“MATH+” Multi-Modal Hospital Treatment Protocol for COVID-19 Infection: Clinical and Scientific Rationale

The "MATH+" protocol was developed by the Front-Line COVID-19 Critical Care Alliance in response to high mortality rates and prolonged mechanical ventilation durations in COVID-19 patients with acute respiratory failure. This protocol included the use of methylprednisolone, ascorbic acid, thiamine, heparin, and non-antiviral co-interventions, diverging from the initial global recommendation of "supportive care only." The protocol was based on clinical observations and emerging data from early outbreak areas, and it aimed to improve outcomes by addressing the inflammatory and coagulopathic aspects of COVID-19. The manuscript provided a detailed review of the scientific and clinical rationale for each component of the MATH+ protocol, supported by various studies on viral syndromes and COVID-19.