Protocol for Covid-19 Treatment
It has taken time for doctors to learn more successful treatments for Covid-19. Here is the critical care protocol developed by Dr. Paul Marik, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School in Norfolk, Virginia, updated through May 5, 2020.
It turns out that recommendations by WHO and CDC were wrong and caused deaths. If you become infected, make sure your doctor is aware of this protocol and its ongoing update.
EVMS Medical Group
COVID-19 MANAGEMENT PROTOCOL
Developed and updated by Paul Marik, MD Chief of Pulmonary and Critical Care Medicine Eastern Virginia Medical School, Norfolk, VA May 5th, 2020
URGENT! Please circulate as widely as possible. It is crucial that every pulmonologist, every critical care doctor and nurse, every hospital administrator, every public health official receive this information immediately.
This is our recommended approach to COVID-19 based on the best (and most recent) literature. We should not re-invent the wheel but learn from the experience of others. This is a very dynamic situation; therefore, we will be updating the guideline as new information emerges. Please check on the EVMS website for updated versions of this protocol. EVMS COVID website: https://www.evms.edu/covid-19/medical_information_resources/  Short url: evms.edu/covidcare 
“We have zero success for patients who were intubated.”
“It is our collective opinion that the historically high levels of morbidity and mortality from COVID-19 is due to a single factor: the widespread and inappropriate reluctance amongst intensivists to employ anti-inflammatory and anticoagulant treatments, including corticosteroid therapy early in the course of a patient’s hospitalization. It is essential to recognize that it is not the virus that is killing the patient, rather it is the patient’s overactive immune system. The flames of the “cytokine fire” are out of control and need to be extinguished. Providing supportive care (with ventilators that themselves stoke the fire) and waiting for the cytokine fire to burn itself out simply does not work… this approach has FAILED and has led to the death of tens of thousands of patients.
“The systematic failure of critical care systems to adopt corticosteroid therapy resulted from the published recommendations against corticosteroids use by the World Health Organization (WHO), the Centers for Disease Control and “Prevention (CDC), and the American Thoracic Society (ATS) amongst others. A very recent publication by the Society of Critical Care Medicine and authored one of the members of the Front Line COVID-19 Critical Care (FLCCC) group (UM), identified the errors made by these organizations in their analyses of corticosteroid studies based on the findings of the SARS and H1N1 pandemics. Their erroneous recommendation to avoid corticosteroids in the treatment of COVID- 19 has led to the development of myriad organ failures which have overwhelmed critical care systems across the world.
“Our treatment protocol targeting these key pathologies has achieved near uniform success, if begun within 6 hours of a COVID19 patient presenting with shortness of breath or needing ≥ 4L/min of oxygen. If such early initiation of treatment could be systematically achieved, the need for mechanical ventilators and ICU beds will decrease dramatically.
“It is important to recognize that “COVID-19 pneumonia” does not cause ARDS. The initial phase of “oxygenation failure” is characterized by normal lung compliance, with poor recruitability and near normal lung water (as measured by transpulmonary thermodilution). This is the “L phenotype” as reported by Gattonini and colleagues. Treating these patients with early intubation and the ARDNSnet treatment protocol will cause the disease you are trying to prevent i.e. ARDS.”
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