Kimberly Milhoan, MD

The news came one Sunday at church. “My brother on the East Coast tested positive for COVID.” 

I said, “Send him our prophylaxis protocol. Keep us abreast of his symptoms. If he gets sicker, call us.” 

This conversation has repeated more times than I can count over the past year. My husband and I are both physicians. Following the success of numerous outpatient physicians across the country, we have recommended to everyone we know and love who have been concerned or at risk for COVID-19 infection to be on a prophylaxis protocol of over-the-counter medicines and supplements.

If they have gotten sick, we have made sure they have access to a combination of prescription medications. We have treated dozens of people both locally and all over the country. No one we’ve tried to help has been hospitalized or died. Until my friend’s brother. 

When he began to be sick at home, even after being vaccinated, my friend’s brother did use some over-the-counter supplements, but he didn’t receive a prescription home treatment protocol. He didn’t know us (we are friends of his sister) and I’m sure didn’t want to inconvenience strangers. He had heard about the treatment protocols and assumed the hospital doctors would know.

As his symptoms worsened, he went to the hospital. I presume he thought that would be the best way to escalate treatment to prescription medicines. I don’t know whether he anticipated getting admitted. I do know that for two weeks, as he steadily got worse, his family advocated for him, eventually hiring a lawyer before a different treatment regimen was tried. At one point, he did seem to be improving, but by then it was too late. He took a turn for the worse and ultimately died.

Then my friend died. She was a busy physician herself, working internationally. 

She believed she caught COVID from a symptomatic reporter who was covering her work. Numerous people were infected, got sick, and recovered. Except her. She must have been sick for a while when another physician friend in a different city spoke with her by phone and could assess her level of illness by her inability to finish sentences. 

We sent treatment protocols as well as evidence supporting them. We arranged for medicines to be sent to her. She didn’t take the medicines. We’ll never know why. Three friends drove hours to get to her, only to find her on death’s door in her apartment. She still refused some of the medicine. She fought us for days, refusing to take them. I saw the CT scan of her lungs when she got to the hospital. I’m not sure, at that point, if anything outside of the miracle we prayed for would have helped.

Dr. Peter McCullough, an internist, cardiologist, epidemiologist, and professor from Texas A&M College of Medicine, has taken the lead on addressing early outpatient treatment for COVID-19. He explains four pillars of response to COVID-19: 

1.     Containment of the spread of infection

2.     Early home treatment (the missing pillar)

3.     Hospitalization

4.     Vaccination

The first emphasis in the U.S. was on reduction of the spread of COVID-19 in an attempt to reduce hospitalizations and death. Hospital mortality has declined over the past year but remains very high.

Dr. McCullough advocates for widespread implementation of effective outpatient treatment for high-risk patients that can be given during the two weeks or so most patients are symptomatic before they eventually become too sick and have to go to the hospital.

In May 2020, based on the available scientific literature and early clinical experience, Dr. McCullough and over 20 U.S. and international physicians and scientists defined the pathophysiologic rationale for early outpatient treatment.

The approach, first published in August 2020 in the American Journal of Medicine, addresses the three main disease processes in COVID-19:  viral replication, cytokine storm, and thrombosis.

In December 2020, with 56 physician and scientist coauthors who have themselves treated many thousands (more likely tens of thousands but they’re too busy to stop and count), Dr. McCullough and his colleagues published the treatment protocol referred to as “sequential multidrug therapy” that has been successful with their own patients and in published studies. He also added a potential fifth pillar: prophylaxis.

In March 2021, Brian C. Procter MD and five coauthors published an observational study of 320 high-risk patients he treated in McKinney, Texas using the multidrug approach: 

“… our early ambulatory treatment regimen was associated with estimated 87.6% and 74.9% reductions in hospitalizations and deaths respectively.”

In April 2021, a team of researchers at the University of Oxford published a randomized controlled trial demonstrating a 91% reduction in urgent care visits, including emergency room evaluations and hospital admissions, when COVID-19 patients received inhaled budesonide compared to usual care.

Budesonide, which doctors prescribe routinely for asthma and other pulmonary inflammatory conditions, is one of the treatments Dr. McCullough and his colleagues include in their multidrug approach. In the Oxford budesonide study, outpatient treatment was begun, on average, three days after the first onset of symptoms.

On the basis of such evidence and reports from their colleagues, more doctors are starting to provide outpatient treatment for early COVID. But most doctors still do not.

The early home care pillar of COVID response is still missing for the vast majority of patients, dooming large numbers of people to unnecessarily severe illness, serious complications, hospitalization, and death.

In an effort to make early home treatment widely available, there is a movement toward COVID-expert doctors providing care through telemedicine. At the time of this writing, the American Association of Physicians and Surgeons lists four national telemedicine outlets, 15 regional telemedicine outlets and more than 250 physicians who provide expert outpatient, early treatment for COVID patients, including prescriptions for the needed medications, which can be called directly to patients’ local pharmacies in many cases.

The list is available on the AAPS website: