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Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)?

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Can early and high intravenous dose of vitamin C prevent and
treat coronavirus disease 2019 (COVID-19)?
Richard Z. Cheng
PII: S2590-0986(20)30015-4
DOI: https://doi.org/10.1016/j.medidd.2020.100028
Reference: MEDIDD 100028
To appear in: Medicine in Drug Discovery
Received date: 19 March 2020
Revised date: 23 March 2020
Accepted date: 24 March 2020
Please cite this article as: R.Z. Cheng, Can early and high intravenous dose of vitamin
C prevent and treat coronavirus disease 2019 (COVID-19)?, Medicine in Drug Discovery
(2020), https://doi.org/10.1016/j.medidd.2020.100028
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Can early and high intravenous dose of vitamin C prevent and treat
coronavirus disease 2019 (COVID-19)?
Richard Z. Cheng*
Cheng Integrative Health Center, Columbia, SC 29212, U.S.A.
*Corresponding author: richzc@gmail.com
The COVID-19 (SARS-2-Cov) pandemic, first reported in Wuhan, China, is now spreading to
many continents and countries, causing a severe public health burden. Currently, there is no
vaccine or specific antiviral drug for this deadly disease. A quick, deployable and accessible,
effective and safe treatment is urgently needed to save lives and curtail the spreading. Acute
respiratory distress syndrome (ARDS) is a key factor of fatality. Significantly increased
oxidative stress due to rapid release of free radicals and cytokines is the hallmark of ARDS
which leads to cellular injury, organ failure and death. Early use of large dose antioxidants, such
as vitamin C (VC) may become an effective treatment for these patients. Clinical studies also
show that high-dose oral VC provides certain protection against viral infection. Neither
intravenous nor oral administration of high-dose VC is associated with significant side-effects.
Therefore, this regimen should be included in the treatment of COVID-19 and used as a
preventative measure for susceptible populations such as healthcare workers with higher
exposure risks.
Coronaviruses and influenza are among the pandemic viruses that can cause lethal lung
injuries and death from ARDS [1-3]. Viral infections could evoke “cytokine storm” that leads to
lung capillary endothelial cell activation, neutrophil infiltration and increased oxidative stress
(reactive oxygen and nitrogen species). ARDS, characteristic of severe hypoxemia, is usually
accompanied by uncontrolled inflammation, oxidative injury and damage to the alveolar-
capillary barrier [4]. Increased oxidative stress is a major insult in pulmonary injury including
acute lung injury (ALI) and ARDS, two clinical manifestations of acute respiratory failure with
substantially high morbidity and mortality [5,6].
In a report of 29 patients with COVID-19 pneumonia, 27 (93%) showed increased hsCRP, a
marker of inflammation and oxidative stress [7]. Transcription factor, nuclear factor erythroid 2
(nfe2)-related factor 2 (nrf2), is a major regulator of antioxidant response element (ARE)-driven
cytoprotective protein expression. Activation of Nrf2 signaling plays an essential role in
preventing cells and tissues from injury induced by oxidative stress. VC, an important
component of the cellular antioxidant system [8], is beneficial to critical care management [9].
Cytokine storm is observed in both viral and bacterial infections [3] and results in increased
oxidative stress via a common and non-specific pathway. Since the prevention and management
of oxidative stress could be realized by large dose of antioxidants, this approach may be
applicable to COVID-19 with intravenous high-dose VC based on the outcome of three previous
clinical studies involving a total of 146 patients with sepsis [10].
Hemila and colleagues reported that various high-dose intravenous VC infusions (e.g., 200
mg/kg body weight/day, divided into 4 doses) shortened the intensive care unit (ICU) stay by
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97.8% [11], accompanied by a significant reduction in the mortality rate [12]. Such an
experience was reproduced among patients ill with severe influenza [13,14]. Indeed, dietary
antioxidants (VC and sulforaphane) were shown to decrease oxidative stress induced acute
inflammatory lung injury in patients receiving mechanical ventilation [15]. In addition, oral VC
(e.g., 6 g daily) was able to reduce viral infection risk [16] or to improve symptoms [17].
High-dose intravenous VC has also been successfully used in the treatment of 50 moderate
to severe COVID-19 patients in China. The doses used varied between 2 g and 10 g per day,
given over a period of 8 to 10 hours. Additional VC bolus may be required among patients in
critical conditions. The oxygenation index was improving in real time and all the patients
eventually cured and were discharged [18]. In fact, high-dose VC has been clinically used for
several decades and a recent NIH expert panel document states clearly that this regimen (1.5 g/kg
body weight) is safe and without major adverse events [19].
Because the development of efficacious vaccines and antiviral drugs takes time, VC and
other antioxidants are among currently available agents to mitigate COVID-19 associated ARDS.
Given the fact that high-dose VC is safe, healthcare professionals should take a close look at this
opportunity. Obviously, well-designed clinical studies are absolutely needed to develop standard
protocols for bedside use.
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... It is known that high-dose VC provides a certain protection against viral infection. Intravenous VC may also attenuate the cytokine storm in the COVID-19 infection besides its antiviral properties (7). High-dose vitamin C is an example of a substance that has proven to alter blood glucose measurements on glucose devices. ...
... Currently, no suitable vaccine or specific antivirals are available for COVID-19. Acute respiratory distress syndrome (ARDS) is considered as the virtual reason for mortality (7). Coronaviruses may lead to significant lung damage and death from ARDS via the activation of pulmonary capillary endothelium, infiltration by neutrophils, and enhanced oxidative stress as a result of "cytokine storm" (3,4). ...
... The oxidization of ascorbic acid at the electrode surface, leading to more electrons and current production, which leads to a false increase in blood glucose reading (5). The antiviral activities of VC were known for decades and high-dose intravenous VC treatment was shown to be effective in patients with sepsis, ill with severe influenza, receiving mechanical ventilation (7). In addition to direct antiviral properties, intravenous VC may also attenuate the cytokine storm in the COVID-19 infection. ...
... It's an antioxidant that keeps the intracellular reductive-oxidative homeostasis [29] . The increased oxidative stress in COVID-19 patients caused by free radicals and cytokine's rapid release during a cytokine storm makes an urgent need to add antioxidants in the treatment protocols for COVID-19, vitamin C is the most suggested antioxidant [30] . ...
... Staying in the intensive care unit (ICU) decreased by 7.8% after 200 mg/kg body weight/day consumption [31]. Some studies have shown that oral vitamin C decreases the risk of infection with viruses [30] . Analysis of 17 COVID-19 patients found that the use of high-dose I.V. Vitamin C can be used in patients with moderate-severe illnesses [31] . ...
... Hasta la fecha, no existe consenso ni eficacia probada de la suplementación con ácido ascórbico en pacientes con COVID-19, pero algunos investigadores recomiendan un posible uso de suplementación IV, como se indica en un documento del panel de expertos del Instituto Nacional de Cáncer del Instituto Nacional de Salud de Estados Unidos, en el que se menciona que una dosis de 1,5 g/kg de peso corporal podría considerarse seguro y sin efectos adversos importantes (29) . Otros autores no hacen recomendaciones para la prevención de infecciones virales y recomiendan para el tratamiento 1 g/día (12) . ...
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... The world outbreak mortality rate is about 3%, and frail patients who had comorbidities such as cardiovascular disease, diabetes, asthma, etc. are at high risk (Pascarella et al., 2020). Both the influenza virus and the coronavirus are deadly respiratory tract infections that cause mortality from acute respiratory distress syndrome (ARDS) (Cheng, 2020). ...
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