To keep up to date on this GLOBAL EMERGENCY, I have combines as much holistic and conventional information as I could into this document. Fear lies in uncertainty and I hope you find solace in knowledge like I do. Note that this information is not intended to treat and is for educational purposes only, you may do more harm than good if you are not under the guidance of a medical practitioner. Happy Persian New Year to all around the world and thank you for staying in during this difficult time.
For up to date number of COVID-19 cases around the world click here.
DANGERS OF COVID-19"Don't panic but don't ignore" - Dr. Paul Anderson, ND
Coronavirus is a family of viruses that are responsible for the common cold to severe acute respiratory syndrome (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. Several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host.
The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV primarily to our lungs as well as our kidneys, intestines and the endothelial lining of our blood vessels. COVID-19 does this by its "spike proteins". (Source)When it enters cells, it uses the hosts machinery to duplicate at high rates. (Source 1, (Source 2)
The 20% of people that end up in hospitals are the ones who have trouble breathing due to a thick mucus build up at the base of their lungs and may end up needing to be put on ventilatory support. As cases are on the rise, and hospitals resources are limited in most areas, flattening the curve and quarantining ourselves is of utmost importance. When we cease to be able to help everyone, some people will die due to pneumonia related complications, much like what has happened in Italy.
When SARS-CoV2 attacks our lung pneumocytes, it prevents cells from making biological detergents, called surfactant, to keep lung passages open.Thus, Acute Respiratory Distress Syndrome (ARDS) ensues and O2 levels fall, hence the necessity for ventilators. CoV genes 1 and 8 are predicted to interfere with heme, the red compound in blood, by kicking out iron, increasing serum iron. This disrupts our oxygen carrying capacity and in combination with pneumonia it becomes deadly.
"The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status." Guo et al.
MOST AT RISK
Elderly over the age of 65.
Children under the age of 2.
Individuals with pre-existing conditions or co-morbidities such as: Diabetes, Hypertension (especially those on ARBs or ACEi medications), Asthma, Kidney disease, COPD, Smokers, Immune Suppressed (due to organ replacement), Immune compromised (Cancer, AIDS/ HIV).
See graph for workers.
Diabetes and Increased Risk:
Blood sugar levels are often dysregulated as you age, this is due to insulin resistance which can lead to pre-diabetes and so on. The elevated levels of blood sugar for a long period of time and when dysregulated in diabetic patients, can cause what is called glycation of hemoglobin.
High Blood Pressure and Increased Risk:
Individuals taking ACEi and ARB medications to control their blood pressure are at increased risk as taking these medications can increase the number of ACE2 receptors in the body, creating more docking sites for the spike proteins of COVID-19. Licorice root also binds these receptors which is why a common side effect is increased blood pressure. Individuals at risk of getting the virus have been recommended to go off the mediation and go on a different antihypertensive, however this may not be common practice at the moment and problems with such a change may arise.
FLATTENING THE CURVE
By staying quarantined, and decreasing our exposure to everyone, since the incubation period of the virus would expose us to someone who is infected but asymptomatic, we are slowing down the spread of disease. Even though the area under the curve or the number of people who will become infected (which is 30-75% depending on public health measures and compliance of the public) will NOT change, by slowing down the spread of the disease we are decreasing the pressure on hospital staff and resources, ensuring a higher recovery rate and a lower death rate and allowing for more time for the most effective cure to be determined before new cases arise later on.
We need to get to the point of "herd immunity" where enough of us have caught the disease and are immune to getting it again, which researchers say reinfection is unlikely, and no new cases are arising.
For trends on confirmed cases between quarantined vs non-quarantined countries click here.
SYMPTOMS AND TRANSMISSIONIncubation
Research has reported a viral shedding period of up to 14 days, though some outliers have demonstrated 27 days. (Source) Furthermore, someone with the illness can be completely asymptomatic until they recover. (Source)
COVID-19 transmission:
Air: 3 hours
Copper: 4 hours
Cardboard: 24 hours
Stainless Steel: 2-3 days
Plastic: 2-3 days
(Source)
Hygiene
Soap and water for washing body surfaces when person has been touching a public environment has been shown to be effective if the individual scrubs thoroughly.
70% isopropyl alcohol has been effective when sprayed on surfaces and left to dry in killing many bacteria and viruses including COVID-19.
1:100 bleach to water solution that has been left on surfaces for 10 minutes then wiped with a damp towel has been proven to also be fully effective. (Do not mix bleach and alcohol)
Of course taking precautionary measures such as covering your face in your elbow when coughing or sneezing is important.
Symptoms can be a combination of any of the following, an individual does not have to have all symptoms to be a carrier:
Asymptomatic
Scratchy throat
Fatigue
Cough (dry)
Body aches
High fever
And in a small population gastrointestinal symptoms such as diarrhea.
In advanced stages, the individual will have trouble breathing. This is the stage at which you need to reach out to your local clinic over the phone, they can guide you as to your next steps. Do not visit the hospital if you are not having difficulty breathing.
TESTINGThree main tests:
Test for the viral RNA (so-called PCR tests)
A 15-minute antibody test for the SARS-CoV-2 spike protein which is less reliable (89% sensitive).
DNA sequencing which will be important to track the evolution of the virus and detect co-infections that make the condition worse, like flu, colds, and bacteria called pneumococci that cause bacterial pneumonia.
Unfortunately testing is currently reserved for individuals who have trouble breathing and enter an emergency department in most places except for China or Singapore.
MORTALITY RATES
The CDC reported that among 508 (12%) patients known to have been hospitalized:
9% were aged ≥85 years,
36% were aged 65–84 years,
17% were aged 55–64 years,
18% were 45–54 years,
and 20% were aged 20–44 years.
Less than 1% of hospitalizations were among persons aged ≤19 years (Figure 2).
The percentage of persons hospitalized increased with age, from 2%–3% among persons aged ≤19 years, to ≥31% among adults aged ≥85 years. (Table).
Among 121 patients known to have been admitted to an ICU,
7% of cases were reported among adults ≥85 years,
46% among adults aged 65–84 years,
36% among adults aged 45–64 years,
and 12% among adults aged 20–44 years (Figure 2).
No ICU admissions were reported among persons aged ≤19 years.
Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table).
Among 44 cases with known outcome of death,
15 (34%) deaths were reported among adults aged ≥85 years,
20 (46%) among adults aged 65–84 years,
and nine (20%) among adults aged 20–64 years.
Case-fatality percentages increased with increasing age, from no deaths reported among persons aged ≤19 years to highest percentages (10%–27%) among adults aged ≥85 years (Table) (Figure 2).
The global mortality rate at the moment is about 3% but this depends on the number of tests to accurately diagnose individuals which is not occurring at this time.
For more information on mortality rate click here.
THE IMMUNE SYSTEM AND COVID-19Once the virus enter our cells, it stimulates the inflammasome (a collection of proteins, receptors and mediators involved in inflammation) leading to uncontrolled inflammation. The inflammasome thus triggers a cytokine storm to tackle the virus. (Source) Certain flus like the Spanish flu pandemic caused the cytokine storm response to be very strong, increasing interleukin- 6, because it down-regulated white blood cells called T regulatory cells which we are also seeing in COVID-19. The immune system of young adults responds with a stronger cytokine storm than older adults and young children. This is what results in scar tissue formation and was responsible for higher mortality rates in young adults in 1919 when the Spanish flu pandemic resurfaced due to the mutation of the virus which ended up costing the lives of young adults. (Source 1, Source 2)
RECOVERY AFTER COVID-19 INFECTIONAs many doctors have seen in clinical practice as well as evidence in research studies, after someone recovers from a viral infection that was hard on their body, an autoimmune condition can arise and often does arise in genetically susceptible individuals. At this point there is no cure for autoimmune conditions other than supportive care to modulate the immune system.
Another concern is that while our immune system fights the virus, it inadvertently destroys our tissues in the process. This may post long term health issues and we may see that if infected with another type of virus months later, the individual may have a hard time recovering if their tissues are still healing.
WHAT YOU CAN DO TO HELP1) Stay home for all non-urgent matters at all times. This includes seeing your family members, who you think are not sick, for at least 14 days.
2) Donate blood and or plasma. Hospitals still need supplies as always.
TREATMENTSPHARMACOLOGICAL
1. These therapies have all been applied to counteract the cytokine storm and have made progress:
Interleukin-6 (IL-6) antibody blocker
Stem cell therapy
Transfusion of convalescent plasma
2. Chloroquine, a cheap malaria drug, "is predicted to prevent ORF1 antibody, ORF3a and ORF10 from attacking heme and inhibit binding of ORF8 to heme. Although 99% of the virus is seemingly stable, whats disturbing is ORF1 and 8 mutate very fast. We still have conflicting results of data, [but some people have improved dramatically taking this medication]" -Dr. David Sinclair, PhD AO. This medication has been used in South Korea and China and has been effective. (Source 1, Source 2)
3. Gilead's remdesivir with interferon beta, has a 50% chance of working.
4. Acetaminophen/ Tylenol/ Paracetamol, has been shown to help decrease dangerously high fevers over 104 F in patients infected with the virus.
Drugs doctors are finding ineffective:
Ibuprofen has been shown to illicit an early onset of pneumonia and is associated with poorer outcomes and disease severity by interfering with the immune system.
HERBS
Antiviral Herbs with strong evidence:
Note that these herbs should be used under the direction of a naturopathic physician.
Epigallocatechin gallate (EGCG) from Green Tea: In addition to reducing inflammation, green tea enhances the immune system and targets one of the processes involved in COVID-19 replication. (Source)
Andrographis paniculata: Research shows that this combination of andrographis and eleuthero relieves cold symptoms better than echinacea or placebo in children. Preliminary clinical research shows that patients with influenza who take a specific product (Kan Jang, Swedish Herbal Institute) containing andrographis extract and eleuthero have more rapid symptom relief when compared with patients taking amantadine. Taking this combination product also seems to reduce the risk of post-influenza complications such as rhinosinusitis or bronchitis when compared with amantadine. (Source)
Glycyrrhiza glabra (licorice): consumption of a licorice herbal tincture stimulated immune cells, as quantified by CD69 expression on CD4 and CD8 T cells. In animal research, an herbal product containing licorice increased the number of leukocytes in the spleen and liver and increased splenic natural killer toxicity. Preliminary evidence suggests that glycyrrhizin may inhibit the growth of the coronavirus, which is associated with severe acute respiratory syndrome (SARS). The exact mechanism of the antiviral effect of glycyrrhizin is not known. In laboratory research, licorice or its constituents have also demonstrated antiviral activity against Epstein-Barr virus, HIV-1, respiratory syncytial virus, arboviruses, vaccinia virus, vesicular stomatitis virus, herpes simplex, influenza A, and others. (Source)
Melissa officinalis (lemon balm): in vitro research shows that the addition of lemon balm essential oil to inoculated cells protects against influenza A virus (H9N2), with the most benefit seen when the oil is added prior to virus inoculation. Evidence from animal research shows that lemon balm extract has immune-stimulating effects. (Source)
Sambucus nigra (elderberry): Clinical research shows that some elderberry extracts might reduce flu-like symptoms. On average, elderberry extract seems to reduce the duration of symptoms by about 56%. (Source) There has been some research showing that different forms and concentrations of elderberry can increase or decrease IL-6.
Herbs to help with high fever (>103F)
Magnolol from Magnolia Officinalis (Source)
Tanacetum parthenium (feverfew)
Herbs that may be doing more harm:
Echinacea purpurea: The use of this herb has been vast for cold and flus and it has strong immune stimulating properties. However it can worsen the cytokine storm by increasing IL-6 and inhibiting T regulatory cells. However this may be due to the constituents extracted dependent on the solvent and part of the plant. Furthermore, its immune stimulating properties can be a contraindication in individuals with autoimmune disorders. (Source 1, Source 2, Source 3, Source 4)
MUSHROOMS
Mushrooms have been long evidenced to help modulate the immune system.
Shiitake
Reishi
Maitake
Cordyceps
FUNGI
(1, 3) - Beta Glucan: While some preliminary clinical evidence suggests that beta-glucans promote Th1 and Th2 immune responses, evidence from various other clinical trials suggests that beta-glucans do not increase the production of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, IL-10, IL-12, IL-1beta, IL-6, IL-8, IL-1, IL-1ra, white blood cell counts, or NK cell activity. However, in one clinical trial, taking a yeast-derived beta-glucans supplement daily for 6 weeks modestly reduced IL-6 levels and increased IL-10 levels in overweight adults. (Source)
VITAMINS AND MINERALS
When it comes to vitamins and minerals we have to keep in mind that all of them have a role in the body at all times. When we eat whole foods, we are getting adequate amounts of the nutrients in our bodies that are helping us maintain a healthy immune system. I will only list the few that at therapeutic doses, have a significant impact on our immune system.
Vitamin A: Helps with wound healing, immune function. Retinoic acid is required in maintaining sufficient levels of natural killer cells, and preliminary evidence suggests that retinoic acid might increase the production of cytokines, such as interleukin 1 (IL-1). Additionally, B lymphocyte growth, differentiation, and activation are dependent on retinol. Vitamin A deficiency is associated with increased risk of infectious morbidity and mortality. In animal research, vitamin A increases surfactant production in the lungs and increases alveolarization. (Source)
B complex (All B vitamins): B vitamins are co-factors for all sorts of reactions in the body. It is of no debate that vitamin Bs are essential for immune health as well as general health.
Vitamin C: Best known for its effects as an antioxidant and its role in maintaining proper immune function, T-lymphocyte activity, phagocyte function, leukocyte mobility, and possibly antibody and interferon production seem to be increased by vitamin C. Vitamin C levels in phagocytes and lymphocytes are up to 100 times greater than in plasma. Vitamin C might protect normal tissues against reactive oxygen species that are produced by phagocytes during a viral infection. It might also enhance the proliferative responses of T-lymphocytes. Some researchers think vitamin C supplements might be useful to prevent other respiratory viral infections, such as severe acute respiratory syndrome (SARS), but there are no reliable clinical studies to support this hypothesis. (Source)
Vitamin D3: Help modulate autoimmune conditions, helps repair lung tissue. Patients with low 25-hydroxy vitamin D serum levels are 27% to 55% more likely to have upper respiratory tract infections compared to patients with normal levels (Source)
Zinc: research has shown that when zinc is administered along with chloroquine, COVID-19 is unable to replicate inside the cell. (Source) Other research supports zincs role in disallowing viruses to stick to cell membranes.
OTHER SUPPLEMENTS
Glutathione: May inhibit the activity of enzymes that help the flu virus colonize cells lining the mouth and throat. Flu-infected mice fed glutathione-enriched drinking water have lower tissue virus levels than untreated mice. Human studies are needed to determine the effects of glutathione on flu infection. (Source)
IV Therapy
Vitamin C
Ozone IV therapy
Glutathione push
Injections:
Vitamin D3
B complex and folate
Resources:
Written: March 20th 2020