Abstract: FLCCC Alliance MATH+ ascorbic acid and I-MASK+ ivermectin protocols for COVID-19 — a brief review Mika Turkia M.Sc., mika.turkia@alumni.helsinki.fi, November 10, 2020 Abstract An alliance of established experts on critical care, Front Line Covid-19 Critical Care Alliance (FLCCC), has published two protocols for treatment of COVID-19. The first one, MATH+, is intended for hospital and intensive care unit treament of pulmonary phases of the disease. It is based on affordable, commonly available components: anti-inflammatory corticosteroids (methylprednisolone, “M”), high-dose vitamin C infusion (ascorbic acid, “A”), vitamin B1 (thiamine, “T”), anticoagulant heparin (“H”), antiparasitic agent ivermectin, and supplemental components (“+”) including melatonin, vitamin D, elemental zinc and magnesium. The MATH+ protocol has received scarce attention due to the World Health Organization advising against the use of corticosteroids in the beginning of the pandemic. In addition, randomized controlled clinical trials were required as a condition for adoption of the protocol. As the hospital mortality rate of MATH+ treated patients was less than a quarter of the rate of patients receiving a standard of care, the authors of the protocol considered performing such trials unethical. Later, other parties have performed clinical trials with e.g. corticosteroids and anticoagulants which has led to their more widespread adoption. Other essential components of the protocol remain unadopted. In October 2020, ivermectin was upgraded from an optional component to an essential component of the protocol. According to the authors, ivermectin is considered the first agent effective for both prophylaxis (prevention) of COVID-19 and for treatment of all phases of COVID-19 including outpatient treatment of the early symptomatic phase. Therefore, at the end of October 2020, a separate ivermectin-based I-MASK+ protocol for prophylaxis and early outpatient treatment of COVID-19 was published. Keywords: COVID-19; SARS-CoV-2; ivermectin, methylprednisolone, ascorbic acid, thiamine, heparin ORCID iD: 0000-0002-8575-9838 Early developments The first version of the protocol was based on corticosteroid hydrocortisone, vitamin C and thiamine.1,2 This protocol had been used for treatment of sepsis for several years.3 In January-February 2020, an anticoagulant was added to the protocol. Hydrocortisone was upgraded to methylprednisolone in April. Ivermectin was added as an optional component in May and upgraded to an essential component in October. In the beginning of the pandemic corticosteroids were a controversial subject, possibly due to the phasespecific nature of COVID-19 not having been fully understood. In early 2020, the World Health Organization advised against the use of corticosteroids. This advisory was later proven to have been misguided.4 It was officially changed no earlier than September 2, 2020.5 According to the current data, corticosteroids appear disadvantageous in the early symptomatic phase but necessary in the late pulmonary phase. 1 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=3723854 Another generally accepted method have been anticoagulants. As an example, adoption of anticoagulants in one US hospital reduced the need for mechanical ventilation from 30% to 8% and reduced the hospital mortality rate from 63% to 29%.6 In the first half of 2020, hospital mortality rate of patients..