Paul Marik, front-line physician at EVMS in battle against COVID-19.
by James A. Bacon
Paul Marik, chief of pulmonary and critical care medicine at the Eastern Virginia Medical School (EVMS), is part of a group, the Front Line COVID-19 Critical Care Consortium, which says that application of a new therapeutic protocol can dramatically reduce mortality rates of the coronavirus.
In a paper outlining the EVMS’ COVID-19 management protocol and a statement released by the COVID-19 Critical Care Consortium, Marik and his colleagues deliver a message of hope: By changing its treatment protocols, hospitals and doctors can save thousands of lives.
“If you can administer ascorbic acid and corticosteroids intravenously starting in the Emergency Room and every 6 hours thereafter while in the hospital, the mortality rate of this disease and the need for mechanical ventilators will likely be greatly reduced,” said Dr. Pierre Kory, the Medical Director of the Trauma and Life Support Center and Chief of the Critical Care Service at the University of Wisconsin in Madison. It is the severe inflammation sparked by the Coronavirus, not the virus itself, that kills patients, he explained in a recent statement of the front-line consortium.
Marik elaborates:
It is our collective opinion that the historically high levels of morbidity and mortality from COVID-19 is due to a single factor: the widespread and inappropriate reluctance amongst intensivists to employ anti-inflammatory and anticoagulant treatments, including corticosteroid therapy, early in the course of a patient’s hospitalization. It is essential to recognize that it is not the virus that is killing the patient, rather it is the patient’s overactive immune system. The flames of the “cytokine fire” are out of control and need to be extinguished. Providing supportive care (with ventilators that themselves stoke the fire) and waiting for the cytokine fire to burn itself out simply does not work… this approach has FAILED and has led to the death of tens of thousands of patients.
The systematic failure of critical care systems to adopt corticosteroid therapy resulted from the published recommendations against corticosteroids use by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the American Thoracic Society (ATS), Infectious Diseases Association of America (IDSA) amongst others. A very recent publication by the Society of Critical Care Medicine and authored one of the members of the Front Line COVID-19 Critical Care (FLCCC) group (UM), identified the errors made by these organizations in their analyses of corticosteroid studies based on the findings of the SARS and H1N1 pandemics. Their erroneous recommendation to avoid corticosteroids in the treatment of COVID-19 has led to the development of myriad organ failures which have overwhelmed critical care systems across the world.
Our treatment protocol targeting these key pathologies has achieved near uniform success, if begun within 6 hours of a COVID-19 patient presenting with shortness of breath or needing ≥ 4L/min of oxygen. If such early initiation of treatment could be systematically achieved, the need for mechanical ventilators and ICU beds will decrease dramatically.
Admittedly, the evidence falls far short of randomized, double-blind clinical trials, the scientific gold standard, so it is inevitable that even some scientists (not just lefty journalists) will disagree. Marik has used the protocol to treat seven COVID-19 patients, and all survived. (One other died of a pre-existing heart condition and gastro-intestinal bleed.) Dr. Joseph Varon in Houston used the protocol to treat 24 seriously ill patients, and all survived. Those are small samples. As the epidemic rages and hundreds of patients die every day, however, we don’t the luxury of waiting for clinical trials. The trial-and-error approach in front-line treatment is all we’ve got.
I have argued repeatedly that physicians are learning more and more about COVID-19 and how to treat it, and I suspect that the Front-Line consortium may have identified a major breakthrough. If their findings are confirmed by other front-line physicians, this is wonderful news both for COVID-19 patients and for anyone who wants to see life return to normal.
If the mortality rate of COVID-19 can be brought down to the level of the common flu, everyone can resume shopping, dining, going back to work, attending church, organizing protests, looting stores, and tearing down statues of Civil War generals.
