The 8th Day Protocol

Saving Lives. Globally.

This one-pager summarises the therapy adopted by Dr Shankara Chetty, from South Africa, to help prevent COVID-19 from progressing towards severe disease. 

Overview

This one-pager summarises the therapy adopted by Dr Shankara Chetty, to help prevent COVID-19 from progressing towards severe disease. Focusing on the 8th day onwards of COVID-19, i.e. the inflammatory phase. It does not cover the initial viral phase, for which early treatment protocols already exist and can be prescribed. 

NOTE: This protocol is for information only, not for therapeutic advice. If you catch COVID-19, please seek immediate medical help.

8th Day Protocol

The 8th Day Therapy aims at mitigating a possible hypersensitivity reaction, that can trigger an inappropriate immune response, including a possible subsequent cytokine storm.

This transition from the initial viral phase typically occurs on Day 8 after the first symptoms. It’s essential for the treating physician to establish as precisely as possible the first day of symptoms, to alert the patient of the date when a possible sudden aggravation of symptoms may occur.

Shortness of breath is typically associated with this aggravation. The 8th Day Therapy encompasses 4 distinct interventions. These 4 interventions sometimes follow a previously prescribed early treatment protocol. Possible drug interactions need to be carefully assessed.

Intervention #1

Corticosteroids

Corticosteroids: To stop the hypersensitivity reaction, to stop the release of mediators and to prevent an inappropriate immune response, including a possible subsequent cytokine storm.

  • Prednisone 80mg dly x 1 week.
  • Note: Increase dose rapidly to get symptomatic relief quickly.
  • CRP and IL6 values must show quick decline. Dose will vary according to variants and severity of reaction.
  • Can go as high as 100mg tds for first few days. Wean off cautiously when CRP and IL6 are normal or patient is well for a few days.
  • Those with prolonged reactions are difficult to wean, so consider adding Azathioprine 50mg dly to decrease steroid requirements
  •  

Intervention #2

Anti-histamines

Anti-histamines:To clear the histamines that have been released.

H1

  • Promethazine 25mg tds x 5 days OR Levocetirizine 5mg bd x 1 month to follow

 

Promethazine H2

 

  • Cimetidine 400mg x 1 month or another H2 blocker.
  • Other anti-histamine drugs can be suitable Intervention 

Intervention #3

Anti-leukotrienes

Anti-leukotrienes clear the leukotrienes that have been released.

Montelukast 10mg bd x 5 days then dly x 1 month 

Intervention #4

Blood Thinners 

Blood Thinners clear platelet activating factors 

Aspirin 325 mg dly x 1 month.

Add Xarelto 15 mg bd if D.Dimer is raised; decrease to 15 mg dly x 1 month once D.Dimer is normal

Optional Interventions

  • Add appropriate antibiotics for those with fever Bacterial co-infection or raised Procalcitonin levels – Add Venteze syrup PRN for those suffering from asthma.

 

  • Add Ivermectin 12 mg dly x 5 days in those with cough, dyspnea or decreased oxygen saturation

 

  • Fluvoxamine may be a suitable drug, yet Dr Chetty has so far no experience with it

dr. Shankara Chetty

General Practitioner