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HOW TO END THE COVID-19 PANDEMIC WITHOUT WAITING FOR A VACCINE
BE IN CHARGE OF YOUR FIGHT AGAINST THE DISEASE

Samir Samuel Missak, MD

Diplomate of the American Board of Internal Medicine

DEDICATION

To my brothers and sisters in humanity

PREFACE
Dear brother and sister,

In March 2020, the World Health Organization ( WHO ) declared a state of pandemic due to the spread of Covid-19 ( a viral illness that has a mere 0.3% mortality rate which does not warrant a pandemic declaration). Public health officials in the developed world announced that only a vaccine can eradicate the virus. The virus turned out to be a formidable foe; its prolific ability to mutate upended the plan of its eradication through vaccines. On November 25, 2021 the WHO called for an emergency meeting because of the emergence of the Omicron variant ( first reported in South Africa ) ; this variant had 32 mutations in the Spike protein. Researchers at Columbia University ( USA ) determined that the Omicron variant was markedly resistant to the currently deployed vaccines. Then in December 2021 and January 2022, the sobering real-world data came: full vaccination plus a third and fourth boosters are not adequate to protect against Omicron. In January 2022, the CEO of Pfizer announced that Pfizer is developing a vaccine specific for the Omicron variant that will be ready in March 2022. The Omicron variant will not oblige and hibernate from November 2021 till March 2022. It will continue to sweep the world and by March 2022 the Omicron wave will be over, and during this interval the virus will mutate again and render the Omicron shot useless? And then the vaccine makers will develop an updated vaccine for the new variant and the wild-goose chase never ends. A turtle ( the vaccine makers) cannot overtake a leopard ( the virus). Vaccine advocates have condemned humanity to endless cycles of vaccine shots and boosters , coupled with suffocating social restrictions with no end in sight ; they have lost control over the situation and they cannot specify when does the pandemic end because they cannot stop the virus from mutating ; the virus is always several steps ahead of them. Is there a way out of this hellish situation?

If you yearn for regaining your pre-pandemic freedoms and relaxed carefree life, and not wear a mask for the rest of your life, and if you want to learn an alternative plan to the vaccine-centric plan , then this book is for you. This alternative plan has 2 pillars : control of risk factors that predispose to severe Covid19 plus early outpatient treatment. This plan can obliterate the pandemic in a few months .

This book also explains why vaccines cannot restore to us our pre-pandemic freedoms and cannot achieve herd immunity ; also it explains why vaccine mandates are unconstitutional ( see chapter 12 for details).

Covid -19 is a mild illness in the majority of patients. In a small subset of patients, it can be severe or lethal. This happens in individuals who have certain vulnerabilities or risk factors. This book will show you those risk factors and how to correct them. Once you identify your risk factor(s) if any and correct them, you can downgrade Covid-19 from a lethal disease to a non-lethal one [ there is a lot that you can do to help yourself]. Vitamin D deficiency is a risk factor for severe Covid-19. Researchers found that bringing the vitamin D level in the blood to 50 ng/ml [ ng means nanogram] can cut Covid-19 mortality to zero which is great news [ see chapter 1 for details]. According to CDC data, 78% of Covid- 19 hospitalizations happen in obese people. If obese people lose weight, hospitalizations due to Covid19 will be slashed by 78%. Easy and feasible steps can render Covid-19 a non-lethal disease and end the pandemic .

On the treatment front, I have great news to share with you. Covid-19 is now a treatable and a curable disease. Dr. Thomas Borody ( a world- famous infectious diseases specialist) has developed a treatment protocol that consists of Ivermectin, Doxycycline and Zinc; the protocol is 100% effective ,safe and with minimal side effects ; the medicines that he uses are readily available, cheap and repurposed for the treatment of Covid-19. In the USA, Dr. Peter McCullough, a distinguished internist, cardiologist and epidemiologist at Baylor heart and vascular institute in Dallas, Texas, has published in a peer-reviewed journal an excellent treatment protocol for the early and outpatient treatment of Covid-19 [ see chapter 11 for details].

So cheer up and do not feel like a helpless sitting duck waiting for the Grim Reaper to harvest your soul. Your own personal effort can make all the difference. A good dose of rugged individualism will serve you well during this pandemic.

I am a naturalized US citizen and I am Board certified in Internal Medicine. I believe that a doctor has the moral obligation to say the truth without any personal agenda in mind. In this book, I shall give you the facts (supported by references) . I strongly encourage you to verify the veracity of the information provided and double check it with your own doctor and then forge ahead with your plan ( with the help of your doctor) . In a nutshell : BE IN CHARGE.

PS I do not own any stocks and I do not have any financial interests in any pharmaceutical company .

Disclaimer: This book is intended as an educational tool and does not establish a doctor/patient relationship. You must continue to seek medical advice and treatment from your doctor.

Table of Contents

Chapter 1: Vitamin D your reliable shield in the war 01
Chapter 2: Uncontrolled hypertension as a risk factor for severe Covid-19 07
Chapter 3: Obesity and diabetes as risk factors for severe Covid-19 08
Chapter 4: The self-inflicted wounds of unemployment, stress and high cortisol levels 10
Chapter 5: Addiction is a foe 14
Chapter 6: The pot of simmering water 16
Chapter 7: Nurture a healthy gut microbiome and recruit an ally 17
Chapter 8: Laboratory tests 18
Chapter 9: Modes of transmission 21
Chapter 10: Long-haulers 24
Chapter 11: Cheer up! Help has arrived 25
Chapter 12: How to end the Covid-19 pandemic without waiting for a vaccine 33
Chapter 13: My two cents worth of research ideas 67

Chapter 01: Vitamin D your reliable shield in the war

Vitamin D is a hormone that is produced by the skin when it is exposed to the ultraviolet B rays of the sun. Vitamin D promotes the absorption of calcium in the intestines. An inadequate amount of vitamin D in the body can result in soft and weak bones [ a condition called rickets in children or osteomalacia in adults]. Also when vitamin D is inadequate, the serum calcium level drops and this triggers the parathyroid glands [glands adjacent to the thyroid gland in the neck] to increase the production of the parathyroid hormone ; this hormone “borrows” calcium from the skeleton to stabilize the level of calcium in the serum; unfortunately this comes at the expense of the bones which become brittle , a condition called osteoporosis.

The function of vitamin D is not limited to maintaining healthy bones and teeth. Vitamin D is a hormone that has many vital functions. It plays a crucial role in the proper function of the immune system and protects the body against high blood pressure, diabetes , infections, immune disorders ( e.g. rheumatoid arthritis, asthma, allergies), multiple sclerosis and cancers of the colon, prostate and breast.

Symptoms of vitamin D deficiency include : fatigue, depression, bone pain, muscle weakness and aches. [ source : “ Vitamin D deficiency” ; my.clevelandclinic.org ; October 16, 2019 ].

Vitamin D deficiency .

According to the US National Center for Health Statistics, an estimated 70% of individuals in the US may be considered vitamin D deficient. A study in the pediatric population showed that 7 of 10 US children have very low levels of vitamin D . [ source : “ The important role of vitamin D” by Yvette C. Terrie, RPh; www.pharmacytimes.com ; February 15, 2010]. Vitamin D deficiency is a worldwide problem. The Covid-19 pandemic hit a worldwide population that is vitamin D deficient and thus vulnerable to respiratory viruses. The widespread vitamin D deficiency in the USA is not a surprise. Most of us live and work indoors without much exposure to the sun. Excluding foods that are fortified with vitamin D, vitamin D is naturally present in a limited number of foods e.g. cod liver oil, salmon, tuna, sardines, beef liver and egg yolk. With the exception of cod liver oil and salmon, vitamin D is present in small amounts that will not provide the daily requirements of the vitamin when those foods are consumed in average servings. [ for details on the vitamin D content of a given food, please consult the above mentioned reference of “ Vitamin D deficiency” from the Cleveland Clinic].

It is important to note that vitamin D deficiency is more common in Blacks and in the elderly population. A black person has a pigment in the skin called melanin that blocks the sun rays and consequently interferes with the production of vitamin D. The melanin content of the skin varies according to the ethnic group of the individual but it is most pronounced in Blacks. An elderly person (above the age of 50) regardless of the ethnicity, is more prone to be vitamin D deficient because the ability of the skin to produce vitamin D becomes more sluggish as the age advances.

Your vitamin D status can be determined by a simple blood draw that your doctor can order. Oral vitamin D supplements are cheap and available over the counter ( without prescription). Some preparations state the vitamin D content in IU [ International Units] or in microgram. For your information : 1000 IU of vitamin D3 are equivalent to 25 micrograms [ 2000 IU of vitamin D3 are equivalent to 50 micrograms].

A helpful tip : Vitamin D is a fat-soluble vitamin. If you have to take oral vitamin D supplements, take them with a meal that contains some fat e.g. butter, egg yolk, meat, cheese, fatty fish ( salmon, sardines), vegetable oil ( canola oil, olive oil…etc), nuts. If you take your oral vitamin D supplement on an empty stomach or with a fat free meal or snack ( e.g. a banana with some orange juice), your vitamin D supplement will be poorly absorbed into the blood and it will be wasted and you will notice that you cannot correct your vitamin D deficiency when your doctor schedules your follow- up blood test.

A word of caution : Sunscreens block the sun rays and interfere with the ability of the skin to make vitamin D. Exposure of the skin to the sun without sunscreens increases your odds of developing skin cancer. It is safer to take vitamin D in the form of foods and oral supplements.

Now it is time for some medical jargon.

How does the Covid-19 virus infect the human cell ?

Your house key allows you access to your house when you insert the key in the keyhole that is on the door knob. The keyhole functions as a receptor for the key.

SARS-CoV-2, the coronavirus that causes Covid-19 , has outer spikes made of a protein called protein S. That spike protein binds to the ACE2 receptor [ Angiotensin Converting Enzyme 2] present on human cells. The ACE2 receptor is a protein ( and an enzyme) present on the cell membrane of cells in different human organs and tissues like the lungs, arteries, heart, kidneys, intestines and brain. Using the analogy of the key and keyhole, the outer spike of the virus is the key and the ACE2 receptor is the keyhole. The spike protein of the virus binds to the human ACE2 receptor on the cell membrane and allows it to gain access to the inside of the cell. It is important to note that the presence of the ACE2 receptor is not restricted to the respiratory tract only but it is present in many organs , which means that Covid-19 can be a systemic illness that can be expressed as respiratory symptoms (e.g. cough, shortness of breath) as well as other symptoms ( e.g. vomiting, diarrhea, loss of the sense of smell and taste…etc).

What are the cytokines ?

The armed forces of a given nation have different branches e.g. ground forces, naval forces, air forces. Likewise our immune system is made up of different branches ( each branch has specific functions and roles) that work in concert. Cytokines are the messengers ( made of proteins) that allow the different branches to communicate with each other[as in war, the ground forces can call the air forces for help].

Our immune system includes : neutrophils ( cells that rapidly ingest microorganisms and kill them), lymphocytes which include B lymphocytes ( cells that differentiate into plasma cells which produce antibodies or immunoglobulins), T lymphocytes and NK cells ( Natural Killer cells), monocytes ( or macrophages) which are large cells that engulf microbes , and some other cells. [ source : “The immune system and primary immunodeficiency” ; primaryimmune.org ].

Cytokines are proteins that are produced by different cells of the immune system. They regulate the immune and the inflammatory response of the immune system. If they are produced by the lymphocytes , they are called lymphokines ( many of which are called interleukins). If they are produced by the monocytes ( macrophages) , they are called monokines. Interleukin-1 and Interleukin-6 are mediators ( producers) of inflammation. [ source : “ What are cytokines” ; www.sinobiological.com ].

Pro-inflammatory cytokines like Interleukin-1 and Interleukin-6 can trigger a cascade of reactions that leads to the formation of blood clots inside blood vessels [ source : “ Covid-19 : How blood clots are involved – and how they could be deadly “ ; science.thewire.in ; June 1, 2020 ].

What is the cytokine storm that develops in Covid-19 ?

When SARS-CoV-2 is inhaled and reaches the lung tissue, it uses its outer spike to bind to the ACE2 receptor that is found on the cells of the alveoli of the lungs. The alveoli are the tiny air sacs of the lungs where the gas exchange between the air and the blood in the capillaries occurs. Once the alveoli are invaded and infected by the virus, the immune system goes in “ attack mode”. Cytokines are produced by different immune cells. In some patients, the response of the immune system is very vigorous and produces excessive amounts of cytokines , hence the term cytokine storm. The cytokine storm can be very dangerous and even lethal. As stated above, some cytokines are mediators of inflammation. The intense inflammation that is generated, leads to the flooding of the alveoli with fluid, making the oxygenation of the blood in the capillaries inefficient. The oxygen saturation of the blood plummets and the patient becomes very short of breath. The filling of the lungs with fluid makes the lung stiff and when the process is severe and diffuse , we call this situation “ Acute Respiratory Distress Syndrome” or ARDS ; at that stage, the patient usually requires mechanical ventilation (i.e. connected to a ventilator); the prognosis of such a situation is usually poor and can end with a fatal outcome. In addition to the flooding of the alveoli with fluid, the pro-inflammatory cytokines can trigger blood clots inside the blood vessels ; if the clots develop in the coronary arteries , the result is a heart attack ; if in the arteries of the brain, the result is a stroke; if in the arteries of the lungs ( pulmonary arteries), the oxygen saturation of the blood plummets further ; if in the arteries of a limb, the result is a gangrene, and an amputation of a limb becomes necessary. Covid-19 can be deadly because of ARDS or because of a blood clotting complication or both.

Several recent articles have established a very strong correlation between vitamin D deficiency and Covid-19 mortality. [ source :‘’ Vitamin D levels appear to play role in Covid-19 mortality rates. Patients with severe deficiency are twice as likely to experience major complications” ; www.sciencedaily.com ; May 7, 2020 ]. In this article, Professor Vadim Backman at Northwestern University found a strong correlation between vitamin D level and the cytokine storm. He stated that vitamin D prevents our immune system from becoming dangerously overactive. This means that having healthy levels of vitamin D could protect patients against severe complications, including death from Covid-19. His analysis shows that a healthy level of vitamin D will not prevent a patient from contracting the virus but it may reduce complications and prevent death. He concludes that vitamin D deficiency is harmful and can be easily addressed with supplementation. He also notes that the severity of Covid-19 in Blacks and the elderly correlates with the fact that Blacks and the elderly are more prone to be vitamin D deficient

In another article[ “ Does vitamin D status impact mortality from SARS-CoV-2 infection ?” by Paul E Marik, Pierre Kory, Joseph Varon ; www.ncbi.nlm.nih.gov ; April 29, 2020 ], the researchers found correlation between vitamin D deficiency and Covid-19 mortality. In the article, the researchers state that vitamin D dampens excessive inflammation; vitamin D deficiency is a risk factor and a driver of the exaggerated and persistent inflammation that is a hallmark of acute respiratory distress syndrome ( ARDS ); vitamin D deficiency has been associated with an increased risk of respiratory infections such as influenza and tuberculosis ; vitamin D deficiency enhances the cytokine storm that may be particularly lethal in patients with SARS-CoV-2 infection.

Researchers at the University of Chicago studied a cohort of 499 patients who had a vitamin D level measured a year before being tested for Covid-19. They found that patients who had vitamin D deficiency were twice as likely to test positive for Covid-19 compared to patients who had sufficient levels of vitamin D. [ source : “ Vitamin D deficiency may raise risk of getting Covid-19” ; www.uchicagomedicine.org ; June 10, 20] .

A recent Indonesian retrospective study of 780 Covid-19 patients indicated that the majority of death cases had below-normal vitamin D levels [ source : “ Vitamin D affects Covid-19 mortality”; www.pharmaceutical-technology.com ; June 11, 2020 ].

German researchers reviewed multiple studies on the relation of Vitamin D3 blood level and Covid-19 mortality and came to the conclusion that a level of vitamin D3 in the blood of 50 ng/ml can bring Covid-19 mortality to zero [ source : “ Covid-19 mortality risk correlates inversely with vitamin D3 status, and a mortality rate close to zero could theoretically be achieved at 50 ng/ml 25(OH) D3; results of a systematic review and meta analysis” by Lorenz Borsche, Bernd Glauner, Julian von Mendel published in the journal “ Nutrients” on October 14,2021 ; link : www.mdpi.com ]. This is great news ; if each one of us can optimize his/her vitamin D3 blood level to 50 ng/ml , Covid-19 becomes a non-lethal disease and the pandemic ends [ this endeavor is quite easy and feasible ; swallowing a pill of vitamin D3 supplement is not climbing Mount Everest].

Now let us put two and two together. Assuming that you do not know your vitamin D status, what would be your intuitive response if researchers are telling you that there is a strong correlation between vitamin D deficiency and severe/lethal Covid-19, and that there is a 70% chance that you ( and your children if you have any) have vitamin D deficiency, and that bringing your vitamin D3 blood level to 50 ng/ml will render Covid-19 a non-lethal disease ? I think the logic response would be : I would like to know my vitamin D status and start vitamin D supplementations if I were deficient and aim to reach a level of 50 ng/ml [ the normal range for vitamin D3 in the blood is 30-60 ng/ml , so aim to be in the range of 50-60 ng/ml] . Put yourself in the driver seat and forge ahead with your plan . Be in charge. Call your doctor and your child pediatrician to arrange for a check on your vitamin D status as well as that of your children. If you are deficient, your doctor will advise you on the proper dose of the vitamin D supplementation ( to correct the deficiency) and arrange for a proper and timely follow-up.

Correcting your vitamin D deficiency is not a license to ignore proper infection control measures and engage in reckless behavior e.g. hugging a coughing/sneezing Covid-19 patient ; in such a scenario you can receive a “direct hit” with a large dose of the virus and end up with a severe infection.

When you correct your vitamin D deficiency , you will be hitting 2 birds with one stone : downgrading Covid-19 from a lethal to a non-lethal disease as well as reaping the other benefits of an adequate level of vitamin D e.g. protection against diabetes, high blood pressure, infections and immune disorders, multiple sclerosis and some types of cancer as outlined at the beginning of the chapter.

In the next chapters, I shall identify more risk factors for severe Covid-19. If each and every one of us can identify and correct his/her risk factor(s), in addition to practicing proper infection control measures at the same time, we can collectively downgrade Covid-19 from a lethal disease to a non-lethal disease.

If we have an effective therapy for the virus, we can further downgrade Covid-19 from a non-lethal disease to a treatable disease and this is how we can obliterate the pandemic. There is excellent news on that front. Therapies with cheap , safe and available medicines have demonstrated efficacy against the virus in observational or small randomized controlled trials. Those therapies can bring to the world much awaited relief without relying on a vaccine. A vaccine is not the only option available to tackle an infectious disease. Doctors and public health officials who adamantly advocate that only a vaccine is the solution to the pandemic have no plan B if a safe and effective vaccine does not materialize. Actually a successful plan B in the field of therapeutics has emerged and will usher the end of the pandemic very soon. I shall discuss those therapies in chapter 11“ Cheer up! Help has arrived” .

Smile, please.

Frequently asked questions about vitamin D

Correction of vitamin D deficiency is a highly effective preventive measure against Covid-19. Correction of vitamin D deficiency with oral supplements of vitamin D3 does not happen overnight. Usually it takes 2-3 months to achieve the correction. It is important to note that taking large doses of vitamin D3 without medical supervision and without monitoring the blood level of vitamin D3 can result in excess of vitamin D3 in the body which is not desirable. As a rule of thumb, it is not advisable to take more than 4000 IU of vitamin D3 per day without medical supervision. If you take oral supplements of vitamin D3 on a regular basis but unable to bring your blood level to the target range, the following 4 tips can be helpful : (1) as stated above, take vitamin D3 with a meal that contains fat. (2) Taking a reasonable dose of vitamin D3 e.g. 2000 or 3000 IU per day is better absorbed by some individuals than taking a mega dose e.g. 50,000 IU per week or month. (3)Some individuals , by genetic predisposition, do not absorb oral vitamin D3 properly; they can add to their oral vitamin D3 a skin patch that delivers vitamin D3 through the skin[ your doctor can help you with this matter]. (4)Orally ingested vitamin D3 has to undergo an activation process in the liver and then in the kidneys before it becomes the “ active” form of the hormone utilized by the body. Persons who have advanced liver or kidney disease might not be able to produce the active form of the hormone; they can benefit by taking the active form of vitamin D3 [ your doctor can help with this matter if you have advanced liver or kidney disease].

For an optimum blood level of vitamin D3 in the pediatric population, please consult with the pediatrician treating your child.