FLCCC Alliance MATH+ ascorbic acid and I-MASK+ ivermectin protocols for COVID-19 — a brief review

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.