An overview of the MATH+, I-MASK+ and I-RECOVER Protocols

An overview of the MATH+, I-MASK+ and

I-RECOVER Protocols

A Guide to the Management of COVID-19

(Updated as of February 22, 2022)

Developed and updated by Paul Marik, MD, FCP (SA), FRCP (C), FCCP, FCCM

for the Front Line COVID-19 Critical Care Alliance (FLCCC)

This is our recommended approach to COVID-19 based on the best

(and most recent) literature. This is a highly dynamic topic; therefore,

we will be updating the guidelines as new information emerges.

Please check on the FLCCC Alliance website () for

updated versions of this protocol.

Disclaimer: The information in this document is provided as guidance

to physicians worldwide on the prevention and treatment of COVID19. Our guidance should only be used by medical professionals in

formulating their approach to COVID-19. Patients should always

consult with their physician before starting any medical treatment.

The FLCCC Alliance? is registered as a 501(c)(3) non-profit

organization.

Updates in this version:

Typographical corrections

Minor changes to the I-RECOVER protocol

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Table of Contents

1. Introduction

1.1 The Vacuum of Truth

1.2 The Use of ¡°Off-Label¡± Drugs

1.3 An Overview of the Treatment of COVID-19

2. Pre- and Postexposure Prophylaxis (I-MASK+ protocol)

2.1 Core Components of the I-MASK+ Prophylactic Protocol

2.2 Nutritional Supplements

2.3 Prevention Protocol in Children and Adolescents

3. Symptomatic Patients at Home (I-MASK+ Early Treatment Protocol)

3.1. First Line Treatments

3.2. Second Line Treatments

3.3. Optional Treatments (and those of uncertain benefit)

3.4. Post Covid (Omicron) treatment

3.5. Management of Pediatric Patients (CHILD CARE)

4. Mildly Symptomatic Patients (On floor/ward in hospital)

4.1 First Line Therapies

4.2 Second Line and Optional Treatments

5. MATH+ PROTOCOL (For Patients Admitted to the ICU)

5.1 Core Components

5.2 Additional Treatment Components

5.3 Second Line Treatments

5.4 Optional Treatments (and those of uncertain benefit)

6. An Approach to the Patient with Severe Life-Threatening COVID-19

7. The ¡°Full Monty¡± for Severe COVID Pulmonary Disease

8. Salvage Treatments

9. Salvage Treatments of Unproven/No Benefit

10. Treatment of Macrophage Activation Syndrome (MAS)

11. Approach to the DELTA/P1 Variant

12. Approach to the Omicron Variant

13. Monitoring

14. Post ICU Management

15. Post Hospital Discharge Management

16. Pathophysiology of COVID-19

17. The Long Haul COVID syndrome (post-COVID syndrome)

17.1 Approach to Treatment

17.2 The I-RECOVER Protocol

17.3 First Line Therapies

17.4 Second Line Therapies

17.5 Third Line Therapies

17.6 Optional Adjunctive Therapies

18. Key Concepts of the I-MASK+ and MATH+ Treatment Protocols

19. References

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1. Introduction

1.1. The Vacuum of Truth

¡°The first step is to give up the illusion that the primary purpose of modern medical research is to

improve Americans¡¯ health most effectively and efficiently. In our opinion, the primary purpose of

commercially funded clinical research is to maximize financial return on investment, not health.¡±

¡ªJohn Abramson, M.D., Harvard Medical School

We are living through a period of time characterized by a ¡°Vacuum of Truth,¡± with misinformation,

disinformation, blatant lies, censorship, and nefarious intentions being the order of the day. It is difficult

to dissect out the actual truth and discern whom to trust. Furthermore, it is no longer controversial to

acknowledge that drug makers rigorously control medical publishing and that The Lancet, New England

Journal of Medicine (NEJM), and Journal of the American Medical Association (JAMA) are utterly

corrupted instruments of Big Pharma.

The Lancet editor, Richard Horton has stated, [1] ¡°Journals have devolved into information laundering

operations for the pharmaceutical industry.¡± Dr. Marcia Angell, who served as an NEJM editor for 20

years, says journals are ¡°primarily a marketing machine.¡± [2] Pharma, she says, has co-opted ¡°every

institution that might stand in its way. Complex scientific and moral problems are not resolved through

censorship of dissenting opinions, deleting content from the Internet, or defaming scientists and authors

who present information challenging to those in power. Censorship leads instead to greater distrust of

both government institutions and large corporations. [3]

1.2 The Use of ¡°Off Label¡± Drugs

Once the FDA approves a prescription medication, federal laws allow any U.S. physician to prescribe the

duly approved drug for any reason. [4] Thirty percent of all prescriptions written by American doctors,

exercising their medical judgment, are for off-label uses. The Attorney General of Nevada,[5] as well as

many other states have asserted the right of physicians to prescribe ¡°off label¡± drugs such as ivermectin

and hydroxychloroquine for the treatment of COVID-19. The office of Nebraska Attorney General Doug

Peterson released a legal opinion on October 15 2021 saying it didn¡¯t see data to justify legal action

against health care professionals who prescribe ivermectin or hydroxychloroquine. [5]

1.3. An Overview of the Treatment of COVID-19

While there is no cure or ¡°magic bullet¡± for COVID-19, recently, a number of therapeutic agents have

shown great promise for both the prevention and treatment of this disease. These include ivermectin,

Vitamin D, quercetin, melatonin, fluvoxamine, spironolactone, corticosteroids, curcumin (turmeric),

Nigella sativa and antiandrogen therapy. It is critical to recognize that infection with SARS-CoV-2

progresses through a number of stages/phases and that treatment is highly stage-specific (see Figures 14 and Table 1). It is likely that no single drug will be effective in treating this complex disease and that

multiple drugs with different mechanisms of action used in specific phases of the disease will be

required. A growing body of evidence suggests that many of these agents may act synergistically in

various phases of the disease. [6-8] Furthermore, an understanding of the structure of SARS-CoV-2 (see

Figure 5) as well as the pathophysiology/pathogenesis of COVID-19 is critical in treating the disease. [9]

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Finally, the relentless malpractice of deliberately withholding effective early COVID treatments, and of

forcing the use of toxic remdesivir in hospitalized patients, may have unnecessarily killed up to 500,000

Americans (see Figures 6a-c). [3]

As the pandemic has played out over the last year, over four million patients have died worldwide, and

the pandemic shows no signs of abating. Most countries across the globe have limited resources to

manage this humanitarian crisis. We developed the MATH+ protocol to provide guidance for the

treatment of the pulmonary phase of this disease with the goal of reducing hospital mortality from this

devastating disease.

However, it soon became obvious that our emphasis needed to shift to the prevention and early (home)

treatment to prevent patients progressing to the pulmonary phase and requiring hospitalization (see

Figure 5). Hence, we developed the I-MASK+ protocol. While we strongly believe that such an approach

can mitigate the development and progression of this disease, limit deaths, and allow the economy to

re-open, so-called ¡°health care authorities¡± across the globe have been silent in this regard, including

the WHO, CDC, NIH, and others (see NIH Guidance, Figure 6a and 6b).

While vaccination may be part of the solution to the COVID-19 pandemic, it will take many months ¡ª if

not years ¡ª to vaccinate the 70-85 percent of the world¡¯s population required for ¡°herd immunity.¡±

Mutant strains of SARS-CoV-2 have recently appeared, demonstrating increased transmissibility. [10-13]

Many of these mutations involve the spike protein (which almost all of the vaccines have targeted),

raising the real possibility that the vaccines may become less effective (or ineffective) against the

mutating strains. [10,11,14-19] Indeed, the protective immunity of the vaccines against both the Delta

and Omicron variants has come into question. [16-20] We believe that the I-MASK+ protocol provides

both a bridge and an alternative to universal vaccination.

And, finally the post-COVID syndrome or ¡°long-hauler syndrome¡± has emerged as a common and

disabling disorder, and its pathophysiology is poorly understood. We offer the I-RECOVER protocol to

help treat this disabling disorder. Recently, post-vaccination syndrome has emerged as a problematic

entity; we believe the I-RECOVER protocol has utility in treating this syndrome as well.

Figure 1. Treatment Phases of COVID-19

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Figure 2. The Course of COVID-19 and General Approach to Treatment

THIS IS A STEROID-RESPONSIVE DISEASE:

HOWEVER, TIMING IS CRITICAL.

Not too early. Not too late.

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