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Sub-Acute and Chronic COVID: “THERAPEUTIC TEST” AND FIRST TREATMENT SCHEME FOR PATIENTS WITH PERSISTENT SYMPTOMS OF COVID TO ASSIST THE DIAGNOSIS OF PERSISTENT VIRAL INFECTION.

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Sub-Acute and Chronic COVID: “THERAPEUTIC TEST” AND FIRST TREATMENT SCHEME FOR PATIENTS WITH PERSISTENT SYMPTOMS OF COVID TO ASSIST THE DIAGNOSIS OF PERSISTENT VIRAL INFECTION. ABSTRACT. There is a high number of patients who have Persistent Symptoms of COVID and there are many difficulties for its proper diagnosis. Faced with this problem, in the month of July 2020 we proposed a "Therapeutic Test" using drugs against Viral Load for patients with Persistent Symptoms of COVID, with the aim of serving as Aid to the Diagnosis of a Persistent Viral Infection, which according to what we have observed, is the main cause of Persistent COVID Symptoms. Therapeutic Tests have been used as a Diagnostic Aid for several decades, for example, Levodopa is used for Parkinson's Disease and other movement disorders. In addition to helping the diagnosis, according to our experience, the applied "Therapeutic Test" was effective in a high percentage of patients as a first treatment scheme. To date, we have completed 4 documents in which cases of Sub-Acute and Chronic COVID treated are reported. The first study presented on July 10, 2020, included 33 patients; the second study presented in September 2020, included 21 patients with anosmia and hyposmia; the third study is a case report of reactivation of a latent infection; and in April 2021 we completed the report of 390 patients where the results show that 75% of the patients with Sub-Acute and Chronic COVID treated treated with drugs against Viral Load responded to treatment and recovered after 1 to 3 weeks of treatment. The drugs included in this "Therapeutic Trial" are based on the Therapeutic Plan for COVID established in the document that we published on May 2, 2020. This Plan includes the following 3 Lines of Action. 1st Line of Action: Reduce Viral Load. It is the main one, and here we include Ivermectin (IVM), being able to also resort to other medications that are effective in reducing the Viral Load. 2nd Line of Action: Reduce platelet hyperactivity and break down persistent clots. Its objective is to counteract the "favorable environment" for the virus that is generated at the level of blood vessels and that we propose becomes a factor associated with persistence. of SARS CoV-2 infection. That is why the first day of the "Therapeutic Test" begins only with the antiplatelet and not yet with the drug against viral load, so that the antiplatelet acts helping to break down the clots and in this way better results would be obtained when give viral load medicine. Another drug that has antiplatelet, anticoagulant or fibrinolytic effect can also be used instead of ASA. 3rd Line of Action: Treat nutrient depletion, oxidative stress and immune dysfunctions. Here, sodium bicarbonate and famotidine are considered, and it is also indicated to follow a diet low in Arginine and Histamine and high in Lysine and Vitamin D. This document describes the doses to be given of each of the drugs included in the "Therapeutic Test", as well as the doses of their alternatives. At the end of the Test, after 6 days of taking medications, the results must be obtained, first for each of the symptoms, and then for all the symptoms as a whole, to determine the actions to follow according to the results obtained. In those who, on the sixth or seventh day of the Test, achieve a 100% improvement in all symptoms, from that day the patient is instructed to take 4 more days of IVM. In those who, on the seventh day, do not achieve 100% improvement in all their symptoms, and presents a partial improvement, of between 40% to 99% in his symptoms, they are instructed to continue taking IVM, ASA, Famotidine and the diet. Which you should continue taking while your symptoms improve, or until you complete a maximum of 10 additional days of continuous treatment. Tables 5 and 9 of this document describe the doses of the drugs included in the "Therapeutic Test". Table 9 includes the evaluation to be carried out on day 7, at the end of the Test.
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1
Sub-Acute and Chronic COVID:
“THERAPEUTIC TEST” AND FIRST TREATMENT SCHEME FOR
PATIENTS WITH PERSISTENT SYMPTOMS OF COVID TO ASSIST THE
DIAGNOSIS OF PERSISTENT VIRAL INFECTION.
If there is a response to treatment, the presence of viral persistence is supported.
Aguirre-Chang, Gustavo and Trujillo, Aurora. ResearchGate. April 19, 2021.
ABSTRACT
There is a high number of patients who have Persistent Symptoms of COVID and there
are many difficulties for its proper diagnosis.
Faced with this problem, in the month of July 2020 we proposed a "Therapeutic Test"
using drugs against Viral Load for patients with Persistent Symptoms of COVID, with the
aim of serving to assist the Diagnosis of a Persistent Viral Infection, which according to
what we have observed, is the main cause of Persistent COVID Symptoms.
Therapeutic Tests have been used as a Diagnostic Aid for several decades, for example,
Levodopa is used for Parkinson's Disease and other movement disorders.
In addition to helping the diagnosis, according to our experience, the applied
"Therapeutic Test" was effective in a high percentage of patients as a first treatment
scheme.
To date, we have completed 4 documents in which cases of Sub-Acute and Chronic
COVID treated are reported.
The first study presented on July 10, 2020, included 33 patients; the second study
presented in September 2020, included 21 patients with anosmia and hyposmia; the third
study is a case report of reactivation of a latent infection; and in April 2021 we completed
the report of 390 patients where the results show that 75% of the patients with Sub-Acute
and Chronic COVID treated treated with drugs against Viral Load responded to treatment
and recovered after 1 to 3 weeks of continuous treatment (every day).
The drugs included in this "Therapeutic Trial" are based on the Therapeutic Plan for
COVID established in the document that we published on May 2, 2020. This Plan
includes the following 3 Lines of Action.
1st Line of Action: Reduce Viral Load. It is the main one, and here we include Ivermectin
(IVM), being able to also resort to other medications that are effective in reducing the
Viral Load.
2nd Line of Action: Reduce platelet hyperactivity and break down persistent clots. Its
objective is to counteract the "favorable environment" for the virus that is generated at
the level of blood vessels and that we propose becomes a factor associated with
persistence. of SARS CoV-2 infection. That is why the first day of the "Therapeutic Test"
begins only with the antiplatelet and not yet with the drug against viral load, so that the
antiplatelet acts helping to break down the clots and in this way better results would be
obtained when give viral load medicine.
Another drug that has antiplatelet, anticoagulant or fibrinolytic effect can also be used
instead of ASA.
3rd Line of Action: Treat nutrient depletion, oxidative stress and immune dysfunctions.
Here, are considered Famotidine, Sodium and/or potassium Bicarbonate and it is also
indicated to follow a diet low in Arginine and Histamine and high in Lysine and Vitamin D.
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
2
This document describes the doses to be given of each of the drugs included in the
"Therapeutic Test", as well as the doses of their alternatives.
At the end of the Test, after 6 days of taking medications, the results must be obtained,
first for each of the symptoms, and then for all the symptoms as a whole, to determine
the actions to follow according to the results obtained.
In those who, on the sixth or seventh day of the Test, achieve a 100% improvement in all
symptoms, from that day the patient is instructed to take 4 more days of IVM.
In those who, on the seventh day, do not achieve 100% improvement in all their
symptoms, and presents a partial improvement, of between 40% to 99% in his
symptoms, they are instructed to continue taking IVM, ASA, Famotidine and the diet.
Which you should continue taking while your symptoms improve, or until you complete a
maximum of 10 additional days of continuous treatment.
Tables 5 and 9 of this document describe the doses of the drugs included in the
"Therapeutic Test". Table 9 includes the evaluation to be carried out on day 7, at the end
of the Test.
PERSISTENT PRESENCE OF VIRUSES SARS COV-2 IN ENDOTHELIAL CELLS
AND IN MULTIPLE ORGANS.
In several published scientific studies, it has been possible to demonstrate by biopsies,
electron microscopy, cultures and molecular tests, the presence of the SARS CoV-2
virus persistently in endothelial cells, in the lung, intestines and other organs (1-8).
The study published by Colmenero et al. demonstrates the presence of the SARS-CoV-2
coronavirus in the endothelial cells of the skin microvasculature (1).
A study carried out by Recalde-Zamacona et al (2), showed in the post mortem, the
presence of a significantly high level of SARS CoV-2 viral load in the lung, heart, kidney
and liver. In an interview subsequently conducted with the authors (3), they stated: “What
we see is that (the virus) is present in other sites (besides the lungs), the quantities that
we see correspond to copies of pathological viruses, viruses that causes damage, it is
not contamination or residual, that is why we say that it is a viable virus”; and "antiviral
treatment may have to be given even in the late stages of the disease".
In another similar study, Deinhardt-Emmer S. et al. (4) report a series of autopsies in
patients with COVID-19. There were 11 autopsies that were performed in the early
postmortem interval (on average 5.6 hours after death), this to avoid bias due to
degradation of the virus RNA and tissue structures. Very high viral loads were detected
in the lungs of most patients, and this high viral load was strongly correlated with
histological damage to the lungs. Variable amounts of viral load were found in the lymph
nodes. High viral loads were also detected in many other tissue samples from different
organs and extrapulmonary tissues, but in these cases without obvious organ and tissue
damage, this based on microscopy images. The presence of SARS-CoV-2 in a
disseminated manner throughout the body supports the hypothesis that there is a high
viral load up to the time of death in patients who develop severe or critical illness.
And there are several other publications that support the presence of persistent viral
infection by SARS CoV-2 (5-11,23,24).
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
3
PERSISTENT INFECTION BY SARS CoV-2.
When reviewing the treatises on virology and medical publications (12-15), it is generally
seen that viral infections for several years are classified as Acute and Persistent. If
viruses persists, virus-host interactions ocurre as part of a persistent and prolonged
infection.
We then have that persistent viral infections are described and occur frequently, so, in
the presence of Persistent Symptoms of COVID, it corresponds investigate for a
persistent viral infection, which can last for several months.
Table 1 presents a general classification with the types of viral infections, and whose names
we have proposed that also apply in the case of SARS CoV-2 and COVID-19.
For our part, we have published documents supporting the viral persistence of SARS
CoV-2 with multiple scientific references (15,16,17,18).
It is clarified that there is a name to be used for the type of infection that causes the
disease, which can be: Acute Infection or Persistent Infection; and apart there is another
name or diagnosis for what corresponds to the disease caused by the infection.
So, we have on the one hand that, an Acute Infection by SARS CoV-2, is the cause of
the Acute COVID disease. While on the other hand, a Persistent Infection by SARS CoV-
2, causes the presence of Persistent Symptoms of COVID, which when exceeding the 4
weeks that Acute COVID lasts, are called Sub-Acute or Post-Acute COVID, and if the 12
weeks of evolution are exceeded, the diagnosis of Chronic COVID should be given (see
Table 2).
Table 2
Denominations for SARS CoV-2 Infections
and for Diseases that cause
Type of Infection causing .
the Disease .
Acute infection by
SARS CoV-2
Persistent infection by
SARS CoV-2
Disease Diagnosis .ACUTE COVID
SUB-ACUTE COVID and
CHRONIC COVID
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
4
ABSENCE OF TESTS TO DIAGNOSE VIRAL LOAD AT THE INTRACELLULAR
LEVEL.
The conventional molecular tests available are based on samples of nasal and
oropharynx discharge, therefore they are not useful for the diagnosis of intracellular
infections and those of a location other than the upper respiratory tract (16,18).
It should be considered that the COVID disease in the sub-acute and chronic stages, is
an infection of an intracellular locatiion, so the virus is not present in secretions, so it will
rarely be detected with the current molecular tests that only take samples of secretions,
which have been outside the tissues. A negative molecular test only indicates that there
is insufficient viral load in the mucosal surface secretions of the nose and oropharynx
(16,18).
Molecular Testing of Stool Sample or Anal Swabs.
The Chinese health authorities implemented anal swabs as of January 27, 2021 and are
currently mandatory for tourists traveling to that country (19). This is based on several
investigations that show that the virus can remain in the intestines for several weeks,
which represents a significantly longer time compared to what can remain in the nose
and oropharynx (20,21,22,23), and its application would be important for the detection of
a SARS CoV-2 infection in patients without symptoms.
Initially, a stool sample should be taken from the patient, but if this procedure is not
possible, the test should be done directly in the patient by inserting the swab through the
rectum up to three or five centimeters deep to take the sample.
Instead of a swab, a cytobrush could be used, with the aim that the sample contains
cells.
On the other hand, at present this test is not available outside the country of China.
Cell Molecular Tests obtained by brushing the mucous membranes.
I t is recommended that PCR be performed on cell samples obtained from inside each
nostril, by brushing at the level of the olfactory epithelium (located in the upper part of the
nasal cavity).
To obtain cells from the epithelium, it is necessary to use a cytobrush such as those
used to take Papanicolaou (PAP) samples. Using swabs does not ensure that cells are
obtained in sufficient quantity for the molecular test to be positive, so the percentage of
False Negatives is high.
Obtaining samples by brushing at the level of the olfactory epithelium is indicated above
all in patients who present a long-term alteration in smell or taste, but it can also be
requested in those who do not present it.
The collection of these cytological samples must be carried out by a health personnel
with due experience.
Molecular Testing of Blood Cell Samples.
Since it is an intracellular infection, it is proposed that molecular tests be performed using
samples that contain cells and not secretions. A sample of blood cells can be obtained
by centrifuging the blood, and using the intermediate layer that is formed in the sample
tube and that corresponds to leukocytes and platelets.
Molecular Tests of Tissues obtained by Biopsy.
Studies have been reported that have identified the active virus in biopsies taken at the
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
5
level of the heart and other organs, but biopsies are not tests that doctors can request
routinely (2,4).
USE OF THE “THERAPEUTIC TESTFOR THE DIAGNOSIS OF PERSISTENT VIRAL
INFECTION.
Given the current absence of adequate tests available to diagnose the presence of viral
load intracellularly and in locations other than the upper respiratory tract (15,16,18), our
team of doctors we have been using since May of 2020 is the "Therapeutic Test" with
drugs against Viral Load.
Therapeutic Tests have been used how to assist diagnostic for several decade for
example, we have the use of Levodopa in Parkinson's disease, in Dystonia and other
movement disorders (24); the use of Proton Pump Inhibitors (PPIs) for
Gastroesophageal Reflux (25), and the Therapeutic Test in Tuberculosis with negative
smear microscopy is also used (26).
The decision to create a "Therapeutic Test" for the Diagnosis of Persistent Viral Infection
was made in part because throughout 2020 the vast majority of the scientific community
did not accept the possibility that the SARS CoV-2 virus would persist any longer after 10
days.
Little by little more studies supporting viral persistence are being published, and it is
becoming more and more accepted (1-12,22,23).
THERAPEUTIC PLAN AND SCHEME OF THE "THERAPEUTIC TEST".
The first studies that have been carried out on an effective treatment using drugs against
Viral Load for Persistent Symptoms of COVID have been in charge of our team of
doctors (30,31,32).
To date, we have completed 4 documents in which treated cases of Sub-Acute and
Chronic COVID are reported.
In the first study (30), 33 patients were included and it was made available on the
ResearchGate page on July 10, 2020. The second study was presented in September
2020 (31), it included patients with anosmia and hyposmia; the third document is a case
report of reactivation of a latent infection (32); and in April 2021 we completed the report
of 390 patients where the results show that 75% of patients with Sub-Acute and Chronic
COVID responded to treatment with drugs against Viral Load and platelet hyperactivity
and recovered after 1 to 3 weeks of continuous treatment (every day).
In September 2020, we made available through the ResearchGate page and groups on
social networks, the “Therapeutic Test” for patients with Persistent COVID Symptoms
(27). The Treatment Schedule of this Test is based on the Therapeutic Plan for COVID
established in the document that we published on May 2, 2020 (57).
This Therapeutic Plan includes 3 Lines of Action, which are developed below:
1st Line of Action: REDUCE VIRAL LOAD. It is the main one, and here we chose to
include IVM, which continues to be the drug against viral load of choice, due to the good
results obtained, the great experience of decades in its use, the few side effects and the
safety in its use, which has been demonstrated both in children and in adults who were
given doses above the usual ones (64,65). It is also important to point out that it is low
cost and can be easily purchased online from the websites of companies that are
dedicated to the sale of medicines (75). However, later on, the alternatives that can be
indicated instead of IVM are mentioned.
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
6
2nd Line of Action: REDUCE PLATELET HYPERACTIVITY AND BREAK DOWN
PERSISTENT CLOTS. Its objective is to counteract the “favorable environment” for the
virus that is generated in the blood vessels and that we propose becomes a factor
associated with the persistence of the SARS CoV-2 infection (28,29). That is why the first
day of the "Therapeutic Test" begins only with the antiplatelet and not yet with the drug
against Viral Load, so that the antiplatelet acts helping to break down the clots and in this
way better results will be obtained when give the medicine against Viral Load, since
persistent clots that have a high fibrin content create a protective layer or wall to the
endothelial cells infected with the virus, and in this way they are protected from the
immune system and the medicines against Viral Load.
As an antiplatelet, Acetyl Salicylic Acid (ASA or Aspirin) has been chosen as the first
option since it is the drug that is most available internationally, it is the best-known
antiplatelet and with the most experience in its use.
You can also resort to another drug that has an antiplatelet, anticoagulant or fibrinolytic
effect.
3rd Line of Action: TREAT NUTRIENT DEPLETION, OXIDATIVE STRESS AND
IMMUNE DYSFUNCTIONS. Here Famotidine, Sodium and/or potassium Bicarbonate are
considered and it is also indicated to follow a diet low in Arginine and Histamine and high
in Lysine and Vitamin D (27).
The following paragraphs describe the doses to be given of each of the drugs included in
the "Therapeutic Test", as well as their alternatives.
DOSE OF THE ANTIPLATELET FOR THE “THERAPEUTIC TEST.
The Treatment Scheme of this Test begins on the first day with the Antiplatelet, which is
taken for the 6 days that the Test lasts.
The first antiplatelet options are Acetylsalicylic Acid or Aspirin (ASA) Lysine
Acetylsalicylate (LASA). The drawback of the latter is that it is not available in several
countries. Both belong to the group of Salicylates.
Before starting to take antiplatelets, it is important to assess whether there is a risk of
gastrointestinal bleeding, especially in people over 50 years of age.
Dose of ASA (Aspirin).
The suggested dose of ASA is 100 mg after breakfast, lunch, and dinner (300 mg daily).
If the patient, instead of 100 mg tablets of ASA, has 81 mg tablets, it is recommended
that they take 162 mg (2 TB) at breakfast, and 81 mg at lunch and dinner (324 mg daily).
For 325 mg tablets, you should take 1 tablet a day.
In those who weigh more than 95 kilos, it is recommended to take double the dose, that
is, 600 to 624 mg a day, this divided into 2 or 3 doses a day, after meals, for 6 days that
the Test lasts.
It is noted that no more days should be taken without medical indication, especially in
people over 50 years of age, due to the greater risk of gastrointestinal bleeding.
In itself, it is a general recommendation to be careful with the consumption of NSAIDs
(non-steroidal anti-inflammatory drugs) since one of its side effects is that it generates
ulcers (wounds) in the stomach and/or duodenum, and as a result of this, a
gastrointestinal bleeding, which is a medical emergency that requires hospital care.
If the patient develops black and shiny stools, they should go urgently to a hospital, since
this is indicative that a digestive bleeding is taking place.
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
7
For this reason it is necessary that the ASA be taken together with the indication of a
gastric protector. Thus, in the Treatment Schemes for COVID we include taking ASA or
LASA together with Famotidine and also taking Sodium and/or potassium Bicarbonate.
Additionally, to avoid an increase in gastric acid and the consequent side effects, it is
recommended to avoid coffee, soda, drinks with caffeine or taurine ("energy drinks"), as
well as alcoholic beverages and chili.
Dose of Lysine Acetylsalicylate or LASA (Aspergic, Inyesprin forte, Antigram,
Coraspir): 250, 500, 900 or 1000 mg sachets. There is also a presentation in ampoules,
900 mg.
It has been identified that it has a greater antiplatelet effect than ASA. It is noted that 900
mg of Lysine Acetylsalicylate is equivalent to 600 mg of Acetylsalicylic Acid.
The dose we suggest is 900 to 1000 mg per day. If they are 500 mg sachets, take 1 after
breakfast and dinner. If they are 900 or 1000 mg sachets, take them after lunch or
dinner.
In those who weigh more than 95 kilos, it is suggested to increase the dose from the third
day to 500 mg after breakfast, lunch and dinner (3 times a day). Then, the dose would go
up from day 3 to 6 of the Treatment Scheme to 1500 mg per day.
Alternatives of AAS and LASA.
In case the patient presents intolerance, allergy or asthma induced by ASA (Aspirin), by
Salicylates or by NSAIDs, the alternatives to ASA and LASA are:
o Clopidogrel (Plavix, Deviplat, generic), TB of 75 mg.
It should not be indicated if the patient is at risk of bleeding.
In general, a dose of 1 TB of 75 mg per day is recommended for the 6 days of the
Test.
In those weighing more than 95 kilos, a dose of 1 TB of 75 mg at 9 am and 9 pm (150
mg per day) is suggested the first 2 days, and then 1 TB of 75 mg per day the
following 4 days (days 3 to 6 of the Test).
If you weigh between 42 and 55 kilos, it is recommended to take 1 tablet of 75 mg the
first 3 days, and then half a tablet of 75 mg per day, that is, 37.5 mg, the last 3 days
(days 4 to 6 of the Test).
o Ginger, (Zingiber officinale) (34). 500, 540, 550, 560 or 1100 mg TB:
A dose of 1100 mg is recommended at the beginning of breakfast and dinner (2200
mg per day) during the first 2 days, and from the 3rd day a dose of 550 mg is added at
the beginning of lunch, then the total dose of the day to 2750mg
In patients weighing 75 to 95 kilos, it is recommended that from the 3rd day a dose of
1100 mg be added at the start of lunch, thus increasing the total dose of the day to
3300 mg. In this case it would be 1100 mg at breakfast, lunch and dinner.
In those who weigh more than 95 kilos, it is suggested that from the 3rd day the total
dose of the day be increased to 4400 mg, then take 1650 at breakfast, 1100 at lunch
and 1650 mg at dinner.
o Dipyridamole, TB 75 mg:
It is another antiplatelet, of which it is recommended to take 3 TB a day, it would be 1
TB at 7 or 8 am (1 hour before breakfast), 4 pm and 11 pm.
It is indicated to take it between 1 to 2 hours away from food and dairy products.
In those who weigh more than 95 kilos, the dose is 4 TB per day: at 7 am (1 hour
before breakfast), 11:30 am, 6 pm and 11:30 pm.
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
8
If the patient weighs between 42 and 55 kilos, it is recommended to take 1 tablet of 75
mg at 11 am and 10 pm (150 mg per day), away from food.
o L-Lysine, TB 500 mg:
The first 2 days it is recommended to take 1 TB of 500 mg at 7 am (at least 1 hour
before breakfast), 4 pm and 11 pm (1500 mg per day), and the following 4 days (from
day 3 to 6) 1 dose is added at 11:30 am (that is, it takes 4 TB per day, which is
equivalent to 2000 mg).
In those who weigh between 76 and 95 kilos, it is recommended to increase the dose
from the third day to 2500 mg per day.
In people who weigh more than 95 kilos, it is recommended to start with 2000 mg per
day, and from the third day they take 3000 mg per day.
In people who weigh between 42 and 55 kilos, the dose is reduced to 1 TB at 7 am
and 5 pm the first 2 days (1000 mg per day), and 1 TB at 7 am, 11:30 am, 5 pm and
11 pm (2000 mg daily) for the next 4 days (days 3 to 6).
The tablets are taken at least 1 hour before or after meals and with 1 full cup of water.
It should be included in cases where the patient has a history of having suffered from
Herpes or it is suspected that there is co-infection by it, and in which case the daily
doses would be increased by an additional 500 to 1000 mg depending on the
evaluation of the case.
o Policosanol, TB 5, 10 or 20 mg.
It is a mixture of higher aliphatic primary alcohols isolated from sugar cane. The
recommended dose for adults as an antiplatelet agent is 1 TB of 20 mg per day, at
breakfast.
In those who weigh less than 56 kilos, the dose is 10 mg at breakfast.
It is noted that it can be used in children and adolescents from 11 years of age.
o Other Alternatives: You can also resort to other alternatives (75), such as those
mentioned below (in alphabetical order):
- Garlic.
- Bromelain.
- Liposomal Glutathione.
- Lumbrokinase
- Naringin.
- Nattokinase.
- Serrapeptase.
- Taxifoline.
IVM DOSE FOR THE "THERAPEUTIC TEST".
Dose established during the year 2020.
The first study that we made available included 33 patients with between 4 to 8 weeks
from the onset of symptoms (COVID Sub Acute) treated between May and June 2020
(30). Patients were given a dose of 0.2 mg per kilogram of IVM in mild cases, and 0.4 mg
per kilogram of weight in Moderate cases.
Subsequently, the "Therapeutic Test" Scheme published in September 2020 (24),
included taking a dose of IVM of 0.2 mg per kilo of weight in cases with mild symptoms.
And if the symptoms were Moderate, it was recommended to take 2 doses a day of
between 0.2 and 0.3 mg per kilo of weight per dose, which is equivalent to a daily dose
of between 0.4 to 0.6 mg per kilo of weight.
A dose of IVM of 0.2 mg per kilo of weight was considered until the beginning of the year
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
9
2021 as the standard dose for each IVM intake. It must be taken into account that, until
January 2021, in countries outside of Latin America there was little experience in the use
of IVM, and the risks of hepatotoxicity, neurotoxicity due to crossing the blood-brain
barrier (BBB) and even of possible unreported side effects, and that were not actually
generated by IVM. So, to make the "Therapeutic Test" more acceptable a dose of 0.2 mg
per kilo of weight was considered in the publications that we made during the year 2020.
Dose established for the year 2021.
Since the last quarter of 2020, in patients who are treated by our team of doctors, we had
already increased the dose to taken in Mild Persistent Symptoms from 0.2 to 0.4 mg per
kilo of weight per day, and from the end of the first trimester From the year 2021 the
dose of 0.4 mg has become the new standard for IVM intakes.
In the new scheme of the "Therapeutic Test" presented in this document, the dose of the
first intake of IVM, to be carried out on the 2nd day of the test (the day after starting to
take the ASA) it is 0.2 mg per kilo of weight. This low dose in the first doce, is being
maintained in part because there is still uncertainty and even fear in the use of IVM by
some patients, even more so in those who are going to take it for the first time, and in
countries where its use is restricted.
This initial dose of 0.2 mg per kilo of weight also helps us to see if the patient has a Herx
or Herxheimer type reaction or any secondary effect.
From day 3 of the "Therapeutic Test", the indicated dose of IVM to take is 0.4 mg per kilo
of weight, to be taken after breakfast (or lunch), for 4 days.
If the symptoms are Moderate, the dose to take is 0.6 mg a day, divided into 2 doses: a
dose of 0.4 mg per kilo after breakfast and a dose of 0.2 mg per kilo of weight after
dinner, for 4 days. You can also choose to give 2 doses of 0.3 mg per kilo of weight per
day.
To avoid a lower absorption of the drug when taking IVM, patients should avoid
consuming the fruits and juice of orange, grapefruit or grapefruit, tangerine and acid
lemon (33).
Persistent symptoms that are considered Moderate.
According to the study carried out between May and June 2020 (30), any of the following
are considered moderate Persistent Symptoms:
- Respiratory rate greater than 22 per minute, while at rest.
- Oxygen saturation less than 93%, at rest, and for more than half the hours of the day
(more than 12 hours).
- Exertional dyspnea that limits the patient to carry out activities of daily living (ADL).
- Oral temperature greater than 37.2°C (greater than 99.0°F), or axillary temperature
greater than 36.7°C (greater than 98.1 ° F), 2 or more times in the last week. This,
having controlled the temperature at least 3 days of the last week. It is indicated that
the temperature control should be carried out around 2.30 pm or 10.00 pm each day,
and at least 1 hour away from food intake.
- Heart rate greater than 100 beats per minute (bpm), while at rest, in at least 3
controls carried out during the day and in the last 3 days.
- At least 2 episodes of heart rate greater than 125 bpm, while at rest, in the last week,
and without having had an elevated temperature.
- Joint or muscle pain that significantly limits your activities of daily living (ADL).
- At least 1 episode of arterial hypotension that forces the patient to stop the activities
he was doing, in the last 2 weeks.
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
10
Each of the mentioned symptoms is considered moderate, and the presence of any of
them justifies taking a higher dose of IVM.
More frequent side effects of IVM.
In general, IVM is well tolerated. Side effects that occur are mild and temporary (64,65).
Based on the experience of more than 1,500 patients with Acute or Chronic COVID
treated with IVM, the most frequent side effects are:
a) Mild gastrointestinal symptoms: such as semiliquid or liquid stools, abdominal pain
and nausea. It occurs in only 1 to 3%. It usually lasts a few hours and within the first
day of taking IVM. Because they are mild symptoms, they are not usually a reason to
discontinue treatment.
The presentation of semi-liquid stools and abdominal pain during the first hours after
the first intake of IVM, we relate it more to the presence of viral load at the intestinal
level, which is eliminated in greater quantity after the first IVM intakes. These
gastrointestinal symptoms that appear on the first day can also be associated with the
presence of parasites or other microorganisms sensitive to IVM at the intestinal level,
and that it may be a pre-existing condition, that is, present before the patient ill with
COVID.
With the use of Nitazoxanide a similar effect has been seen, and in this case semi-
liquid or liquid stools, during the first day of taking the drug, occur more frequently
than with IVM.
b) Blurred or yellowish vision: when given at doses greater than 0.6 mg per kilo of
weight, blurred or yellowish vision, vision with small lights, shadows or dark spots,
photophobia and other visual disturbances may occur. These occur with greater
intensity and frequency when waking up and during the morning. It usually lasts
between 3 to 6 hours. In these cases, it is indicated to postpone taking IVM until there
are no visual disturbances, and when restarting treatment, it should be done with 50%
of the dose that was being taken. There are a few people who have presented these
visual symptoms with doses less than 0.6 mg per kilo of body weight.
c) Temporary dizziness and confusion: these symptoms can occur when IVM is given at
doses greater than 1 mg per kilo of weight. They occur at dawn, upon waking up and
can last until the early hours of the morning. In these cases, it is indicated to postpone
the next IVM intake until dizziness or confusion no longer occurs, and when restarting
treatment it is indicated that the doses be given after breakfast or lunch, and that IVM
doses not be given in hours later than 6 pm, since these symptoms appear with
greater intensity in the early morning hours and when waking up.
d) Herx-type reaction: some patients after taking IVM present a Herx or Jarisch-
Herxheimer-type reaction. A part of the patients describe this reaction as an increase
in the severity of the persistent symptoms that they already had. This reaction would
be associated with a release of cytokines which were found inside cells infected by
pathogenic microorganisms, or by the breakdown of persistent blood clots or protein
deposits, which contained inflammatory cytokines and served as protection for the
virus. It could also be a defense mechanism of the virus, which activates it when it is
attacked by an effective medicine.
If this reaction occurs, it is recommended to indicate: 1 1st Generation H1 Blocker
such as Diphenhydramine, Hydroxyzine or Promethazine, to be taken before going to
bed and; 1 3rd Generation H1 Blocker such as Fexofenadine or Desloratadine to be
taken at breakfast and lunch. You must continue taking Famotidine and Sodium
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
11
Bicarbonate. What he stops taking is the IVM and ASA, and he doesn't restart them
until the reaction subsides, which usually lasts 1-2 days.
d) Others: other side effects are rare. Hives, redness or rashes on the skin, sweating with
a sensation of skin irritation and lower back pain may occur.
Variability in the presentation of side effects.
The frequency of occurrence of side effects is directly related to the amount of the IVM
dose. Thus, with a dose of between 0.2 to 0.4 mg per kilo of weight, the side effects that
occur are infrequent. But there is great variability in the presentation of side effects that
depends on the susceptibility of the patient, since most of the patients in whom doses
greater than 2 mg per kilo of weight have been given did not present side effects, and
there are some patients who with doses of 0.4 mg have manifested that they are
intolerant.
Alternatives of the IVM.
When IVM is not available in the place where the patient is located, or if the patient does
not have tolerance for taking it, the following alternatives can be used:
o Nitazoxanida + Zinc Picolinate + Vitamin C:
Nitazoxanide is indicated at doses of 1 TB of 500 mg after breakfast and dinner (1000
mg per day). If the patient weighs more than 75 kilos, from the 3rd day the dose is
increased to 3 TB of 500 mg per day (1500 mg per day), it would be 1 TB at breakfast,
lunch and dinner.
If the patient weighs more than 95 kilos, from the first day he starts, he takes 1 TB of
500 mg at breakfast, lunch and dinner (1500 mg per day).
Nitazoxanide in most patients causes a change in urine color to yellow or orange.
Zinc Picolinate is a form of chelated Zinc. Is indicated at a dose of 200 mg per day, it
would be 100 mg at 11 am and 10 pm. If the patient weighs less than 56 kilos, a lower
dose of 150 mg per day may be indicated.
If they are 100 mg capsules, it is indicated to take it at 9 am and 9 pm, approximately
1 hour after meals.
If they are capsules of 50 mg or less, it is indicated to distribute it in 3 doses a day, it
would be at 9 am, 3 pm and 9 pm.
In general, it is recommended to take it approximately 1 hour after meals. And the
patient should avoid consuming dairy 2 hours before or after taking it, as it reduces its
absorption.
Vitamin C is recommended at a dose of between 12 to 16 grams per day, it would be
3 to 4 g in 4 doses within the day. In those who weigh between 75 and 95 kilos, it is
recommended between 16 to 20 g per day divided into 4 to 5 doses during the day.
And in those who weigh more than 95 kilos, between 20 to 24 g per day in 5 to 6
doses is suggested. It could also be given intravenously.
o Antivirals + Nitazoxanide or Niclosamide or Gromwell: As of the date of this
publication, there are still no highly effective antivirals against Viral Load. Since only
one of the currently available Antivirals will not reduce Viral Load to a minimum, it is
recommended to also take Nitazoxanide or Niclosamide or Gromwell (Lithospermum
Erythrorhizon Root: powder or Tollovid or Zi cao) or another effective medication or
supplement against Viral Load.
If Niclosamide is indicated, the regular dose is 1 TB of 500 mg every 8 hours (1500
mg daily). If the patient weighs more than 95 kilos, the dose is increased to 4 TB per
day (2000 mg per day), taking 2 TB at 8 am and 8 pm.
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
12
FAVORABLE EFFECTS AND DOSE OF FAMOTIDINE FOR THE "THERAPEUTIC
TEST"
4 reasons why Famotidine is indicated are described below:
1) EFFECTS ON COVID-19. Several studies have been carried out in which favorable
effects of Famotidine have been observed in patients with COVID-19 (39,40,41,42).
In these studies, doses of between 120 to 240 mg per day are indicated, which are 3
to 6 times higher than the usual doses regularly indicated in adults, which is 40 mg
per day.
2) ANTIHISTAMINE. Due to its H antagonist action, by blocking H2 receptors,
Famotidine has been observed to be useful in Histaminosis and Mastocytosis or
Mast Cell Activation Syndrome, also known as MCAS by its initials. In this there is an
exaggerated proliferation of mast cells, and a dysfunctional state of these with the
consequent release of excess histamine (43). With the use of H1 and H
antagonists, decreased inflammation due to mast cells has been reported (44,45).
3) ANTIACID. Traditionally it is its main indication. It inhibits the production of acid in
the stomach, thus reducing the risk of gastrointestinal bleeding, which can be caused
by the frequent use of ASA and NSAIDs.
4) ANTI-INFLAMMATORY. It has been identified to significantly reduce serum and
splenic levels of TNF and serum levels of IL-6 (66).
5) CARDIOPROTECTIVE EFFECTS. It has been identified that it generates a
beneficial effect in patients with congestive heart failure (CHF). In a meta-analysis,
its use was found to reduce heart rate and blood pressure, leading to an
improvement in CHF symptoms (79).
The recommended dose of Famotidine for Acute and Chronic COVID is an average of 3
mg per kilo of weight per day, divided into 3 doses.
Thus, in the average weight adult (between 56 and 75 kilos) with COVID, a dose of 60
mg is suggested at 7:30 am, 3 pm and 11 pm, this is equivalent to 180 mg per day.
In those weighing 75 to 95 kilos, the dose is increased to 80 mg, to be taken at 7:30 am,
3 pm and 11 pm (240 mg daily).
If the patient weighs more than 95 kilos, the recommended dose is 100 mg at 7:30 am, 3
pm and 11 pm (300 mg per day) during the 6 days of the "Therapeutic Trial".
And if the patient weighs between 42 to 55 kilos, the dose is lowered to 40mg at 7:30am,
3pm and 11pm (120mg a day).
FAVORABLE EFFECTS AND DOSE OF SODIUM AND/OR POTASSIUM
BICARBONATE FOR THE "THERAPEUTIC TEST".
Its chemical formula is NaHCO3. There are at least 8 reasons why Sodium Bicarbonate is
included in the “Therapeutic Test” scheme:
1) EFFECTS ON COVID-19. Studies have been carried out in which favorable effects
of its use have been observed in patients with COVID-19, especially when it is
indicated in nebulizations (34,67,68,69,70,71). These effects could be due to several
of the mechanisms of action described below.
2) ALKALIZING. It increases the pH of the organism, making it more alkaline, which is
unfavorable for viruses in general.
3) ANTI-INFLAMMATORY. Bicarbonate has been shown to activate the cholinergic
anti-inflammatory pathway (CAP), in which the spleen is an essential site for this
process, since there is a circuit through the vagus nerve that requires the spleen for
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
13
the anti-inflammatory effect to occur (35,36,37,38).
4) FAVORABLE EFFECTS ON THE IMMUNE SYSTEM. It has also been identified that
it generates a beneficial effect in autoimmune diseases (35,36,37,38).
5) ERGOGENIC effect. It is considered an ergogenic substance, because it improves
exercise performance and can delay the onset of fatigue (70,71,72,73).
6) PROTECTOR OF RENAL FUNCTION. Several studies have shown that bicarbonate
supplementation protects kidney function, suppresses inflammation, and improves
cellular metabolism in patients with chronic kidney disease. (76).
7) ANTI-CANCER. In cancer, the production of lactic acid is increased, generating an
acidic microenvironment at the intratumoral level, which in turn promotes cancer
progression. Several studies have reported possible anticancer effects of sodium
bicarbonate, especially when indicated via local infusion through a procedure that
aims to counteract intratumoral lactic acidosis (77,78).
8) ANTACID. Reduces acidity in the stomach, which in turn reduces the risk of
gastrointestinal bleeding due to the frequent use of ASA and NSAIDs.
Sodium Bicarbonate is sold in capsules of 325, 500, 650, 870, 1000, 1500 and 1600 mg.
It is also sold as a powder in jars or packets for use in the kitchen. It is also known as
Bicarbonate of Soda or Baking Soda. If it is taken in powder, its taste is not pleasant. As
alternatives, there are commercial presentations in effervescent sachets such as the so-
called Andrews Salt, which contains 2.18 grams of Sodium Bicarbonate and 0.88 grams
of Magnesium Sulfate in each sachet. There are other commercial brands with similar
content, but you should check if it contains ASA, in which case the dose of ASA that you
will take in pill form will be reduced.
The recommended dose to take during the 6 days of this Therapeutic Test is between
0.10 to 0.15 mg per kilo of weight per day. The daily dose is divided into 2 or 3 doses to
be taken during the day. It is recommended to take it 1 to 2 hours after meals on an
empty stomach and should not be taken with other medications.
Taking into account the aforementioned, the recommended dose is between 3 to 3.3
grams (it can be in capsules, or 3 g in powder that would be 1/2 teaspoon, or 1 and a half
sachets of Andrews Salt) to be taken with 1 glass of water, at 10am and 10pm during the
6 days that this Protocol lasts.
In patients who weigh more than 75 kilos, they are instructed to add a third dose at 4pm
the first 3 days, and in the following 3 days they take 2 doses a day, at 10am and 10pm.
Patients who weigh more than 95 kilos continue with 3 shots a day, at 10am, 4pm and
10pm, during the 6 days of this Therapeutic Test.
It is contraindicated in patients with hypocalcemia and hypochlorhydria.
It can be replaced by POTASSIUM BICARBONATE, this is especially indicated in
patients who follow a diet low in salt (sodium) as is the case of hypertensive patients or
those with heart failure or pulmonary edema. It can also be indicated to take a part of
Potassium Bicarbonate and another part of Sodium Bicarbonate, reaching between the
sum of both the dose per intake of between 3 to 3.3 g. You can also choose to give it
interspersed with the daily intakes, some of potassium and others of sodium. It is sold in
capsules of 250, 800, 1020, 1350 and 3200 mg, and also in powder. It should not be
taken together with Spironolactone, or with any other medicine, supplement or food that
increases Potassium levels.
It is recommended that daily intakes of sodium and/or potassium bicarbonate do not
exceed 10 continuous days without a medical indication.
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
14
DIET LOW IN ARGININE AND HISTAMINE AND HIGH IN LYSINE, VITAMIN D,
MAGNESIUM, NITRATES.
The initial version of the "Therapeutic Test", published in September 2020 (27), includes
a diet in which it is indicated to avoid foods with high arginine content and to consume in
greater quantity foods with high lysine content. In a simplified way it was called Antiviral
Diet, since arginine is considered a key nutrient in the structure and life cycle of several
viruses. It is also pointed out that lysine is chemically similar to arginine, and when there
is a greater amount of lysine available, the virus uses it instead of arginine, which slows
down its replication.
Grimes JM, Khan S et al. have published an article on arginine depletion for patients with
COVID-19 (46), in which they point out that this should be considered in the COVID-19
treatment plan, since arginine depletion would help reduce viral load. Arginine depletion
therapy has also been used in cancer patients, and several articles have been published
about it (47,48). For its part, on the amino acid Lysine there are publications in which it is
mentioned that it has a favorable effect on SARS CoV-2 infections (49,50, 51) and also
in other viral infections such as Herpes simplex and Chikungunya (52,53).
In the cases of COVID, in practice, several of the patients who have been prescribed
Lysine have shown improvement in the symptoms associated with a deficiency in blood
circulation, especially in the legs.
On the other hand, considering that in Chronic COVID symptoms associated with an
increase in histamine (Histaminosis) occur with some frequency, it has also been
considered that foods with a high histamine content should be avoided. So, from the
recommended Antiviral Diet has been removed from the list of foods that should be
consumed in greater quantity all fish, tomato, pork, soy and most dairy products have
been removed from the list of foods that should be consumed in greater quantity, as they
are considered among foods that have a high histamine content.
Table 3 shows the foods high in arginine and histamine, and which are the foods to
avoid. The consumption of these is related to the presentation of acute inflammatory
symptoms and allergies in susceptible people.
Table 3
FOODS WITH HIGH CONTENT OF ARGININE AND HISTAMINE
coffee, soda, drinks with caffeine or with lactate, black tea;
alcohol of all kinds (cocktails, beer, wine, etc);
walnut of all kinds, hazelnut, pecan, almonds, peanut, chestnuts, pistachios;
orange, tangerine, grapefruit, lemon, banana, coconut, blackberries, cashew or
marañon, kiwi, cocoa, cocoa chocolate;
sesame seeds, oats, brown rice, wheat, whole wheat bread, peas, green bean,
chickpeas, barley, flax or flax seed, seeds of: pumpkin, chia, poppy and sunflower;
tomato, spinach, eggplant, rutabaga or kohlrabi, cabbage, cucumber;
chili, curry, chucrut, monosodium glutamate, tomato sauce, vinegars, soy sauce
(shoyu), mayonnaise, mustard;
sausages, cold cuts, canned meat (food preserves);
fish and shellfish (especially canned or smoked fish);
sweets, pastries, colorants; eat low sugar and salt.
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
15
On the other hand, it is indicated that patients should consume a greater amount of foods
with a high content of Lysine, due to the favorable effects of this on infections by SARS
CoV-2, Herpes simplex and other viruses (49,50,51).
Table 4 shows foods with a high content of Lysine, and that also have a higher content of
Vitamin D, Magnesium, Nitrates, Tryptophan, Glycine, Glutamine, Cysteine and Niacin
(Vitamin B3).
Table 4
FOODS WITH HIGH CONTENT OF LYSINE, AND ALSO OF VITAMIN D,
MAGNESIUM, NITRATES, TRYPTOPHAN, GLYCIN, GLUTAMINE, CYSTEINE
AND NIACIN
turkey, chicken, egg, beef (not canned, fresh);
beet in juice, turnip, carrot, ginger, garlic, celery juice, aguacate (avocado) but not
more than 1 a day;
cheese, but up to 75 grams a day (and not cured or semi-cured, or goat),
yogurt, but up to 1 glass a day;
mango, apricot, loquat or medlar, pineapple, pear, cherry, carambola, fig;
potato, quinoa, amaranth (kiwicha).
There is a particular food that is rich in Lysine and at the same time rich in Nitrates (NO3-
) that are precursors of Nitric Oxide (NO), that is, it will raise NO levels, this is beets.
Several studies have been carried out indicating that the consumption of beet juice rich
in Nitrates improves performance and resistance to physical exercises (80). It also
improves blood circulation and reduces blood pressure in healthy adults. It is
recommended to consume the root of the beet plant in the form of juice, since if it is
cooked, the amount of Nitrates is reduced. The patient should be made aware that its
frequent consumption will cause the feces and urine to appear reddish.
CONSOLIDATED TABLE OF THE "THERAPEUTIC TEST".
Table 5 shows in a consolidated way the new scheme of the "Therapeutic Test" to be
applied to patients with Persistent Symptoms of COVID, to guide the diagnosis of
Persistent Viral Infection.
The table includes the detail of the doses of ASA, IVM, Famotidine and Baking Soda or
Sodium and/or potassium Bicarbonate.
And it includes the foods to avoid, as well as the ones to consume the most.
PREPARATION OF THE LIST OF PERSISTENT SYMPTOMS OF COVID.
Before starting the "Therapeutic Test", a list must be made of all the symptoms that the
patient presents. When there are several symptoms, the symptoms that belong to the
same organ or, to the same anatomical area within the body, should be consecutively
listed in the list, so that at the end of the test a better interpretation of the results can be
made, since the viral load may be eliminated from some organs, but not in all.
GENERAL SYMPTOMS ASSOCIATED WITH PERSISTENT INFECTION.
There are general persistent symptoms of COVID that are associated with the presence
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
16
Tabla 5
of a persistent infection, these are:
- Low-Grade Fever or Fever: this occurs most frequently between 1 and 3 pm and
between 7 and 11 pm. A low-grade fever is considered an axillary temperature that
ranges from 36.5 to 37.5°C (97.7 to 99.5°F). If the temperature is oral (under the
tongue), it would be 0.5°C higher. If the low-grade fever is mild (around 36.7°C or
98.1°F axillary temperature, or 37.2°C or 99.0°F oral temperature) it can go
unnoticed, so the patient is instructed to take the oral temperature at 2.30 pm and
9.30 pm for at least 3 days in a row. And taking the oral temperature should be at
least 1 hour away from food intake, to prevent this from altering the result.
Older adults may not have a low-grade fever.
- Night sweats: sweating occurs mainly in the early hours of the morning (between
midnight and 4 am), it is located more frequently at the base of the neck and the
upper part of the chest, it can become profuse, making it necessary to change
clothes, which correlates with a higher degree of infection. Sometimes the patient
only perceives a greater sensation of cold, which may be due to a cooling at the level
of the skin caused by the body, but with very little or no sweating.
The presence of low-grade fever, fever and / or night sweats are symptoms that guide us
a lot towards the diagnosis of a Persistent Infection. An infection is the most frequent
cause of the presence of these symptoms, and if the patient has had COVID a short time
before, the first diagnostic possibility is that there is a Persistent Viral Infection due to
SARS CoV-2.
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
17
The sequelae do not produce fever or sweating, both symptoms are associated with an
active infection, not a sequela in which there is no infection.
In our experience we have observed that when applying the “Therapeutic Test” in
patients who presented with low-grade fever and night sweats, they resulted in almost all
cases with a 100% improvement of these symptoms. Two cases were identified that did
not respond in their entirety, and upon expanding the history of the pathological
antecedents, it was identified that they presented other pre-existing chronic infectious
pathologies, which would explain why these symptoms were not fully resolved.
LOCALIZED SYMPTOMS AND SIGNS, ASSOCIATED WITH PERSISTENT
INFECTION.
According to what we have observed, the organs, systems and anatomical areas where
persistent symptoms and sings associated with Persistent SARS CoV-2 Infection are
most frequently generated are: the nose, tongue, pharynx, bronchi, lungs, heart,
pericardium, brain, skin and hair follicles. And the persistent symptoms of COVID
associated with an affectation at these levels are:
- Nose (olfactory mucosa): anosmia or hyposmia, nasal congestion.
- Tongue: dysgeusia (taste alteration).
- Pharynx: hoarseness, rasp, hoarse voice, cough, sore throat, swelling in the throat,
sensation of having a foreign body, cough.
- Bronchi: bronchospasm, wheezing, cough.
- Lungs: dyspnea related to exertion, dry cough, decreased oxygen saturation.
- Brain: decreased concentration and memory, mental fatigue, confusion, mild
disorientation, insomnia and other sleep disorders.
- Heart: palpitations, tachycardia, arrhythmias, pain in the middle of the chest, high
blood pressure, hypotension, changes in the ECG.
- Pericardium: pain in the middle of the chest and/or back.
- Skin: localized lesions on the fingers and toes, type erythema pernio, also known as
chilblains or perniosis, which are lesions in reddish to purplish plaques. In some
cases ischemic lesions and even gangrene occur.
- Hair follicles: hair loss, which occurs at the level of the head.
The mentioned symptoms, because they are associated with a Persistent Infection by
SARS CoV-2, are the ones that we have observed that best respond to the “Therapeutic
Test”. But in alterations of smell and taste, treatment is often required for more days and
with more medications, since in addition to the persistent viral infection there may have
been persistent inflammation and injury to the nerves, blood vessels and tissues.
Anosmia or hyposmia, dysgeusia and chilblains or perniosis, are localized symptoms and
signs that bring us closer to a diagnosis of SARS CoV-2 infection, since they are rare
symptoms in other pathologies.
On the contrary, the symptoms of fatigue, weakness, asthenia or general malaise are
nonspecific symptoms, very frequent in other pathologies.
SYMPTOMS AND PRE-EXISTING PATHOLOGIES.
The symptoms or signs that the patient had since before suffering COVID-19 should also
be included in the lower part of the list. There have been cases in which some previous
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Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
18
pathologies have been cured after taking IVM, such as warts or other skin lesions,
supposed sequelae of viral infections that they suffered before becoming ill with COVID,
among other symptoms, signs or pre-existing pathologies.
It should be inquired whether the patient previously had a diagnosis of a chronic or latent
viral infection or by another microorganism, such as: Borrelia burgdorferi, Herpes
simplex, Herpes zoster, Epstein-Barr Virus (EBV), Cytomegalovirus, Herpesvirus 6, 7
and 8, HPV, Babesia, Bartonella, or other types of chronic or latent pathologies.
MONITORING OF IMPROVEMENT IN SYMPTOMS
After preparing the list of symptoms, to monitor the improvement in symptoms, a table
must be prepared. The first column of this table lists the symptoms that the patient
presents, and all symptoms are given an assessment with which they start, in a
percentage of 100% (or 10 points).
From the 2nd day, at breakfast time, the patient hould write down the percentage that he
considers to have improved or reduced for each of the symptoms. This will be done on
days 2, 4, 6 and 7 counting from the start of the Test.
Table 6 is the Model to be used for monitoring persistent symptoms of COVID in patients
in whom the "Therapeutic Test" is applied. The patient should be writing down in each
column the improvement or reduction of symptoms that he estimates has taken place in
him.
Table 6
"THERAPEUTIC TEST": MONITORING TABLE FOR PERSISTENT SYMPTOMS OF COVID
WITH PERCENTAGES OF IMPROVEMENT AND TEST RESULTS
DATE
/ /21
/ /21
/ /21
Test Results:
100% = Positiv e 100%
40-99% = Positive
5-39% = Interm ediate
0-4% = Negative
ASA taking day
4th day
6th day
7th day
(the day after
finishing)
IVM taking
day
3er day
IVM
5th day
IVM
SYMPTOMS
% Improvement/ reduction of symptoms
1.
%
%
%
2.
%
%
%
3.
%
%
%
4.
%
%
%
5.
%
%
%
6.
%
%
%
7.
%
%
%
OBTAINING THE RESULTS OF THE "THERAPEUTIC TEST" ACCORDING TO THE
PERCENTAGE OF IMPROVEMENT OF THE SYMPTOMS.
On the 7th day, that is, the day after having finished taking the 6 days of medication, the
results of the "Therapeutic Test" should be obtained by means of the percentage
improvement in symptoms on that date.
Table 7 is shown as an example of the recording of the improvement percentage of each
of the persistent symptom of COVID.
The penultimate column of the table, which corresponds to the 7th day counting from the
start of the test, The percentage of improvement of each of the symptoms obtained at the
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
19
end of the “Therapeutic Test” is shown, which is equivalent to the day after the last
medication intake. It is based on this percentage that the test result will be determined.
Table 7
"THERAPEUTIC TEST": EXAMPLE OF THE RECORDING IN THE TABLE OF THE PERCENTAGES
OF IMPROVEMENT OF EACH PERSISTENT SYMPTOMS OF COVID AND THE TEST RESULTS
DATE
20/04/21
22/04/21
24/04/21
25/04/21
Test Results:
100% = Positiv e 100%
40-99% = Positive
5-39% = Intermediate
0-4% = Negative
ASA taking day
2nd day
4th day
6th day
7th day
(the day after
finishing)
IVM taking
day
1st day
IVM
3er day
IVM
5th day
IVM
SYMPTOMS
% improvement/ reduction of symptoms
1. Anosmia
5%
65%
90%
90%
Positive
2. Night sweats
5%
95%
100%
100%
Positive 100%
3. Pain in the center of the chest.
10%
75%
98%
100%
Positive 100%
4. Tachycardia and Palpitations
5%
45%
75%
78%
Positive
5. Semi-liquid stools
0%
90%
100%
100%
Positive 100%
6. Muscle fatigue in lower limbs
2%
20%
30%
35%
Intermediate
7. Hair loss
0%
15%
30%
35%
Intermediate
Based on our experience of 390 treated cases, we consider that the parameters shown
in Table 8 should be used for the “Therapeutic Trial” Results.
Table 8
PARAMETERS TO BE USED FOR THE RESULTS OF EACH
SYMPTOM AFTER THE “THERAPEUTIC TEST” WITH IVM AND ASA
% IMPROVEMENT
OF THE SYMPTOM
TEST RESULTS
100%
POSITIVE 100%
40 to 99%
POSITIVE
5 to 39 %
INTERMEDIATE
0 to 4%
NEGATIVE
It is specified that the results of the "Therapeutic Test" are iven for each of the
symptoms, independently, this because COVID is a multi-organ disease, so that several
organs and systems are affected at the same time, then in a Persistent Infection by
SARS CoV-2 we can find that the diagnoses of Bronchitis, Gastroenteritis, Myocarditis
and other pathologies coexist. After the "Therapeutic Test", the symptoms and signs that
were caused by a Persistent Viral Infection due to SARS CoV-2 will significantly improve,
and for symptoms in which there is no response to the test, other causes should be
investigated.
INTERPRETATION OF THE RESULTS FOR EACH SYMPTOM.
For each of the symptoms there are 4 possible results according to the percentage of
improvement achieved at the end of the "Therapeutic Test" with IVM and ASA in a
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
20
patient with Persistent COVID Symptoms. The interpretations proposed for each of the 4
outcome alternatives are the following:
POSITIVE 100% (with 100% improvement): the interpretation of this result is that the
symptom was due to a Persistent Infection by SARS COV-2 highly sensitive to
treatment with IVM, and the symptom resolved in 100 % at the end or before finalizing
of the "Therapeutic Test".
There is a group of patients who respond more quickly and present a 100%
improvement in all their symptoms before finishing the trial with 5 days of IVM. In
these cases, the "Therapeutic Test", in addition to having fulfilled the objective of
serving as an aid to diagnosis, it becomes a Treatment Scheme for the elimination of
the existing viral load.
POSITIVE (40% to 99% improvement): the interpretationis that the symptom is due
to the existence of a Persistent Infection by SARS COV-2, and according to the
percentage of improvement we estimate the sensitivity of the SARS CoV-2 virus to
treatment with IVM, we have as follows:
- If it was Positive with 76 to 99% improvement, it is: sensitive to treatment with IVM.
- If it was Positive with 40 to 75% improvement, it is: moderately sensitive to
treatment with IVM.
The clinical and epidemiological correlation must be made to give greater support to
this diagnosis. If the patient was diagnosed with COVID in the previous weeks or
months, and the symptoms in which he has shown great improvement are
characteristic or associated with COVID, the diagnosis would be of a Persistent
Infection by SARS CoV-2, this also supported by the fact that, of According to the
studies carried out, the main effect of IVM in COVID is to reduce the viral load of
SARS CoV-2 (54,55,56), therefore, if the symptom improves between 40 to 99 % with
IVM, this would be explained by its effect against Viral Load.
INTERMEDIATE (5 to 39% improvement): due to the fact that the percentage of
symptom improvement has been low, we have then that a low response to the applied
treatment scheme has been obtained, and the interpretation given this result is that, in
addition to a Persistent SARS COV-2 Infection, there is one or more of the following
situations or conditions that cause or favor the persistence of symptoms:
1) PERSISTENCE OF VIRAL LOAD LITTLE SENSIBLE OR MEDIUM RESISTANT
TO IVM: due to the partial response in the improvement of the symptom, it can be
interpreted that there is a Viral Load that would be little sensitive or moderately
resistant to treatment with IVM at a dose of 0.4 to 0.6 mg per kilo of weight per day.
In these cases, although it is best to evaluate each case in a personalized way, in
general we recommend applying a new treatment scheme in which the dose of IVM
is increased and other drugs are included to reduce the Viral Load, which should be
give together with IVM, which may require several days of treatment and even
higher doses than usual for these drugs.
2) EXISTENCE OF A "FAVORABLE ENVIRONMENT" AT THE LEVEL OF THE
BLOOD VESSELS WITH THE PRESENCE OF CLOTS THAT SERVE AS
PROTECTION AND REFUGE FOR THE PERSISTENCE OF MICRO-
ORGANISMS: at the end of 2020 we have published a document in which a
description is made of how several of the pathogenic microorganisms that cause
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
21
persistent intracellular infections use platelets and clots to generate a “favorable
environment” with the formation of what we call bioclots because they have
functions of protection and shelter similar to biofilms or biofilms. In this case, the
clots are produced at the level of the cells. walls of the blood vessels, covering the
infected and injured andothelial cells, and there is also hypercoagulability and the
presence of clots in the bloodstream (29), and this means that part of the viral load
cannot be eliminated, since clots they serve the microorganisms to evade host
immunity and viral load medications, thus promoting persistence of infection. We
associate the generation of this "favorable environment" with presence of persistent
bioclots to: platelet hyperactivity, megakaryocytosis, the release of extracellular
vesicles, the hyperactivity of neutrophils that generate and release excessively
Extracellular Neutrophil Traps (NETs), hypoperfusion, the inhibition of the
Physiological Mechanisms of Thrombolysis that includes the Fibrinolysis System,
with the increase of PAI-1 and Alpha-2-Antiplasmin, and the decrease of the
ADAMTS13 enzyme, the greater survival of blood cells infected with the virus and
the increase of serotonin (28,29). These findings support the recommendation to
include antiplatelets, anticoagulants, and fibrinolytics in the COVID Treatment
Protocol or Schedule.
3) ALTERATION OF MICROBIOMES: there are studies that indicate that in Chronic
Fatigue Syndrome (CFS) an excessive growth of some groups of bacteria and a
reduction with very low levels of other groups of bacteria occurs, at the intestinal
and oral cavity level (62). This alteration in the intestinal microbioma generates an
increase in D-Lactate, and an increase in lactate (also known as lactic acid)
generates an increase in acidosis, which would be associated with the symptoms of
CFS (63). Among the alterations of the intestinal bacterial flora we include is the so-
called SIBO, which is the acronym for small intestine bacterial overgrowth,
characterized by an excessive presence of bacteria in the small intestine that are
normally found in the large intestine; and is associated with symptoms such as
flatulence, bloating, abdominal pain, fatigue and/or diarrhea. Oral health is also
important, the patient must receive treatment for cavities, dental plaque must be
removed, if it exists, since this is a biofilm that contains multiple microorganisms, to
reduce its presence it is recommended to use a mouthwash that contains
cetylpyridinium chloride (CPC).
In addition to the intestinal and oral microbiomes, alterations can occur in other
microbiomes, such as the oral, vascular, that of bioclots, kidneys, lungs, brain,
upper respiratory tract and others.
4) DEPLETION OR DEFICIT OF VITAMINS, MINERALS AND OTHER NUTRIENTS:
COVID disease, when it lasts for weeks or months, due to a lower contribution to
the cells due to hypoperfusion, as well as a greater requirement and consumption
of vitamins, minerals and other nutrients due to persistent infection, there is often a
depletion of the reserves within the organism, which in turn can lead to presence of
persistent symptoms associated with this deficit or higher requirement. This occurs
more frequently with the B complex vitamins, Vitamin D, Zinc, Magnesium, Iron,
Selenium, Copper, Vitamin A, among others. It should be taken into account that
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
22
the deficiency of vitamins B9 (folic acid), B12 and B6 are the cause of
thrombophilia, and this predisposition is related to the increase of homocysteine in
the blood.
5) HITAMINOSIS, MASTOCYTE HYPERACTIVITY, MASTOCYSIS OR MASTOCYTE
ACTIVATION SYNDROME (MCAS): greater mast cell activity leads to the
presence of an excess of histamine in the body and the symptoms that this causes
(44,45). This greater activity of mast cells could be explained in part by the invasion
of the virus and its permanence inside the mast cells, generating their hyperactivity,
in a similar way to what happens with other blood cells.
6) IMMUNE DYSFUNCTIONS: there are frequent alterations in the immune system,
with hyperactivity of some cells and suppression of others. The most frequently
observed dysfunctions are:
- Immunocompromised or immunodeficient host: is a patient who, either because
of a congenital or acquired disease (for example, cancer or neoplasia), or
because of immunosuppressive treatment (for example, chemotherapy,
radiotherapy or treatment with corticosteroids) has a compromised immune
system and is susceptible to acquiring infections.
Patients who have had a solid organ transplant are indicated for
immunosuppression treatment, also those who receive transplantation of blood
stem cells and bone marrow.
- Lymphopenia: it must be taken into account that in the acute stage of COVID
Lymphopenia frequently occurs, so in the post-acute stages the presence of this,
or some other alteration at the level of lymphocytes, should be investigated,
especially Lymphopenia of the subpopulation of CD 4 (T Helper).
- Low amount of neutralizing antibodies against SARS CoV-2: Several cases of
Sub-Acute and Chronic COVID or Long COVID have been observed that
present a low amount of neutralizing antibodies against SARS CoV-2. The
persistence of IgM and the disappearance of IgG in a few weeks orients us
towards the existence of an insufficient generation of neutralizing antibodies. We
have observed that there is an association between the persistence of IgM and
the presence of a persistent SARS CoV-2 infection.
On the other hand, it is known that vaccines induce the body to generate
neutralizing antibodies against SARS CoV-2, (among other effects on the
immune response), and this would be the mechanism by which it has been
observed that some patients improve their persistent symptoms after vaccination
(57,58,59,60), but cases have also been reported in which the patient worsens
his symptoms, presenting an increase and dissemination of Viral Load after
vaccination, developing acute disease at that some patients have to be
hospitalized. Therefore, further studies on the effects of vaccines in patients with
Chronic or Persistent COVID are required.
- Elevated levels of CD8 cytotoxic T lymphocytes and cytokines: an increase in
CD8+ T cells with cytotoxic potential has been identified (61), of NK cells, and
increase in secretion of interferon gamma (IFN-γ) associated with cytotoxic T
cells (CD8). An elevation of Interleukin 2 (IL-2) and in some cases of IL-6 has
also been identified.
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
23
7) COINFECTIONS AND REACTIVATION OF LATENT INFECTIONS: it is very
important to investigate the presence of pre-existing chronic infectious diseases
that may have been found in a latent or silent state and that are reactivated when
the patient becomes ill with COVID. The most frequent co-infections are:
Herpesviridae family viruses (HSV-1, HSV-2, VZV, Epstein-Barr virus: EBV, CMV,
HHV-6, HHV-7, HHV-8 or Kaposi's Sarcoma virus), Enterovirus, Coxsackievirus,
Lyme disease (caused by Borrelia), Babesiosis, Ehrlichosis, Anaplasmosis, other
Rikettsiosis, Bartonellosis, Human Papillomavirus (HPV), Mycoplasma, Prevotella,
Candidiasis, Aspergillus and Mucormycosis.
8) OTHER PATHOLOGIES, CONDITIONS AND ASSOCIATED FACTORS: there are
several other conditions, pathologies or factors associated with the presentation
and persistence symptoms of COVID. Have:
- Pathological history of: Chronic Fatigue Syndrome, Fibromyalgia, Polymyalgia,
Irritable Bowel Syndrome, Depression, Anxiety and other related pathologies.
- Presence of Biofilms or Dental Plaque and other foci of microorganisms in the
oral cavity.
- Presence of diseases associated with immune dysfunction or autoimmunity:
such as Thyroiditis, Lupus, Sjögren Syndrome, Vitiligo, Multiple Sclerosis,
Vasculitis and others.
- Allergies: Allergic rhinitis, Asthma or Bronchial Hyperreactivity, Contact
dermatitis, Conjunctivitis, Allergies to medicines or food, etc.
- Other Comorbidities: Diabetes, hypothyroidism, cardiac, neurological or renal
pathologies, and other pathologies or predisposing factors.
9) SEQUEL: An evaluation of the patient should be made to identify if the persistent
presence of symptoms is due to sequelae of the disease and not to a persistent
viral load. The sequelae are associated with significant damage or injury to the
tissues, with replacement of the original tissues by fibrosis, amyloid or fibrin
deposits, with a low probability of recovery. If symptoms persist despite several
days of viral load treatment, the sequelae may explain a large part of the
symptoms.
NEGATIVE (without improvement: 0%, or if the improvement is only 1 to 4%): in
these cases it is interpreted that there may be one of the following causes of the
symptom:
1) Sequel: that is, the symptom is due to damage or injury to tissues, nerves and/or
blood vessels.
2) A different pathology from the persistent SARS CoV-2 infection: and that this does
not respond to treatment with IVM at a dose of 0.4 mg per kilo of weight per day.
Consider possible reactivations of viral infections or pre-existing intracellular
pathogens or that are part of the host's microbiome or virome.
3) Alteration in the gut microbiota or microbiome: it should be investigated, especially
in the face of persistent fatigue and gastrointestinal symptoms.
4) Depletion or deficiency of nutrients: it should be investigated if the symptoms are
due to the lack of some vitamins, minerals or other nutrients. Vitamin B12 should
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
24
be evaluated above all, and also Vitamins B1, B3, B6 and D. In addition, the
possible deficit of Iron (anemia), Zinc, Magnesium, Selenium, Copper, among
others, should be investigated.
There may also be the coexistence of 2 or more of the mentioned conditions.
ACTIONS TO FOLLOW ACCORDING TO THE RESULTS OBTAINED FOR ALL
SYMPTOMS.
On the 7th day, after determining the results for each of the symptoms, a joint evaluation
of all the symptoms is carried out, and according to the results obtained, it is
recommended to follow the actions described below:
1. PATIENTS WHO PRESENT 100% IMPROVEMENT IN ALL THEIR SYMPTOMS
AT THE END OF OR BEFORE THE TEST IS ENDED.
In patients who on the seventh day, achieve a Positive result with 100% improvement in
all their symptoms, it is considered that these were due to a Persistent Infection by SARS
CoV-2, and that the causative virus strain was highly sensitive to the treatment with IVM.
There is even a group of patients who respond more quickly, and present a 100%
improvement in all their symptoms before the end of the Test.
In these cases, where an improvement of 100% of all symptoms is achieved, the
"Therapeutic Test", in addition to having fulfilled the objective of serving as an aid to the
diagnosis, serves as treatment, so the Test becomes a Scheme of Treatment that must
be completed with the objective of eliminating the entire viral load existing in the body.
The therapeutic recommendations to follow in patients who manage to achieve 100%
improvement in all their symptoms, they vary depending on the day you achieve 100%
improvement in symptoms, since if the total improvement is achieved with only 3 or 4
days of treatment, it is interpreted that it was a virus strain that was highly sensitive to
IVM.
Considering the aforementioned, the recommendations to complete the Treatment
Scheme in patients who achieve a 100% improvement in symptoms are the following:
- In those who on the FOURTH or FIFTH DAY of the Test achieve 100% improvement
in all symptoms: in these cases the recommendation is that, from that same day,
take the IVM at a dose of 0.2 mg per kilo of weight per day, and until completing 3
days at this dose, that is, take that same day and 2 more days at a dose of 0.2 mg
per kilo. And the ASS, the Famotidine, the Sodium Bicarbonate and the Diet take
them only 1 more day,
that is, he only takes them until the night of the day that he achieved the
improvement of 100%.
- In those who on the SIX or SEVENTH DAY of the Test achieve 100% improvement
in all symptoms: the recommendation in these cases is that, from that same day,
take the IVM at a dose of 0.2 mg per kilo of weight per day, and until completing 4
days at this dose, that is, take that same day and 3 more days at a dose of 0.2 mg
per kilo. In addition to IVM, the patient will continue to take ASA for 3 more days, but
2 doses of 100 mg per day (instead of 3), and it is recommended to take it after
breakfast and dinner. Famotidine also continues to be taken at 60 mg doses at 10
pm, and should continue to be taken while taking ASA. You should also continue the
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
25
low Arginine and Histamine high Lysine diet and taking sodium and/or potassium
bicarbonate for the next 3 days
2. PATIENTS WHO PRESENT 40 TO 99% IMPROVEMENT IN THEIR SYMPTOMS
AT THE END OF THE TEST.
If on the seventh day, at the end of the 6 days of the "Therapeutic Test" the patient
presents, in all or almost all his symptoms, an improvement of between 40% to 99%, we
have that his symptoms are explained in a greater part by the presence of an Infection
Persistent by SARS CoV-2.
In these cases, the patient is instructed to continue taking IVM, ASA, Famotidine every
day and continue with the diet described, and to continue taking them while observing
that the medications generate an improvement in their symptoms, or until they reach a
maximum 10 additional days of treatment.
The patient is then instructed to continue taking all medications until one of the following
2 situations occurs:
o Up to 6 days after achieving total (100%) improvement in your symptoms, or
o Until you notice that you no longer show improvement with treatment, or up to a
maximum of 10 additional days of treatment, that is, up to a cumulative of 16 days of
continuous daily treatment.
At the end of this extension of the "Therapeutic Test", a part of the patients will achieve
100% improvement in all their symptoms, while another part will not. In those who do not
achieve 100% improvement, an evaluation of the symptoms that persist should be
carried out, this is described in the final part of this document.
Table 9 describes the doses of the drugs included in the "Therapeutic Test" and the
evaluation to be carried out on day 7, at the end of the Test.
3. PATIENTS WHO PRESENT BETWEEN 5 TO 39% IMPROVEMENT IN THEIR
SYMPTOMS AT THE END OF THE TEST.
There is a direct association between the percentage of improvement of the symptom
and the support of the existence of a persistent viral infection as the cause of
thebsymptom. The lower the percentage of symptom improvement, the less likely it is to
be caused by viral persistence.
In the cases that, at the end of the 6 days of the "Therapeutic Test", present between 5
to 39% improvement in their symptoms, It is interpreted that the symptoms that still
persist are not produced only by a Persistent Infection by SARS CoV-2, but there are
other important causes, therefore, the patient should be evaluated in a personalized way
to obtain more guidance on the causes of the symptoms that still persist. The parameters
to be taken into account for the evaluation are described in the final part of this
document.
Table 9
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
26
4. PATIENTS WHO HAVE NO IMPROVEMENT IN THEIR SYMPTOMS OR THIS IS
ONLY BETWEEN 1 TO 4% AT THE END OF THE TEST.
In these cases the symptom are most likely not due to a persistent infection by SARS
CoV-2, so an extension of the evaluation of the patient should be carried out investigating
other possible causes, especially it should be considered that it is treated Sequelae of
the disease, or of another pathology or coinfection.
Line of Action Agents/Drugs DAY 1 DAY 2 DAY 3 DAY 4,5,6 DAY 7
ASA
(AcetylSalicylic
Acid or Aspirin)*
IVM (Ivermectin)
0.4 mg/kg
after Breakfast
0.4 mg/kg
after Breakfast
Mild Symptoms
0.2 mg/kg
after Dinner
In Moderate
0.4 mg/kg
after Breakfast
0.4 mg/kg
after Breakfast
Symptoms
0.2 mg/kg
after Dinner
0.2 mg/kg
after Dinner
0.2 mg/kg
after Dinner
Diet
300 mg per day. When TBs are 100 mg, 1 TB is indicated at
breakfast, lunch, and dinner. If the TBs are 81 mg, 1 TB is
indicated at breakfast, 2 at lunch and 1 at dinner. If the TBs
are 325 mg, 1 TB is indicated at lunch. If you weigh more
than 95 kg, double the doses mentioned are taken.
FAMOTIDINE
In those who weigh betwee n 76 and 95 kg the dose of each dose
increases to 80mg (240mg per day). In >95kg it goes up to 100mg for
each intake (300mg per day). And in those who weigh from 42 to 55 kg,
40mg is indicated for each intake (120mg per day)
Avoiding: foods rich in Arginine and Histamine;
coffee, sodas, beverages with caffeine or with lactate.
Consume: foods rich in Lysine and Vitamin D.
* Verify that there is no risk of digestive bleeding. From at least 3 days before the patient must stop taking drugs,
supplements, plants and herbs with effects on blood clotting. Disclaimer: All information mentioned is for educational
purposes only and is not a substitute for medical treatment that must be individualized for each patient.
Source: Aguirre-Chang, Gustavo and Trujillo, Aurora. COVID Sub-Acute and Chronic: “Therapeutic Test” and First
Treatment Scheme for patients with Persistent Symptoms of COVID to assist the diagnosis of Persistent Viral Infection.
ResearchGate. April 19, 2021.
In those who weigh from 76 to 95 kg, the 3rd dose is added at 4pm the
first 3 days, then it is taken at 1 0am and 10pm. Those who weigh more
than 95kg take at 10am, 4pm and 10pm all 6 days.
60mg at 7.30 am, 3 pm and 11 pm (180mg daily)
3 to 3.3 grams (Capsules, or 1/2 teaspoon of Bicarbonate, or
1 and a half sachets of Andrews Salt) at 10 am and 10 pm
"THERAPEUTIC TEST" AND FIRST TREATMENT SCHEME FOR PATIENS WITH PERSISTENT
SYMPTOMS OF COVID TO ASSIST THE DIAGNOSIS OF PERSISTENT VIRAL INFECTION
REDUCE
PLATELET
HYPERACTIVITY
AND BREAK
DOWN CLOTS
.ASSESS
RESPONSE.
- In those who, on
the 6th or 7th day of
the Test, achieve a
complete
improvement (10
out of 10, or 100%),
from that day on it is
indicated: IVM
0.2mg/kg/day x 6
days; ASS 200
mg/day and
Famotidine 60 mg
10 pm x 3 more
days.
- In those who on
the 7th day present
an improvement of
between 4 to 9
points out of 10 (or
between 40% to
99%) in their
symptoms, they are
instructed to
continue taking
IVM, ASA and
Famotidine at the
same doses. And he
continues taking it
as long as his
symptoms improve,
or until he
completes a
maximum of 10
additional days of
continuous
treatment.
Alternatives: 1) Lysine Acetylsalicylate 1000mg/d; 2) Clopidogrel 75mg/d; 3) Ginger
1100mg at breakfast and dinner x 2 d, then 550mg is added at lunch, for 75 to 95kg it
increases to 1100mg 3 times/day; 4) Dipyridamole 75mg 3 times/day; 5) Policosanol
20mg/d; 6) Lysine 1500mg/d x2 days, then 2000mg/d; 7) Garlic 5 g/day, in >75kg 6 g/d.
REDUCE THE
VIRAL LOAD
None
None
Alternatives: 1) Nitazoxanide 500mg breakfast and dinner + Zinc 100mg at 11am/10pm
+ Vit. C 12 to 16g/day, 16 to 24g if weighing >75kg, 2) Antiviral+ Nitazoxanide or
Niclosamide or Gromwell (Root of Lithospermum erythrorhizon powder or Tollovid).
TREAT
NUTRIENTS
DEPLETION,
OXIDATIVE
STRESS AND
IMMUNE
DYSFUNCTIONS
BAKING SODA or
Potasium Bicarb.
(or Andrews Salt
or similar)
Sub-Acute and Chronic COVID: “Therapeutic Test” and First Treatment Scheme for patients with Persistent
Symptoms of COVID how to assist the diagnosis of Persistent Viral Infection. Aguirre-Chang, G. Trujillo A.
ResearchGate. April 19, 2021.
27
As no improvement has been presented with the "Therapeutic Test", in these cases the
patient would no longer be managed as a case in which a persistent SARS CoV-2
infection is suspected.
EVALUATION OF THE SYMPTOMS THAT PERSIST ON THE END OF THE DAYS OF
EXTENSION OF THE TEST.
In patients in whom symptoms still persist at the end of the extension days of the
"Therapeutic Test", the interpretation is that there are other causes of the symptoms, so
a new clinical evaluation should be carried out in these patients in which it should be
identified whether the symptoms that persist are characteristic or not of COVID.
The evaluation must differentiate if the symptoms are localized (such as cases in which
they only present an alteration of smell), or if they involve 2 or more organs or systems.
The involvement of various organs and systems, which includes the following:
musculoskeletal system, lungs, brain, skin, hair and heart, guides us to the fact that it is a
Disseminated Infection, which, being persistent, may be associated with the presence of
persistent clots, so in these cases it is justified to request diagnostic aid tests.
According to the new clinical evaluation and the results of the requested examinations,
the following Treatment Scheme to be followed will be established, which is developed in
the document on the Therapeutic Plan for patients with Persistent Symptoms, of COVID
(81).
The importance of frequent monitoring of symptoms is emphasized, and it should be
recorded whether or not there is a response to treatment, since this information guides
us in the treatment to continue
REFERENCES
1. Colmenero I, Santonja C, et al. SARS CoV-2 endothelial infection causes COVID-19
chilblains: histopathological, immunohistochemical and ultrastructural study of seven
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