COVID-19: The Modern Pandemic

Updated: May 15, 2020


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 TRANSMISSION

Incubation

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.




TESTING

Three 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-19

Once 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 INFECTION

As 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 HELP

1) 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.


TREATMENTS

PHARMACOLOGICAL


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