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What is the current state of knowledge around COVID-19 at-home remedies?

by Dorikka1 min read12th Jul 20207 comments

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Followup to: https://www.lesswrong.com/posts/CewTrCRfyCgW4NJQM/rob-bensinger-s-covid-19-overview and https://www.lesswrong.com/posts/ETqyWKoHpP9LytGmS/you-ve-been-exposed-to-covid-19-what-do-you-wish-you-knew

It's been ~4 months since COVID-19 become a globally relevant topic; most of the treatment work that I've seen is focused on reducing mortality in the context of high-severity cases (usually post hospitalization) ie remdesivir, dexamethasone etc. Wanted to share my current synthesis around "what should I take if I'm experiencing covid-like symptoms?"; would greatly appreciate any feedback as well as info around other positive-effect-on-current-balance-of-evidence treatments that I've missed.

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The big ones I think:

DON'T take dextromethorphan, the substance in a lot of cough syrup. Preliminary untested-in-animals results that it increases viral reproduction in tissue culture.

DO take N-acetyl cysteine (NAC).

Recharges glutathione, one of the primary reducing-agent intermediaries in cells (not involved in energy metabolism).

Several likely good effects. Mucolytic - breaks the disulfide bonds between mucous proteins to make it more fluid. Known to decrease the symptom strength of flu and other respiratory diseases. Believed to reduce pathological clots (while not really being a classic anticoagulant) via changing the disulfide bond status in some of the clotting proteins in capillary walls. Possibly an effect decreasing the amount of NET production by neutrophils in the inappropriate inflammation that's going on here.

Smaller ones:

For the same effect on NET production I also might suggest L-carnosine, there's mouse work to the effect that it reduces immune-mediated lung damage from a wide variety of different insults. Lots of people around here are also fans of niagen, and I would take it while actively sick based entirely on the fact that the virus has enzymes that cleave off NAD-generated tags from proteins as part of its actions against the innate immune system.

Agree with the things listed above.

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On a side note, I am appalled and flabbergasted that there are not multiple clinical trials ongoing for indomethacin, a prescription NSAID. There's in vitro data from SARS classic and SARS-2 that it dramatically suppresses viral replication via triggering the PKR pathway that senses dsRNA and makes ribosomes more selective against viral proteins. There's the fact that it's known to stop the cough that high doses of ACE2-inhibitors cause, suggesting something of the mechanism of this virus triggering cough and inflammation. There's in vivo data in dogs infected by canine enteric coronavirus that twenty four hours into the dose you give people for arthritis there's 1/100 the viral load. And there's anecdotal reports from large numbers of doctors in NYC and India of massive symptom relief in non-hospitalized patients, way above and beyond other NSAIDs.

Also still quite interested in the ivermectin trials when they come out.