By Mary Beth Pfeiffer
He is 57 years old with mild asthma, hypertension and atherosclerotic cardiovascular disease. His medical issues did not stop him from jogging six miles last Saturday, October 24th. But nor did his blue-ribbon fitness stop him from testing positive two days later for COVID-19.
Meet Dr. Peter McCullough, vice chair of internal medicine at Baylor University Medical Center in Dallas and author of 20 manuscripts on the pandemic he calls “a disaster of a lifetime.” Like many newly infected COVID patients, McCullough is sheltering at home, windows open for ventilation, waiting out what he so far calls “no picnic…no fun.”
The key difference, however, is that McCullough is getting early treatment. Unlike too many other patients, the internist has access to essential medications and the expertise to use them. For the rest of us, the National Institutes of Health recommends no early treatment at all while government edicts discourage or forbid doctors from using drugs that haven’t been subject to lengthy trials.
In the last two weeks, COVID-19 cases have soared 42 percent in the United States, and deaths have gone up 16 percent. The lack of early stage care for the infected alarms a growing number of physicians and advocates, who have started Facebook groups, networked through Twitter, filed lawsuits and organized protest groups.
Media reports regrettably sometimes paint them as misguided and ill-informed. McCullough is about as mainstream and COVID savvy as it gets. And he believes that a medically sound and ethical COVID approach should involve aggressive care with drugs that are safe, even if not specifically approved for COVID. Indeed, only one drug – the minimally effective remdesivir – has the FDA’s stamp of approval for COVID-19.
McCullough shared his unfolding COVID experience with me after, rather unexpectedly, revealing his infection last Tuesday October 27th in a webinar on COVID treatment sponsored by the policy group COVEXIT. About 40 minutes into his low-key, fact-filled talk, McCullough said, “You may have noticed that I sneezed a little bit through the presentation. Yesterday I got the bad news that myself, I, developed COVID-19.”
And so, this researcher, who has treated more than 100 COVID patients, went from physician to patient in an early treatment protocol that he helped design. The protocol is a collaboration of about two dozen U.S. and Italian researchers; it was published in August in the American Journal of Medicine and since updated. Like other protocols – originating in France, California and New York – the regimen firmly rejects the current sicken-in-place approach that leaves COVID patients untreated until, intensely ill, they land in a hospital. Rather, it lays out a regimen of safe, common drugs as the first resort for patients over 50 or those with obesity, cancer, diabetes or cardiac, kidney or pulmonary disease.
“We cannot have patients at risk, like myself, sit at home with no treatment,” McCullough said during the webinar. “It’s wrong and it shouldn’t happen.” Sick with COVID and showing signs of respiratory distress, McCullough continued his crusade two days later, posting a YouTube video on why the hospital-dependent approach must change. In Italy, he said, 12 percent of hospital patients on oxygen succumb to COVID, as do 22 to 34 percent of Americans who land in the ICU. “All of this,” he commented, “in my view is largely avoidable.”
Treat patients like Trump
Significantly, President Trump’s care is an instructive, though hardly practical, model in two ways, McCullough maintains.
First, “President Trump in the United States had an illness at about my level of severity right now,” told viewers from Belgium, Denmark, Kosovo, Australia, Canada and the U.S. “He had fever, nasal congestion and other symptoms. He received prompt treatment.”Second, Trump’s care included two of the three types of drugs, though not the same drugs, that McCullough recommends starting early – namely an antiviral drug, which in Trump’s case was the classic underperformer remdesivir, and a steroid to tamp down COVID’s sometimes harmful immune response, dexamethasone. (The third drug class recommended by McCullough is an anticoagulant to stop blood clotting and potential stroke.)
That’s where the similarities between the models end.
The day he tested positive, McCullough began treatment with two drugs that for decades have successfully fought off human parasites and are on the WHO’s List of Essential Medicines: ivermectin on the first day and hydroxychloroquine on the second. (The dosages and duration are listed below.)
An antimalarial-turned-antiviral drug, hydroxychloroquine has been vilified largely because of Trump’s repeated endorsement, its exaggerated side effects, and failed trials that often gave the drug too late. But a body of peer-reviewed early-stage studies has found it effective, particularly with an antibiotic and zinc. A recent meta-analysis of 126 studies found that early treatment led to a 63 percent reduction in the outcome measured, including in mortality and hospitalization.
Ivermectin, known as a wonder drug against river blindness in the tropics, is emerging as a less-controversial antiviral for COVID with an excellent safety record. Several studies have shown promise in preventing and treating COVID at several stages, including a combination drug trial with ivermectin that saved critically ill patients in Broward County, Florida. Both antiviral drugs are being used against COVID in poorer or third-world countries that have few choices in care – Guatemala, Peru, parts of India, Bangladesh, Brazil and Greece — and citizens there appear to be benefitting. One theory holds that COVID rates are low in Africa because of routine mass administration of ivermectin for parasite control. Clearly more studies are needed.
Beyond their effectiveness, these generic drugs are cheap and available. Outpatient care with ivermectin or hydroxychloroquine costs $10 to $20 in the United States. Compare that to $3,000 for Trump’s remdesivir course, excluding its cost of intravenous administration.
In addition to the antiviral drugs, McCullough’s daily regimen includes zinc sulfate, azithromycin and aspirin. On day six of his infection, Thursday, he developed a cough and shortness of breath and expected to begin five days of prednisone. He said then that he planned “for a prolonged illness” – up to 30 days — because of his age and complicating conditions.
However, by day 7, he posted a second YouTube video in which he said he felt “much better” and would hold off on prednisone until needed. “I feel like I’ve turned the corner and hopefully will start recovery,” he reported. In summing up his response to the drugs, he said ivermectin gave“ some minor relief from the viral malaise and waves of fever, chills and feeling of illness.” But of all the therapies, he told me in an interview, hydroxychloroquine may have made the biggest difference. “Studies suggest that ivermectin is…shorter acting and doesn’t hold the virus as long,” he said. “Hydroxychloroquine is long acting. With every subsequent dose, you feel much better.” Other patients I’ve spoken with say ivermectin made the difference in their course of care, which is why studies are urgently needed.
Regardless, having had the chance at early treatment for COVID, McCullough said, “I fully expect to return to work and avoid the risks of hospitalization and death.”
Not a one-drug treatment
When the history of COVID is written, McCullough said, it will be “very unkind” to those who crafted a paradigm that withheld treatment until patients were so debilitated that hospitalization was needed. The National Institutes of Health will be called to account. “It didn’t do a single clinical trial for patients at home for COVID-19, not a single one,” McCullough told me.
McCullough acknowledges that his “sequenced, multi-drug regimen”– antivirals, antibiotics, anti-inflammatories and anti-thrombotics – has not been clinically proven. While it has worked well for most of his patients, he cited one early-treated patient who at that moment was “fighting for his life” in an ICU. “We can’t figure out why some do worse,” he said. In general, he said, “We must take COVID seriously… We can’t wait until patients are getting really sick to start treatment. The minute you start feeling symptoms, we gotta get you on medications right away.”
With options narrowing and coronavirus circulating widely, with case counts and hospitalizations destined to get far worse in coming weeks, McCullough says there is every reason to make a major push to treat early with known, safe, available medications. “The mass of infected people is so large now, it’s mind-boggling,” he said in our interview. “The hospital system will be on its knees by Thanksgiving.”
Then, perhaps, the menu of early treatment advocated by McCullough and other “rebels,” as he calls them, may finally be given a chance.
Given what we know about their performance, based on successful preliminary studies, and considering records of safety, “they have a reasonable probability of success,” he said.
“That’s the reason why I’m doing it in myself right here right now as a patient with SARS-CoV-2, COVID-19.”
Mary Beth Pfeiffer is an investigative journalist, science writer and author of two books. Follow her on Twitter: @marybethpf.
Dr. McCullough’s personal treatment regimen, as of Day 7
- Ivermectin, 12 mg a day for 3 days
- Hydroxychloroquine, 200 mg twice a day for 5-30 days in an open label safety study
- Zinc sulfate, 220 mg a day all days
- Vitamin C 3000 mg a day all days
- Vitamin D3, 5,000 IU all days
- Azithromycin, 250 mg twice a day all days
- Aspirin, 325 mg a day all days
- Colchicine or Placebo as part of the COLCORONA Research Study Medication for 30 days
- Prednisone, 60 mg five days (holding it for backup if pulmonary symptoms worsen)
- Apixaban 5 mg twice a day (holding it for backup if pulmonary symptoms worsen)
Other steps McCullough is taking at home:
- Contacted all individuals that he and infected housemate had come into contact with.
- Keeping windows open to reduce the viral density and remove stagnant air; goal is to reduce risk of re-inoculation.
- Sterilizing surfaces daily under the assumption that everything is contaminated with COVID-19.
- Enrolled in a clinical trial, which he recommends that patients seek out.
Quote from “Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection” by McCullough et al American Journal of Medicine 2020: “In the absence of clinical trial results, physicians must use what has been learned about the pathophysiology of SARS-CoV-2 infection in determining early outpatient treatment of the illness with the aim of preventing hospitalization or death.”