COVID-19 Early Outpatient Treatment & Prevention Options

Richard B. Fox, M.D., J.D.,


IMPORTANT ANNOUNCEMENT: Thanks to the great work of Children’s Health Defense and their legal team, including Robert F. Kennedy, Jr., a federal judge has enjoined the State of California from enforcing AB2098 that prevented doctors like me from properly treating COVID-19. See the story HERE.

While COVID-19 vaccines will help reduce the toll of COVID-19 on the country, not everyone is convinced that they should receive  that vaccine. The benefit is likely greater for those of advanced years who are at greater risk. Despite the vaccines, there are still cases of COVID-19 occurring. Indeed, in recent weeks the numbers of cases reported has, again, risen sharply although, thankfully, the numbers of deaths has not. It seems likely that the recent uptick in cases is due to the so-called “delta” variant of the COVID-19 (SARS-2) virus, which appears to be more transmissible but less lethal. It also appears that the COVID-19 vaccines, especially the Pfizer vaccine, are less effective against the “delta” variant. For these reasons it now appears reasonable to to recommend preventive treatments, including ivermectin, even among those fully immunized against COVID-19, to reduce the impact and transmission of the “delta” variant.

Thus, our current recommendation is for COVID-19 prophylaxis for all those 65 or older or those with risk factors such as chronic illness, obesity, or type 2 diabetes. Our current recommendation for prophylaxis is ivermectin, four 3mg tablets once per week. For those less than 65 years I also recommend obtaining 8 tablets of ivermectin to be kept on hand for use at the first sign of COVID-19 infection, 4 tablets on the first day and the other four tablets on day four of the infection.

A word of caution. It has been reported that large chain pharmacies, like CVS and Walgreen’s, are refusing to fill ivermectin prescriptions. Thus, you may need to shop around to find a pharmacy that will fill your prescription. There is also a website that lists pharmacies that will fill ivermectin prescriptions at:

For those who think you have been exposed to, or might have, COVID-19, the main early symptoms are:

  •  fever (often the first)    
  •  cough    
  •  feeling tired

Other symptoms can include: difficulty breathing, chills, sore throat, runny nose, headache, muscle ache, loss of ability to taste or smell. If you think you have COVID-19, it is important to start treatment as soon as possible. Click here to get the form for treatment. Then get tested for COVID-19. You do not have to wait for your test result to start treatment.

Early Treatment For COVID-19

On January 14, 2021, the National Institutes of Health COVID-19 Treatment Guidelines Panel dropped its previous opposition to the use of the common and inexpensive anti-parasite drug, ivermectin, for use in treating COVID-19, now stating that, “there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19.” This now opens the door for the early, inexpensive, outpatient treatment of COVID-19 positive patients in the early, more treatable, phase of COVID-19 infections, potentially avoiding the later, harder to treat, often fatal, late phase of the disease. Indeed, in an Argentine study recently described on Fox News, “800 healthcare workers received ivermectin, while another 400 did not. Of the 800, not a single person contracted COVID-19, while more than half of the 400 did.

India has been spectacularly successful treating COVID-19 with ivermectin. India began to see a surge of COVID-19 cases in April of 2021. On April 28, 2021 India’s Ministry of Health & Family Welfare issued Revised Guidelines For Home Isolation Of Mild/Symptomatic COVID-19 Cases. Those Guidelines recommended treating COVID-19 patients with ivermectin and treating all caretakers and household contacts with hydroxycholoroquine. The drugs were quickly and widely deployed in the community, no doctor visit required, as seen here:

India was spectacularly successful with this plan, which stopped its COVID-19 epidemic in its tracks. Seen below are India’s daily cases and deaths per million population since February of 2020 (in light blue) as compared to the United States (in black), with the introduction of its ivermectin and hydroxychloroquine treatments on April 28, 2021:

At the time that India accomplished this miracle it had only 2% of its population fully vaccinated. This data shows that vaccination is neither necessary nor sufficient to control the COVID-19 pandemic.

The comparison between India’s COVD-19 statistics and those of the United States is tragic, with the U.S. suffering almost six times more total COVID-19 cases per capita than has India and nearly seven times more deaths per capita, as seem below:


As of November 9, 2021 the U.S. has suffered about 778,000 COVID-19 deaths and counting. If the U.S. had only the same death rate as India, it would have saved about 670,000 of those deaths. For a more detailed analysis of India’s spectacular success fighting COVID-19 with ivermectin, see this recent review.

Some states in Peru have been similarly successful using ivermectin as compared to Lima, which did not use ivermectin and the improvement in their numbers occurred as soon as ivermectin was introduced, where the introduction of ivermectin is shown by the vertical black lines in the figures below:

Early outpatient treatment is highly effective at reducing these deaths, including treatment with ivermectin (approx. 75-85% reduction), hydroxychloroquine (67% reduction), and/or vitamin D3 (75% reduction).

The benefits of widespread vaccination are not so apparent as seen by comparing the United States with India. The reason is unclear. While vaccines were very effective in early U.S. trials, their effectiveness seems to wear off over time, which is why we are now seeing booster shots, and may see them repeatedly in the future. More worrisome are data from Great Britain that suggest that, nine or ten months after completion of COVID-19 vaccinations, not only do they become less effective, it appears that vaccinated persons over the age of 18 are more likely to become infected with COVID-19 than those who are not vaccinated, with those over 30 more than twice as likely to become infected, as seen below in a recent report from the Health Security Agency of the British Government:


Another recent British study found that, “….fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts.”

Thus, the first of these British reports shows that vaccinated persons are just as likely, if not more likely, to become infected with COVID-19 and, once infected, can easily spread it to others, even to other vaccinated persons. In fairness to COVID-19 vaccines, the British Health Security Agency data do show that vaccinated persons are much less likely than unvaccinated persons to require a visit to the Emergency Room (p. 14) or to die (p. 15). However, early treatment is not offered for COVID-19 in Britain. Thus, it cannot be determined from this data whether vaccines are more effective than early treatment for COVID-19.

The need for early, effective, treatment (and prevention) now is especially great among certain racial and ethnic groups. According to the U.S. C.D.C., the rates of hospitalization due to COVID-19 for Black or African-American are 3.7 times higher than those for White, Non-Hispanic persons and 2.8 times higher for death due to COVID-19. The rates for Hispanic or Latino persons are 4.1 times higher for hospitalization due to COVID-19 and 2.8 times higher for death due to COVID-19.  The experience in California has been similar. As of January 13, 2021, African-Americans, who make up 6% of California’s population, comprise 6.7% (2,050) of California’s COVID-19 deaths while Latino’s who make up 38.9% of California’s population, comprise 46.5% (14,292) of California’s COVID-19 deaths.

The information provided here is for those who either: (1) have recently tested positive for COVID-19 but are not sick enough to be in the Emergency Room or the hospital, or (2) have not had COVID-19. It is not for those who need to seek emergency medical attention or to be hospitalized.


Your risk of getting COVID-19 depends on your exposure to others who have it. Several of the main factors are:

  • how close you are to them, try to keep six (6) feet apart,
  • whether you and/or they are wearing face masks,
  • how long you are exposed to that person or persons,
  • whether your exposure is indoors with little or no ventilation or outdoors with good ventilation

You can help to prevent serious infection COVID-19 infection by taking these over-the-counter medicines to boost your resistance to it (in this order of importance):

For those 65 or older or with diabetes, chronic lung or heart disease, cancer, or immunodeficiency, a prescription medication, ivermectin, is also recommended for prevention of COVID-19:

  • ivermectin* 12 mg once per week for 10 weeks, then once every other week; cost about $17-25 for two week supply with coupon.

     * use of ivermectin for prevention of COVID-19 has not been approved by the U.S. F.D.A. This is known as an “off-label” use of an approved drug, which is permitted. The U.S. F.D.A. advisory on “off-label” use of drugs can be found here where it is stated that, “From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient.” 

(Sources: Eastern Virginia Medical School COVID-19 Protocol; McCullough Protocol, Fareed-Tyson Protocol)

For those who think you have been exposed to, or might have, COVID-19, the main early symptoms are:

  •  fever (often the first)    
  •  cough    
  •  feeling tired

Other symptoms can include: difficulty breathing, chills, sore throat, runny nose, headache, muscle ache, loss of ability to taste or smell

If you think you might have COVID-19, get tested, the sooner the better, so that you can get started on early treatment. The federal Centers for Disease Control website has information about COVID-19 testing. The California Department of Health Website lists locations where free, confidential COVID-19 testing is available to every Californian who needs it. 


If you test positive, start by visiting the California Department of Health Website for their advice on “What to Do If You Are Sick.” But, don’t stop there, read on.

Next, understand that COVID-19 has three stages. The first stage is the viral proliferation phase where the COVID-19 virus is growing in your body but you are not seriously ill, just the minor symptoms described above (fever, cough, fatigue, difficulty breathing, chills, sore throat, runny nose, headache, muscle ache, loss of ability to taste of smell). This first, mild, stage is often around five days. If you are younger, do not have the risk factors described above, and are taking some of the medicines mentioned above, you will hopefully start to feel better by then and won’t progress to the second, serious, sometimes deadly, second and third stages that requires hospital treatment.

The second stage is the cytokine injury stage in which the body’s own immune defenses that have been building up during the first stage to fight the COVID-19 infection get out of control and attack the body’s own vital organs.

The third stage is the thrombosis stage  in which tiny blood clots form in the body’s small blood vessels that have been damaged by the attacks of the cytokines on them. When enough of an organ’s blood vessels become plugged up with these tiny blood clots, the organ fails to due inadequate blood flow. Multiple organs can fail, including lungs, heart, liver, and kidneys. This can, and often does, lead to death.

This second and third stages can only be treated in the hospital and, even then, this often leads to death, especially in the most vulnerable. The three stages of COVID-19 infection are shown below:

Source: Peter McCullough, M.D., and others.

The goal of preventive or early treatment of the first phase is, of course, prevention or decreasing the severity of the second phase.


Monitoring required:

  •  Get an accurate, reliable thermometer that you can use. Ear thermometers are more reliable and accurate than forehead thermometers. Check your temperature and record it every four hours while you are awake and while fever continues.
  •  If possible, get a pulse oximeter to measure your blood oxygen level from your fingertip or earlobe every four hours while you are awake and anytime you feel short of breath. You will need some practice to get reliable readings so use it and get familiar with how to use it before you get too sick and really need it and so that you know your baseline oxygen level. Here is a YouTube video on how to use a pulse oximeter. Most healthy people who do not live at higher altitudes have oxygen levels of 95% or more. A significant drop in your oxygen level from your own normal baseline reading, especially in conjunction with difficulty breathing, should prompt urgent medical attention.

Major pharmacies carry pulse oximeters which you can buy off the shelf. They often run around $50. (CVS) (Walgreens) (Rite Aid) (Target) (Walmart). Amazon also sells pulse oximeters but you usually cannot get them the same day. TIP: if you are in a high-risk group, consider getting a pulse oximeter before you get sick and become familiar with using it.

Medications typically required, number of tablets needed for course of treatment:

  • HCQ 200 mg tabs, 16 tabs needed (HCQ = hydroxychloroquine)*(prescription required)
  • vitamin D3, 5000U capsules
  • zinc sulfate 220 mg (or elemental Zinc 50 mg), 15 tabs needed
  • azithromycin (Zithromax)* 500 mg, 5 tabs (or Z pack), OR Doxycycline* 100 mg tabs, 10 tabs needed (prescription required for both)
  • ivermectin* 3 mg tabs, 8 tabs needed (prescription required)
  • aspirin 325 mg tabs, 30 tabs needed
  • pepcid 20 mg tabs, 5 needed                

    * use of hydroxchloroquine, azithromycin, doxycycline, and/or ivermectin for treatment of COVID-19 has not been approved by the U.S. F.D.A. This is known as an “off-label” use of an approved drug, which is permitted. The U.S. F.D.A. advisory on “off-label” use of drugs can be found here where it is stated that “From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient.” Recently the National Institutes of Health’s COVID-19 Treatment Guidelines Panel stated that, “there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19.”

Day 1

  • HCQ, 2 tabs twice a day
  • zinc sulfate tab, 1 tab twice a day
  • azithromycin tab one per day or doxycycline tab twice a day
  • ivermectin four 3 mg tabs on day 1 only
  • vitamin D3 (see below)
  • aspirin 325 mg, one tab per day
  • pepcid 20 mg tab, one tab per day

Days 2-5

  • HCQ tab, one tab 3 times a day
  • zinc sulfate, one tab 3 times a day
  • azithromycin tab daily* or doxycycline cap twice a day
  • vitamin D3 (see below)
  • aspirin 325 mg, one tab per day
  • ivermectin 12 mg tab on day 3 if symptoms warrant (not improving)
  • pepcid 20 mg tab daily
  • vitamin D3 (very important): if you have already been taking vitamin D3, 5,000U per day, for several days, just continue the same. If not, take vitamin D3, 50,000U each day for three days to get caught up, then 5,000U per day.

(Sources: Eastern Virginia Medical School COVID-19 Protocol; Fareed-Tyson Protocol, Zelenko Protocol)

Note: Unfortunately, most, if not all, the major pharmacy chains are now refusing, without explanation, to fill ivermectin prescriptions for COVID-19. Fortunately, some smaller, independent pharmacies will still fill ivermectin prescriptions. This website maintained by the Front Line Doctors lists some pharmacies that will fill ivermectin prescriptions. Many will do so by mail.


The goal of the treatments described above for treatment of the first, milder, viral replication phase is to prevent progression to the second, deadly, cytokine storm phase which usually requires hospital treatment.

Unfortunately, neither the California Department of Health, nor the federal Centers for Disease Control, nor the National Institutes of Health currently have any recommendations for outpatient treatment of the early, viral replication, phase of COVID-19 infection, not even the basics like checking your temperature or monitoring your oxygen level. Their only advice for those in the early phase of COVID-19 is to isolate yourself and try not to pass it on. Unfortunately, many of those go on to serious illness or death. This is both unacceptable and unnecessary. Deaths in the United States alone are now in nearing 800,000 out of a total number of cases of nearly fifty million. That is a case fatality rate of about 1.6%.

By contrast, two physician in Southern California, who have treated more than 10,000 COVID-19 patients with the above early treatment protocol have a 100% survival rate.


The antibiotic, ivermectin, is especially effective in treating COVID-19 at all stages of the illness, both for prevention and treatment, especially for prevention and early in the course of the disease as shown here:


Although ivermectin may have minor side effects such as headache, dizziness, nausea, or diarrhea, it has been widely and safely used for decades around the world. As noted by the U.S. Centers For Disease Control, “Given as a tablet in mass drug administrations, oral ivermectin has been used extensively and safely for over two decades in many countries to treat filarial worm infections. Although not FDA-approved for the treatment of lice, ivermectin tablets given in a single oral dose of 200 micrograms/kg or 400 micrograms/kg repeated in 9-10 days has been shown effective against head lice.”

Indeed, ivermectin is far safer than the COVID-19 vaccinations, which are far less safe than any other vaccines, including flu vaccines, as seen below in data covering only through June 2021:

As seen above, COVID-19 vaccines have been much more frequently reported in association with fatal outcomes in just the past year than have all other vaccines over the past 25 years, as reported by the federal Vaccine Adverse Event Reporting System (VAERS). As VAERS says repeatedly on their website, just because a death was reported after a vaccination does not mean that the vaccination was the actual cause of the death. But look at the annual incidence of fatalities reported to VAERS since 1976:

Source: CDC WONDER VAERS Data Search

As we can plainly see, something happened in 2021 that caused the numbers of reports to skyrocket. What could it have been? The really shocking thing about this graph is that after stoutly and repeatedly insisting that mere occurrence does not prove causation,  neither the FDA nor the CDC has made, or plans to make, any investigation into the cause of this skyrocketing of the death rate after vaccination. If there was a sudden and dramatic skyrocketing of the numbers of fatal plane crashes, there would be a lot of investigations and, most likely, all the airplanes would be grounded until the cause was discovered. Obviously, the reason that the FDA and CDC are not investigating is that they already know the cause, it is their vaccines. And, if they know it, they should be telling people about the risks rather than just claiming that their vaccines are “safe and effective” and letting it go at that.

Editorial Comments:


Millions of people in the United States have gotten COVID-19 vaccines without incident. However, as seen above, COVID-19 vaccines have been associated with more VAERS reports within the last year than have all the flu vaccines for the past 25 years. Thus, while the risk of vaccine complications is low, it is higher than that for any other vaccine. And when you are the rare person who has a severe or  fatal COVID-19 reaction, it is, for you, not at all rare. It’s sort of like being hit and killed by a drunk driver, it does not happen very often but it is very tragic when it does happen, as seen in this recent roundtable hosted by Sen. Johnson. Patients deserve to know about these tragedies so that they can make informed decisions. Government mandates that people expose themselves and their children to these risks are quite troubling. To put it another way, how many innocent children are we prepared to have die due to mandated vaccines for the supposed greater good of society, especially when India has shown us that there are other safer and more effective alternatives. We need and deserve a debate on this question.

Early Treatment

The reason that effective, early COVID-19 treatment has not been widely adopted in the United States may be as much political as scientific, as illustrated by two recent hearings (November 19, 2020, December 8, 2020) on the subject before the Senate Homeland Security Committee:

November 19, 2020 Hearing:

  • Chairman Sen. Ron Johnson, (R-WI)(YouTube) (text)
  • Ranking Member Sen. Gary Peters (D-MI)(YouTube)(text)
  • Peter McCollough, M.D., M.P.H. (Baylor College of Medicine)(YouTube) (text)
  • Harvey Risch, M.D., Ph.D. (Yale School of Public Health)(YouTube) (text)
  • George Fareed, M.D., Medical Director, Pioneers Health Center, Brawley, CA)(YouTube) (text)
  • Ashish Jha, M.D., M.P.H., Brown University School of Public Health (YouTube) (text)
  • Questions by Senators & Answers by Witnesses (YouTube)

December 8, 2020 Hearing:

  • Chairman Sen. Ron Johnson (R-WI)(YouTube) (text)
  • Ranking Member Sen. Gary C. Peters (D-MI)(YouTube) (text)
  • Ramin Oskoui, M.D., Sibley Memorial Hospital (YouTube) (text)
  • Jean-Jacques Rajter, M.D., Broward Health Medical Center (YouTube) (text)
  • Pierre Kory, M.D., St. Luke’s Aurora Medical Center (YouTube) (text)
  • Armand Balboni, M.D., Ph.D., Appili Therapeutics Inc. (YouTube) (text)
  • Jane M. Orient, M.D., Association of American Physicians and Surgeons) (YouTube) (text)
  • Jayanta Bhattacharya, M.D., Ph.D., Stanford University (YouTube) (text)
  • Questions by Senators & Answers by Witnesses (YouTube)

However, the testimony of these experts did not sit well with Google and YouTube, which censored Dr. Kory’s Senate presentation until they were forced to relent. This censorship of a simple, safe, inexpensive treatment that could potentially save countless lives did not sit well with Senator Johnson, as he explained in the Wall Street Journal and to Fox News. Senator Johnson and Dr. Kory may want to keep in mind that, as bomber pilots like to say, you know you are over the target when you are taking a lot of flak.

Big Pharma’s money interests may underlie the politics. Big pharma has made many billions producing COVID-19 drugs, such as remdesivir, and vaccines, such as the Pfizer and Moderna vaccines. Under the arcane rules of the Food and Drug Administration, these drugs were hurriedly approved for general use under an FDA procedure known as an Emergency Use Authorization (EUA). However, under the laws that govern the FDA, EUA’s are only available when there are no FDA-approved drugs available to meet the need. Since ivermectin and hydroxycholoroquine are inexpensive generic drugs that have been FDA-approved for many years to treat other conditions, if the FDA were to acknowledge that they are effective against COVID-19, then the FDA could not have issued the EUA’s for Big Pharma’s pricey proprietary drugs. This makes even more sense when one considers that nearly half of the FDA’a budget comes from Big Pharma. Without Big Pharma, half of the people at the FDA would be out of their jobs. In the field of law and economics, we call this “regulatory capture,” where the regulators become captured by those that they regulate because the regulated have lots of money for lobbyists and political contributions, and to give well paying jobs as lobbyists to the top regulators when those top regulators decide to leave the government and go to work lobbying for those that they used to regulate. So, smart regulators may not want to bite the hand that may be feeding them in the future. Makers of inexpensive generic drugs like ivermectin don’t have that kind of money. or clout. As noted above, if the U.S. had only the same death rate as India, we could have saved about 670,000 lives so far. That is a very high price to pay for the regulatory capture of the FDA, CDC, and NIH.

Rev. 11-9-2021.