As you will no doubt know, the current pandemic facing the globe is coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the World Health Organisation (WHO), it is mainly spread by close contact or by touching a contaminated surface and then touching your face. COVID-19 can survive on surfaces up to 72 hours and is most contagious during the first three days after symptom onset.
At the time of writing, there are 976,249 confirmed cases worldwide (5,350 cases in Australia) and 50,489* deaths. Deaths are largely due to respiratory illness and the fact that the SARS-CoV-2 virus significantly suppresses surfactant production, which is otherwise designed to reduce fluid accumulation in the lungs and prevent their collapse by keeping alveoli (air sacs) open. Without surfactant, lungs fill with cellular debris and fluid, and without treatment, lung impairment exponentially increases with time, leading to respiratory failure and eventually death.
Naturally, a large part of the conversation is now centred around finding the treatment for COVID-19 and there has been much discussion on the role of intravenous vitamin C (IVC). Let’s take a closer look.
Vitamin C, also known as ascorbic acid and ascorbate, is an essential nutrient as it is not made by the body and must be consumed by dietary and/or supplemental sources. While it is most famous for treating and preventing scurvy in the 1700s, the powerful antiviral action of vitamin C has been demonstrated for decades. The specific mechanisms include:
- Enhanced response to oxidative stress from inflammation, which helps to fight microbes and viruses that would otherwise proliferate to create an infection;
- Improved immune response via the enhanced function of white blood cells, B-cells, T-cells and NK cells;
- Increased anti-inflammatory cytokine production, compounds produced by the immune system in response to an infection, that attack and remove foreign bodies;
- Reduced production of pro-inflammatory cytokines, tumor necrosis factor alpha (TNF-a) and interlukin 6 (IL-6);
- Increased production of interferon, a powerful anti-viral defence that prevent cells from being infected by a virus;
- Specific viral anti-replication processes that results in the inactivation of the RNA or DNA of viruses.
- Improved phagocyte function, the body’s mechanism for removing viral particles and unwanted debris.
Why IV Vitamin C?
Anyone who has taken too much vitamin C orally will be all too familiar with the associated gastrointestinal symptoms including diarrhoea or reflux. By contrast, IVC has the following benefits:
- Delivery is direct into the bloodstream, by-passing the gastrointestinal tract and gastric upset associated with high oral doses;
- A higher absorption rate resulting in higher concentrations in the blood;
- Simply a more practical and effective method of delivering high doses;
- Good tolerance in the majority of people;
- Very high doses (e.g. 30,000 – 200,000 mg) divided into multiple doses over the course of one day are remarkably non-toxic. Vitamin C is water soluble and therefore has no danger of being stored in high levels. Excess is simply eliminated by the body.
COVID-19: What We Know So Far
As vitamin C is critical for the function of both the innate and adaptive immune system, a lack of vitamin C has been long known to increase susceptibility to viruses. So what does this mean for our current pandemic?
This understanding is critical as in a COVID-19 patient, vitamin C levels drop dramatically when they suffer sepsis, an inflammatory response that occurs during a cytokine storm – more on this to come.
Secondly, the mechanism for reduced pro-inflammatory cytokine production is of great interest as vitamin C is thought to prevent neutrophils from accumulating in the lungs, which would otherwise destroy alveolar capillaries, leading the respiratory failure and death. Without suppression, a cytokine storm occurs which leads to an excessive immune response, acute respiratory distress and multi-organ failure. Current research indicates that the immune system and not the virus itself, may be the cause of death.
Researchers in China are conducting a clinical trial to treat patients with coronavirus and severe respiratory complications. The randomized, triple-blind study (n = 140) involves 12g of intravenous vitamin C, twice a day for seven days. While the study is expected to be completed by September 30th 2020, preliminary results are positive, especially when preventing sepsis and the associated cytokine storm.
In one New York hospital, intensive-care patients with the coronavirus immediately receive 1,500 milligrams of intravenous vitamin C. Identical amounts are then re-administered three or four times per day. Similar protocols are being used in other hospitals across New York. Although not clinical trials, significantly positive results are observed.
You may have also heard of the pharmaceutical combination of a malaria drug (hydroxychloroquine) and antibiotic (azithromycin), that has more recently been approved by the U.S. Food and Drug Administration (FDA) for desperately ill patients (at this stage). This was based on one study that found “hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients”. This was a non-randomised study with an extremely small sample size (n = 36), where six patients tested negative for COVID-19 by day six.
It is important to acknowledge that SARS-CoV-2 is viral, antibiotics are technically of no use to treat this specifically (just like they can’t treat influenza, which is also viral). The precise mechanism behind the combination of azithromycin with hydroxychloroquine is still unknown, but it is hypothesised to “prevent severe respiratory tract infections when administrated to patients suffering viral infection”.
Significantly, there are currently no randomised control trials (RCT) to show that this cocktail of drugs is successful in treating COVID-19. So it has to be asked, why is this being approved but IVC therapy ignored and even, suppressed? We can’t completely ignore the potential long term effects of this pharmaceutical intervention, especially considering hydroxychloroquine is known to have side effects including cardiomyopathy, which can result in fatal cardiac failure. Remember the first rule of medicine, “first do no harm”? While at present it is only being administered to critically ill-patients, only time will tell how far the FDA will go.
At present the TGA state there is no robust scientific evidence to support the usage of this vitamin in the management of COVID-19. More research is absolutely required and we do need randomised, double blind, placebo controlled RCTs specific to COVID-19, but as there are no negative side effects of the levels of IVC considered, it is extremely important that those that are unwell are given the opportunity to explore this natural therapy, which has the potential to save many lives. The question must be asked: are innocent people dying because it takes an average of seven years for a clinical trial to reach publication in a top tier medical journal?
*Due to a significant delay in accurate COVID-19 testing, the reported number of deaths are thought to be extremely inaccurate. This is a concern as the large majority of the big decisions (including stage 4 restrictions) that have been made worldwide were based on these numbers (and algorithmic predictions from here), so it does need to be considered if the social and economic consequences will be worth it in the long run. But that’s a conversation for another time.
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