Patrick  Holford   0:00
So now let’s talk to Dr. Paul Marik who’s chief of the Division of Pulmonary and Critical Care Medicine at the East Virginia medical school in the US, who has told me he has cracked the covid code. Dr. Paul Marik, I’m extremely honoured to be speaking to you. I know how busy you are saving lives. So have you cracked the COVID code?

Dr. Paul Marik 0:23
Yeah, well, thanks, Patrick. Thanks for speaking with me this morning. So, you know what we think we figured out how to treat this disease. And, you know, this is based on our previous understanding of the treatment of sepsis. This is based on our understanding of this disease, covid. And then our personal experience, the problem is that no one believes us. So it’s obviously extremely frustrating. You know, we have good results. And we see it work with our own eyes. And I have a colleague in Houston, who’s using the same protocol, and he sees the same thing. But the frustration is, is that people just don’t want to believe us because it’s too straightforward. It’s too simple. And it’s cheap. And, you know, that goes against many basic principles.

Patrick Holford   1:20
And to put it into context, because I was getting information from Dr. Jason Varon over in Houston. And he reported on I think, his first 24 people through ICU with no deaths, how many people have you had with covid 19 through your ICU and what’s your mortality rate?

Dr. Paul Marik 1:41
Yeah, so we’ve had about 40 patients, we’ve had two deaths. Both of these patients were over the age of 85, had severe comorbidities, like end stage cirrhosis, end stage lung disease. So you know, I think their chances of putting through were minimal. Otherwise, all the other patients have left and have done really well. We actually had a patient who was admitted dead. So this patient had a cardiac arrest at home. He had COVID and had massive coma ambalaj. He was admitted dead to our hospital. And remarkably, he left, walked out of the ICU last week. So not only have we really not had deaths, but a patient who was admitted dead, we’ve actually managed to resurrect.

Patrick Holford   2:32
Yeah, I mean, it’s extraordinary. Here in the UK, every week, we get a report from the Intensive Care National Audit and Research Group. And they are reporting 51 to 52% leave dead from ICU’s. Of those on ventilators which unfortunately, in the UK is the majority, the death rate is two thirds. It’s a terrible thing. So in essence, and remember, we’re talking here more to a public audience, so we are about nutrition. So these are not ICU specialists who we are addressing but what is the essence of your protocol?

Dr. Paul Marik 3:05
So yeah, so you know, if you look what you said is true. So there’s recent data out in New York, they looked at the first 5700 patients, and the mortality on a ventilator was 86%. So basically, all patients who go onto a ventilator die. And you obviously then have to question what they are doing. And if something’s not working, you have to say, well, this is not working. We need to do something else. So I think fundamentally, and this is where many people have gone astray, is you have to understand the disease. And it seems somewhat obvious and basic. You have to understand the disease you’re treating to effectively treat the disease. And I think without question COVID-19 has two phases. There’s the early viral replicator phase, where the virus COVID, COVID 2, replicates in the nasal pharynx. And it actually replicates aggressively and reaches very high concentrations. And that’s why it’s so infectious, is that it’s highly contagious, because it replicates to an enormous degree. What then happens is some patients and we don’t know how many, may just have an asymptomatic infection, the host immune response overcomes the virus and the virus goes away. There is a percentage of patients who become symptomatic. So they develop typical flu like symptoms, which is typical of influenza; fever, cough, headache, myalgia (myalgia, being sore muscles), which is typical of influenza, so the duration of those symptoms depends upon whether they stayed home, or come to hospital. If they stay at home, it generally lasts about five days, six days and can be pretty severe. Those patients who have more severe symptoms, who come to hospital, they remain symptomatic for up to about 12 days. So this is a pretty aggressive virus. So that’s the first symptomatic phase, which is really characterised by viral replication in the upper airway. And then what happens is it goes from the upper airway to the lower airway. And the factors that predict that are not entirely clear, it probably is a interrelationship between the patient’s defence mechanism, the viral load, and that happens at about day seven. So you, you transition from the upper airway replicator phase to the lung phase. Once it gets into the lung, the virus binds to specific receptors on the pulmonary lining, the alveoli, and then it induces an intense inflammatory response. So this is really the key. You have a early viral replicator phase where patients have symptoms like flu, but then they transition into a phase which is marked by severe hyper-inflammation. So the virus triggers the production of inflammatory mediators. So we call these cytokines. A cytokine is a protein made by the host, with the goal of increasing the host immune response. But what happens in some patients is the immune response gets completely out of control.. So this is a fire which is out of control. And indeed its the host immune response, which is killing the patient, and not the virus at this stage. And it’s a vital concept to understand. Because what is actually happening is the host immune response is out of control. And it’s the host immune response, which is killing the patient.

Patrick Holford   7:18
And that’s what happens in sepsis, isn’t it?

Dr. Paul Marik 7:21
Yes, it’s very similar to sepsis. This is the analogy between COVID and sepsis. And so the current treatment is just to support them, and wait for the storm to die down. The problem is, what happens if you do that, is the storm damages the lung, and I think we now have data, particularly from New York, that if you don’t institute anti inflammatory treatment, this then progresses to severe, what’s called the fibroproliferative stage of acute lung injury, and that these patients have severe irreversible lung injury and will likely never come off a ventilator. So, you know, what we say is that, in the early phase, like you know, when patients are symptomatic, you want to give them medications and dietary supplements which improve their immune system. However, when they get to this pulmonary phase, you really want to down regulate the immune response. And this is such a vital key. The World Health Organisation, American Thoracic Society, etc, etc. basically said you should not use steroids. Steroids are drugs, which down regulate the immune response. And because of this advisory, people were absolutely scared to use drugs which down regulate the immune response. However, they made this basis, this decision based on superficial and inadequate review of the literature. And this was a major mistake. We now know that it’s wrong. We know that a study from SARS that looked at 5000 patients with SARS, show that if you gave steroids early, it was not helpful and they made it worse. But if you gave it in the latest stage of SARS, it significantly reduced mortality.

Patrick Holford   9:16
So what are you giving in this later stage?

Dr. Paul Marik 9:19
So what we do is we give a combination of corticosteroids. So corticosteroids are probably the most powerful anti-inflammatory drugs, they switch off inflammation. I think most people know about corticosteroids. Together with corticosteroids, we add vitamin C. So vitamin C has very potent antioxidant and anti-inflammatory properties. And what we’ve shown clinically and in the laboratory, is that vitamin C and corticosteroids act together, they act synergistically to down regulate the inflammatory response.

Patrick Holford   9:57
How much vitamin C do you give?

Dr. Paul Marik 9:59
So we’ve increased the dose slightly from our sepsis protocol because this is a different disease. So with the sepsis protocol, we gave 1.5 grams Q6, we found that with covid we need a higher dose. And this may be because you require a higher dose to get into the lung. So we give 3 grams Q6.

Patrick Holford   10:22
Q6 means every six hours.

Dr. Paul Marik 10:23
Every six hours.

Patrick Holford   10:24
So 12 grams spread out over that 24 hours.

Dr. Paul Marik 10:28
Yeah, so we give this together with corticosteroid. Our standard dose is methylprednisolone 14 milligrams twice a day. In addition, the other third component is we anticoagulate these people. It’s become absolutely clear that the cytokine storm or this inflammatory storm activates clotting, and the clots can be big clots or small clots. And this bears on both patients having major clotting events, but also the small clots interfere with oxygenation in the lung. So we start full anticoagulation at the beginning when we give vitamin C and we give corticosteroids.

Patrick Holford   11:12
Now obviously, the ideal is not to have people coming into this massive immune cytokine storm. So when someone comes into your hospital, what do you give them?

Dr. Paul Marik 11:24
Yes, so that’s a really good question. So, you know, we’re not really sure, you know, you don’t want to give anti inflammatories too early. And then obviously, you transition over to this stage. So, you know, what we do when patients come to the floor is, which is the medical ward, we watch them closely. We give them oral vitamin C, we give them zinc, we give them some anticoagulants, and we watch them closely. And then at the moment that we see they’re deteriorating, and they’re progressing to the pulmonary inflammatory phase, that’s the point we hit them hard with vitamin C, corticosteroids and heparin. So I think the problem is people wait too late. And it’s like, it’s like a fire. The earlier you can extinguish the fire, the better the outcome.  And the longer you wait, the more damage it does to the lung.

Patrick Holford   12:24
Now you give them zinc, but I read in your earlier protocol, that you also gave quercetin and then I was reading that quercetin is a zinc ionophore, it helps to get zinc inside virally infected cells and then helps to kill them. Are you still using quercetin?

Dr. Paul Marik 12:43
Yeah, so you know, people think that, you know, we just sucked out this protocol out of thin air. And, you know, each and every element is based on science and extensive scientific publications. So for example, zinc, it’s been known for a long time that people who zinc deficient, have impaired immunity and higher risk of infection. What is fascinating though with covid, is that zinc ions actually interfere with viral replication, they interfere with the ability of the virus to replicate themselves. So it has an added benefit. The problem is zinc doesn’t get into cells really well, and as you say, quercetin is a zinc ionophore which helps zinc get into the cell.

Patrick Holford   13:30
And how much do you give in a hospitalised patient? Of zinc and quercetin?

Dr. Paul Marik 13:35
Yeah, so it seems based on a meta analysis with influenza, so you know, a lot of this data is based on projections and assumptions. So it’s been shown that if you, in order to prevent influenza and reduce the duration you need between 60 and 100 milligrams of elemental zinc a day. So, that’s the dose we use, which is a little bit higher than the regular doses of zinc. But I think it’s pretty safe if you give it for a reasonably short period of time. It’s pretty safe. In terms of

Patrick Holford   14:12
How much vitamin C and how much quercetin?

Dr. Paul Marik 14:14
Yeah, so in terms of quercetin, unfortunately, it’s, it’s not available in most hospital pharmacies because it’s considered a nutritional supplement. So we recommend that to patients at home who symptomatic, unfortunately, most hospital formularies don’t have it available. We recommend a dose of about 500 milligrams, twice a day. So if patients can get it from, you know, it’s very readily available over the counter at most supermarkets and pharmacies. So we would recommend that. So I think that quercetin, the zinc and the vitamin C has a more important role in preventing progression of disease and in the early phase. Once the patient has actually become severely symptomatic, ie has respiratory symptoms, that’s when we hit them hard with the trifecta of corticosteroids, ascorbic acid and heparin.

Patrick Holford   15:20
And how much vitamin C when they come into your hospital do you give? Because this is oral.

Dr. Paul Marik 15:25
Yeah, so, we give about 500 milligrams twice or three times a day. So the dosage and the route depends on how sick they are. So if patients are, are not that critically ill, they’re absorption is adequate, and you can probably get adequate levels orally. However, the sicker they become the lower the vitamin C levels, and at that point, you require IV vitamin C.

Patrick Holford   15:52
So this is the thing I find fascinating. The adrenal glands have 100 times more vitamin C than anywhere else in the body. And I know that you’ve measured scurvy, literally scurvy, and that is incredibly low vitamin C levels almost undetectable in your sepsis patients. So two questions, really. Have you checked vitamin C level in any COVID patients, and also, if this virus is expending and consuming and using up all this vitamin C, then surely, the cortisones just not going to work. And that means that the person’s fight or flight mechanism designed to keep them alive, is not going to kick in.

Dr. Paul Marik 16:30
Yeah, so you ask two really important questions. So you know what people don’t realise that two important points is that humans, guinea pigs, a few fish and pets are the only species on this planet that actually don’t synthesise vitamin C. And vitamin C actually is not really a nutrient. It’s a stress hormone, so that when sheep, or cats or dogs get stressed, they increase the vitamin C concentration, partly by being secreted by the adrenal gland. So the adrenal gland secretes both cortisol, as well as vitamin C. In addition, the liver increases synthesis of vitamin C. So this is not, this is not made up stuff. This is based on absolute science. And we know this absolutely and categorically that vitamin C in other species is an important stress hormone. So I have a colleague who’s actually measured vitamin C levels in COVID patients, and they are undetectable. Undetectable. The levels are so low in all COVID patients they cannot be detected. So we absolutely know, that patients with COVID, apart from all the other benefits, are absolutely profoundly deficient in vitamin C. So all of them actually meet the diagnostic criteria for so called scurvy. So just on that basis, they shouldn’t be so much controversy about giving vitamin C; these people have a disease induced scurvy.

Patrick Holford   18:09
Are you trying to keep people off ventilators at all costs?  In these first 40 of your COVID patients, how many have you managed to keep off ventilators?

Dr. Paul Marik 18:18
Yes, so we’ve realised, as most people have, that getting them on a ventilator is precarious because the likelihood is they’re not going to get off. So we’ve had about, out of the 40, maybe five or six who actually went on a ventilator. There is a small group of [p?] patients who repeat rate so rapidly, that you need to put them on a ventilator. But those patients we treat, we use very gentle modes of ventilation. And we treated them aggressively with our protocol to down regulate the inflammatory storm. And with that technique, all of them have come off a ventilator. So we haven’t had a single patient who’s become ventilator dependent, which is completely at odds of experience in New York City and in Italy and Spain. I have a colleague who’s gone to volunteer in New York City, and he tells me that patients who’ve been on ventilators for four to five weeks with absolutely no hope these patients will ever get off a ventilator.

Patrick Holford   19:28
And how long is it taking you to get people out of ICU?

Dr. Paul Marik 19:33
So about, the usual is, so there’s no question this is a very pesky disease. So you know, my patients come to our ICU in septic shock. We get them out within three days, and they turn around quickly. There’s no question that this is a different disease, they have overwhelming inflammatory storm. So it takes longer to quell the storm or put out the fire. So I would say generally about five to six days to get them out of the ICU, which seems to be a lot shorter than other people are reporting.

Patrick Holford   20:10
Now the tragedy here in the UK, there’s now a couple of ICU’s who are using vitamin C, I think the dose is too low about a gram every 12 hours. I’m not sure that that’s enough. But the biggest tragedy is that they are being presented with patients who already have multiple organ failure. And they’re effectively putting everybody straight onto a ventilator. And I’ve stressed that they’ve got to start earlier, the minute a patient comes into hospital, that’s when you need to start.

Dr. Paul Marik 20:42
Yeah, so you make some important points. The first is, I think there’s been a lot of misinformation and false information and inadequate information that has been volunteered to, to the general community.  This is in the US and I presume in the UK, that people don’t understand this disease. And if you don’t understand this disease, you’re not going to seek medical attention in a timely fashion. So there’s absolutely no question about it. Once patients, obviously not every patient can be admitted to hospital. Most of these patients have flu like illness and they get better. But those that are at home, once they develop shortness of breath, or difficulty breathing, they must move their butts to the hospital. That’s a very important transition from the viral replicator phase to the cytokine storm phase. And if you wait until the last minute, obviously, the longer you wait, the more damage has been done, the more difficult it is to reverse the course. So it’s absolutely essential that the public understands that once they develop shortness of breath, difficulty breathing, they must come to hospital. And its at that time that the physicians need to treat them aggressively. And we have some dose finding studies and the dose that you’re suggesting is way too low. This is a highly inflammatory disease, and you need to get adequate concentrations into the line. So a dose of one gram Q12 or 12 hourly is just not going to be adequate. We discovered that our sepsis dosing of 1.5 grams every six hours actually had some effect, but wasn’t adequate. That’s why we increased the dose to 3 grams every six hours, which we think is optimal, in combination with steroids. It’s really important to stress that the vitamin C and the corticosteroids work together.

Patrick Holford   22:49
Are there any adverse effects from the vitamin C? Do you need to check people for G6PD deficiency or kidney problems?

Dr. Paul Marik 22:56
Yeah, so that’s a good question. That’s absolutely safe. There’s no question of doubt. We’re unaware of this. We’ve treated here, over 1600 patients with sepsis, and we follow these patients very closely. We’re unaware of a single side effect. The only caveat is that if you use point of care glucose testing, which with a certain glucometer (this is a finger stick which measures glucose level) with one of the manufacturers, it can’t distinguish between glucose and vitamin C. So it can give you a falsely elevated blood glucose level. So that’s the only caution. And that’s only with a particular point of care glucose monitor. Otherwise, we’re absolutely unaware of a single side effect. So it’s completely and utterly safe.

Patrick Holford   23:49
Dr. Paul Marik I’m aware that every minute I keep you on this podcast is a minute that you are not out there helping someone so I’m going to thank you immensely for sharing this little pocket of time which we will get to thousands of people. So everybody listening, please make sure that all your friends and family and any medical colleagues, you know, listen to this. Dr. Paul Marik thank you very, very much.

Dr. Paul Marik 24:14
Sure, Patrick, and stay healthy.

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