Vitamin C and covid-19

The purpose of this article is to help you understand that there is a lot you can do at home to help your body duding a COVID-19 crisis. Sure you might have Type A blood, have a AG genotype for RSID 2070788 and have some other factors you can't control. But there is still a lot you can do to avoid becoming a bad statistic for this pandemic.

The Townsend Letter (online examiner of alternative medicine) has a really great medical discussion of treatments for COVID-19 with a long discussion of the role of Vitamin C. This is about a 30-page article with lots of medical references so I will do my best to hit the high points in a couple of pages. Vitamin C and ascorbic acid are used interchangeably throughout this article. If the ascorbate form is important, it will be pointed out.

• COVID-19 is somewhat unique in that asymptomatic people can be effective transmission agents. This was not true for bird flu, Ebola, avian flu, MERS, H1N1 etc.
• No treatment or prevention has been agreed upon in the epidemiology community except for limiting person to person contact (social distancing).
• Chloroquine and hydroxychloroquine (made popular by some media outlets) have not reached the level of general acceptance. Studies are showing very mixed results. Also these drugs are not without important negative effects. Although France had reported some positive results, it is no longer being used in that country due to increased cardiac and other risks. The list of people who should not take these drugs is long enough to give a thinking person pause.
• The primary killer in this disease is ARDS or acute respiratory distress syndrome. The mortality rate if you develop ARDS is about 30-50%. The primary driver of ARDS is something called cell-free hemoglobin. Basically, the little balloon like alveoli in your lungs become leaky from cell damage and allow fluids to enter making it difficult to exchange oxygen and carbon dioxide. Also inflammation from effects of CFH makes the membrane of the alveoli thicker and less elastic. You notice this as difficulty breathing.
• Hemoglobin bound in red blood cells is doing its job to keep you alive. When red blood cells get damaged from the virus, the hemoglobin leaks out and you get elevated CFH or cell-free hemoglobin.
• One effect of elevated CFH is the scavenging of nitric oxide. CFH can bind to nitric oxide (NO) 1000x faster than hemoglobin in the RBC. This rapid loss of NO leads to hypertension, coagulation and development of systemic inflammation.
• CFH is an unstable ferric form (iron) that can attach to a variety of amino acids and set off a chain reaction of free radical formation that ultimately is highly cytotoxic. These are words you have heard before but now the rate of this effect is unusually rapid and pervasive. The pink sputum from COVID-19 patients is from cell-free hemoglobin.
• The body's normal defense for the CFH is haptoglobin. Haptoglobin can attach to CFH to limit the damage. Haptoglobin needs plentiful antioxidants like ascorbic acid (vitamin C).
• One study in China showed IV vitamin C (10-20 grams per day depending on severity of symptoms) in the hospital with zero deaths and 3-5 fewer days in the hospital than those who didn't get C.
• COVID-19 patients are difficult to oxygenate because of the loss of red blood cells and resulting increase in serum cell-free hemoglobin and the cascade of leaky alveoli and increase in inflammation of alveoli with decreased elasticity.
• The heart and blood vessels also require NO which is bound to the CFH too.
• Iron in the blood is reduced or made less reactive by a transmembrane enzyme cytochrome b561 (Cytb561). Cytb561 is absolutely vitamin C dependent. To emphasize, Cytb561 reduces the negative effects of iron in the blood and requires vitamin C. Low levels of vitamin C means a decrease in Cytb561 activity and more tissue destruction from serum iron from free-cell hemoglobin.
• Critically ill patients of many causes (sepsis, burns, trauma etc. show consistently low levels of plasma ascorbic acid.
• The virus uses specific proteins to modify host membrane permeability (viroporins). The body uses ascorbic acid to support lymphocytes, neutrophils and other regulators of the immune system to stop a serious cascade of events called a cytokine storm.
• At this stage the body needs melatonin or the depletion of vitamin C becomes exponential. This means that without melatonin, vitamin C becomes rapidly depleted. Melatonin works to control the inflammation (inflammasomes).
• If vitamin C levels drop, iron centers in the hemoglobin start to oxidize into the unstable ferric redox state. This form does not bind and transport oxygen. Only iron in the ferrous form in hemoglobin can bind and transport oxygen. Again you notice this as difficulty breathing-all from the mechanisms described above related to vitamin C and now melatonin too.
• Red blood cells (erythrocytes) need vitamin C to maintain hemoglobin in ferrous redox state. Without sufficient vitamin C, heme is subject to oxidation and can easily become cell-free hemoglobin (CFH). Remember that CFH is the key player in ARDS (acute respiratory distress syndrome) seen in infections like COVID-19.
• The mechanism of cell-free hemoglobin causing ARDS was only worked out in 2018 by Kuck et al. Kuck was able to begin reversal of the damage from CFH in 18 hours with the addition of ascorbic acid (vitamin C) dissolved in sterile water. He found that ascorbic acid worked better than ascorbate in his studies.
• Further study found that oral ascorbic acid raised serum levels faster than IV ascorbate levels. Take-away is that oral vitamin C in ascorbic acid form is very effective at raising serum levels but must be taken every hour or two to keep levels up which is important in an acute case.
• For general health we recommend taking a gram or two of vitamin C daily just because. Divided doses will be more effective.

The following is a general guide for taking vitamin C as ascorbic acid for an acute viral infection like COVID-19. Your response might require some modification so this is not a medical prescription but a general guide. Hopefully you have a knowledgeable health care professional you can work with to manage your case.

Initial onset of symptoms: 3 to 5 g in one dose, followed by 1 g every 30 to 60 mins for the following 3 hours. Repeat this cycle until symptoms subside.

Milder cases: 2 to 5 g in one dose, followed by 1 g every hour for the following 4 – 6 hours. Repeat this cycle until symptoms subside.

Severe or critical cases: 10 g in one dose, followed by 2 g every 15 to 30 mins for the following 2 hours. Repeat this cycle until symptoms improve.

Children under age 9 vitamin C application
Initial dose: 200 mg per 10 lb. body weight. For example, 40 lbs body weight-use 800 mg vitamin C

Subsequent doses: 100 mg per 10 lb. body weight. For example, 40 lbs body weight-use 400 mg

Follow the time schedule under mild cases for adults. If symptoms worsen, change to the time schedule for severe cases.

Ages 10-15
Initial dose: 300 mg per 10 lb. body weight. For example, 80 lbs body weight-use 2400 mg or 2.4 g vitamin C

Subsequent doses 200 mg per 10 lb. body weight. For example, 80 lbs. body weight 1600 mg or 1.6 g

Follow the time schedule under mild cases. If symptoms worsen, change to the time schedule for severe cases.

Above 15yrs treat as adult

If a person has stomach upset with the above regimen, try squeezing fresh lemon into the water used to drink down the vitamin C. Apple cider vinegar can also help (1 tbs for each 2-3 oz of water).

Keep an eye on blood pressure as the vitamin C should stop the binding of NO thereby stabilizing blood pressure.

Quercetin can lower ascorbate transport. Quercetin in food shouldn't be an issue but you should probably cut back on quercetin supplementation during treatment of acute symptoms.

To read a more complete version, COVID-19, ARDS & Cell-Free Hemoglobin - The Ascorbic Acid Connection. Doris Loh does a fantastic job of making this complex topic readable. 

Personally I, Dr. Dan, use Ecological Formulas Vitamin C -1000 from non corn sources. Every company has what they believe to be the most effective version but if you look at the response graphs in the above referenced articles, you will see that plain old ascorbic acid is still king in many respects.