with the replication of the coronavirus. Here is a link to that fascinating earlier video:
Next, Dr. Seheult talks about a natural substance called quercetin. He describes this flavonoid that is found in berries (raspberries, cranberries, blueberries), fruits, vegetables, green tea and red wine. He puts up a link to WebMD about quercetin:
“This study indicates that quercetin showing inhibitory activity in the early stage of influenza infection provides a future therapeutic option to develop effective, safe and affordable natural products for the treatment and prophylaxis of IAV [influenza A virus] infections.”
This, of course, is not COVID-19 but influenza virus. What about the coronavirus?
Dr. Seheult mentions that quercetin:
“has already proven successful at treating Ebola and Zika viruses.”
He then goes on to cite a CBC (Canadian Broadcasting Corporation) report that Montreal researchers are getting ready to test quercetin against COVID-19 in China. Here is a link to the CBC video from a few weeks ago.
You will find this interview with Michel Chrétien quite understandable and impressive. Here is a link to his biography. He is a heavy hitter!
Dr. Seheult has done some research on this OTC dietary supplement. In particular, he translated dosing information from Ebola and Zika tests. He reports that 3 to 7 grams per day were necessary against these viruses.
He goes on to summarize his observations:
1) We have no randomized controlled trials, so we can’t say any of this works.
2) Hydroxychloroquine was more active than chloroquine based on a Chinese test in vitro. The dose that in that in-vitro test translates to 400 mg twice a day for one day and 200 mg twice a day for four days.
3) Quercetin is OTC and we don’t know dosing.
He does not encourage boosting zinc levels as long as people are not zinc deficient. People who are low in zinc may need a supplement.
To Put Hydroxychloroquine into Perspective:
The dose for people with rheumatoid arthritis is:
“Initial adult dosage: 400 mg to 600 mg (310 to 465 mg base) daily, administered as a single daily dose or in two divided doses. In a small percentage of patients, side effects may require temporary reduction of the initial dosage.
“Maintenance adult dosage: When a good response is obtained, the dosage may be reduced by 50 percent and continued at a maintenance level of 200 mg to 400 mg (155 to 310 mg base) daily, administered as a single daily dose or in two divided doses.”
Some Side Effects of Hydroxychloroquine:
Headache, ringing in the ears
Digestive distress: nausea, vomiting, diarrhea, stomach pain, weight loss
Itching, serious skin reactions
Heart rhythm irregularities, heart disorders
Side Effects of Quercetin:
This natural flavonoid is available over the counter. It helps reduce inflammation. Some people take it for symptoms of arthritis. Others find it helps their allergies. There is even some data suggesting that quercetin may have anti-cancer activity.
In gram doses quercetin may cause stomach pain or headaches. It is generally considered relatively safe, especially compared to most medications.
“Quercetin has GRAS (Generally Recognized As Safe) status, and no side-effects have yet been noted in doses of a few grams a day in either humans or animals.”
Compared to hydroxychloroquine, quercetin is very safe. Whether it will work in humans to control coronavirus will take several weeks or months to demonstrate. Dr. Chrétien is hoping to get data from his Chinese colleagues within a few weeks. How soon we will learn about the outcome remains to be seen.
Other Compounds That May Prove Useful:
Remdesivir for COVID-19?
One medication that is currently being tested is an antiviral drug called remdesivir. Gilead Sciences was developing it as a possible treatment for the horrific and lethal viral disease called Ebola, but it had shown potential against previous coronaviruses SARS and MERS (PNAS, Feb. 13, 2020). Remdesivir jams the “machinery” the virus uses to replicate itself, an enzyme called a polymerase. For this trick to work well, though, it needs to be given as early in an infection as possible.
The World Health Organization is hopeful that it might be at least somewhat effective against SARS-Cov-2 as well, and it is now in five clinical trials. You can learn a bit from this YouTube video about the research going on at the University of North Carolina. The clinical trials are crucial, since we don’t yet know if it will work.
Without the results of clinical trials, we also don’t know much about the side effect profile. Presumably, it was far enough along in testing against Ebola that it is considered “safe enough.” Preliminary reports suggest that it may cause gastrointestinal distress such as diarrhea, and high liver enzymes could indicate stress on that organ. Researchers will be considering how well patients tolerate the drug as well as how well it works.
Repurposing Antiviral Combinations to Control Coronavirus:
A combination of lopinavir and ritonavir is used to treat HIV infections. Doctors prescribe this combo by the brand name Kaletra. Now, some scientists are testing it to see if it is effective for COVID-19 infections as well. Chinese researchers have published very preliminary results, based on ten patients in Hangzhou (International Journal of Infectious Diseases, March 12, 2020). Another group of Chinese investigators found that this combination worked more quickly to knock down viral load if they added arbidol, an antiviral drug used in China and Russia to treat influenza (Journal of Infection, March 11, 2020). However, as with the other drugs, we need placebo-controlled trials to see whether this combo really works. One very early trial conducted in Wuhan as the epidemic was getting underway has now reported disappointing results (New England Journal of Medicine, March 18, 2020). In the US, some organizations are testing Kaletra, with or without an anti-flu drug such as oseltamivir, to see if it can control coronavirus.
At the moment, we can only say that there are no FDA-approved drugs or dietary supplements to control coronavirus. Everyone is rushing to develop a vaccine, but Dr. Anthony Fauci (Director of the National Institute of Allergy and Infectious Diseases) has stated repeatedly that it could well take a year or longer before we even know if a vaccine works. In the meantime, we hope that some existing drug may prove to work in vivo (in the body) to control coronavirus. Perhaps one of the compounds Dr. Seheult describes in his videos will prove to be effective. Fingers crossed.
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Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” Read Joe's Full Bio.
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Yao, X., et al, "In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)." Clinical Infectious Diseases, March 9, 2020. DOI: 10.1093/cid/ciaa237
de Wit E et al, "Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection." PNAS, Feb. 13, 2020. DOI: 10.1073/pnas.1922083117
Liu F et al, "Patients of COVID-19 may benefit from sustained lopinavir-combined regimen and the increase of eosinophil may predict the outcome of COVID-19 progression." International Journal of Infectious Diseases, March 12, 2020. DOI: 10.1016/j.ijid.2020.03.013
Deng L et al "Arbidol combined with LPV/r versus LPV/r alone against Corona Virus Disease 2019:a retrospective cohort study." Journal of Infection, March 11, 2020. DOI: 10.1016/j.jinf.2020.03.002
Cao B et al, "A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19." New England Journal of Medicine, March 18, 2020. DOI: 10.1056/NEJMoa2001282
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