Disclaimer: I am not a doctor and this is not medical advice. If you require medical treatment, call your doctor and/or go to the hospital.

COVID-19 is still paralyzing much of the nation and the world and will continue to do so, probably for months to come. Communities, states, and entire nations are in lockdown. Even areas that are less affected are still being forced to navigate the fallout affecting businesses and supply chains.

Many are able to stay home, but a great many of us are essential workers: doctors and nurses, first responders, grocery workers, business owners, and volunteers who are especially at risk. Even when we are able to stay home, we must still engage with others to procure supplies and live as normal a life as possible.

With that in mind, this list has been compiled from doctors and others in the medical community that we trust to help keep you safe and increase your chances not only to survive, but to thrive long after this pandemic has subsided.

First, a bit of background. The three biggest risk factors leading to hospitalization for COVID-19 are old age, obesity, and chronic inflammation. Obesity in particular doubles the chances of hospitalization for patients under 60.

Among those that do get hospitalized, the worst outcomes and the deaths from COVID-19 related pneumonia seem to stem from an inadequate innate immune response early in the disease. This creates an exaggerated immune response later in the disease, resulting in the most severe cases and negative outcomes.

Given that background, much of the proposed prevention and early treatment guidelines here are designed to decrease obesity and chronic inflammation, stimulate the innate immune response, and regulate the potentially exaggerated immune response later if you do get sick.

Prevention

Hydrate. Staying hydrated is essential not only for your day-to-day health, but to keep your immune system functioning as well as possible. This is particularly relevant for respiratory infections to keep secretions as liquid as possible and not allowing thick mucus to fill your lungs.
Eat Well. Following the Gentleman Spy diet (paleo, Bulletproof, etc.) will minimize chronic inflammation while fueling your body for top performance. Minimize inflammatory foods like grains, sugar, alcohol, and dairy. Focus on lots of different vegetables, good fats, and high quality meats. Don’t go hungry. If you do get sick, your body needs to be fueled for the fight.
If you can’t eat well, supplementing with green smoothies is a good way to increase your nutrient intake. Spinach, kale, chard, mizuna, watercress are good options (get the mix that includes a few of them). Add in frozen fruits (berries are best) to taste. Enough water to blend well. Feel free to play with other additions like protein powder, coconut milk, egg yolk (not whites), turmeric, ginger, etc.
Don’t skimp on getting your diet dialed in because you think it’ll take too long to see results. Patients with type-2 diabetes, pre-diabetes, insulin-sensitivity who go on low-carb diets see results in days to weeks. If you’re not already eating well, get on it ASAP.
Exercise. Exercise is a necessary component of staying in top shape and warding off disease. If you have a home gym feel free to keep pushing hard. If not, focus on bodyweight exercises that are easy to do at home. Go for walks or easy runs outside.
Get outside. Whether it’s going for a walk, running, hiking, swimming, or just laying out getting some sun on your porch, getting outside and getting as much sun as possible will help in myriad ways, not least of which includes optimizing your vitamin D levels after the winter.
Supplement as necessary. Most Americans are vitamin D deficient and an early study showed ~80% of COVID cases showed vitamin D deficiency, while a 2021 study showed that vitamin D levels above 40ng/ml were associated with a significantly decreased risk of contracting Covid among black people (but not white people). If you can’t get lots of sun, supplement up to 5000 IU daily with vitamin D3.
Vitamin C and zinc probably aren’t necessary during normal times, but supplement with up to 2000mg vitamin C + 50mg zinc, twice a day, for a week if you do start to feel sick.
Turmeric, ginseng, garlic, and ginger all show anti-inflammatory properties. These have been used as immune boosters across the world for centuries. These are easily incorporated as supplements or dietary additions (turmeric ginger tea, add turmeric to Bulletproof coffee, etc.).
Take hot/cold showers or baths. I recommend and have used the “James Bond Shower” since it was introduced to me by a former Spetsnaz instructor in Germany a decade ago. Shower with very hot water, then finish with as cold water as you can stand for the last few minutes. This is good for your circulation, skin, hair, and to build mental toughness. Other approaches include alternating hot and cold baths, the Finnish sauna, ice baths, etc.
Specifically for this pandemic, heat and cold exposure creates a short duration artificially induced fever that stimulates innate immune system response. Not just good not just for overall health and longevity, this appears particularly relevant due to the worst COVID-19 results stemming from depressed immune system response in the early phases of infection. Hot and cold therapies are being tested as COVID-19 treatments right now.
Take care of your overall hygiene. Shower/bathe daily. Wash your hands before/after every social interaction and outing. Brush your teeth. Wear a protective mask if you have or can make one. Disinfect whatever supplies you bring in from outside. Wear clean clothes daily and wash any exposed clothing.
Breathing exercises. Yoga, Systema breathing, and the Wim Hoff method are all recommended. To take your exercise to the next level, invest in an incentive spirometer and use it daily. This will keep your lungs in top shape, especially if you’re off your feet for a while.
Get vaccinated: Vaccination is a generally safe and effective method of reducing your risk of infection and likeliness to spread COVID-19. There are five major vaccines which use differing technologies and dosage schedules:
1. Janssen/Johnson & Johnson – carrier vaccine; single shot; emergency approval in USA and EU
2. Oxford-AstraZeneca – carrier vaccine; 2 shots 4-12 weeks apart; approved in UK, EU; not approved for use in USA.
3. Novavax – protein adjuvant; 2 shots 3 weeks apart; emergency use approval in USA.
4. Pfizer-BioNTech – mRNA; 2 shots 21 days apart; full FDA approval in USA, emergency use approval in EU and elsewhere.
5. Moderna – mRNA; 2 shots 28 days apart; emergency use approval in USA, EU (full approval in Switzerland).
  - NOTES: Risk profiles of the vaccines vary greatly:
    - Janssen/J&J: slightly increased risk of Guillain-Barré Syndrome (GBS) for men over 50 and slightly increased risk of thrombosis with thrombocytopenia syndrome (TTS; blood clots) in women aged 30-49 (~4 cases per 1 million vaccines).
    - Both Pfizer and Moderna mRNA vaccines increase the risk of myocarditis and pericarditis, especially in younger men (~50-105 cases per 1 million vaccine doses in men aged 12-24).

Treatment

These recommendations do not constitute medical advice and ARE NOT NECESSARILY SUPPORTED BY EXISTING MEDICAL STUDIES.

I’m breaking the treatment section into two sections, a general “I’m feeling sick but don’t need to go to the hospital” section, and the “I know I have COVID-19 and am seeking treatment” section. Read both, as they build on each other.

I’m feeling sick, but don’t need to go to the hospital

BLUF (Bottom Line Up Front): If you are feeling sick and/or have tested positive for COVID-19 but do not need to be hospitalized, supplement with D3 + C + Zinc at the minimum. Add 30mg/day of melatonin and famotidine (Pepcid) as desired. Treat cough, sinus, and respiratory discomfort as desired.

D3 + C + Zinc: If you haven’t already, begin supplementing with up to 5000 IU of D3, 2000mg of vitamin C, and 50mg of zinc, twice a day, for a week.
Melatonin: While most people know melatonin as a sleep-aid, it has powerful anti-oxidant and anti-inflammatory therapeutic effects against multiple viruses and respiratory syndromes. Most people take 3mg for sleep. If you’re sick, take up to 30mg/day.
Antihistamines. Blocking the histamine reaction may help protect against the worst effects of the disease when the exaggerated immune response is in full effect. Benadryl and Pepcid are H1 and H2 blockers, respectively. They’re cheap and widely available, so if you start to see onset of COVID-19 symptoms, it might be worth taking a normal dose of each for the next week or two. If you’re only going to take one, famotidine (Pepcid) has been used successfully in several high-profile COVID treatments.
Do not take ibuprofen, naproxen, aspirin (Advil, Motrin, Aleve, etc.). Non-steroidal anti-inflammatory drugs (NSAIDs) may to lead to poorer outcomes with COVID-19. Tylenol is preferred if you need to control pain and fever and you’re not sure yet whether you have COVID-19. If you know for sure your illness isn’t related to COVID-19, you can use whatever painkiller you prefer.
- NOTE: Evidence of NSAIDs contributing to poorer outcomes is limited at best. If you already rely on NSAIDs for existing issues, do not discontinue their use without consulting your doctor.
Medications: Zicam lozenges, Vic’s vaporub, and a cough suppressant like dextromethorphan (Delsym 12-hour) have been recommended by folks who have gotten through low-grade COVID-19 infections.
Sinus relief: My recommendation is to follow Dave Asprey’s Bulletproof Sinus Rinse. It takes some getting used to, but works wonders. Whether it’s a head cold or allergies, the Bulletproof sinus rinse will help immensely. If you can’t bring yourself to do it, a Neti Pot or other sinus sprays may provide relief.
Respiratory relief: If you are sick or do get sick, a vaporizer (old school version that heats up, not cool mist) and vaposteam or nebulizer + saline ampules and albuterol (prescription) may be helpful/necessary. NOTE: This may contribute to a greater risk of infection to those around you. Use carefully.
A fingertip pulse oximeter can also be useful (there’s a reason it’s always been part of the Gentleman Spy extended first aid kit). Anything below 92%, especially coupled with shortness of breath or harder work of breathing mean you’re getting sicker and should see the doctor or be at the hospital.

I know I have COVID-19 and am seeking specific treatment.

BLUF (Bottom Line Up Front): If you are feeling sick and have tested positive for COVID-19, supplement with D3 + C + Zinc, 30mg/day of melatonin, and famotidine (Pepcid).
Monoclonal antibodies are the current first-line treatment for COVID not requiring hospitalization.
COVID-specific anti-viral drugs Paxlovid (Pfizer) or Molnupiravir (Merck) were both granted emergency use authorizations in December 2021.
Fluvoxamine, 100mg, twice daily, for 10 days.
Talk to your doctor about ivermectin and/or corticosteroids. Take them if you can.**

If you are sick, go to the doctor or the hospital. If you have significant trouble breathing, are coughing blood, have persistent pain or pressure in your chest, new confusion or inability to arouse, or bluish lips or face, seek immediate medical help.
Monoclonal Antibodies (mAb): Authorized since May of 2021 and recommended for prioritization in September 2021, monoclonal antibodies are recommended for treatment of and prophylaxis after known exposure to COVID-19. If you have COVID but are not hospitalized or require oxygen or ventilation, monoclonal antibodies should be the first step in treatment.
Paxlovid or Molnupiravir: Both granted emergency use authorizations in December of 2021, Paxlovid (Pfizer) and Molnupiravir (Merck) are new anti-virals developed specifically in response to COVID. Monoclonal Antibodies, and either Paxlovid or Molnupiravir have been shown to reduce hospitalization and death by anywhere from 50-90%.
Fluvoxamine: An 40-year-old SSRI antidepressant, Fluvoxamine has been repurposed to treat COVID and shown in clinical trials to reduce hospitalizations by 66% and death by 91%.
**Ivermectin: Ivermectin is an anti-parasitic drug currently undergoing studies and clinical trials as an anti-viral and as a treatment for COVID-19. Existing studies have been inconclusive, with insufficient data either for or against it. Some clinical studies showed no benefits or worsening of disease after ivermectin use, whereas others reported shorter time to resolution of disease manifestations that were attributed to COVID-19, greater reduction in inflammatory marker levels, shorter time to viral clearance, or lower mortality rates in patients who received ivermectin than in patients who received comparator drugs or placebo (reference here). Given that Ivermectin may be helpful and is not contraindicated, if your doctor can prescribe it, go ahead.
- DO NOT CONFUSE THIS WITH VETERINARY IVERMECTIN! Just like the idiocy surrounding hydroxychloroquine in 2020, if you do not have a doctor’s prescription for Ivermectin, do not attempt to source your own via other avenues!
**Corticosteroids: Corticosteroids (dexamethasone, or either hydrocortisone or prednisolone when dexamethasone cannot be used or is unavailable) are recommended as COVID-19 treatment when the patient is hospitalized and on supplemental oxygen. That said, they are well tolerated by most, routinely used for other ailments, and not contraindicated by current medical studies. If you have COVID-19 and your doctor can prescribe a corticosteriod, go ahead.

**These recommendations do not necessarily reflect current recommendations or best practices.

If you are hospitalized and/or need supplemental oxygen, you will likely also be prescribed Remdesivir and/or dexamethasone, possibly with baricitinib or tocilizumab depending on severity. These drugs are not recommended until/unless you are hospitalized and require supplemental oxygen. That level of care is far beyond the scope of this guide.

I hope you and your family are healthy and weathering this storm as well as you can.

Remember, this too will pass. If you’re using your resources productively, you should come out of this better and stronger than ever.

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