Since I started exhibiting symptoms of Covid-19 about 28/29th March, the wife and I began to scour academic journals to see if there was anything we could do that was evidence based. Roughly written up the best of what we discovered. Thx to Peter Myers also for shunting some of this my way. Check this Swiss Doctor as an excellent Covid aggregation source. See also Doris Loh.


COVID-19 self help (peer reviewed) solutions?

DISCLAIMER: All information provided is for educational purposes & should not be construed as medical advice

Vitamin C in [oral] megadoses (1g hourly for 6 hours, 3x1g daily thereafter) administered before or after the appearance of cold and flu symptoms relieved and prevented the symptoms... Overall, reported flu and cold symptoms in the test group decreased 85% compared with the control group after the administration of megadose Vitamin C.1

The above 'megadose' could be quintupled (and done half hourly) in the case of a more serious virus — to bowel tolerance as per the Vitamin C protocol first described by Dr R F Cathcart in 19812,3, and further outlined by Dr Steve Hickey below… [Buy 1kg unbuffered ascorbic & 250ml Liposomal – only use latter if show signs of infection]

Vitamin D — if you are in a vitamin D deficient group4 you have a 20x higher ICU risk: take a heap vitamin D starting at about 10,000IU daily! [Buy here]

the Problem

  • why are people dying?

      General consensus is that Covid19 can cause viral pneumonia5 which leads to mucus in lungs. Mucus can become infected leading to bacterial pneumonia, leading to more mucus in lungs, which can lead to not being able to breath, sepsis, septic shock (and—as vitamin C levels drop—clinical scurvy6), which can lead to death.

      A significant alternate path suggest otherwise7,8,9,10 — and that the way in which ventilators are used may be causing a great deal of additional harm and death.

      In some cases Covid may cause cytokine storms, whereby the body's autoimmune system in fighting the virus greatly reduces lung functionality.

  • hospital

      You will need hospital if you cannot breathe properly: to get oxygen — and if you get on a ventilator it's hopefully even odds — but probably worse11,12 — it can't save you.

      Viral pneumonia is a dangerous condition with a poor clinical prognosis. For most viral infections, there is a lack of effective targeted antiviral drugs, and symptomatic supportive treatment is still the current main treatment.13

      If we can keep the symptoms mild, we can keep out of hospital, we save a bed for someone else, avoid hospital bugs (which can make the illness more severe) and hugely increases our chances of survival. Thus, it is in our great interest to keep the illness mild, which is what most of this post is about.

Benefit 1: vitamin C

  • harmless & inexpensive

      I have no problem with Vitamin C... it's essentially totally harmless.14

      Dr Anthony Fauci, director of NIAID, NIH

      In doses up to 25g, IV C can safely be used to treat presumptive ascorbate deficiency based on symptoms and could favourably affect clinical parameters such as inflammation, fatigue, and quality of life.15

      Risks of kidney stones16 are way overcooked given demonstrated mortality benefits whilst on Vitamin C with ARDS/sepsis etc. — you need only use it temporarily!

  • oral usage guide

      Dr Steve Hickey (PhD in medical biophysics), Vitamin C expert,17,18 on the precise mechanics of taking vitamin C — type, frequency, duration and quantity (12 minutes):

      summary notes from video...
      • one must follow a low carb diet: carbohydrates interfere with absorption — vit c will mainly have laxative effect without this.

        Remember to stay off sugar and refined carbohydrates. Complex carbohydrates such as
        wholegrains are fine.19

        Dr Damien Downing, MBBS MSB

      • best to buy the low cost ascorbic acid in powder form (avoiding special forms): by the kilo...
      • prevention: 12g ascorbic acid in 3g doses 4x a day, with each meal...
      • prevention at high risk: small doses more frequently, e.g. 1/2g/hour to 80% of bowel tolerance – or 12g of a good quality liposomal vit-c in divided doses, perhaps one gram every 2 hours
      • first hint of infection:
        • consume 5g half hourly tailing off to avoid bowel tolerance limit (which will be high)...
        • if available I would immediately take about 10g liposomal vit-c in a single dose and then perhaps one gram of liposomal vit c/hour
        • I would stay near bowel tolerance for the next 24 hours
      • Infection
        • load up on cheap ascorbic acid: 5g every half hour to bowel tolerance, lowering dose gradually, 4g/hour, 3g/hour etc. – staying near bowel tolerance
        • top up with liposomes when at bowel tolerance, 1g/hour
      • you may want to supplement with liposomal vit c too (your gut will limit absorption, IV is 100-500g more effective20 because it bypasses this) — for Steve's comments on liposomal vitamin C see beneath video on YouTube, but some brands are LivOn/Altrient, LipoLife Gold, NutriGold etc.
      • Steve Hinckey co-authored a paper21 showing it is possible to get very high plasma levels (400μg/L) using oral liposomal vit C. This is important, because regular ascorbic appeared subject to a maximum of 220μg/L, but plasma levels above 280μg/L have selectively killed cancer, bacteria or viruses (in laboratory experiments).
      • 1g of LipoLife Gold can produce plasma levels of 297.5μg/L.22
      • Liopsomal superior to unencapsulated oral vit C.,23
      • Sunflower superior to soy liposomes?24
      • synergistic add ons (of distinctly secondary importance):
        • ALA, Lipoic Acid (200mg/day prevention; 1200mg/day sickness)
        • Selenium (200μg/day prevention; 400-1600μg/day sickness)
        • Vitamin D3 (4000IU/day prevention; 10000IU/day sickness – see more below)
        • Zinc (25mg/day)

  • intravenous (IV)

      Dr Richard Cheng MD PhD heard from Chinese doctors in Shanghai who about their use of intravenous (IV) Vitamin C25 to help COVID-19 patients:26,27,28

      • 50 Covid 19 cases treated with high dose (10-20g) Vitamin C — no one died, all recovered... [pulled from YouTube repeatedly, so see here at 1m29s]

      • Actively take Vitamin C as a preventative measure (from interview on CGTN)

        Vit C IV is 100-50029 times as effective as that taken orally — and if you are vomitting you can't take orally anyway!

      other articles on active Covid practice

        WHO

            Even the WHO consider vitamin C an "adjunctive intervention with biologic plausibility"30 for COVID.31

        USA
          • 5 doctors using Marik's HAT Vit C protocol with 0% fatalities to date — Coronvirus Task Force has contacted Doctor and is currently examining their data.32
          • Three hospitals use IV Vitamin C and other low-cost, readily available drugs to cut the death-rate of COVID-19 — without ventilators!33
          • Intravenous Vitamin C "Widely Used" To Treat COVID-19 In NY Hospitals,34 and NY Post article.35
          • Dr Fred Wagshul Lung Center of America: Long-standing physician Bias Contributing to COVID-19 Death Rates.36
        China

          Shanghai Treatment Expert Consensus37 specifically lists high dose IV Vitamin C in its guidance. Wuhan, the diseases epicentre, is a district of Shanghai.

        Turkey

          High-dose intravenous vitamin C treatment for COVID-19.38

  • sepsis, septic shock & pneumonia

      Sepsis, septic shock & Covid

        At a virtual conference on sepsis and its relation to Covid-19 held at the University Hospital Charité in Berlin, Niels Riedemann, CEO of Inflarx NV, showed data suggesting that sepsis is diagnosed in 100% of COVID associated deaths…39

        Septic shock occurs when a body is overtaken with sepsis (an infection of the blood).40

        Critically ill patients with COVID-19 often develop septic (distributive) shock.41

        Critically ill patients have low vitamin C concentrations despite receiving standard ICU nutrition. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response observed in septic shock.42

      Pneumonia

        Three controlled trials found that vitamin C supplementation decreases the incidence of pneumonia by >80%.43

        The following is of interest given it comes from Cochrane who are notoriously equivocal about everything:

        The prophylactic use of vitamin C to prevent pneumonia should be further investigated in populations who have a high incidence of pneumonia, especially if dietary vitamin C intake is low. Similarly, the therapeutic effects of vitamin C should be studied, especially in patients with low plasma vitamin C levels. [T]herapeutic vitamin C supplementation may be reasonable for pneumonia patients who have low vitamin C plasma levels because its cost and risks are low.44

        You are bound to have low vitamin C plasma levels if you have some kind of nasty virus!

        From a large series of animal studies we may conclude that vitamin C plays a role in preventing, shortening, and alleviating diverse infections. It seems evident that vitamin C has similar effects in humans. Controlled studies have shown that vitamin C shortens and alleviates the common cold and prevents colds under specific conditions and in restricted population subgroups. Five controlled trials found significant effects of vitamin C against pneumonia.45

        The conclusion of a comprehensive 2017 review of 148 animal studies & very many human ones!

  • clinical trials

      There are over 400 peer-reviewed experimental, pre-clinical and clinical publications evaluating vitamin C in sepsis — and the evidence is summarised in numerous review papers. Below is just a small sampling of some key recent ones.

    CITRIS-ALI (2019)

      The CITRIS-ALI Randomised Clinical Trial (RCT)46 carried out in the USA in 167 patients with sepsis-related ARDS indicated that administration of 50mg/kg/6h47 of IV vitamin C for 4 days decreases mortality — during the first 96 hours while on IV vitamin C mortality was ~23% in the placebo vs ~4% in the vitamin C group.48

      Rescue therapy with high-dose vitamin C can also be considered.

      British journal referencing CITRIS-ALI49

      debunking debunkers

      There is much stuff abusing CITRIS-ALI to 'debunk' vitamin C, Forbes,50 the Australian Gov't51 for instance (borrowed wording from Yale52), but if you read the secondary endpoints of the CITRIS-ALI trial or listen to the man who ran it, it's all about the secondary end points! Judge for yourself which side of 'significant' you want to be on: mortality and hospital-free are fairly cool things. Read PulmCrit's Can a secondary end point stage a coup d'etat53 if you want to really think about it in detail.

    Marik Protocol/HAT (2017-06)

      Dr Paul Markik's highly controversial HAT protocol: hydrocortisone, ascorbic acid and thiamine in treatment of severe sepsis.

      Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, are effective in preventing progressive organ dysfunction, including acute kidney injury, and in reducing the mortality of patients with severe sepsis and septic shock.54

      debunking debunkers

      The VITAMINS RCT55 is widely used to dismiss Paul Marik's profound and awesome results, e.g. the above listed Australian Gov't article.56 It found 'no difference', possible harm caused by Marik's protocol.

      Paul Marik's seminal (20 minute) reply destroying VITAMINS. If you don't have time for it — and it's the stuff movies are made of — then read further below for relevant excerpts…

      Choice quotes Paul Marik's VITAMINS editorial (see above video):

      I contend that doing a study designed to fail is ethically and morally unacceptable.

      Door to needle time is absolutely essential, you want a door to needle time of less than six hours, septic shock is a highly time-dependent disease. If you give it less than six hours, patients do not die!57 With increasing delay response is attenuated. Once you are after 18 hours, you're done.58

      Time from ICU admission to randomisation 13.7 hours, from randomisation to first dose of vitamin C, 14.9 hours median – including time from door to ICU admission, 32 hours median59 — [to audience] Does anyone think waiting 32 hours from presentation to intervention is acceptable? Please stand up…

      The jury is unanimous, waiting 32 hours to give a first dose is not acceptable… Why don't we look at the studies presented yesterday, all of them, the time from disease onset to intervention was less than six hours — here we have 32 hours. This was a study designed to fail.

      My last point is: if you don’t believe me, anybody in this audience is welcome to visit me in my ICU, when I'm on round with patients, and actually see what we're talking is not BS — this is the damn truth.

      Nutra Ingredients Article, 2020-01-28

      Two minutes of heart-warming from nurses who worked with sepsis patients and Paul Marik…

    Straight IV vit C (2016)

    25mg/kg intravenous ascorbic acid every 6 h… 28-day mortality was significantly lower in the ascorbic acid than the placebo group (14.28% vs. 64.28%, respectively; P = 0.009)… High-dose ascorbic acid may be considered as an effective and safe adjuvant therapy in surgical critically ill patients with septic shock.60

    upcoming clinical trials

      • [Complete, pending results] [USA] VICTAS: Vitamin C, Thiamine, and Steroids in Sepsis61
      • [USA] COVIDAtoZ: Coronavirus 2019 (COVID-19)- Using Ascorbic Acid and Zinc Supplementation62
      • [USA] EVICT-CORONA-ALI:63 Early Infusion of Vitamin C for Treatment of Novel COVID-19 Acute Lung Injury 64
      • [Italy] Use of 10g IV Ascorbic Acid in Patients With COVID 1965
      • [China] 24g Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia66
      • [Canada] LOVIT: (50mg/kg/6h) Lessening Organ Dysfunction With VITamin C67 — patients with COVID-19 are eligible (though it predates it by more than a year).

  • debunking debunkers

      To augment the above. The history is long and almost beyond belief — truth is stranger than fiction…

      In June 1949 when polio was at its peak, Dr Frederick Klenner, a clinical researcher from Reidsville, North Carolina, reported that a massive intravenous dose of Vitamin C - up to 20,000mg daily for three days (today's recommended daily allowance is 60mg) - had cured 60 of his patients.68,69 The findings were published in a medical journal, yet there was virtually no interest. Apart from a couple of minor trials, no attempt was made to find out if they had any scientific substance.70

      Jane Feinmann, The Independent, 2005-04-12

      debunking Pauling/Cameron debunkers

      Linus Pauling and Ewan Cameron are two major trial contributors to proving Vitamin C as an effective anti-cancer therapy in the 1970s.71,72 Dr Charles Moertel's clinical trials73,74 while at the Mayo Clinic disproved them for nearly three decades. Linus Pauling has also been ad hominem'd post facto:

      Pauling was taking 12g/d vit C, but still died of cancer... Physician, heal thyself!

      Pauling said it would improve outcomes not extend life forever! He died at 93, whilst Charles Moertel died of cancer at 66 — 27 years younger. I think the boot is on the other foot, if at all. Though that's not how the case is proved or disproved.

      Dr Moertel’s work arguably deprived very very many (including himself) of good medicine/treatment because of his own bad science, albeit in a more rigorously performed clinical trial. Better to be roughly right than precisely wrong…

      Allow Cancer.gov to speak to Dr Moertel’s trials:

      Given the fact that cancer patients were only treated with vitamin C orally in the Mayo Clinic studies, the studies do not disprove high dose vitamin C’s efficacy as a cancer treatment.75

      Pauling and Cameron made the issue of oral ≠ intravenous very clear at the time, but were ignored and still dismissed. Only recently has Pauling’s name and IV Vit C therapy gained wide acknowledgement in Cancer treatment. The University of Iowa's Vitamin C revival also helps to explain why Linus Pauling and Cameron's seminal work in 1970s was dismissed.

      Further to the above see also: "The most influential RCT on vitamin C and the common cold by Thomas Karlowski and Thomas Chalmers et al. (1975) was analyzed erroneously and misled the public opinion on vitamin C for 4 decades (1995/6)."76

  • wider reflections

        Cancer websites make good reading in several articles.77,78 An interesting upload from Cancer Action.79

Benefit 2: vitamin D

  • excellent quotes

      COVID-19 (Coronavirus) mortality disproportionately (20x) impacts BAME (Black, Asian and Minority Ethnic) UK individuals, African Americans, Swedish Somalis, and the institutionalised; particularly care-home residents. COVID-19 severity and mortality, appear related to vitamin D deficiency, helping explain higher COVID-19 mortality rates in BAME and the obese.81

      Vitamin D deficiency is common in people who develop ARDS. This deficiency of vitamin D appears to contribute to the development of the condition, and approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed.82

      We have evidence to support a role for Vitamin D in the prevention of chest infections, particularly in older adults who have low levels. In one study Vitamin D reduced the risk of chest infections to half in people who took supplements. Though we do not know specifically of the role of Vitamin D in COVID infections, given its wider implications for improving immune responses and clear evidence for bone and muscle health, those cocooning and other at-risk cohorts should ensure they have an adequate intake of Vitamin D.83

      We have identified the mean levels of vitamin D for 20 Europeans Countries for which we have also got the data regarding the morbidity and mortality caused by COVID-19. The mean level of vitamin D in each country was strongly associated with the number of cases per million, respectively with the mortality per million. We believe we can advise Vitamin D supplementation to protect against SARS-CoV2 infection.84

      To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d.85

      The Institute of Medicine recommendation for adults younger than 70 years of age is 600 IU of vitamin D daily. We are told that this would achieve a level of 50 nmol/L in greater than 97.5% of individuals. Regrettably, a statistical error has resulted in erroneous recommendations by the Institute of Medicine leading to this conclusion and it might actually take 8800 IU of vitamin D to achieve this level in 97.5% of the population. This is a serious public health blunder.

      A colleague of mine and I have introduced vitamin D at doses that have achieved greater than 100 nmol/L in most of our patients for the past number of years, and we now see very few patients in our clinics with the flu or influenzalike illness. In those patients who do have influenza, we have treated them with the vitamin D hammer, as coined by my colleague. This is a 1-time 50,000 IU dose of vitamin D3 or 10,000 IU 3 times daily for 2 to 3 days. The results are dramatic, with complete resolution of symptoms in 48 to 72 hours. One-time doses of vitamin D at this level have been used safely and have never been shown to be toxic.86

      Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient […] experienced the most benefit.87

      Conclusion of review of 25 vit D RCTs covering 11000 subjects.

      the NHS is not impressed and barely moves

      But this opinion is not shared by all experts in the UK. Professor Louis Levy, head of nutrition science at Public Health England (PHE), said: 'The evidence on vitamin D and infection is inconsistent, and this study does not provide sufficient evidence to support recommending vitamin D for reducing the risk of respiratory tract infections.'

      As this debate is ongoing, it would seem sensible to stick to the relatively new guidelines88 about vitamin D – that is, everyone should consider taking supplements during the winter months.89

      What on earth would it take to convince PHE one wonders? The dosage recommended is the bottom end of the RDA: 10μg – 400IU, peanuts according to the papers above. That the known vitamin D deficient groups are not singled out for particular positive advice is borderline criminal negligence, and possibly discriminatory/racist. Maybe grounds for a class action lawsuit?

  • other papers & clinical trials

      • Paper: Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths90
      • Trial: Vitamin D on Prevention and Treatment of COVID-19 (COVITD-19)91
      • Trial: Single megadose oral vitamin D (400k IU vs 50k IU) COVID-1992
      • Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavrius 2019 (COVID-19)93 – the first COVID Vit D paper to publish, excellent charts best looked at here.
      • Does vitamin D status impact mortality from SARS-CoV-2 infection?94
      • Why COVID-19 May Be Disproportionately Killing African Americans: Black Overrepresentation among COVID-19 Mortality Increases with Lower Irradiance, Where Ethnicity Is More Predictive of COVID-19 Infection and Mortality Than Median Income95

  • Prior Deficiency Pandemic

      Vitamin D deficiency (hypovitaminosis) is of generally agreed (some question96) global pandemic proportions in the medical community, and has been for some time. Is the proof in the pudding shown by the levels found in folk dying of Covid etc. as above? Here is a sampling of papers:

      • 2008: Vitamin D deficiency: a worldwide problem with health consequences97
      • 2009: The Vitamin D Deficiency Pandemic and Consequences for Nonskeletal Health: Mechanisms of Action98
      • 2015: Hypovitaminosis D and its association with lifestyle factors99
      • 2016: Vitamin D deficiency in Europe: pandemic?100
      • 2017: Epidemic of Vitamin D Deficiency and Its Management: Awareness among Indian Medical Undergraduates 101

other sundry stuff

    This is subsidiary stuff I've looked into a little bit, and document below to save making another page!

  • Hydroxychloroquine (& azithromycin)

  • saline nebulisation

      Getting saline vapour into your respiratory tract will discourage bacteria that want to nest there (then you'll hopefully just have to deal with the viral pneumonia). It will also help to clear mucus as by osmosis it causes it to clump together and allows easier excretion.

      Steam inhalation, oral atomising106 or full on nebulising isotonic saline (i.e. same as blood levels: 0.9%) or hypertonic (say 3%, 6% or 7%). Isotonic ampoules are cheap: 20ml eyewash variety particularly so. Unfortunately you'll get fleeced if you want hypertonic ampoules because it's prescription only — 'tis much cheaper via presciption. You can make your own of course, only if using an excellent water source (i.e. if not distilled saline, very thoroughly boiled and very very definitely salinated) — you want to be careful what you put in your respiratory tract! (Although some of us haven't always been so.) They do say sea air is good for you, of which this is a hefty dose, but bronchospasm is a risk! So test mild form first — standard saline is isotonic 0.9% and pretty mild.

      We recommend an emphasis on the study of the use of aerosolized hypertonic saline solution to reduce pathogen burden in the airways of subjects infected with microbes of low virulence... These therapeutics are still in their infancy but show great promise.107

    isotonic (0.9%) vs hypertonic (>0.9%)

      • Nebulized hypertonic saline solution may help preserving lung clearance in premature infants108
      • Safety and efficacy of 7% hypertonic saline in patients with bronchiectasis109
      • No benefit to hypertonic (over isotonic)110,111,112,113
      • Hypertonic has benefit over isotonic114,115,116 — certainly the NHS has drawn this conclusion117 — and also Cochrane, to wit, a rare moment of relative effusivity:

        Hypertonic saline does appear to be an effective adjunct to physiotherapy during acute exacerbations of lung disease in adults.118

      • From memory there are contra-indications for hypertonic, such as weak heart etc. — risk of bronchospasm is very slight.119

    adding iodine?

      Iodine is by far the best antibiotic, antiviral and antiseptic of all time. Dr. David Derry

      Does adding povidone-iodine help?120 — even if it does, Lugol's is not PV-I. The UK is iodine deficient,121 perhaps transdermal application is safest? Though only 6-12% is absorbed.

        • Dr David Derry's paper re: iodine & H1N1122 is well worth a read, some highlights following…
        • In 1945, Burnet and Stone found that putting iodine on mice snouts prevented the mice from being infected with live influenza virus in mists. They suggested that impregnating masks with iodine would help stop viral spread. They also recommended that medical personnel have iodine-aerosol-treated rooms for examination and treatment of highly infected patients.
        • When iodine was suspended in a solution, viral inactivation occurred at dilutions of 1/1,000,000.123,
        • Aerosols inactivated many viruses within 30 seconds or less.124,125,126

          …it may be worth considering iodine vapor as a practical means of limiting indoor infection during an influenza epidemic. Aerosols inactivated many viruses within 30 seconds or less.127,128

          Burnet and Stone

        • The three PVP-I (Povidone Iodine) products tested in this study demonstrated virucidal activity against MVA and MERS-CoV at room temperature, within only 15s of exposure.129

        • It is used for water sanitation the world over130
        • Iodine safety warnings, you have to drink crazy amounts to be at risk (though could vital gut flora be at risk if iodine taken on empty stomach etc.?)...131
        • Mayo clinic article on oral iodine dosing132 — note iodine deficiency treatment levels. 2.2% Lugols is the standard USA strength.

    adding h2o2 (hydrogen peroxide)?

      Let the reader beware!! Much less safety in the science here…

      Dr Thomas Levy: Nebulise 3% hydrogen peroxide133,134 — his explanation here. He's made some excellent comment and explanations of liposomal vitamin c and other things, but I can't follow him in this!

      Toxicity concerns are real135,136,137,138 and open minded folk can't abandon concerns!139 Folk have tried nebulising h2o2 (unsuccessfully) with chickens,140 and found that humans have low tolerance.141 h2o2 exhalation is elevated in pneumonia patients, anyway – as someone said, it's a marker of lung problems,142 so why nebulise it? It is very far from risk free.143

      Many anecdotes, but little science seemingly in favour:144

      • possible mechanism of action in Vit-C vs cancer145
      • synergistic combination with iodine146

      Where Dr Frank Shallenberger's name is associated with something—while he clearly has many professional and patient proponents147—you have reason for caution.148,149

  • ACTs: air clearance techniques

  • OPEP: Oscilatory Positive Expiratory Pressure

      Amongst the range of available respiratory physiotherapy devices offering superior effectiveness to standard CPT150, let me single out the Clement Clarke/Medix Flutter and the Pari OPEP — both are effective in "draining sputum, improving oxygenation and reducing inflammatory status".



footnotes