The MATH+ Protocol Will Likely Have the Most Dramatic Impact on Survival of Critically Ill Covid19 Patients Worldwide.

As Co-coordinator of Communications (with Betsy Ashton) for the Frontline Covid19 Critical Care Working Group (FLCCC), I am sharing this essay from the entire team‚ including our Critical Care physicians. Together, we are hoping you will take a few minutes to learn why the team believes that its MATH+ Hospital Treatment Protocol for Covid19 will likely save countless lives throughout the world.

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Months ago, early on in COVID19, the FLCCC created the MATH+ protocol based on our physicians’ insights into COVID19 as a steroid-responsive disease. This treatment recommendation went against all the major national and international health care societies that had misinterpreted the medical literature, a body of published evidence which, upon careful and deep review, actually supported the use of corticosteroids in prior pandemics.

One of our members, Dr. G. Umberto Meduri, published the landmark paper which highlighted the errors the societies had made in recommending against the use of corticosteroids, and despite it being published in a journal of the Society of Critical Care Medicine, which then disseminated it to all of its members, little systemic change in treatment approaches occurred. Thousands of patients who became critically ill with Covid19 and who were suffering from massive inflammation may have been saved if this safe and powerful anti-inflammatory medicine had been provided.

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We would like to call attention to today’s news of a major, large, randomized controlled trial which validates our now long-standing recommendation that corticosteroids must be used, and be used early on, in the hospital course of a COVID19 patient. The RECOVERY trial, conducted by the University of Oxford, reported today that the use of a corticosteroid called dexamethasone improved survival by 1/3 in ventilated patients and by a 1/5 in patients requiring oxygen. While news of these impacts is deeply encouraging and validates our months-long position that Covid19 is indeed a steroid-responsive disease, we believe that larger and more dramatic impacts on survival can be achieved with the drug and dosing strategy incorporated into MATH+.

The reasons for this are as follows: 1) Methylprednisolone reaches higher concentrations in lung tissue and 2) Based on analysis of the inflammatory gene activation patterns induced by SARS-CoV-2, Methylprednisolone gene suppression activity most closely matches it, suggesting a higher efficacy when used in Covid-19 than dexamethasone and 3) The dose of dexamethasone in the RECOVERY trial was modest and likely insufficient for more severe cases. The Methylprednisolone dose advocated by the FLCCC has been shown to be the most highly effective dose based on prior pandemics and ARDS trials. Additionally, the FLCCC advocates for longer durations as well as escalation/tapering according to the clinical condition of each individual patient. A prospective Italian study using this protocol was submitted for publication and the results will be disclosed upon acceptance.

In the hospitals of two of our FLCCC physicians — each having treated over 100 hospitalized patients with MATH+ often early on in the hospitalization, the hospital mortality rate to date is 7% in one hospital (Dr. Paul Marik, Norfolk, Va.) and less than 1% in the other (Dr. Joseph Varon, Houston, Texas). Manuscripts are in progress.

The MATH+ protocol was developed using the deep clinical expertise of these highly published Critical Care medicine physician-scholars. We believe that MATH+ saves lives. And, if implemented widely, it will save thousands.”

Share this please — as widely as you possibly can. Together, we will save lives.

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