COVID-19 / Coronavirus Updates

What is going on and is this serious?

At this time we have more unknowns than knowns about covid-19 / coronavirus.  What we do know is 1.8% of those infected will be asymptomatic and up to 80% will have a more mild form of the illness. That means approximately 82% of people infected will not met the criteria for being tested for covid-19 due to the mild nature of their illness. So, this is good for those 82% but not great for spreading the illness.

The approximate 82% of those with mild or no symptoms, who have not traveled internationally and who have not had direct covid-19 contact do not meet the criteria for testing. Even if they did get tested the current testing has a high false negative rate, which is why most patients are getting multiple tests. An initial negative test does not mean someone does not have the germ but repeat negative test may mean the patient is not infected.

For me one of the biggest concerns is that up to 82% of people not being tested will not know they have covid-19. For these people hopefully the disease remains mild. But they will still be able to spread the disease and they can spread it to people over 60, and people with comorbidities or other illnesses. For these special groups of people covid-19 illness could be severe and may be fatal. Approximately 14% of cases are severe and include pneumonia and 5% are critical and include complications such as ARDS (acute respiratory distress syndrome), septic shock and multiple organ system failure. The only way to prevent these severe and fatal cases is to prevent spread of illness.

How do I know if I have the illness?

Most infected people have a fever, but having a perceived fever without actual fever is just as important. Most people have a cough, but some start with a sore throat, some with a headache and others GI symptoms. And some show no symptoms. The presentation is far from standard.

When will this end?

The good news is spring is around the corner. There is evidence that the germ persists best in cold temperatures and less so in a warmer and more humid climate. Just like for influenza A and B we are hoping warmer weather leads to decrease number of cases.

I keep seeing conflicting data. What’s up?

Many of my patients have been asking me about strategies to stay safe and healthy. As I have been writing this the Johns Hopkins site covid-19 numbers for the US rose from 128 to 153. This is not surprising. And we know based on the information above that these numbers only represent positive tests for the limited number of people who met criteria to get tested. 153 is much lower than the number of people who actually have covid-19.

And it is true, most of us will be fine. But think if you have parents, grandparents, or know anyone with a chronic illness it is reasonable to be concerned for these people. These folks need to be protected from the virus and that will only happen with our help. Keep in mind that the flu (influenza A and B) has a mortality rate of less than 1% of those infected each year and we now think covid-19 has a motility rate of 2-3%. At this point we know there are many more cases of the flu worldwide as opposed to covid-19 cases but we will better understand how these illness compare in the next 4-8 weeks. If you saw the 3.4% mortality rate reported by the WHO for covid-19 keep in mind that the percentage they reported was calculated prior knowing the actual total number of covid-19 cases worldwide and so is likely falsely elevated.

How can I keep myself and my loved ones safe?

 For those in the highest risk category I have been recommending isolation at home with no outside contact until we get more data. I consider the highest risk category to include those over 60 years of age and those with hypertension, cardiovascular diseases, cerebrovascular diseases, diabetes, hepatitis B infections, chronic obstructive pulmonary disease. chronic kidney diseases, malignancy and immunodeficiency. Your risk increases if you meet 1, 2 or 2+ of these comorbidities For most others, those under 60 and without a chronic illness, lots of hand washing and social distancing may be sufficient.

If you have been engaging in regular activities over the past week I recommend you do not visit with anyone over the age of 60 or with anyone with any ongoing illness, especially those listed above, over the next 2-4 weeks when we can hopeful offer better advice.

What’s on the Horizen?

As far as treatment there is a clinical trial on intravenous Vitamin C (Clinical trials in COVID-19). Some have been receiving the drug Remdesivir which is not FDA approved but was also tested in patients with Ebola. In animal studies this drug shows promise against covid-19, but this is not available in the US at this time unless under compassionate care treatment. The Remdesivir clinical trial is currently underway. A potential new therapeutic for Lyme disease is disulfiram which also showed potential activity against SARS and MERS, covid-19 relatives, and may be beneficial against covid-19.

Even the NSAID indomethicin has a potent antiviral activity against the SARS coronavirus. So could it help with covid-19? I wouldn’t count on it, but if you are on any of these medications you may have a nice side effect if they do turn out to be protective.  For those of you who need more science regarding potential therapeutics then knock yourself out with this read.

Potential Integrative support

We have no known covid-19 support. We have ideas on how to generally support immune function and how to treat other viruses. This may very well not work on covid-19.

For prevention and general support we also only have our best educated guesses. Use behavior modification including hand washing and social distancing or isolation as appropriate.  We know zinc is antiviral generally and there is evidence it decreases replication of SARS (a COVID-19 relative) in vitro and so may be of some benefit. Generally zinc 30 mg 1 or 2 times daily over the next 4-8 weeks may be beneficial.  Black Elderberry extract, syrup or capsules generally antiviral and is helpful this time of year with influenza A and B. Probiotics including sacromyces Boulardii are immune supportive.

As mentioned above high dose IV vitamin C is currentlyin clicnial trial. IV vitamin C does things that oral vitamin C generally cannot do. However, adding in regular vitamin C (1-2 gram 3-4 times daily) will likely not be harmful. Local unprocessed honey can be supportive generally, as can regular lower dose vitamin D 5,000 iu daily and vitamin A10-25,000 u daily (do not use if pregnant) especially if deficient. For those with immune struggles I recommend Proboost 1 packet daily as an immune supportive supplement or Transfer Factor Multi-Immune 1 pill 2 times per day empty stomach.

For kids there are kids formulations of elderberry (watch for honey content and avoid giving to those under 12 months), Liposomal vitamin C maybe be supportive as can probiotics including sacro B. The probiotics can be opened and the contents dumped out making them easier to take by smaller children. Kids can also take lower doses of vitamin A , Vitamin D and Zinc as directed by their pediatrician.

If you have an obvious exposure or start feeling sick vitamin A 100,000 one time (if not pregnant) is antiviral and Vitamin D 50,000 one time is immune supportive. Only take these 1 time to avoid toxicity. It is OK to follow the high doses with the maintenance doses listed above. Increasing proboost to 3 times daily may be helpful. Another beneficial supplement to consider is medical grade manuka honey. It can come in different strengths (400 or 550) and can be taken by the teaspoon 2-3 times daily.

If a cough develops I recommend both Guaifenesin daily and NAC 500-600 mg 3 times per day to thin and to help expel mucus.

Please take these guidelines to your doctor. Do not give your children any supplements without discussing with your pediatrician first. The above recommendation are only general health guidelines. The only proven way to prevent covid-19 is with social distancing, hand washing and mask warring.

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