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Given both the current health crisis and the accompanying loss of jobs and businesses, resulting in reductions in state and federal services, it is important we think outside the box as we navigate this crisis.

The COVID-19 Critical Care Working Group, comprised of seven pulmonologists and emergency room doctors — critical care doctors who run ICU teams in different parts of the country — developed a protocol they have been using to successfully treat all of their COVID-19 patients since early March. This includes challenging cases, such as an 87-year old patient already on oxygen.

Initially developed by Dr. Paul Marik, MD, Chief of Pulmonology and Critical Care at Eastern Virginia Medical School in Norfolk, Virginia, the protocol additionally includes early oral dosing with vitamins C and D and notes that ventilators may be part of the problem.

No randomized control trials have been conducted regarding ventilator safety and use. While the is successfully treating all patients, ventilator use is associated with very poor outcomes. The EVMS protocol, which includes IV vitamin C along with other aggressive treatments, can be found here.

Medical doctors on the cutting edge cite extensive research to treat viral illness. It includes studies designed to fail plus experience in maintaining baseline levels of vitamins C, D, B and dosing additionally with vitamin C (5,000-10,000 mg). Doctors have been keeping patients out of the ICU.

Researchers at Northwestern University have found a correlation between low vitamin D levels and mortality rates from COVID-19, as has Marik. We know that cold and flu season tracks the annual movement indoors in northern climates and resulting drop in vitamin D. Individuals with darker skin tones produce less vitamin D to start with, even when exposed to sunshine, as do those who are older.

Marik suggests preventative dosing of 1,000-4,000 mg of vitamin D. This might be particularly important to know for certain populations and locations.

While this protocol was developed by critical care physicians, a comparative study could look at COVID-19 statistics from these ICUs relative to other ICUs in the same cities treating COVID-19 patients at the same time, as controls. Such an analytical study would be the ethical way to establish a control in this situation, so as not to intentionally delay, withhold or mis-administer a lifesaving treatment in ICU.

A flu-like respiratory virus swept the island from mid-January through early February. Given constant travel and family and business ties between Hawaii, China and Japan, COVID-19 logically would have arrived here early on.

Unfortunately, it appears antibody tests may not detect antibodies that far post infection. But, this would logically explain the jump in respiratory cases we saw in January and February here.

Were we to understand that more people in Hawaii have had COVID-19 already, this would be good news for our population. Having a virus provides the body with a blueprint that can be used to ramp up antibodies any time, that our bodies can learn from in response to future strains. It provides more complete and lasting protection via learned immunity, and a full immune response rather than depending on a vaccine.

Prior year coronavirus infection rates may help explain mild cases, as would higher levels of vitamins C and D. A 2019 military study showed that military personnel who had the flu vaccine were at a 36% increased risk of infection by coronavirus. The study notes the concept of non-specific immunity — that having a virus, and full immune response, helps build immune response in general, increasing resilience.

MDs around the world are starting to share their concerns regarding the impact shutdowns will have on health and well-being. They express concern over deaths added to the COVID-19 count without confirmation or when there is a different primary cause.

They note that this cold/flu season, with this strain of coronavirus, is not very different from a normal year, apart from the panic. They worry about the focus on fear, rather than on understanding the broader concepts of immune function or careful analysis of the issues inherent in our response, like the use of ventilators.

They worry about the health crisis that will result from taking people’s livelihoods. Already we see millions of people dying every year of the flu, car accidents, air pollution and hunger.

Fear and stress themselves take a toll on the immune system. Being worried about how to feed your family isn’t being selfish. It’s being a parent.

Taking positive steps forward — adopting a working treatment protocol — is essential, not only for COVID-19 patients and health care providers, but for everyone in Hawaii.