Science, Public Health Policy,
and The Law
Volume 2:4-22
July, 2020
Clinical and Translational
Research

An Institute for Pure
and Applied Knowledge (IPAK)
Public Health Policy
Initiative (PHPI)

A Novel Approach to Treating COVID-19 Using
Nutritional and Oxidative Therapies
David Brownstein, M.D. ∗†, Richard Ng, M.D. †, Robert Rowen, M.D. ‡, Jennie-Dare Drummond ,
PA †, Taylor Eason, NP †, Hailey Brownstein, D.O. §, and Jessica Brownstein ¶
Abstract
Objective: This report is a case series of consecutive patients diagnosed with COVID-19
treated with a nutritional and oxidative medical approach. We describe the treatment program
and report the response of the 107 COVID-19 patients.
Study Design: Observational case series consecutive.
Setting: A family practice office in a suburb of Detroit, Michigan.
Patients: All patients seen in the office from February through May 2020 diagnosed with
COVID-19 were included in the study. COVID-19 was either diagnosed via PCR or antibody
testing as well as those not tested diagnosed via symptomology.
Interventions: Oral Vitamins A, C, D, and iodine were given to 107 subjects (99%). Intravenous
solutions of hydrogen peroxide and Vitamin C were given to 32 (30%) and 37 (35%) subjects.
Thirty-seven (35%) of the cohort was treated with intramuscular ozone. A dilute, nebulized
hydrogen peroxide/saline mixture, with Lugol’s iodine, was used by 91 (85%).
Main Outcome Measures: History and physical exam were reviewed for COVID-19 symptoms
including cough, fever, shortness of breath, and gastrointestinal complaints. Laboratory
reports were examined for SARS-CoV-2 results. Symptomatic improvement after treatment
was reported for each patient consisting of first improvement, mostly better, and completely
better.
continued on next page
c The Author - Published Under the Creative Commons License ShareAlike
Copyright 
(See https://creativecommons.org/licenses/)
Keywords
SARS-CoV-2, COVID-19, ozone therapy, hydrogen peroxide therapy, Vitamin A, iodine, Vitamin
C, Vitamin D, immune system, antiviral.

∗

Clinical Assistant Professor of Family Medicine, Wayne
State University School of Medicine. Corresponding author,
info@drbrownstein.com
†
private practice West Bloomfield, MI
‡
private practice Santa Rosa, CA.

§

resident physician, Providence Hospital, Southfield, MI
4th year Michigan State College of Osteopathic Medicine
student
¶

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COVID19 Therapy Case Series- July 7, 2020

Contents
1

Introduction

6

2

Methods

7

3

Results

8

4

Discussion

Abstract ( Continued from page 1 )
Results: There were a total of 107 patients diagnosed with COVID-19. Thirtyfour were tested for SARS-CoV-2(32%) and
twenty-seven (25%) tested positive. Three
were hospitalized (3%) with two of the three
hospitalized before instituting treatment and
only one requiring hospitalization after beginning treatment. There were no deaths. The
most common symptoms in the cohort were
fever (81%), shortness of breath (68%), URI
which included cough (69%), and gastrointestinal distress symptoms (27%). For the
entire cohort, first improvement was noted
in 2.4 days. The cohort reported symptoms
mostly better after 4.4 days and completely
better 6.9 days after starting the program. For
the SARS-CoV-2 test positive patients, fever
was present in 25 (93%), shortness of breath
in 20 (74%) and upper respiratory symptoms
including cough in 21 (78%) while gastrointestinal symptoms were present in 9 (33%).
The time to improvement in the SARS-CoV2 test positive group was slightly longer than
the entire cohort.
Conclusion: At present, there is no published cure, treatment, or preventive for
COVID-19 except for a recent report on dexamethasone for seriously ill patients. A novel
treatment program combining nutritional and
oxidative therapies was shown to successfully treat the signs and symptoms of 100%
of 107 patients diagnosed with COVID-19.
Each patient was treated with an individualized plan consisting of a combination of oral,
IV, IM, and nebulized nutritional and oxidative therapies which resulted in zero deaths
and recovery from COVID-19. Keywords:
SARS-CoV-2, COVID-19, ozone therapy,
hydrogen peroxie therapy, Vitamin A, iodine,
Vitamin C, Vitamin D, immune system, antiviral.

10

4.1 Vitamin A . . . . . . . . . . . . . . . . . . . . . . . . . 11
4.2 Vitamin C (Ascorbate) . . . . . . . . . . . . . . 12
4.3 Vitamin D . . . . . . . . . . . . . . . . . . . . . . . . . 12
4.4 Iodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4.5 Nebulized Hydrogen Peroxide . . . . . . . 14
4.6 Intravenous and Intramuscular Therapies
14
4.7 IV Hydrogen Peroxide

. . . . . . . . . . . . . 14

4.8 IV Vitamin C (Ascorbate) . . . . . . . . . . . 15
4.9 Intramuscular Ozone . . . . . . . . . . . . . . . 15

5

Conclusion

16

6

Acknowledgments

17

References

17

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COVID19 Therapy Case Series- July 7, 2020

1. Introduction
SARS-CoV-2 is the strain of coronavirus that causes
coronavirus disease 2019 known as COVID-19.
To date, COVID-19 has infected 7,669,872 cases
worldwide and 2,090,553 cases in the US with
116,347 reported fatalities (as of 6.13.2020).[1]
COVID-19 is a pandemic that is unparalleled in
the modern world and the global response to SARSCoV-2 has no parallel in history. Coronaviruses are
found in many bat and bird species, which are believed to be natural hosts.[2] It is estimated that
coronaviruses have been around from 10,000 to
millions of years. Coronaviruses are pathogenic
viruses native to birds and mammals. They are classified into four subspecies: alpha-, beta-, gamma-,
and delta- coronavirus.[3] Alpha- and beta- coronaviruses are found exclusively in mammals and
gamma- and delta-coronavirus primarily infect birds.
[4] Coronaviruses include a family of viruses that
contain an RNA genome. Some of these viruses
have been shown to cause illness in animals and
humans.
SARS (severe acute respiratory syndrome) was
discovered in 2003.[5] It was described as an outbreak of atypical pneumonia in Guangdong Province,
Peoples Republic of China. SARS, which occurred
during 2002-2003 infected approximately 8,098
and resulted in 774 deaths. The outbreak was primarily concentrated in Southeast Asia and Toronto,
Canada although the outbreak spread to more than
24 countries. SARS was found to be caused by
a strain of coronavirus that infects the epithelial
lining within the lungs.[6] Prior to the SARS outbreak, coronaviruses were only thought to cause
mild influenza-like illnesses in humans.
The second major human outbreak of coronavirus was in 2012 in Saudi Arabia. It was referred
to as MERS (Middle East Respiratory Syndrome).
It spread to several countries including the US. Most
people infected with MERS suffered with respiratory problems including cough and shortness of
breath. The World Health Organization confirmed
2,519 cases of MERS as of January, 2020.[7]
SARS-CoV-2 is a new strain of coronavirus that
has not been known to previously infect humans.
6

COVID-19 was first identified in Wuhan, China
in December 2019. China informed the WHO
that a novel strain of coronavirus was causing severe illness. It was named SARS-CoV-2 as the
cause of COVID-19. The virus was sequenced and
found to most resemble viruses found in bats and
pangolins.[8] SARS-CoV-2 was found to be highly
transmissible between humans. SARS-CoV-2 can
be diagnosed via nasal swab PCR testing. According the Centers for Disease Control and Prevention, people with COVID-19 have a wide range of
symptoms reported from mild symptoms to severe
illness.[9] People with these symptoms may have
COVID-19:
• Cough
• Shortness of Breath or difficulty breathing
Or at least two of these symptoms:
• Fever
• Chills
• Repeated shaking with chills
• Muscle pain
• Headache
• Sore throat
• New loss of taste or smell
The CDC further states, that this list is not inclusive. According the CDC, the signs and symptoms
of COVID-19 present at illness vary, but over the
course of the disease, most persons with COVID19 will experience the following:[10]
• Fever (83-99%)
• Cough (59-82%)
• Shortness of breath (31-40%)
• Sputum production (28-33%)

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COVID19 Therapy Case Series- July 7, 2020

Our patients’ symptomology correlated well
with the percentages reported by the CDC.
We will present data on clinical presentation
and treatment provided to help patients recover
from COVID-19 symptoms. This treatment program has been utilized for over 20 years (with some
variations) in treating patients suffering from viral illnesses such as influenza-like disease. This
treatment program was not designed to cure a viral
illness rather its purpose is to provide a therapeutic
regimen designed to support the immune system
when it is challenged with a viral infection.

tions, and a nebulized solution of dilute hydrogen
peroxide and iodine.
Oral dosing consisted of taking the following
supplements for four days at the first sign of symptoms or at the direction of the practitioner. The
supplements consisted of:
• Vitamin A: 100,000 IU/day*** in the
form of emulsified Vitamin A palmitate
• Vitamin C: 1,000 mg/hour while awake in the
form of ascorbic acid until bowel tolerance
(loose stools) was reached

2. Methods

• Vitamin D3: 50,000 IU/day in an emulsified
form

The setting for this retrospective review is an outpatient medical office (referred to as CHM) consisting of five practitioners. The office is in the
metropolitan Detroit area, which was one of the
hot spots for COVID-19. The practitioners include
three medical doctors as well as a nurse practitioner
and a physician’s assistant. For the calendar year of
2020, charts were retrospectively reviewed for the
presence of COVID-19 diagnosis occurring from
February 2020 through May 2020. The charts were
analyzed for clinical symptoms, physical findings,
imaging and coronavirus testing results. Additionally, the charts were analyzed for interventions provided and duration to relief of symptoms. Three
endpoints were taken from the charts – hospitalization, death, and time to improvement.
All patients gave fully informed consent for integrative medical management of their condition.
Historical information from the charts included age,
sex, birthdate, initial date of service, care provider,
past medical history, medications, and nutritional
supplements. The number of days of illness prior to
being seen by a provider was documented as well.
For x-ray imaging we used the report provided
by the radiologist. Coronavirus testing was done
through outpatient and inpatient laboratories. Coronavirus was diagnosed by PCR nasal swab testing.
The interventions provided at the outpatient
medical office included oral supplementation of
iodine, Vitamins A, C and D, intravenous hydrogen
peroxide and Vitamin C, intramuscular ozone injec-

• Iodine: 25 mg/day in the form of Lugol’s
solution or tableted Lugol’s solution
Most patients were instructed to nebulize a dilute solution of 0.04% hydrogen peroxide in normal
saline. The solution was mixed for the patient in
the office. A sterile 250 cc bag of normal saline was
injected with 3 cc of 3% food grade hydrogen peroxide and 1 cc of magnesium sulfate. The patient
was instructed to draw off 3 cc of the dilute solution
and nebulize it hourly until symptoms improve. Additionally, the patient was instructed to add in one
drop of 5% Lugol’s solution to the dilute hydrogen
peroxide mixture. As the symptoms improved, the
frequency of nebulizing could be reduced by the
patient.
If symptoms worsened or there was a concern
that the patient was suffering from a more severe
case, the patient was advised to come to the office
and receive intravenous injections of Vitamin C
and hydrogen peroxide along with intramuscular
injections of ozone. The dosing of these items is
shown below:
• Vitamin C: 2.5 grams of sodium ascorbate
(5 cc of a 500 mg/cc ascorbic acid solution)
mixed with an equal amount of sterile water
given as an intravenous push over 2-3 minutes.
7

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COVID19 Therapy Case Series- July 7, 2020

Table 1. Patient Characteristics

Total patients

N(%)
107(100)

Age
Range
Average
Median

2-85
54.2
56.5

Sex

Figure 1. Patient Age distribution

Male
Female

• Hydrogen peroxide: 30 cc of a 0.03% solution of dilute hydrogen peroxide given as an
intravenous push over 2-3 minutes

27 (25)
80 (75)

Comorbid Conditions
Hypothyroidism
Hypertension
Asthma
Lyme Disease
Hashimoto’s disease
Smokers
Grave’s disease
Chronic sinusitis
Diabetes
Cancer

• Ozone: 20 cc of 18 mcg/cc ozone (as an oxygen/ozone gas mixture) given in each buttock
as an intramuscular injection

3. Results
There were 107 patients identified in our chart review among five practitioners. Table I outlines the
patient characteristics of the sample. The age of
patients ranges from 2-85 years old with an average age of 54.2 and median age of 56.5. 80 patients were female (75%) and 27 were male (25%).
The major comorbid conditions of the sample include hypothyroidism (18%), hypertension (10%),
asthma (8%), Lyme disease (6%), Hashimoto’s disease (5%), cigarette smoking (3%), Grave’s disease
(2%), chronic sinusitis (2%), diabetes (2%) and
cancer (2%).
Figure 1 exemplifies the age distribution of the
107-patient population at the practice. The majority
of the patients were between 51-75 years old (59%).
The second highest cohort was between 26-50 years
old (31%). Followed by those 76 years old and older
(10%) and those aged 2-25 (7%).
Table II illustrates the patient symptoms of the
total cohort. The most common patient symptom
was fever (81%), shortness of breath (68%), URI
(69%) and GI symptoms (27%).

19 (18)
11 (10)
9 (8)
6 (6)
5 (5)
3 (3)
2 (2)
2 (2)
2 (2)
2 (2)

Table 2. Patient Symptoms ’Total Cohort’

N (%)

8

Fever
Shortness of breath
URI (symptoms including cough)
GI (diarrhea, loose stools, pain)

87 (81)
73 (68)
74 (69)
29 (27)

Total patients

107 (100)**

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COVID19 Therapy Case Series- July 7, 2020

Table 3 demonstrates the interventions that the
patients received from CHM (total cohort). The
most common intervention was a protocol of oral
supplements, including Vitamin A, Vitamin D, Vitamin C, and iodine. 106 patients of the 107 total
patients were taking oral supplements (99%). The
other interventions at CHM include 32 patients receiving IV hydrogen peroxide (30%), 37 patients
receiving IV Vitamin C (35%), 37 patients receiving
intramuscular ozone injections (35%), 91 patients
receiving a nebulized solution of normal saline and
dilute hydrogen peroxide (85%), and 91 patients
receiving nebulized iodine (85%).
Figure 2 shows the average number of days
that patient reported symptomatic improvement after CHM interventions (for total cohort). On average, patients reported their first improvement by
2.4 days following CHM interventions. Patients reported feeling mostly better by 4.4 days following
interventions. Patients reported feeling completely
better after 6.9 days following CHM interventions.
Table 4 illustrates the disease course in the total cohort. 34 of the 107 total patients (32%) were
tested for COVID-19. Of those 34 tested, 27 patients tested positive for COVID-19 (79%). Therefore, 25% of the entire cohort (107 patients) had
tested positive for COVID-19.1 Of the total 107
patients, 0 died (0%).
Table 5 illustrates the symptoms of the COVID19 cohort which was similar to Table 2 for the entire cohort.2 Figure 3 shows the symptomatic improvement after intervention in the SARS-CoV-2
laboratory positive cohort. Compared to the entire
cohort (Figure 2), there was approximately a one
day longer time period to feeling mostly better and
completely better for those who tested positive for
SARS-CoV-2 as reported by the patients.

Table 3. Patient Interventions

INTERVENTION

total (cohort)
N (%)

Total patients

107 (100)**

Oral supplements
IV H202
IV Vitamin C
IM Ozone
Nebulized NS/H202
Nebulized Iodine

106 (99)
32 (30)
37 (35)
37 (35)
91 (85)
91 (85)

Table 4. Disease Course

N (%)
Total cohort
107 (100)
Tested for COVID-19
34 (32)
Tested positive for COVID-19 27 (25)
Hospitalized
3 (3) ∗
Death
0 (0)
∗

Of the three patients hospitalized, two
were hospitalized before instituting treatment
One was hospitalized on the oral Vitamin
regimen of Vitamins A, C, D, and iodine. All
three made a full recovery and were treated
with nebulized hydrogen peroxide and iodine.
Table 5. Symptoms of COVID-19 Positive Cohort

N (%)
COVID positive patients 27 (100)∗∗
Fever
25 (93)
Shortness of breath
20 (74)
URI (includes cough)
21 (78)
GI
9 (33)
∗∗ Two

patients in the SARS-CoV-2 positive
cohort reported a return of mild symptoms after
reporting a resolution of major symptoms.
One patient reported feeling foggy in his head
and another reported a fast heart (90-100 bpm)
along with mild shortness of breath with any mild
exertional activity. A workup on both failed to
find a cause for the symptoms.

1 Of

the 107 total patients, three were hospitalized (3%)
with two of the three hospitalized before beginning treatment.
2 Two patients in the SARS-CoV-2 positive cohort reported a return of mild symptoms after reporting a resolution
of major symptoms. One patient reported feeling foggy in his
head and another reported a fast heart (90-100 bpm) along
with mild shortness of breath with any mild exertional activity.
A workup onboth failed to find a cause for the symptoms.

9

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COVID19 Therapy Case Series- July 7, 2020

Figure 2. Intervention Results

4. Discussion
COVID-19 is a worldwide pandemic caused by
coronavirus. Currently, there is no vaccine or cure
for COVID-19. Dexamethasone has been reported
to reduce hospitalized case mortality.[11] Those
who have recovered from COVID-19 have done
so because their immune system was successful
in fighting off the illness. Therefore, a successful
treatment for COVID-19 will have to either have
viricidal activity or work by aiding the immune system’s response in fighting the pathogen. Many feel
COVID-19 will come back during the next flu season—fall/winter of 2020-2021. Therefore, there is
an urgent need for any therapy that supports the
host’s immune system and allows for an uneventful
recovery from the illness.
This cohort study consisted of a retrospective
review of 107 patients who were either diagnosed as
COVID-19 positive by PCR nasal swab testing or
presumed to have COVID-19 due to symptomatology. The most common symptom in our cohort was
fever. The fever was reported as fluctuating varying
between 99-102 degrees Fahrenheit for most sub10

jects. The next most common symptom included
upper respiratory symptoms which included a rhinorrhea, drippy eyes, cough, and congestion. Shortness of breath was the third most common complaint. Gastrointestinal distress, though common,
was lower on the symptom list. Although symptoms
varied between patients, all patients exhibited symptoms that could be consistent with a viral pathology.
Treatments of the cohort consisted of first using oral nutrient therapies. The vast majority—91
(88%) started taking vitamins A, C, D3 and iodine
at the first sign of a viral illness such as a cough,
runny nose, sore throat, etc., All subjects (100%)
took vitamin C in suggested doses of at least 35,000 mg/day of ascorbic acid. Three patients took
vitamins C and D only.
There were three hospitalizations in the cohort
group. One patient was taking the oral protocol of
vitamins A, C, D and iodine when he became ill
with a cough and fever. His condition worsened
over the next seven days and was admitted to the
hospital where he was diagnosed with pneumonia.
He was treated with antibiotics. He phoned the

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COVID19 Therapy Case Series- July 7, 2020

Figure 3. ∗ Two patients in the SARS-CoV-2 positive cohort reported a return of mild symptoms after

reporting a resolution of major symptoms. One patient reported feeling foggy in his head and another
reported a fast heart (90-100 bpm) along with mild shortness of breath with any mild exertional activity. A
workup on both failed to find a cause for the symptoms.
office after he was discharged from the hospital
because he was having breathing difficulties. He
started nebulizing hydrogen peroxide and felt an immediate improvement in his breathing difficulties
from this therapy. By the third nebulized therapy
he reported to being 80% improved. He stated his
breathing difficulties began to return to normal after
day two of nebulizing every 2 hours while awake.
The other two patients started our protocol after

being hospitalized for COVID-19. One of the two
was recently diagnosed with acute myelogenous
leukemia and recently received chemotherapy. Both
were discharged still symptomatic with breathing
difficulties and a severe cough. Both patients were
treated with nebulized hydrogen peroxide and iodine as well as the oral protocol of vitamins A, C,
D, and iodine. All three patients fully recovered.

4.1 Vitamin A

Over 100 years ago, — before the chemical
structure was elucidated — studies of vitamin A
pointed to its important role in immune system functioning. Fat in butter, a good source of vitamin A,
improved the outcome of infections in malnourished animals and humans.[14] Rats were shown to
be more susceptible to infections when they were
vitamin A deficient.[15] Vitamin A is fundamental
in maintaining the integrity of the epithelium.[16]
Vitamin A deficiency has been associated with dis-

Vitamin A consists of a group of retinoid compounds that have a wide range of physiological
effects including the support of immune system
functioning. Vitamin A deficiency is a worldwide
problem affecting 250 million preschool children
and half of all countries.[12] In children, vitamin
A supplementation has been shown to dramatically
decrease the mortality from the viral illnesses such
as measles and diarrheal infections.[13]
11

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COVID19 Therapy Case Series- July 7, 2020

ruptions in normal epithelium of the respiratory
tract[17][18] and gastrointestinal tissue.[19][20] Vitamin A has been shown to be an important regulator of monocyte differentiation and function.[21]
COVID-19 is characterized by cytokine storm
in the severely ill.[22] Therapies that lower cytokine formation are being investigated. Retinoic
acid, when added to monocytic, myelomonocytic,
or dendritic cell line cultures promotes cellular differentiation and influences the secretion of key cytokines produced by macrophages including TNFα, IL-1β , Il-6, and IL-12. It has been hypothesized that supplementation with preformed vitamin
A may down-regulate the secretion of specific proinflammatory cytokines such as TNF- α and Il-6 by
macrophages.[23]
Acute respiratory distress syndrome (ARDS)
accompanied by respiratory failure is a major cause
of death from COVID-19.[24][25] Treatments to
combat respiratory failure are urgently needed.
In vitro and in vivo studies have found that IgA
antibodies can neutralize intracellular pathogens
including viruses by inhibiting or blocking their
attachment to epithelial cells.[26][27][28] Researchers studying the acute humoral response to
SARS-CoV-2 in serum and bronchoalveolar fluid
of 145 patients with COVID-19 reported that early
SARS-CoV-2 specific humoral responses were
found to be typically dominated by antibodies of
the IgA isotype.[29] Furthermore, the subjects who
had the highest levels of IgA against the spike protein for SARS-CoV-2 were the ones who had the
greatest ability to neutralize the virus. Vitamin A
deficiency has been shown to inhibit the production
of influenza-specific IgA in mice.[30] Furthermore,
vitamin A supplementation has been shown to increase IgA levels.[31]

with IV vitamin C, thiamine, and hydrocortisone.
The early use of vitamin C along with thiamine
and hydrocortisone were found to be effective at
preventing progressive organ dysfunction including
kidney injury and in reducing mortality of patients
with severe sepsis and septic shock. In CITRIS-ALI
researchers reported a trial where ARDS patients
were randomized to receive IV ascorbic acid or
placebo every six hours for 4 days. Patients had
to develop ARDS within 24 hours of I CU admission. The authors reported a reduction in 28-day
all-cause mortality rate in those receiving IV vitamin C: 29.8% mortality in the treatment group
versus 46.3% mortality in the placebo group.[33]
COVID-19 patients are characterized by elevated
levels of inflammatory markers and oxidative stress
such as hsCRP.[34] Vitamin C is known to have
anti-oxidant and anti-inflammatory effects. Erythrocytes (red blood cells) can deliver oxygen to
bodily tissues because they carry iron-containing
hemoglobin which reversibly binds oxygen. Oxidative damage to red blood cells can impair the
ability to deliver oxygen to tissues.[35] The management (and possibly the prevention of) oxidative
stress in COVID-19 may be addressed with the use
of anti-oxidant therapies. High-dose IV vitamin C
was found to have an antioxidant effect for lung
epithelial cells.[36] Vitamin C has also been shown
to prevent the oxidation of iron from its reduced
ferrous state to the oxidized ferric form.[37] Intravenous (but not oral) ascorbate has been shown to
act as a pro-drug for hydrogen peroxide creation in
interstitial fluids in animal studies (see hydrogen
peroxide discussion below).[38]

4.2 Vitamin C (Ascorbate)
A Chinese report of intravenous vitamin C (IVC)
infusion for 50 moderate to severe COVID-19 subjects found all patients eventually recovered and
discharged from the hospital. The subjects were
given between 10 and 20 g of IVC per day over a
period of 8-10 hours.[32] In 2017, Paul Marik, M.D.
developed a protocol for treating septic patients
12

4.3 Vitamin D
Vitamin D is being researched as an effective treatment option for COVID-19 patients. Researchers
used 25-hydroxyVitamin D [25(OH)D] levels as a
marker to predict clinical outcomes of COVID-19
subjects.[39] Of 212 cases of COVID-19, serum
25(OH)D level was lowest in critical cases but highest in mild cases. The authors reported vitamin D is
significantly associated with clinical outcomes. A
logistic regression analysis reported that for each
standard deviation increase in serum 25(OH)D, the

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COVID19 Therapy Case Series- July 7, 2020

odds of having a mild clinical outcome rather than
a severe outcome were approximately 7.94 times
(OR=0.126, p<0.001) while interestingly, the odds
of having a mild clinical outcome rather than a
critical outcome were approximately 19.61 times
(OR=0.051, p<0.001). The results suggest that an
increase in serum 25(OH)D level in the body could
either improve clinical outcomes or mitigate worst
(severe to critical) outcomes, while a decrease in
serum 25(OH)D level in the body could worsen
clinical outcomes of COVID-2019 patients.
There are several mechanisms by which vitamin
D could reduce the risk of influenza-like infections
and death. Viral infections have been shown to
disrupt airway epithelial cell junctions.[40] Vitamin D has been shown to maintain tight epithelial
junctions and adherens junctions.[41]
Vitamin D has been shown to modulate cellular immunity and reduce cytokine storm by reducing the production of proinflammatory cytokines
including TNF-α and interferon-γ as well as increasing the anti-inflammatory cytokines produced
by macrophages.[42] A study comparing deceased
rates for patients with COVID-19 from countries
with a large number of confirmed patients (including Germany, S. Korea, China, Switzerland, Iran,
UK, US, France, Spain, and Italy) found a risk of
severe COVID-19 cases among patients with very
low vitamin D levels is 17.3%, while the equivalent
figure for patients with normal vitamin D levels is
14.6%–a reduction of 15.6%.
The authors hypothesized that vitamin D may
reduce symptoms of COVID-19 by suppressing cytokine storm in COVID-19 patients.[43]
Vitamin D is produced in the bone, skin, lungs,
colon, parathyroid glands, and immune system cells.
Activation of vitamin D in response to viral infection has been described.[44] A deficiency of vitamin
D could impair this response in the lung.[45]

of childbearing age are deficient in iodine.[47] In
fact, the mean urinary iodine concentration among
pregnant US women is 134 ug/L which signifies
deficiency.[48] We have tested over 6,000 patients
and found the vast majority—over 97%– are deficient in iodine.
Iodine is needed for proper immune system functioning. Iodine supplementation has
been shown to increased IgG synthesis in human lymphocytes.[49] Iodine deficiency is associated with decreased phagocytic activity of blood
neutrophils.[50] This was associated with a decrease in peroxidases in neutrophils. Iodine has
been shown to increase the ability of granulocytes
to kill infectious organisms.[51] Iodine is used as an
antiseptic throughout the US because it has antiviral
and antibacterial properties. Two of us (DB and RN)
have used iodine successfully as an antimicrobial
agent for over two decades.
In order to reduce transmission of viruses, antisepsis of human and non-human surfaces must
be identified. Researchers reported an in-vitro
study where SARS-2-CoV was exposed to iodine
(povidone-iodine) at 1-5% concentrations as a nasal
antiseptic formulation and an oral rinse. The iodine
solutions effectively inactivated SARS-CoV-2 after
exposure times of 60 seconds.[52] In vitro studies
of 0.23% PVP-I mouthwash (1:30 dilution) was
shown to inactivate both SARS-CoV and MERSCoV following a 15-second exposure.[53]
Japan has one of the lowest rates of COVID-19
illnesses in the Western world even in a crowded
city such as Tokyo. Furthermore, Japan has not
gone on a total lockdown. The Japanese are known
to have a much higher iodine intake through their
diet when compared to other Western countries. It
is estimated that the Mainland Japanese ingest over
100x the RDA as compared to US citizens.[54] Perhaps Tokyo and Japan itself has had less serious
COVID-19 illness because of their iodine intake.
The full oral supplementation regimen (vitamins A, C, D, and iodine) in COVID-19 subjects
was used in 91 out of 104 subjects in the cohort. The
subjects were instructed to take the supplements for
four days. Some were treated with vitamin C (1),
vitamins C and D (2) and vitamins C, D, and io-

4.4 Iodine
Iodine is an essential element; therefore it must
be obtained from the diet or via supplementation.
For over 40 years, US iodine levels have fallen
in the National Health and Nutrition Examination
Survey (NHANES).[46] Nearly 60% of women
13

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COVID19 Therapy Case Series- July 7, 2020

dine (1). All of these patients recovered without
sequalae.

4.7 IV Hydrogen Peroxide
A dilute IV solution of hydrogen peroxide was
given in either an IV drip over 30 minutes or a rapid
infusion as an IV push over 2-3 minutes. One of
the earliest known uses of hydrogen peroxide was
used by Dr. T.H. Oliver in 1920. Dr. Oliver used
IV hydrogen peroxide to treat Indian troops who
were suffering from an influenza and pneumonia
epidemic. The death rate was reported to be over
80% at that time. Dr. Oliver’s results showed his
IV hydrogen peroxide-treated cohort of 24 soldiers
had a mortality rate of 48% compared to the 80%
death rate from those treated with the usual care at
that time.[60] In the article published by Dr. Oliver,
he stated that the low oxygen symptoms his patients
suffered from were markedly benefited by the use
of intravenous hydrogen peroxide. Furthermore, he
reported that the ‘toxemia’ (spread of bacterial products in the blood stream) appears to be overcome in
many cases. Poor oxygenation and sepsis are both
conditions experienced by COVID-19 subjects.
When H2 02 is produced extracellularly or
added to a cell culture system, a gradient of
H2 02 is quickly established across the plasma
membrane.[61] Researchers reported that the gradient is the result of H2 02 -scavanging enzymes including catalase and GSH-peroxidase that maintains a
steady-state intracellular H2 02 concentration being
10x less than the extracellular concentration.[62]
As Bocci states, “This result is important because
the intravenous (IV) infusion of a low and calculated concentration of H2 02 results in a marked
dilution in the plasma pool with partial inactivation and in intracellular levels able to exert biological effects on blood and endothelial cells without
aggravating the concomitant oxidative stress.”[63]
COVID-19 is known to cause oxidative stress
which may be the cause of multi organ failure and
hypoxemia.[64][65][66] H2 02 is known to activate
glycolysis, ATP and 2,3-DPG in red blood cells
which can lead to improved oxygen delivery to ischemic tissues.[67][68] H2 02 has also been shown
to increase the production of NO which can aid in
vasodilation and tissue oxygenation.[69][70]
Researchers studying the effects of intravenous
H2 02 therapy reported that it barely increases the

4.5 Nebulized Hydrogen Peroxide
If there were more serious problems or the oral supplementation regimen failed to fully help alleviate
the symptoms of COVID-19, the next step was to
initiate the use of a combination of nebulized hydrogen peroxide and iodine. A solution of 250 cc of
normal saline was mixed with 3 cc of 3% hydrogen
peroxide providing a final concentration of 0.04%
hydrogen peroxide. (Note, the hydrogen peroxide
used was initially a 35% food grade source then
diluted to 3% using a 10:1 mixture of sterile water
to 35% hydrogen peroxide.) Additionally, 1 cc of
magnesium chloride (200 mg/ml) was added to the
250 cc saline/hydrogen peroxide bag. (This was
mixed in the office for the patients.)
Patients were instructed to nebulize 3 cc of the
mixture three times per day or more often if there
were breathing problems. Usually one or two nebulizer treatments were reported to improve breathing
problems.
A total of 91 COVID-19 subjects (85%) utilized the nebulized solution. They reported no adverse effects. One We have been using nebulized
saline/hydrogen peroxide at this concentration for
over two decades in his practice.
Hydrogen peroxide is continually produced in
the human body with substantial amounts produced
in the mitochondria.[55] Every cell in the body is exposed to some level of hydrogen peroxide.[56] The
lungs are known to produce hydrogen peroxide.[57]
Nebulized hydrogen peroxide has been shown to
have antiviral activities.[58] Hydrogen peroxide can
activate lymphocytes[59] which are known to be depleted in COVID-19.
4.6 Intravenous and Intramuscular Therapies
If COVID-19 patients continued to have symptoms
such as shortness of breath, fever, or cough, they
were offered intravenous injections of hydrogen peroxide, Vitamin C and intramuscular injections of
ozone.

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COVID19 Therapy Case Series- July 7, 2020

plasma level of peroxidation end-products (lipid
oxygenation products). This stimulates the production of antioxidants which act as reducing agents.
The scientists report similar effects with ozone therapy. This results in an up-regulation of antioxidant
enzymes (SOD, GSH-peroxidase, G-6PD) in erythrocytes which has been demonstrated in-vivo.[71]
Coronaviruses have been shown to be sensitive to
oxidizing disinfectants such as a 0.5% hydrogen peroxide solution used as a surface disinfectant.[72] It
is well accepted that the response of the immune
system is the production of pro-oxidants which are
known to disinfect pathogens.[73]

Europe and Cuba and in outpatient offices in the
United States. Ozone has been used to treat infections and wounds as well as other illnesses over
this time period. Ozone therapy can be administered by many different methods including intravenously and intramuscularly. Intramuscular ozone
was given in these cases to reduce transmission risk.
Since we were only treating COVID-19 patients
outside the office in the parking lot, intramuscular
injections of ozone were deemed the easiest and
safest modality.
IM ozone was provided to 37 patients (35%).
Of these, a single ozone injection was given to 31
(82%). Seven (18%) required more than one IM
injection. Five received two ozone shots, one patient had four and another had six. The patients
who required four and six injections had been ill
for a longer time period (over 10 days) before
instituting therapy. Both recovered uneventfully.
In viral infections, ozone has been shown to improve both the innate and adaptive immune systems while also reducing cytokine storm. Ozone
improves neutrophil counts in children with compromised phagocyte cell-mediated immunity.[75]
Antibodies have been shown to kill pathogens by
producing ozone gas.[76] Ozone has been shown
to have direct viricidal effects by disrupting the
lipid envelope of a virus at sites of double bonds.
When the lipid envelope is fragmented, its DNA or
RNA cannot survive. SARS-CoV-2 is an enveloped
virus which would make it an excellent candidate
for treatment with ozone.[77] Furthermore, SARSCoV-2, as well as other coronaviruses, have abundant cysteine–a thiol containing amino acid– in their
spike proteins. Rowen has hypothesized that ozone
is the ideal therapy for viruses.[78] In order to successfully penetrate cell membranes, many viruses
require membrane glycoproteins to be in the R-SH reduced form as opposed to the oxidized—RS-S-R– form. If virus thiol groups are oxidized
they lose infectivity.[79] Rowen states, “Creating
a more “oxidized” environment may allow ozone
therapy. . . to assist the body in inactivating thiols
in viruses in blood and tissues.” SARS-CoV-2 cell
entry spike proteins are particularly rich in both
cysteine and tryptophan the two most vulnerable

4.8 IV Vitamin C (Ascorbate)
Intravenous use of vitamin C has been used in hospitals and outpatient settings for COVID-19 patients
after a report from China showed improvement in
those treated with it.[74] IV ascorbic acid was introduced to moderately to severely sick COVID19 patients in Chinese hospitals. The researchers
reported that intravenous ascorbic acid provided
safe and effective adjunctive care of hospitalized
COVID-19 patients. There was no mortality, no
reported side effects and shorter hospital stays universally. The Shanghai expert group recommends
intravenous ascorbic acid use in extremely critical
settings within COVID-19 patients. In the US, multiple hospital centers utilized IV vitamin C to treat
COVID-19 patients.
We have been successfully utilizing IV vitamin
C therapies for over two decades in order to aid
the immune system in its ability to fight pathogens.
For this study, we administered 2.5 gm of sodium
ascorbate mixed with 5 cc of sterile water as an
intravenous push over 1-2 minutes. There were no
adverse effects from this regimen.
4.9 Intramuscular Ozone
Ozone is a colorless gas with a pungent odor. It
is a natural molecule made up of three atoms of
oxygen. Ozone is produced by an ozone generator
where oxygen (O2) gas is exposed to an electrical
discharge combining O2 molecules into a mixture
of up to 5% O3 and 95% O2. Ozone therapy has
been used for over 100 years and is widely used in
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COVID19 Therapy Case Series- July 7, 2020

amino acids to alteration by ozone.[80][81] The
thiol group of cysteine is easily oxidized reversibly
to disulfide which is widely accepted to neutralize the function of its protein/enzyme. Effectively,
it is an “on-off” switch. Potent oxidants, such as
hydrogen peroxide or ozone, can irreversibly oxidize the thiol. Regardless, viruses have no means
to self-repair even when in the disulfide oxidation
state. Regarding tryptophan, its electron rich indole group is very vulnerable to irreversible oxidation, even by hydrogen peroxide.[82] Ozone,
like ascorbate, has been shown to increase the production of hydrogen peroxide.[83][84] This viral
redox vulnerability theory was verified with the
use of ozone rapidly remitting 100% of 5 cases of
Ebola in 2014. The Ebola virus similarly has a
large quantity of cysteine in its membrane glycoproteins.57 COVID-19 is associated with microthrombotic events and, often, a cytokine storm of inflammation. Ozone could be particularly useful as it improves the prostacyclin:thromboxane ratio and enhances nitric oxide production.[85] Ozone has been
shown to reduce production of TNF-α[86] as effectively as steroids do and increases the production
of the anti-inflammatory enzyme heme oxygenase1.[87] Ozone treatment also induces Nrf 2 phosphorylation, which has been reported to reduce oxidative stress and proinflammatory cytokines in multiple sclerosis patients, and, in low doses.[88] Nrf
2 is a regulator of genes related to antioxidant
responses.[89] The limitations of this study include
that most patients were taking nutritional supplements before they became ill. Therefore, they may
have had fewer nutritional deficiencies compared to
the average American. Furthermore, the majority
of the subjects in this study, which mirrored the
practice, were women. As compared to women,
more men die of COVID-19.[90] Hypertension, diabetes, and obesity are known co-morbidities with
COVID-19.[91] Our patient population had lower
rates of these illnesses when compared to US averages. Since this was not a randomized, doubleblind, placebo-controlled study, the therapies provided here cannot be proven to cure the symptoms
of COVID-19. The observations of the positive
outcomes are supported by this consecutive case

series even without a control group. During the
COVID-19 pandemic, we felt that it was not ethical to use a control group and withhold treatment
from ill COVID-19 patients.
Case control series have been shown to play an
important role in evidence generation and in clinical practice.[92] The author of the fore worded
report, Cynthia Jackevicius states, “Who better than
clinicians—who are the first to see how new therapies are being used and how patients respond to
the new therapies—to share their valuable insights
and experience in the medical literature through
the use of case reports? A fundamental tenet of
evidence-based clinical practice is to use the best
available clinical evidence, and at times, a case report or case series is the best available evidence to
guide decision-making.”
Additionally, the results of this study offer a
new consideration for the current medical study
paradigm, which generally evaluates a single agent
(or occasionally more) against a disease or pathogen.
Considering the very favorable outcome of our consecutive case cohort (no deaths, only one hospitalization in patients treated prior to admission, and
rapid recovery), this work supports an alternate
paradigm for infection and medical challenges: providing support of the body’s biochemical/nutritional
needs and augmenting its innate physiological defense responses. Every substance used in our cohort
is either an essential nutrient or an oxidant mediator
actually manufactured by the body. Nothing foreign
to the body was used, nor anything patentable. The
disparity in the health outcomes under our treatment
protocol and the outcomes in the rates of serious
and critical illness and death under other protocols
is stark and demands further investigation.

16

5. Conclusion
In summary, we treated 107 COVID-19 patients,
solely with biological therapies, who all recovered.
Only three were hospitalized. Of the three hospitalizations, two were hospitalized before beginning
our treatment and sought our care post hospitalization. One was hospitalized while solely taking the
oral regimen of Vitamins A, C, D, and iodine, and

 Sci, Pub Health Pol, & Law

COVID19 Therapy Case Series- July 7, 2020
[3]

King A, Lefkowitz E, Adams M, and Carstens
E. Virus Taxonomy. 9th ed . Elsevier, pages
806–828., 2011. Elsevier .

[4]

Wertheim JO, Chu DK, Peiris JS,
Kosakovsky Pond SL, and Poon LL. A
case for the ancient origin of coronaviruses
. J Virol., 87(12):7039-7045, 2013. DOI .

[5]

Peiris JSM, Lai ST, LLM Poon, Y Guan, LYC
Yam, W Lim, J Nicholls, WKS Yee, WW Yan,
MT Cheung, VCC Cheng, KH Chan, DNC
Tsang, RWH Yung, TK Ng, and KY Yuen.
Coronavirus as a possible cause of severe
acute respiratory syndrome . The Lancet,
361(9366):1319–1325, 2003. The Lancet .

[6]

Fehr A.R. and Perlman S. Coronaviruses: An
Overview of Their Replication and Pathogenesis. In: Maier H., Bickerton E., Britton
P. (eds) Coronaviruses. Methods in Molecular Biology . Humana Press, New York, NY,
1282, (2015). Springer .

[7]

WHO EMRO. MERS Outbreaks . 2020.
PubMed .

[8]

Kristian G. Andersen, Andrew Rambaut,
W. Ian Lipkin, Edward C. Holmes, and
Robert F. Garr. The proximal origin of SARSCoV-2. . Nature Medicine, (26):450–452, 2020.
Nature Medicine .

[9]

6. Acknowledgments

Coronavirus (COVID-19) frequently asked
questions. . Centers for Disease Control and
Prevention, June 2020. CDC .

[10]

The authors would like to acknowledgment Mark
Rosner M.D. for his encouragement and help with
the design of the study.

CDC. Information for Healthcare Professionals about Coronavirus (COVID-19) .
CDC, 2020. CDC .

[11]

Heidi Ledford. Coronavirus breakthrough:
dexamethasone is first drug shown to save
lives . Nature, JUne 2020. Nature .

[12]

WHO. Micronutrient Deficiencies . World
Health Organization, 2020. WHO .

[13]

Eduardo Villamor and Wafaie W. Fawzi. Vitamin A Supplementation: Implications for
Morbidity and Mortality in Children . The
Journal of Infectious Diseases, 182:122–133,
September 2000. Oxford .

not the oxidative therapies. All recovered uneventfully. There were no deaths.
In the state of Michigan, as of 6/21/20, the case
fatality rate was 9.0% (6,067 deaths and 67,097
positive cases of SARS-CoV-2). [92] Therefore,
out of our 107 COVID-19 patients, 10 deaths could
be predicted. At the very least, with 25 patients
testing positive for the virus, we should have expected two deaths, but in reality, we should have
seen significantly more morbidity considering we
only had 33 tests performed on the 107 patients (all
symptomatic), a median age of 56, and comorbid
conditions. Of the 107 patients total, we should
have experienced at least eight hospitalizations considering the median age, according to a published
analysis. [93]
As of this publication, no cure, treatment, or
preventive for SARS-CoV-2 has yet been proven
effective in a randomized study, except for
dexamethasone (a potent steroid) use in severely
ill, hospitalized patients. In this study a novel
treatment program, which is hypothesized to aid
and support the immune system, was highly
effective in the re-covery of 100% of 107 patients.
This case review points out that specific and
relatively inexpensive nutritional support along
with oxidative intravenous as well as
intramuscular, and nebulized oxidative solutions
may be helpful for COVID-19 patients. Future,
randomized studies are needed to elucidate the
effectiveness of this or similar regimens.

References
[1]

[2]

MSN. MSN covid tracker . MSN.com, 2020.
MSN coronavirus .
Wertheim JO, Chu DK, Peiris JS,
Kosakovsky Pond SL, and Poon LL. A
case for the ancient origin of coronaviruses
. J Virol., 87(12):7039-7045, 2013. DOI .
17

 Sci, Pub Health Pol, & Law
[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

COVID19 Therapy Case Series- July 7, 2020

Osborne TB, Mendel LB, Ferry EL, and Wakeman AJ. THE RELATION OF GROWTH
TO THE CHEMICAL CONSTITUENTS
OF THE DIET . Journal of Biological Chemistry, 15:311–326, 1913. .
Green H. N. and Mellanby E.. . VITAMIN
A AS AN ANTI-INFECTIVE AGENT . Br
Med J , 2:691, 1928. PubMed Central .
Villamor E and Fawzi WW. Effects of Vitamin a supplementation on immune responses and correlation with clinical outcomes . Clin Microbiol Rev, 18(3):446-464,
2005. PubMed .
Freudenberg N., Freudenberg M.A., and Guzman J and et al. . Identification of endotoxinpositive cells in the rat lung during shock .
Vichows Archiv A Pathol Anat , 404:197–211,
1984. DOI .
Wong YC and Buck RC. An electron microscopic study of metaplasia of the rat tracheal epithelium in Vitamin A deficiency .
Lab Invest, 24(1):55-66, 1971. PubMed .
Wannee Rojanapo, Adrian J. Lamb,
and James A. Olson.
The Prevalence,
Metabolism and Migration of Goblet Cells
in Rat Intestine following the Induction of
Rapid, Synchronous Vitamin A Deficiency
. The Journal of Nutrition, 110(1):178–188,
January 1980. DOI .
Rosemary A. Warden, Marisa J. Strazzari, Peter R. Dunkley, and Edward V. O’Loughlin.
Vitamin A-Deficient Rats have Only Mild
Changes in Jejunal Structure and Function
. The Journal of Nutrition, 126(7):1817–1826,
July 1996. PubMed .
Dillehay D, Walia A, and Lamon. Effects of
Retinoids on Macrophage Function and IL1 Activity . J Leukoc Biol, (44):353–360, 1988.
DOI .
Mehta P., McAuley D., Brown M., Sanchez
E., Tattersall, R, and Manson J. COVID19: consider cytokine storm syndromes
18

and immunosuppression .
The Lancet,
395(10229):1033–1034, 2020. PubMed .
[23]

IBID Villamor E and Fawzi WW. Effects
of Vitamin a supplementation on immune
responses and correlation with clinical outcomes . Clin Microbiol Rev, 18(3):446-464,
2005. PubMed .

[24]

Mehta P., McAuley D., Brown M., Sanchez
E., Tattersall, R, and Manson J. COVID19: consider cytokine storm syndromes
and immunosuppression .
The Lancet,
395(10229):1033–1034, 2020. PubMed .

[25]

Wang D, Hu B, Hu C, and et al. Clinical
Characteristics of 138 Hospitalized Patients
With 2019 Novel Coronavirus–Infected
Pneumonia in Wuhan, China. . JAMA,
323(11):1061–1069, 2020. PubMed .

[26]

Mazanec and et al. Intracellular neutralization of influenza virus by immunoglobulin A anti-hemagglutinin monoclonal antibodies . J. Virol, 69:1339– 1343, 1995.
PubMed Central .

[27]

Mazanec et al. Intracellular neutralization
of Sendai and influenza viruses by IgA monoclonal antibodies . Adv. Exp. Med. Biol,
371:651–654, 1995. Springer .

[28]

Lamm Michael and et al. IgA and mucosal defense. . APMIS: Journal of Pathology, Microbiology and Immunology, January 1995. DOI .

[29]

et al. Sterlin, Delphine. IgA dominates
the early neutralizing antibody response to
SARS-CoV-2. . 2020. DOI .

[30]

Gangopadhyay NN, Moldoveanu Z, and
Stephensen CB. Vitamin A deficiency has different effects on immunoglobulin A production and transport during influenza A infection in BALB/c mice. . J Nutr., 126(12):29602967, 1996. DOI .

[31]

Lie C, Ying C, Wang EL, Brun T, and Geissler
C. Impact of large-dose Vitamin A supplementation on childhood diarrhoea (sic), respiratory disease and growth. . Eur J Clin
Nutr, 47(2):88-96, 1993. PubMed .

 Sci, Pub Health Pol, & Law
[32]

[33]

COVID19 Therapy Case Series- July 7, 2020

Shanghai new coronavirus disease clinical
treatment expert group. Shanghai 2019 coronavirus disease comprehensive treatment expert consensus . Journal of Infectious Diseases (Network Pre publishing), 38, May 2020.
LINK .
Fowler AA, Truwit JD, Hite RD, and et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and
Vascular Injury in Patients With Sepsis
and Severe Acute Respiratory Failure : The
CITRIS-ALI Randomized Clinical Trial .
JAMA, 322(13):1261–1270, 2019. DOI .

[34]

Chen L, Liu HG, Liu W, and et al. Zhonghua
Jie He He Hu Xi Za Zhi . Journal of Tuberculosis and Respiratory Diseases, 43(0), Feb
2020. EuropePMC .

[35]

Mohanty J., Nagababu E., and Rifkind J. Red
blood cell oxidative stress impairs oxygen
delivery and induces red blood cell aging .
Frontiers in Physiology, 5, 2014. PubMed .

[36]

Erol A. High-dose intravenous Vitamin C
treatment for COVID-19 . DOI .

[37]

Lu P, Ma D, Yan C, Gong X, Du M, and Shi
Y. Structure and mechanism of a eukaryotic transmembrane ascorbate-dependent
oxidoreductase . Proc Natl Acad Sci U S
A, 2014. DOI .

[38]

Chen Q, Espey MG, Krishna MC, and
et al. Pharmacologic ascorbic acid concentrations selectively kill cancer cells: action
as a pro-drug to deliver hydrogen peroxide to tissues . Proc Natl Acad Sci U S A,
102(38):13604-13609, 2005. DOI .

tight junction integrity. . Clin Exp Immunol,
190:351–359, 2017. DOI .
[41]

Schwalfenberg GK. A review of the critical role of Vitamin D in the functioning of
the immune system and the clinical implications of Vitamin D deficiency . Mol Nutr
Food Res, 55(1):96-108, 2011. DOI .

[42]

Sharifi A, Vahedi H, Nedjat S, Rafiei H, and
Hosseinzadeh-Attar MJ. Effect of singledose injection of Vitamin D on immune cytokines in ulcerative colitis patients: a randomized placebo-controlled trial. . APMIS,
127(10):681-687, 2019. DOI .

[43]

Daneshkhah A, Agrawal V, Eshein A, Subramanian H, Roy H, and Backman V. The Possible
Role of Vitamin D in Suppressing Cytokine
Storm and Associated Mortality in COVID19Patients . preprint, 2020. DOI .

[44]

Hansdottir S, Monick MM, Hinde SL, Lovan
N, Look DC, and Hunninghake GW. Respiratory epithelial cells convert inactive Vitamin D to its active form: potential effects on
host defense . J Immunol, 181(10):7090-7099,
2008. DOI .

[45]

Gombart AF. its role in protection against
infection . Future Microbiol., 4(9):1151-1165,
2009. DOI .

[46]

CDC.
Second National Report On Biochemical Indicators Of Diet And Nutrition
In The U.S. Population . 2020. CDC .

[47]

Caldwell K., Makhmudov A., Ely E., Jones R.,
and R. Wang. Iodine Status of the U.S. Population National Health and Nutrition Examination Survey, 2005–2006 and 2007–2008 .
Thyroid, 21(4):419–427, 2011. DOI .

[39]

Alipio Mark. Vitamin D Supplementation
Could Possibly Improve Clinical Outcomes
of Patients Infected with Coronavirus-2019
(COVID-19) . April 2020. Abstract .

[48]

Kathleen L. Caldwell, Yi Pan, Mary E.
Mortensen, Amir Makhmudov, Lori Merrill,
and John Moye. . Thyroid, pages 927–937,
Aug 2013. DOI .

[40]

J.I. Kast, A.J. McFarlane, A. Głobińska,
M. Sokolowska, P. Wawrzyniak, M. Sanak,
J. Schwarze, C.A. Akdis, and K. Wanke. Respiratory syncytial virus infection influences

[49]

Weetman AP, McGregor AM, Campbell H,
Lazarus JH, Ibbertson HK, and Hall R. Iodide enhances IgG synthesis by human peripheral blood lymphocytes in vitro . Acta

19

 Sci, Pub Health Pol, & Law

COVID19 Therapy Case Series- July 7, 2020

ide Nebulization Against Murine Norovirus
and Feline Calicivirus, Two Surrogates of
Human Norovirus . Food Environ Virol.,
8(4):275-282, 2016. DOI .

Endocrinol (Copenh), 103(2):210-215, 1983.
DOI .
[50]

Zel’tser ME. Vliianie khronicheskogo defitsita ı̆oda v ratsione na razvitie infektsionnogo protsessa [Effect of a chronic iodine deficit in the ration on the development
of the infectious process] . Zh Mikrobiol
Epidemiol Immunobiol., 0(9):116-119, 1975.
PubMed .

[51]

Venturi S and Venturi M. Iodine, thymus, and
immunity . Nutrition, 25(9):977-979, 2009.
DOI .

[52]

Pelletier J., Tessema B., Westover J., Frank S.,
Brown S., and Capriotti J. In Vitro Efficacy of
Povidone-Iodine Nasal And Oral Antiseptic
Preparations Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2). . PrePrint, 2020. PrePrint .

[53]

Eggers M, Koburger-Janssen T, Eickmann
M, and Zorn J. In Vitro Bactericidal and
Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and
Oral Tract Pathogens . Infect Dis Ther,
7(2):249-259, 2018. DOI .

[59]

M Reth. Hydrogen peroxide as second messenger in lymphocyte activation . Nat Immunol 3, page 1129–1134, 2002. PubMed .

[60]

Oliver T. and Murphy D. INFLUENZAL
PNEUMONIA : THE INTRAVENOUS INJECTION OF HYDROGEN PEROXIDE
. The Lancet, 195(5034):432–433, 1920.
PDF .

[61]

Antunes F. and Cadenas E. Estimation
of H2O2 gradients across biomembranes
.
FEBS Letters, 475(2):121–126, 2000.
PubMed .

[62]

James R. Stone and Tucker Collins . The Role
of Hydrogen Peroxide in Endothelial Proliferative Responses . Endothelium, 9(4):231–
238, 2002 . DOI .

[63]

Bocci V., Aldinucci Carlo, and Bianchi L. The
use of hydrogen peroxide as a medical drug
. Rivista Italiana di Ossigeno-Ozonoterapia,
4:30–39, 2005. PDF .

[54]

Abraham G., Flechas J, and Hakala J. Orthoiodosupplementation: Iodine Sufficiency Of
The Whole Human Body . Optimox.com,
2020. OPTIMOX .

[64]

Clinicaltrials.gov.
Correlation Between
Oxidative Stress Status And COVID-19
Severity .
Clinicaltrials.gov, 2020 .
ClinicalTrials .

[55]

Chance B, Sies H, and Boveris A. Hydroperoxide metabolism in mammalian organs .
Physiol Rev., 59(3):527-605, 1979. DOI .

[65]

[56]

Halliwell Barry and Clement Marie
Veronique and Long Lee Hua.
Hydrogen peroxide in the human body . FEBS
Letters, page 486, 2000. DOI .

Zhang C, Wu Z, Li J, Zhao H, and Wang
G. Cytokine release syndrome in severe
COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality . Int J Antimicrob Agents,
55(5):105954, 2020. DOI .

[66]

Rysz J, Stolarek RA, Luczynski R, and
et al. Increased hydrogen peroxide concentration in the exhaled breath condensate of stable COPD patients after nebulized N-acetylcysteine . Pulm Pharmacol
Ther., 20(3):281-289, 2007. DOI .

Menéndez R Bermejo-Martin J, Almansa R,
Mendez R, Kelvin D, and Torres A. Lymphopenic community acquired pneumonia
as signature of severe COVID-19 infection
. Journal of Infection, 80(5):e23–e24, 2020.
PubMed .

[67]

Bocci V.
Oxygen-Ozone Therapy .
Dordrecht: Springer, page 1440, 2002.
Springer .

[57]

[58]

Zonta W, Mauroy A, Farnir F, and Thiry
E. Virucidal Efficacy of a Hydrogen Perox20

 Sci, Pub Health Pol, & Law
[68]

[69]

[70]

[71]

[72]

[73]

[74]

[75]

[76]

COVID19 Therapy Case Series- July 7, 2020

Bocci V. . Ozone - A New Medical Drug 2nd
ed. Dordrecht: . Springer Netherlands, pages
1–295, 2011. Springer .

Killing and Inflammation .
Science,
298(5601):2195–2199, 2002. DOI .
[77]

Valacchi G and Bocci V. Studies on the biological effects of ozone: 11. Release of factors from human endothelial cells . Mediators Inflamm., 9(6):271-276, 2000. DOI .

Walter LA and McGregor AJ. Sex- and
Gender-specific Observations and Implications for COVID-19. . West J Emerg Med.,
21(3):507-509, Apr 2020. DOI .

[78]

Rowen RJ. Ozone and oxidation therapies
as a solution to the emerging crisis in infectious disease management: a review of current knowledge and experience . Med Gas
Res., 9(4):232-237, 2019. DOI .

[79]

Mirazimi A, Mousavi-Jazi M, Sundqvist
VA, and Svensson L. Free thiol groups
are essential for infectivity of human cytomegalovirus . J Gen Virol, 80(Pt 11):28612865, 1999. DOI .

[80]

Broer R, Boson B, Spaan W, Cosset FL, and
Corver J. Important role for the transmembrane domain of severe acute respiratory
syndrome coronavirus spike protein during
entry . J Virol., 80(3):1302-1310, 2006.
PubMed .

[81]

Virender K. Sharma and Nigel J.D. Graham .
Oxidation of Amino Acids, Peptides and
Proteins by Ozone: A Review, Ozone . Science & Engineering, 32(2):81–90, 2010 .
DOI .

[82]

KUNAPULI S, KHAN N, DIVAKAR N, and
VAIDYANATHAN C. OXIDATION OF INDOLES . Journal of the Indian Institute of
Science, 2020. LINK .

[83]

IBID. Bocci V. Oxygen-Ozone Therapy .
Dordrecht: Springer, 1440, 2002. Springer .

[84]

IBID. Bocci V, Aldinucci Carlo, and Bianchi
L. The use of hydrogen peroxide as a medical drug . Rivista Italiana di OssigenoOzonoterapia, 4:30–39, 2005. PDF .

[85]

Schulz S, Ninke S, Watzer B, and Nüsing
RM.
Ozone induces synthesis of systemic prostacyclin by cyclooxygenase-2 dependent mechanism in vivo . Biochem Pharmacol, 83(4):506-513, 2012. DOI .

Thengchaisri N and Kuo L. Hydrogen peroxide induces endothelium-dependent and
-independent coronary arteriolar dilation:
role of cyclooxygenase and potassium channels . American Journal of Physiology-Heart
and Circulatory Physiology, 285(6):H2255–
H2263, 2003. DOI .
IBID. Bocci V, Aldinucci Carlo, and Bianchi
L. The use of hydrogen peroxide as a medical drug . Rivista Italiana di OssigenoOzonoterapia, 4:30–39, 2005. PDF .
Kampf G, Todt D, Pfaender S, and Steinmann
E. Persistence of coronaviruses on inanimate surfaces and their inactivation with
biocidal agents . Journal of Hospital Infection, 104(3):246–251, 2020. DOI .
Aaron J. Smith, John Oertle, Dan Warren,
and Dino Prato. Ozone Therapy: A Critical Physiological and Diverse Clinical Evaluation with Regard to Immune Modulation,
Anti-Infectious Properties, Anti-Cancer Potential, and Impact on Anti-Oxidant Enzymes . Open Journal of Molecular and Integrative Physiology, 5(3):37–48, 2015. DOI .
IBID. Shanghai new coronavirus disease
clinical treatment expert group. Shanghai
2019 coronavirus disease comprehensive
treatment expert consensus. . Journal of Infectious Diseases, 38, 3 2020. LINK .
Dı́az LJ, Sardiñas PG, Menéndez CS, and et al.
Immunomodulator effect of ozone therapy
in children with deficiency in immunity mediated by phagocytes . Mediciego, 18(1),
2012. Medigraphic .
Wentworth P. Evidence for AntibodyCatalyzed. Ozone Formation in Bacterial
21

 Sci, Pub Health Pol, & Law

COVID19 Therapy Case Series- July 7, 2020

[86]

Zamora ZB, Borrego A, López OY, and et al.
Effects of ozone oxidative preconditioning on TNF-alpha release and antioxidantprooxidant intracellular balance in mice
during endotoxic shock . Mediators Inflamm,
2005(1):16-22, 2005. DOI .

[89]

Ma Q. Role of Nrf2 in Oxidative Stress
and Toxicity . Annu Rev Pharmacol Toxicol,
53:401–426 , 2013. DOI .

[90]

Lancet Staff. The gendered dimensions of
COVID-19 . The Lancet, 395(10231):1168,
2020. DOI .

[87]

Pecorelli A, Bocci V, Acquaviva A, and et al.
NRF2 activation is involved in ozonated human serum upregulation of HO-1 in endothelial cells . Toxicol Appl Pharmacol,
267(1):30-40, 2013. DOI .

[91]

Yang J, Zheng Y, Gou X, and et al. Prevalence
of comorbidities and its effects in patients
infected with SARS-CoV-2: a systematic review and meta-analysis . Int J Infect Dis,
94:91-95, 2020. DOI .

[88]

Delgado-Roche L, Riera-Romo M, , Mesta
F, Hernández-Matos Y, Barrios J, and et al.
Medical ozone promotes Nrf2 phosphorylation reducing oxidative stress and proinflammatory cytokines in multiple sclerosis patients . Eur J Pharm, 811:148–154, 2017.
PubMed .

[92]

Jackevicius Cynthia. The Value of Case Reports . Can. J. Hosp. Pharm., 71(6):345–6,
Nov-Dec 2018. PubMed Central .

[93]

Verity R and et.al. Estimates of the severity
of coronavirus disease 2019: a model-based
analysis . Lancet Journal of Infectious diseases, 20(6):669–677 , 2020. The Lancet .
***Editor's Erratum Note, 7/9/2020, 8:20PM
Due to a typographical error, the amount of
Vitamin A in the protocol was originally
reported as 10,000 IU/day.
The correct
value should have been 100,000 IU/day.

22