I LEARNED HOW TO TREAT COVID-19 BACK IN 1978

An effective, $10 early treatment for Covid-19, by Richard Malotky, M.D.

I am a Family Physician and have been in solo practice for 26 years.  I am just finishing my 36th year of private practice, and I’d like to share some of my experiences from the last two years diagnosing and treating Covid-19 patients.

The pandemic started for me in February 2020.  My son and son-in-law are both plastic surgeons, and they both were temporarily out of work because all hospitals canceled all elective surgery.

We were up on Lake Shasta fishing for bass and we had a conversation about the pandemic.

I had been reading about this disaster for two weeks, and it was obvious from the news reports out of Italy and New York that the new virus was killing people by triggering something that we call the cytokine storm.

Many different things can trigger the cytokine storm.  Influenza causes it, gunshot wounds to the chest can cause it (in Vietnam the military trauma surgeons called it Da Nang Lung), and any major blunt trauma can trigger it, like going through the windshield of your car.

In my years of work I have seen it about 30 times prior to February 2020.  The first time I saw the cytokine storm was back in 1978 in Minnesota at med school.

During my first year of med school, which is mostly classroom learning, I was assigned to follow an E.R. doctor around to watch and learn.  Medicine is best learned from people with experience.  One time, a 60-year-old guy rolled into the E.R. about 11:00 at night in January.  That means 30 degrees below zero in Minnesota!

Anyway, he had a fever and terrible cough and right away my mentor said that he probably had influenza.  We had already seen a couple of other influenza patients that evening.  But this guy was different…he had labored breathing and his oxygen saturation was just 85%.  For a nonsmoking guy, even with influenza, his oxygen should have been over 95%.

When we did his chest X-ray both lungs were uniformly white (we call that a “ground glass” appearance).  As soon as my mentor saw the chest X-ray, he poked me in the chest with his finger and said: “Son, I want you to run, don’t walk, to the pharmacy and get 10 mg of IV Decadron, and run back.”

I was a little surprised because usually we just wrote orders and waited for the nurses to do everything.  Not this time!  While I ran he started the IV, and as soon as I got back from the pharmacy we pushed the drug into his vein and sent him up to the ICU. 

The phenomenon our patient in 1978 experienced – and almost died from – is the same phenomenon that has killed many Covid-19 patients for the last two years.  It turns out that the way to stop the cytokine storm is with immediate treatment with steroids.  I have been explaining it to my patients this way: Pretend that I’m standing on top of a big mountain covered with snow.  I make a snowball and roll it down the mountain.  Halfway down that snowball is the size of a car.  If you let the snowball get to the bottom of the mountain it’s the size of a house!  The doctor's job with the cytokine storm is to stop the snowball before it becomes the size of a car.  Steroids stop the snowball wherever it is on the mountain…the key is early administration.  

When you wait too long and the patient is hit by a snowball the size of a house, the damage is done and it’s very difficult for the ICU doctors to save your life.  The storm triggers blood clotting inside your blood vessels (which is not supposed to happen!) and causes your lungs to fill with fluids.  Essentially, your immune system drowns you.  Not a pretty sight.

If that first ER patient back in 1978 had waited just 8-12 more hours before coming to the ER he would have been hit by the house-sized snowball and we might not have saved him.  As it happens he went home in just 3 days (on oral steroids) and enjoyed a complete recovery.  Many Covid patients have died as a result of no early treatment with steroids.

Anyway, when I told this story to my sons (I consider my son-in-law as my second son) they shook their heads and said, “Dad, you’re old, nobody uses steroids anymore…”

And I realized that, for the past 20 years, the med schools have all been teaching the students to avoid using steroids.  Mostly because of liability issues—steroids can have lots of side effects, mostly from chronic daily use.

But our job is a constant struggle between the pros and the cons, and when the con is drowning in your own fluids and clotting all your blood inside your blood vessels, USE THE STEROIDS!

Anyway two months later I read a press release:  Genius doctors in Great Britain discover the cure for Covid 19.  Decadron!  Needless to say I forwarded the email to my sons!  

The cytokine storm is nothing new to us physicians.  40 years ago we called it shock lung, 20 years ago they called it ARDS (Acute Respiratory Distress Syndrome), and currently they are calling it SARS (Severe Acute Respiratory Syndrome), but it’s all the same side of the same physiological coin.

Humans are capable of generating four different types of allergic reactions.

A Type I allergic reaction is familiar to many.  We call it anaphylaxis.  An example is when someone eats a peanut and their breathing tubes immediately start swelling shut and they need an epinephrine shot immediately to survive.  Scary!

This reaction is mediated by the antibody we call IgE.

A Type IV allergic reaction is known as cell mediated immunity, and is most familiar to northern California residents as the immune reaction that causes poison oak.  No fun!

The cytokine storm is a combination of Type II and Type III allergic reactions.  Type II is a chain reaction issue triggered by overreacting IgG and IgM antibodies, as well as overactive killer T cells and T and B memory cells.  (Yes, sorry, the immune system is pretty sophisticated!)

A Type III allergic reaction involves antigen-antibody complexes that can trigger something called the complement cascade, which is beyond the scope of this discussion (you can look it up).  I like to explain it like this: when there’s lots of dead virus laying around as you recover from the infection (the virus is the antigen, IgM is the antibody), all those dead viral bodies make the immune system overreact.

Anyway, it turns out that the Covid-19 virus is particularly good at triggering the cytokine storm. 

So for the past 2 years I’ve tried to get my Covid patients to come to the parking lot (we’re not supposed to sit them in the waiting room) right as soon as they have symptoms.  When I get them in the first 3 days they all do well and enjoy a rapid full recovery.  I did have to admit 6 people to the hospital -- and 4 of the 6 were over 300 lbs.  (The biggest risk factor of Covid mortality is obesity.)

I saw 4 new cases last Friday which makes 248 total cases — no deaths.  In my office, early use of steroids saves everyone.  Decadron is only $10, and it saves lives.  Why our public health officials refuse to consider early treatment of Covid might be the defining issue  of the pandemic.  I have been censured by my local public health officials and threatened with having my license revoked by the California Medical Board.  I just don’t get it…but I plan on continuing to do everything I can to heal my patients.

Author’s Note: To be clear, there are other available early treatments for Covid-19 besides steroids, including monoclonal antibodies, new EUA antivirals, two off-label, repurposed (and demonized) drugs – Ivermectin and Hydroxychloroquine, an antiviral nasal spray/mouthwash, as well as a host of other immune-system supports that help fight Covid-19 such as supplements (vitamin C, vitamin D3, zinc, and magnesium), good nutrition, rest, and proper hydration.  This article focuses on steroids (specifically Decadron) but that is not meant to imply there aren’t other options for early treatment – there are!  Please refer to the Frontline Covid Critical Care Alliance page on early treatments for more information on other early treatment options.