ICU resources for COVID-19
Marik Protocol; Front
Line COVID-19 Critical Care Working Group Protocol; Farid Jalali's
beautiful detective work hypothesising about exactly what is happening
in the lungs of COVID-19 patients; Vitamin D to stabilize the
endothelium . . .
Robin Whittle firstname.lastname@example.org
. 2020-04-09 Last update 2020-05-27 15:00 UTC
To the main COVID-19 page of this site: http://aminotheory.com/cv19/
, concerning nutritional supplements - especially vitamin D and boron -
for all adults and some children ASAP, so their immune system will not
be thrown into deadly sepsis by COVID-19. This begins with links to research showing a sharp dichotomy between generally mild symptoms for people with vitamin D 25OHD levels of 30ng/ml or more, and much greater rates of serious symptoms and death for those with 25OHD levels below 30ng/ml.
If everyone in the
world was already replete in vitamin D alone (with the current very
poor boron status) or boron replete (with the current poor vitamin D
status) then I believe that very few people would be dying of COVID-19.
Be sure to read the Disclaimer!
Farid Jalali's hypothesis of vascular damage and shunting via diffuse pulmonary-bronchial anastomoses
Be sure to read this beautiful
detective work which offers the best explanation yet for many
perplexing aspects of COVID-19. The first link is to a video
podcast with PDF and discussion and the second is to a text and graphic
presentation with comments by Cameron Kyle-Sidell MD:
Cameron Kyle-Sidell's appreciative comments begin with:
I applaud Dr. Jalali for proposing a model for COVID-19 injury based on
seemingly sound physiologic principles. This model does provide
explanations for anecdotal observations made by bedside physicians
treating COVID-19 patients. For example, the presence of
dorsal-predominant shunting would explain why proning leads to marked
oxygenation improvement that is not sustained once the patient returns
to the supine position.
This work highlights the importance of protecting the integrity of the endothelium and limiting vasoconstriction, which is caused by excessive angiotensin II, resulting from SARS-CoV-2 destroying the ACE2 receptors. See the next item.
Vitamin D and Endothelial Function
Your COVID-19 patients are (according to Philippino and Indonesian research I cite here cv19/
generally seriously deficient in vitamin D. Surely you can
improve their chances of survival with vitamin D supplements.
Cholecalciferol (D3) takes days to convert to 25OHD in the liver - and
the liver may not be functioning well. So high dose oral D3 -
such as 50,000 or 100,000IU, ideally with a meal including fats - when
they arrive in hospital, is one way to start. If you can do oral
of IV 25OHD (calcifideol = Rayaldee
then this would be faster. Most immune system cells require
plasma 25OHD for their internal synthesis of 1,25OHD to activate their
internal (intracrine) vitamin D receptor signaling. So the whole
of immune regulation depends on a good 25OHD level.
Other cells, such as endothelial cells, require 1,25OHD calcitriol at
their membrane bound vitamin D receptors, and so may not rely directly
on plasma 25OHD levels.
Please see this recent review article:
Adequate vitamin D activation of endothelial cells achieves numerous functions:
- Increase vasodilation by releasing NO.
- Bring more calcium into the cell and release it from internal
stores to activate eNOS which produces the NO and stop AG2 catabolizing
L-arginine so it can be used by eNOS.
NO is a primary vasoactive substance that works as a potent vasodilator in addition to other vasoprotective properties such as protection from vessel inﬂammation and lesion formation.
NO acts on adjacent vascular smooth muscle cells in a paracrine manner
and induces vascular muscle relaxation . . .
. . . protects the vessel from developing atherosclerosis by inhibiting platelet adherence and aggregation, and leukocyte activation.
COVID-19 Protocol for early intervention to reduce cytokine storm
and so reduce or eliminate the deadly hypercoagulative state
The website of the Front
Line COVID-19 Critical Care Working Group
Please follow all the links to protocol, press release and other
documents there, as well as documents linked from theirs:
in Critical Illness: Glucocorticoid Receptor-alpha Master Regulator of
Meduri & Chrousos
The original website was: recoverywithoutwalls.com/covidprotocol/
The protocol concerns the early
use of methylprednisolone, low molecular weight heparin, IV vitamin C
and hydroxychloroquine, before to reduce or prevent the development of
the cytokine storm which causes the hypercoagulative state which is
what harms and kills people. Other elements are nasal cannula
oxygen with prone positioning and avoidance of incubation as much as
possible. In late April, they added optional vitamin D to
their ICU protocol.
An excellent write-up by Caitlin Dickson: news.yahoo.com/...doctors-question-how-we-use-ventilators-123733204.html
The Marik Protocol
EMCrit discussion on timing of corticosteroids
Josh Farkas and
commenters discuss the timing and strength of corticosteroid use with
Dr Cameron Kyle-Sidell's videos on how different COVID-19 is from
what he trained for
L. Gattinoni et al. on L and H "phenotypes"
Dr Farid Jalali's COVID-19 diagram concerning cytokine storm and
resulting hypercoagulative state
Farid Jalali twitter.com/farid__jalali
tweeted a detailed diagram twitter.com/farid__jalali/status/1247036001349849088
depicting the cytokine storm turning a moderately PAI-1 elevated
coagulative state, which apparently can be controlled with heparin,
into a hypercoagulable Progressive Thrombotic Cascade. The long
progression of this thrombosis apparently enables the oxygen levels to
drop slowly enough that the patient copes with it better than would be
the case with normal ARDS. This leads to microvascular thrombosis
in the lungs, heart, kidney, gut, pancreas, skin and CNS - and so
frequently to death.
He states that COVID-19 is cytopathic to the endothelium and that
this degenerates (as far as I know, in the absence of vitamin C etc.
treatment) into the Severe COVID-19 cytokine storm. This makes me
think that the vitamin C, corticosteroid etc. treatment prevents the
virus and the consequent (at least in these patients) immune response
doing so much harm to the endothelium.
../ to the main COVID-19
page of this site.
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2020 Robin Whittle - please link to this site rather than copy the
whole of its contents Daylesford, Victoria,