Comment; We have good news! From what we can see thus far, Hydroxychloroquine is effective, there are other things that can also help and having CIRS does not seem to be a major risk factor for a bad outcome from CIRS.

A fellow family physician sent this Clip of Dr. Oz interview of a COVID19 treating physician. Interesting…https://www.youtube.com/watch?v=Y3NDMPxTA_k

Proposed mechanism & strategy;The Hydroxycholorqine does not work as an “antibiotic.”The 3 mechanisms:1. It dials down the immune system that is over-reacting to the virus2. It has the capability of pushing zinc across the virus’ cell wall to stop it from replicating. 3. When Azithromycin is added, they work synergistically to improve the strength of the hydroxychloroquine.

CAUTION:Be aware, people with an EKG showing an elevated QTc (time of electrical flow from the upper to the lower chambers) are at risk for heart problems using these drugs.Your doctor would have this information to determine if you are at risk from using these meds.


Vitamin C/Ascorbic acid; 10,000 mg/d inpatient dosing, spread throughout the day, perhaps 2500 mg every 6 hours if tolerated without loose stools, if necessary, give intravenously (IV).20,000 mg/d (5000 mg q 6 hours) keeps patients out of the ICU and reduces incidence of ventilator support/acute respiratory failure.  May need to be given IV.Outpatients can use as much vitamin C as they can tolerate; giving too much vitamin C loosens stool–a great safety mechanism to avoid over-absorption.  Vit. C needs to be dosed frequently–not just once daily but at least 2-3 times (ideally 4 or more) times daily.  An easy way to do this is to use crystalline Vit. C (powder) and put it in a water bottle to sip on through the course of the day–is a bit tart, provides flavor to water–which we should all be drinking extra of to remain well-hydrated.  Caution; The only true toxicity with Vit. C is for those born with a congenital Glucose-6-Phosphate Dehydrogenase (an enzyme) deficiency–more common in Mediterranean and African origin folks–can cause significant adverse effects.

International Society of Environmentally Acquired Illness (ISEAI) Information (Sorry that I don’t have more precise attribution);

Vitamin A 10,000 IU/d helps seal tight junctions between cell membranes reducing the possibility of passage of Covid19 across the pulmonary membranes and into the circulation.  For Vit. A naive patients, who have not been on it previously, would give it 3-4 times/d for a couple of days as a “loading dose”–but it accumulates in tissues and can cause toxicity issues–I wouldn’t recommend higher dosing without  medical supervision/lab testing to ensure lack of toxicity).

Vitamin B3 (Niacin) provides the oxidative burst necessary to neutralize (kill) the virus inside of the macrophages & neutrophils (white blood cells that fight infection). 

Note; B3 causes a sudden release of histamine which causes skin to flush/burn/itch/redden.  High doses of Vit. C reduce to eliminate this based on the doses involved of B3 & C.those with pale complexion (Eg. northern European) are most susceptible to this issue.I find that a dose of 1:2 B3 to Vit. C (Eg. if taking 1,000 mg of Niacin/B3, take 2,000 mg of Vitamin C per dose.

Zinc; also helps neutralize the virus

Just a thought: For those on the front line, prophylactic use may be wise.Because Hydroxychloroquine has such a long half life, use twice weekly for prophylaxis along with zinc supplementation and possibly a ZPak should do the trick.
Immunocompromise is risk factor for Covid19/severe infection with respiratory failure.  I’m unaware of this happening with Chronic Inflammatory Response Syndrome (CIRS), Lyme or similar illnesses.

From Marty Ross MD

High risk factors for getting severe illness or death with Covid-19 should take steps to limit getting the infection. High risk medical conditions include:

  • Diabetes,
  • Heart disease like congestive heart failure
  • Lung diseases like chronic bronchitis, asthma, emphysema, and smoking damage
  • Immunosuppression from chemotherapy or other illnesses (this category may include a small percentage of Lyme patients as I describe above.

Preventing Covid-19 Infection is still the most important initial step!

These are common recommendations put forward by public health departments like the US Centers for Disease Control.

Physical Distancing

Stand at least six feet away from others. This decreases your chances of contacting respiratory and mucous droplets that carry the virus. 

Wash Your Hands Frequently

Washing your hands for 20 seconds with soap and water or a hand sanitizer removes germs you may pick up. Simple soap works great.

Avoid Touching Your Face, Mouth, Nose, and Eyes

Covid-19 is spread through respiratory droplets. If these get on your hands and then you touch your face or parts of your face, you could spread the virus to yourself.

Wear a Homemade Mask

Newer evidence suggests facemasks, if worn by those infected with Covid-19, prevent spread of the infection. Masks work better at preventing transmission from a person with the illness than they do at blocking a person wearing one from breathing in the infection. Because 25 percent of infected patients do not have symptoms, wearing face masks could prevent these people from spreading the infection.

Surgical and the N95 face masks are in short supply. They likely work better than homemade masks, but we should save surgical and N95 masks for the heroes working on the frontline of this illness. Refer to this New York Times article for information about how to make a face mask.

Finally, a lot of my patients have been concerned about being in an immuno-compromised state due to their inflammation/autoimmune condition.  I’ve been following the Covid19 pandemic and how it affects this patient population on the International Society of Environmentally Acquired Illness website.   So far, we’re only aware of 2 patients with definite Covid19, one with possible Covid/diagnosis pending–none of which have been on a ventilator or have died.  They’ve essentially had a case of the flu.

Dr. Raymond Oenbrink
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