COVID-19 Update

COVID-19 update

The Preamble 

The entity that currently has this world under siege is known as Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-CoV-2. The SARS-CoV-2 virus is thought to be the cause of disease known as COVID-19.   

This virus is described as “novel,” meaning that it has never before been encountered. The situation in which we find ourselves is also “novel.” We are encouraged to engage in “novel” and mostly unproven actions (i.e. social distancing, avoiding gatherings, and the wearing of cloth face coverings) in the hopes that we can “flatten the curve.” I use the term unproven to describe the aforementioned actions, as there are no “gold-standard” (randomized controlled trials) of any consequence proving them—or disproving them. Regardless, the ramifications and consequences of these actions have and will affect life as we know it, indefinitely.  

In this age of the Internet, information and misinformation abounds. As integrative medicine practitioners, we look at traditional, conventional, and unconventional  sources.  Thoughts and theories abound, all backed by “facts” and tainted by biases.  All smack of varying degrees of plausibility.   

The cry is to look to science for the answers, however, the science (or at least 50% of it) has been bought.1 Don’t be deceived, my friends. Look around with your eyes wide open. There is a ton of money to be made by pharmaceutical companies by repurposing medications to treat COVID-19 and in the development of the much sought after “solution” to our predicament, a vaccine.  

The less tangible, more hotly debated, and more precious commodity at stake is our freedom.  Consider the slippery slope of blindly following those in power. Nuff said.  

Introduction to the Virus 

SARS-CoV-2 is in the family of viruses known as coronaviruses. Some of these viruses are only strong enough to cause common cold symptoms and some are lethal. It appears SARS-CoV-2 is over 87% biologically similar to the original SARS Coronavirus (SARS-CoV)2, the coronavirus that caused the SARS outbreak in 2003. The illness caused by SARS-CoV-2 has been dubbed COVID-19. 

Characteristics 

One of the significant pieces of information to underscore when talking about  SARS-CoV-2, is that it is not comparable to influenza or other common respiratory viruses. Its method of entering cells and the way it incites the immune system is unusual.  Understanding these characteristics become important as we consider potential agents for prevention and treatment.  

  • SARS-CoV-2 is a single-stranded RNA virus. It infects human cells, taking over their cellular machinery to replicate itself. It is lipid-enveloped, having an oily coating that helps it to evade our immune system.   

  • SARS-CoV-2, SARS-CoV3, and one other virus in the family, Human Coronavirus NL63, are the only known viruses that use the substance, angiotensin-converting enzyme-2 (ACE2), to enter human cells. ACE2 is part of normal human physiology and helps to modulate blood pressure and healthy cardiovascular function and lung function.  ACE2 is highly expressed in the lungs, small intestine and to a lesser extent, many other tissues, including the brain.4  This could explain why SARS and COVID-19 primarily manifest as lung problems but also may cause headache, loss of smell and taste, other neurological manifestations, diarrhea, and cardiac damage.5 

  • Another unique feature of SARS-CoV that likely could be extrapolated to SARS-CoV-2, is its potential ability to evade an antiviral mechanism in the body called interferon, induce interferon resistance, which in turn can increase the production of cytokines (inflammatory signaling molecules) resulting in significant lung damage.6,7,8 

  • It has also been proposed that SARS-CoV-2 attacks the oxygen-carrying component of the red blood cell, hemoglobin.9 If true, this could explain the significantly low oxygen levels in the blood and the diminished ability to deliver oxygen to all the tissues. This could result in the presence of excess amounts of iron in the blood, increased oxidative stress, and direct damage to the lungs. 

Signs and Symptoms 

COVID-19 has presented with a wide range of severity, from minimal symptoms to severe symptoms and death. Symptoms may develop from 2 days to 2 weeks following exposure. The mean incubation is 5.1 days with 97.5% of individuals developing symptoms within 11.5 days of infection.10 

Cough and shortness of breath or difficulty breathing plus at least two of the following symptoms may indicate COVID-19: 

  • Fever 

  • Chills 

  • Repeated shaking with chills 

  • Muscle pain 

  • Headache 

  • Sore throat 

  • New loss of taste or smell 

Other reported symptoms have included the following: 

  • Fatigue 

  • Productive cough 

  • Diarrhea 

  • Malaise 

  • Respiratory distress 

  • Neurological symptoms, to include stroke 

  • Skin manifestations (rash, hives, chicken pox-like blisters) 

The most common serious manifestation of COVID-19 appears to be pneumonia.  

Symptoms in children with infection appear to be uncommon, although some children with severe COVID-19 have been reported. 

Diagnosis

The diagnosis of COVID-19 is based on the presence of characteristic signs, symptoms, and evidence of the SARS-CoV-2 virus on a lab test called reverse transcription polymerase chain reaction, RT-PCR. There are several different manufacturers of these tests looking at different evidential targets of the virus.  False-negative and false positive tests are not uncommon.  It is recommended that if clinical suspicion is high, negative tests should be repeated. 

There are many antibody tests becoming available, also with varying accuracy of results. Antibodies are proteins made by the adaptive part of the immune system in response to contact with a foreign substance or pathogen. Therefore, antibodies in the blood are indirect evidence of exposure or infection.  However, these tests are also fraught with problems of standardization and poor or undefined sensitivity and specificity.11 

Prevention  

Transmission of SARS-CoV-2 is believed to occur via exposure to respiratory droplets from sneezing and coughing, as with other respiratory pathogens like the flu. Most respiratory droplets do not travel more than 6 feet.  

There is also the risk of transmission from fomites (inanimate objects or materials). The virus can also persist on surfaces to varying durations and degrees of infectivity.  Interestingly, one of the longest survival times was on surgical masks. “Strikingly, a detectable level of infectious virus could still be present on the outer layer of a surgical mask on day 7 (~0.1% of the original inoculum).”12 

The current recommendations to prevent infection can be found on the CDC’s website at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. These recommendations have been spread ad nauseum.  I would like to add a couple of cautionary statements, though.   

  • There is no good data to support the current recommendations regarding the use of cloth face coverings. As a matter of fact, the data supports an INCREASED risk of infection with the use of cloth masks.  

  • The data supporting the use of surgical and/or N-95 masks versus no masks isn’t much better. 

  • Ditto for quarantining.13 

According to the NIH, there are no solid, evidence-based recommendations for medications or supplements to prevent or treat COVID-19.14  The best that we can do is extrapolate information gleaned from dealing with its relatives in the coronavirus family, anecdotal data from ongoing trials, and theoretic effects against known viral mechanisms of infection.  

Support your immune system and reduce your baseline inflammation15:   

  • Cover your cough and sneeze 

  • Frequent handwashing with good ole soap and water 

  • Get 7-9 hours of sleep nightly 

  • Eat a diet of whole, real, and organic foods 

  • Avoid sugar, alcohol, and processed foods 

  • Stay hydrated (with water) 

  • Manage stress with prayer, breathing techniques, meditation 

  • Get outside and enjoy fresh air, sunshine, and free vitamin D 

  • Exercise regularly 

Supplementation (this list is not exhaustive):  

  • Optimize your vitamin D through sun exposure and supplementation to get your 25(OH)D level to at least 40 ng/ml.16 There are varying responses to vitamin D supplementation making it important to test your baseline and follow your response with repeat testing. 

  • A good quality multivitamin as an insurance policy against ubiquitous nutritional deficiencies 

  • Additional zinc, as a lozenge (concentrating its ions in the upper airway, the portal of infection) or ingested as a pill,  is very supportive of the immune system and theoretically inhibits viral replication.  Consider a total daily amount of 30-45mg daily divided into 2-3 doses, optimally taken on an empty stomach.  Ideally, lab values of zinc would be monitored. Excess doses of zinc can tend to deplete copper levels, another mineral important for immune function. 

  • Consider 1 mg of copper for every 20mgs of supplemental zinc taken.    

  • Consider elderberry extract 700mg-1000mg divided into twice daily doses.  Elderberry appears to break down the viral lipid envelope and to inhibit viral attachment to ACE2 receptors.  Previously held concerns about elderberry inciting the “cytokine storm” appear to be unfounded.17  

  • Varying amounts of vitamin C are recommended from 150mg to several grams daily.  A reasonable preventative dose would be 500mg-1000mg twice daily.  

  • Polyphenol agents like quercetin display action against viral enzymes.  It is found in a variety of foods and is very safe.  Reasonable doses would be 250mg to 500mg twice daily.  

  • N-acetyl-cysteine is an amino acid and one the main constituents in glutathione, the “master antioxidant” and a significant immune modulator in our body. Consider doses from 600mg to 900mg, once to three times daily. This is best taken on an empty stomach.  

Promising Therapies

In addition to the supplements recognized as beneficial for prevention and immune support, some other interventions that are readily available are gaining evidence for use in COVID-19.  

Ozone therapy appears to be one of the most promising therapies. It is being used with increasing success in those countries hardest hit with the illness, like Italy and Spain—saving patients from ICU admission18,19   

  • Ozone is a special molecule consisting of 3 oxygen atoms.  

  • When mixed with an aliquot of blood removed from a patient and then reinfused it has a multitude of beneficial effects 20,21:  

  • It is directly antiviral 

  • Potently reduces inflammation 

  • Modulates the immune system 

  • Reduces oxidative stress 

  • Enhances oxygen delivery to tissues 

High dose intravenous vitamin C (HDIVC), up to 200000mg at a time, has been around for decades and used safely and effectively for a variety of indications to include infections and cancer. The conventional medical establishment considers anything above the TUL (tolerable upper limit) of 2000mg per day (orally) to be high dose.  In 2016, intravenous vitamin C  was found to be potentially useful as an adjunct in treating sepsis, a severe immune response to infection.  Since then, it has found its way even into U.S. ICUs at a dose of 1500mg, four times a day for a whopping total of 9000mg/day.  A study of twice daily dosing of 12000mg IVC for critically ill COVID-19 patients is ongoing in China.22 It is slated for completion in September.  

Vitamin C has a spectrum of action based on its dosing.  The RDA of 60mg may be just enough for some to prevent frank scurvy, but not enough to optimize function.  Doses up to 25000mg per day reduce oxidative stress, inflammation, and modulate immune function.  Doses above 50000mg daily act as an oxidizing agent and appear to be directly antiviral.23    

From a review of the literature, it appears that HDIVC has been relegated to critical care and at levels that would appear to be more supportive.  We should consider higher doses, earlier in the illness and higher doses in those already sick in our ICUs.  

References: 

  1. https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704 

  1. u J, Zhao S, Teng T, et al. Systematic Comparison of Two Animal-to-Human Transmitted Human Coronaviruses: SARS-CoV-2 and SARS-CoV. Viruses. 2020;12(2):244. Published 2020 Feb 22. doi:10.3390/v12020244 

  1. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. 2020;94(7):e00127-20. Published 2020 Mar 17. doi:10.1128/JVI.00127-20 

  1. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–637. doi:10.1002/path.1570 

  1. https://www.sciencealert.com/some-covid-19-patients-are-also-reporting-neurological-symptoms 

  1. Kindler,  E., Thiel, V. &  Weber, F. Interaction of SARS and  MERS Coronaviruses with the  Antiviral Interferon   Response.  Adv.  Virus Res.  96, 219–243 (2016).   

  1. Hu,  Y. et al. The  Severe  Acute  Respiratory Syndrome Coronavirus Nucleocapsid  Inhibits Type I Interferon  Production by  Interfering with TRIM25-Mediated  RIG-I  Ubiquitination J. Virol. 91, (2017).   

  1. Huang,  K.-J. et al.An interferon-gamma-related cytokine storm in SARS patients. J. Med. Virol. 75, 185–194 (2005).   

  1. Wenzhong, Liu; Hualan, Li (2020): COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv. Preprint. https://doi.org/10.26434/chemrxiv.11938173.v5 

  1. Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020; [Epub ahead of print 10 March 2020]. doi: https://doi.org/10.7326/M20-0504 

  1. https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf 

  1. https://www.sciencedirect.com/science/article/pii/S2666524720300033?via%3Dihub 

  1. https://www.medrxiv.org/content/10.1101/2020.03.30.20047217v2.full.pdf 

  1. https://www.covid19treatmentguidelines.nih.gov/overview/ 

  1. https://wholehealthhouston.com/node/62 

  1. https://www.mdpi.com/2072-6643/12/4/988/htm 

  1. https://naturalmedicines.therapeuticresearch.com/news/news-items/2020/april/clear-up-confusion-about-elderberry-in-covid-19-patients.aspx 

  1. https://theibizan.com/ozone-therapy-proving-successful-in-covid-19-patients/ 

  1. https://www.repubblica.it/salute/medicina-e-ricerca/2020/04/06/news/coronavirus_l_ozonoterapia_evita_la_terapia_intensiva-253290022/?refresh_ce 

  1. https://clinmedjournals.org/articles/jide/journal-of-infectious-diseases-and-epidemiology-jide-6-113.pdf?jid=jide 

  1. https://www.pagepressjournals.org/index.php/ozone/article/view/9014/8692 

  1. https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02851-4 

  1. http://www.vitaminc.co.nz/pdf/OBSERVATIONS-ON-THE-DOSE-AND-ADMINISTRATI 

About the Author

Jason Gourlas, MPAS PA-C

For as long as he could remember, Jason has wanted to be a detective.  While serving as an Army medic, Jason realized that medicine combined detective work with his other love, science. He went through the Army PA program at Fort Sam while serving as a member of the Texas Army National Guard.  During his 22 + years in medicine, he has had a wide variety of experience in family practice, emergency medicine, neurotology (hearing and balance specialty), and surgical/trauma critical care.  For the last several years he has been studying and practicing functional and integrative medicine. He maintains certification in functional medicine through the American Academy of Anti-aging Medicine. 

About the Author

Jason Gourlas, MPAS PA-C

For as long as he could remember, Jason has wanted to be a detective.  While serving as an Army medic, Jason realized that medicine combined detective work with his other love, science.

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