Turkia Mika
Qualitative Research, Independent Researcher, Helsinki, FIN.
Cureus. 2020 Dec 31;12(12):e12403. doi: 10.7759/cureus.12403.
An alliance of established experts on critical care, Front Line COVID-19 Critical Care Alliance (FLCCC), has published two protocols for treatment of COVID-19. The first one, methylprednisolone, ascorbic acid, thiamine, and heparin (MATH+), is intended for hospital and intensive care unit treatment of pulmonary phases of the disease. It is based on affordable, commonly available components: anti-inflammatory corticosteroids (methylprednisolone, "M"), high-dose vitamin C infusion (ascorbic acid, "A"), vitamin B1 (thiamine, "T"), anticoagulant heparin ("H"), antiparasitic agent ivermectin, and supplemental components ("+") including melatonin, vitamin D, elemental zinc, and magnesium. The MATH+ protocol has received scarce attention due to the World Health Organization (WHO) advising against the use of corticosteroids in the beginning of the pandemic. In addition, randomized controlled clinical trials were required as a condition for adoption of the protocol. As the hospital mortality rate of MATH+ treated patients was approximately a quarter of the rate of patients receiving a standard of care, the authors of the protocol considered performing such trials unethical. Other parties have later performed clinical trials with corticosteroids and anticoagulants, which has led to a more widespread adoption of these components. In October 2020, ivermectin was upgraded from an optional component to an essential component of the protocol. According to the authors, ivermectin is considered the first agent effective for both prophylaxis (prevention) of COVID-19 and for treatment of all phases of COVID-19 including outpatient treatment of the early symptomatic phase. Therefore, at the end of October 2020, a separate ivermectin-based I-MASK+ protocol for prophylaxis and early outpatient treatment of COVID-19 was published.
由重症监护领域的权威专家组成的前线 COVID-19 重症监护联盟（FLCCC）发布了两份 COVID-19 治疗方案。第一个方案是甲泼尼龙、维生素 C、硫胺素和肝素（MATH+），用于医院和重症监护病房对该疾病肺部阶段的治疗。它基于价格亲民、普遍可得的成分：抗炎皮质类固醇（甲泼尼龙，“M”）、高剂量维生素 C 输注（维生素 C，“A”）、维生素 B1（硫胺素，“T”）、抗凝剂肝素（“H”）、抗寄生虫药伊维菌素，以及包括褪黑素、维生素 D、元素锌和镁在内的补充成分（“+”）。由于世界卫生组织（WHO）在疫情初期建议不要使用皮质类固醇，MATH+方案受到的关注较少。此外，该方案的采用需要随机对照临床试验。由于接受 MATH+治疗的患者的医院死亡率约为接受标准治疗患者死亡率的四分之一，该方案的作者认为进行此类试验是不道德的。后来其他方对皮质类固醇和抗凝剂进行了临床试验，这导致这些成分得到了更广泛的采用。2020 年 10 月，伊维菌素从该方案的可选成分升级为必需成分。据作者称，伊维菌素被认为是第一种对 COVID-19 预防（预防）和 COVID-19 所有阶段治疗（包括早期症状阶段的门诊治疗）均有效的药物。因此，2020 年 10 月底，发布了一份单独的基于伊维菌素的 I-MASK+方案，用于 COVID-19 的预防和早期门诊治疗。
