Coronavirus Update & Integrative Natural Considerations
By Dr. Devaki Lindsey Berkson (4/2/2020)
How the Virus Binds, Possible Natural Answers to Block & Protect
(If you are already well acquainted with Coronavirus/COVID-19 then
scroll down to Underlying Mechanisms of Viral Attack)
We are in a war. A war with a powerful virus.
Viruses are bags of genetic material that just want to make more and more copies of themselves. They do this by infecting you and me, potential hosts. Often these copies start to make mistakes and eventually make milder mutated copies that help the virus go away.
This novel virus appears to be able to “self-correct” its mistakes, making it less vulnerable to getting milder. This virus has a longer incubation period so many can be infected without symptoms and unknowingly walk among us, moving this virus foreword.
Most of the world is rightfully scared.
I am not an epidemiologist but have been practicing functional and natural interventions for many years. I teach continuing medical education courses to medical doctors, pharmacists, and nurse practitioners, write books, blogs and host a podcast, all focused on agile thinking and integrative and science-based approaches.
This new respiratory virus, which causes an illness officially known as COVID-19, has rapidly spread to every continent except Antarctica since first apparently emerging in China in December 2019 (time will tell where and how this all happened). More than 950,063 diagnosed cases have been reported as of today by the Center for Systems Science and Engineering at Johns Hopkins University (updates easily found at Coronavirus Worldometers.com).
The U.S. has by far the highest national tally in the world. A voice of reason through all this is Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. Dr. Fauci reports that statistical models, that usually give worst case scenarios, say hundreds of thousands of U.S. citizens may die even if guidelines of social distancing are extended.
We need to know what we can do. It makes sense to look at the biology of how this virus works to possibly theorize protective answers to safeguard ourselves. To make these potentially devastating statistics not come true. Also, to provide hope and peace of mind that we can take proactive steps beyond washing our hands and social distancing.
Eighty percent of infected people will have milder symptoms, 15% will have serious symptoms and 5% will be fighting for their lives. It is the goal of this article, armed with informative concepts, to help prevent infection or extend the group of 80%.
Originally, I was writing that since so few testing kits have been available, we don’t really know the accurate extent of fatality rates. But, we are seeing huge fatality rates now in countries where kits are available. For example, Italy, the second hardest hit country in the world and the most drastically affected in Europe, reported a staggering 10,000 cases in just 3 weeks.
During a press briefing at the White House on March 14th, the administration’s coronavirus coordinator, Dr. Deborah Birx, reported that people under 20 may be “asymptomatic carriers” passing this disease forward. When I switched to drive-thru pick-up only, I could look into Whole Foods and people, including babies, were elbow to elbow. It looked like business as usual. I went to HEB, my local grocery, when the store opened. Within a half hour, literally hundreds of folks in one organized line waiting with carts, but all breathing each other’s air. COVID-19 passed in droplets that are passed by talking[i], coughing and sneezing, so crowded air right now is not safe.
Immunity is a Developing Story
Immunity in many diseases occurs after you have been ill. When enough humans get immunity, this is called “herd immunity” and it helps stop the virus. Along with the viruses own copying mistakes as mentioned above.
What is really scary with COVID-19 is that immunity may not necessarily occur after being sick. This remains to be validated. In China, some people that tested positive, then became well and tested negative. But, within a short period of time tested positive once again. We are not sure if this was an issue with testing or that immunity is short lived. Many aspects of this virus remain to be seen.
In response to this issue, Dr. Fauci said he is willing to bet anything that people who recover from this new virus are protected[ii]. We hope so.
I was going to try to calm us down; but after reading, listening, and diving into the science, this viral “isness” is a dangerous reality. I hope to give theories as to how this virus attacks and maims and then outline plausible natural science-based interventions. Of course, the virus is so new that some of these tools haven’t been tested yet, although some have been tested for other viruses. These natural tools are based on the physiology of how this virus is so far known to act.
I am known for taking diverse elements of science and physiology and connecting-the-dots to come up with natural safe answers that you and your doctor should both consider. That is what I intend to do in this article.
At first many young adults and media thought mostly seniors were most at danger, so there has been a slow start to take this seriously enough to stop celebrating spring break or partying. A whole group of UT Austin students went to Mexico for spring break. Turns out many were positive when they got to Mexico spreading the virus in that country. Upon returning in commercial flights, they spread the virus there.
This Virus Can Attack Anyone
A report came out of China about a baby, born from a mother that had the virus, which tested positive for the virus. As of writing this missive, three infants have died from COVID-19, one in China and two in the states. Pregnant? Stay home and interact with much smaller groups. Buy your groceries online and have them delivered.
Several startling studies out of China early showed that young adults can get this disease. More startling, these patients can have CT scan-proven pneumonia (meaning both lungs look angry and filled with ground glass looking opacities), yet a few patients in this condition didn’t even exhibit any kind of symptoms[iii]. It’s startling but you can have pneumonia and not know it.
On March 19th Medscape, a conservative on-line medical journal that goes out to about 6 million health-care providers, published that 20% of U.S. COVID-19 patients were aged 20-64 years[iv]. Houston, Texas reported on March 29, 2020 that 30% of its hospitalizations for COVID-19 were young adults aged 20 to 44 years old[v]. More than 50% of the most severe coronavirus patients in France[vi] are under age 60.
One of my colleagues wrote yesterday that her completely healthy 25-year old daughter, within two days, was fighting for her life on a ventilator. Fortunately, she is pulling through. But some patients that pull through, even young ones, may have permanent or long-term health consequences or tissue damage such as heart, lung or kidney on-going issues.
U.S. children are some of the unhealthiest the world. About a third of U.S. children are obese and/or have underlying health issues. Many of U.S. young adults smoke by vaping. Smoking makes one more vulnerable to the virus. We can only hope that our statistics will not be the worst in the world because our underlying health is so challenged.
It’s established that this is not just a disease of the elderly, though the elderly are more at risk for fatalities. Much of the world is now responding though a few American politicians and one world leader are still not on board.
But Good Can Come Out of Anything
Heroes show up. Crisis is transformative. Perspectives get honed. Who we are shows up.
As the economy halts, one industry leader, My Pillow CEO, fired 150 workers without pay. In contrast Columbia Sportwear CEO cut his own salary to $10,000 a year to keep his retail employees paid.
In an appeal issued on March 30th 2020, the UN Chief Secretary-General António Guterres urged warring parties across the world to lay down their weapons in support of the bigger battle against COVID-19: the common enemy that is now threatening all of humankind.
“The fury of the virus illustrates the folly of war”, Guterres urged. “That is why today, I am calling for an immediate global ceasefire in all corners of the world. It is time to put armed conflict on lockdown and focus together on the true fight of our lives.”
While the world reels, let’s see what we can, in science-based and sensible manner, do for ourselves. It’s obvious that hand washing is good, but not good enough.
Phases of COVID-19
Phase One: For 80% of people it is the only phase. The incubation period from exposure to illness is 2 to 14 days, with an average of 5 days. Unlike the flu, COVID-19 symptoms appear gradually with fatigue, aches and pains and a sore throat or mild dry cough or occasionally a stuffed or runny nose, sometimes nausea and loss of appetite. For some people, the first symptom is abdominal pain or diarrhea without respiratory complaints. Those presenting with “only” gastrointestinal symptoms (gut pain and/or diarrhea) seem to fare worse.
Loss of smell and taste frequently occurs. These symptoms typically last about 5 days and are followed by recovery.
Keep in mind, some people get infected and proceed to becoming seriously ill, without any symptoms at all.
Phase Two occurs in approximately 20% of people, typically starting at 5 days. People experience increasing cough and shortness of breath, and symptoms of pneumonia. But remember, this can also occur without symptoms.
Both Phase One and Phase Two groups of patients will continue to shed the virus in various secretions for several weeks. They may still be contagious after symptoms end.
Fecal shedding has been demonstrated from some patients, meaning the virus is found in bowel material[vii]. Some studies show that even though an ill patient finally gets well demonstrated by a follow-up negative throat swabs, their fecal material may still test positive with COVID-19 due to viral shedding’s. This is not the time to consider fecal transplantation. Households must be very careful of toilet hygiene when any member has been ill with COVID-19. If anyone has been ill with COVID-19 consider be extremely careful of toilet hygiene for at least a month.
The French Marseille’s Study found that taking the anti-malarial drug hydroxychloroquine significantly reduced the duration of viral shedding; and adding the antibiotic azithromycin shortened it even further. The combination of these medications caused, by day 6 of the illness, almost no detectable virus.
However, this may not be a consistent outcome. Some U.S. ER doctors report positive clinical response with these medications and some do not. The Food and Drug Administration (FDA) has passed an emergency bill okaying the use of these medications to treat COVID-19 as well as stop viral shedding, but responses are not consistent.
Social Distancing Is Not the Only Answer
The Skagit Valley Chorale, made up of 60 dedicated singers, decided to hold its March 10th choir meeting. They used sanitizers at the door, didn’t hug or touch, and sat apart. They sang for 2 ½ hours. Neary 3-weeks later 45 have now been diagnosed positive for COVID-19 and two are sadly, dead.
A March 17th article in the New England Journal of Medicine[viii] wrote that this virus can be suspended in mist coming out of an asymptomatic carrier and remain “viable and infectious” for three hours. So even if you go to a supermarket with gloves and sanitizer you can be inhaling someone else’s exhales. This is where masks help. If there are contaminated droplets in the air, you can inhale it while you push your sanitized supermarket cart if not wearing a mask. Masks do prevent you inhaling contaminated droplets as well as help you stop touching your face.
Since air can hold contaminated viral droplets it seems prudent that anyone over 60 years of age and all people with underlying health issues, order food curbside and not go into supermarkets. You also need to have “viral hygiene” when unpacking the goods, which we will address further down this article.
Let’s Get Some Facts Straight
- COVID-19 is the name of the illness.
- SARS-CoV-2 is the new coronavirus causing the disease COVID-19.
Getting Coronavirus Straight
- Corona viruses are a family of viruses made from RNA instead of DNA.
- There are many species of corona viruses that produce respiratory and gastrointestinal illness in both humans and animals. Four strains cause the common cold.
- Corona family of viruses can cause symptoms ranging from common cold symptoms to gut pain to severe pneumonia[ix]. Old people and those with underlying chronic health conditions are most vulnerable. But we are seeing young people and infants die, too.
- Viruses want to enter into you—the host—into your cells, and make copies and more copies and more copies of themselves. They proliferate. Inside us.
- The coronavirus has spikes on its surface that allow it to attach to receptors on the membrane of our cells, with a preference for cells in the lungs, heart, kidneys and the entire gastrointestinal tract.
- Once a coronavirus enters a person—lodging itself in the upper respiratory system and hijacking the cell’s hardware—the virus hijacks our DNA operating system inside the cells and injects information into our own DNA.
- The DNA passes the information to our cell’s RNA, with instructions to make millions of photocopies of the virus.
- The virus uses us, the host, to replicate. That’s all it wants to do. Make more of itself.
- Once this all happens in the lungs, the infected cells cannot adequately take up oxygen and transfer that oxygen to our blood when we breathe.
- When most RNA viruses replicate themselves in a host, the process is quick and dirty, as most RNA viruses have no “proofreading” mechanism. This can lead to frequent and random mutations. Mutations where the virus might get worse or milder. The vast majority of these mutations kill the virus, and along with “herd immunity” increasing, the virus slowly dies out.
- Unlike other RNA viruses, however, coronaviruses such as this novel SARS-CoV-2do have some capacity to “check for errors” when they replicate[x]. They have an enzyme that actually corrects mistakes. This makes the COVID-19 virus more dangerous, like a Ferrari of viruses. It’s a novel, smart, stealth virus.
- Most people with a bacterial pneumonia need to be on ventilators 3-4 days. COVID-19 patients are on them an average of 11-24 days. This virus plays dirty.
Routes of Transmission
Air: COVID-19 is transmitted via droplets that can remain in the air for 3 hours. If someone coughs or sneezes, or talks, even if asymptomatic, you can walk by where they had been and “catch” COVID-19 by inhalation. In a Zumba class with a few to 50 sweating folks, some of that flying sweat, if contaminated, might get onto and thus into you. In line at a supermarket you can inhale in some droplets.
Viruses are small particles, typically around 0.1 microns in size (by comparison, a red blood cell is about 7 microns). The SARS-CoV-2 virus is on the large size for viruses and thus has plenty of room to house “smarts”, such as the self-correcting replication mentioned above.
A recent study from the National Institutes of Health[xi] found that droplets may remain airborne for 3-4 hours, but they start losing infectivity rapidly. The droplets lose half their potency within 66 minutes.
Food-borne or water-borne infection is possible but not yet demonstrated.
Surfaces: The COVID-19 virus can live on hard, shiny surfaces for up to 72 hours. This includes your phone, door handles, and toys. If the surface is contaminated, and you touch it and then touch your face, you can become infected.
The virus does degrade over time. Still, avoid touching surfaces in shared spaces and avoid touching your face and frequently wash your hands. For example, be mindful of buttons at cross-walks. In Sydney, Australia, pedestrian crossings have now become automated, so people can avoid touching these buttons!
Wash your hands frequently with soap and in the hottest water you can stand for at least 20 seconds. Wash your hands more often than usual.
If you are going out into the world, besides hand-washing, avoid constant touching of the mucous membranes that lead to your airways. Masks help you stop touching your face.
Try not to rub your eyes, pick your nose, or touch your lips and mouth. If you are quarantining at home this is not necessary. If you live with folks quarantining you need to practice all these mindful actions.
COVID-19 can live on cardboard for up to 24-hours. This means things like food containers, pizza boxes, and Amazon packages. So leave these items in your garage if possible for a few days before bringing them into the house. Order in pizza? Remove the food with gloves and leave the container outside where you will throw it away later with gloves on.
- Cards and cash may carry COVID-19.
- COVID-19 does not live on food. But it might on skins like oranges, avocadoes and bananas so wash these in relatively hot water and soap before storage.
- The virus is not killed by freezing.
- It is killed by heat and/or microwaving for a few minutes.
- Clean your phone once home, every time you leave.
- Leave your grocery bags outside the house and move items, using gloves, carefully into your home.
- Put anything in a carton somewhere outside your inner home, like inside your garage or a room or corner you can avoid, for at least 5 days.
- With gloves, take food out of plastic wrappers, which then need to be carefully thrown away.
- Wash all food cans in hot water for 20 seconds.
- Try to think of acting within as much a” sterile field” as you can accomplish inside your home and kitchen.
To slow the spread of SARS-CoV-2, assume everything outside your home is potentially contaminated and needs to be treated as such when you bring items into your sacred home space.
The following cleansers will kill most viruses, including corona viruses, on hard surfaces with 30 seconds of contact: 70% alcohol, 0.5 % hydrogen peroxide, 0.1 % bleach (hypochlorous acid).
The studies have been done on hard nonporous surfaces, so alcohol, peroxide or bleach will work on counter tops but may not work the same on your skin or other porous surfaces.
Purelle hand sanitizer is 70% alcohol and may be an adequate substitute for soap, but remember that contact needs to be maintained for up to 30 seconds. Grapefruit seed extract cleaners work. Clean door-knobs, phones and keyboards daily or more often if you are going outside the home. I am not other than for walks.
What makes a lot of sense for protection?
Researchers report that the virus can remain in your nose and sinus cavities for up to three days. If you need to go out and interact among society, when you come home, steam will help viruses caught in nasal passages from penetrating your mucous linings and going into your lungs.
Things You Can Do
Steam: Heat inactivates the virus. We can use this information by using steam. Bring salted water to a boil. Let it cool down a bit, to below 120 degrees F. Put a towel over your head. Breathe in the moist steam for about two minutes.
Be very mindful not to burn your mucous membranes!
You don’t need to inhale the steam into your mouth. Any virus that gets swallowed will be inactivated by your gastric acid juices. Thank goodness. Often elders have much less, if no gastric acid, this may be one reason (of the many) that seniors are more vulnerable.
Consider adding a couple drops of eucalyptus essential oil to disinfect airways.
Sitting in the sauna at 140 degrees F for 15 minutes daily, if you own a home unit, would be helpful.
Masks: Masks that make a complete seal are hard to find anymore, like the N95 mask. More commonly used masks are not well sealed. If you are in a public place, you might consider wearing a mask anyway to keep yourself from touching your mouth, nose, or eyes. We touch our face frequently without even realizing it.
Natural Home Cleaner: Dr. Erica Elliot, an environmental physician in Santa Fe, NM, and a dear colleague (we have co-taught several courses) recommends grapefruit seed extract to wipe down surfaces. Grapefruit seed extract has been shown to inactivate various viruses[xii] and probably will be helpful with COVID-19 though this has not been yet validated.
A significant number of individuals that are infected actually remain “asymptomatic”. This may be as many as 25% up to 50%! These are individuals that may not have any symptoms yet can contribute to transmission. Testing identifies these people. Without sufficient testing of more and more people, symptomatic people are left to interact with society and spread the disease.
Those that are asymptomatic[xiii] can still shed significant virus into their oropharyngeal) compartment (throat right behind your mouth), probably up to 48 hours before showing symptoms. This helps explain how rapidly this virus continues to spread across the country, because we have asymptomatic transmitters transmitting 48 hours (or longer) before they become symptomatic. Or we have people that carry the virus without ever getting ill. Much remains to be proven over time.
Coronavirus is a family of viruses that has been with humans for a long time. Most corona viral infections are mild. Some are deadly.
The SARS-CoV (Severe Acute Respiratory Syndrome) epidemic of 2003 infected over 8,000 people worldwide, with a 10% mortality rate[xiv] within 8 months[xv]. The closely related MERS-CoV of 2012 also induced acute pneumonia, similar to the one caused by SARS-CoV[xvi].
The current SARS-CoV-2 has 79% similarity to SARS-CoV. It also can cause pneumonia of varying severity in all adult patients regardless of age!
This new SARS-CoV-2 is estimated to be up to 1,000 times more infectious than SARS-CoV or other coronaviruses[xvii].
No one knows what will happen or when this will end. The “tincture of time” will tell.
WHO Declares an Epidemic
On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic (meaning humans world-wide are vulnerable to getting infected). On that day, 126,000 people around the world contracted COVID-19, while 122 countries around the world reported COVID-19 infections.
Containment is critical. Countries like South Korea and Taiwan acted fast and aggressively. We in the U.S. have not. Our government did not. It is trying to catch up. We are going to see a lot of people get ill and many fatally because doctors didn’t have test kits and we were not instructed as to the severity of this virus and how to appropriately create containment.
Startling CT Scans of Chinese COVID-19 Patients
What really turned my head around was a study[xviii] looking at 101 cases of COVID-19 patients that all had pneumonia. All had imaging of their lungs, from multiple centers in China, called lung CT scans. What was startling, as scientists and government have been saying that mostly the elderly are at risk, was that 70% of these 101 COVID-19 pneumonia patients were aged 21 to 50 years old! Over two-thirds were younger than we have been led to believe are at high risk.
This study came out March 3rd 2020 in The American Journal of Roentgenology. It was run by three departments of radiology from The Second Xiangya Hospital, the First Hospital of Changsha, and Quality Control Center, all in China, and the Changsha Public Health Treatment Center, in Hunan, P.R. China.
Thus, this virus is not only an enemy of the elderly. Anyone can get it. And get it bad enough to get pneumonia. Pneumonia then sets the scene for catastrophic lung damage and possible death.
The major issues is if your lungs get damaged enough, you can lose the ability to breathe on your own. Once a patient gets severe lung issues, such as acute respiratory distress syndrome, which requires ventilation, 86% of these patients statistically go on to die[xix].
Unofficial reports from doctors and healthcare workers in China and Italy describe many very ill COVID-19 patients as having symptoms of bilateral interstitial pneumonia that require help to breathe (ventilation). That’s the issue: how many ventilators do countries have to keep up? In Italy they report they cannot. They’ve been running out of ventilators. We in the U.S. are also running out of ventilators.
Even young patients without underlying health issues can and have been getting severe pneumonia that requires intensive ICU care and the need for ventilators[xx] [xxi]. This virus loves the lungs. You will soon see it also has a proclivity for other tissues.
Another stunning study was released by scientists in Germany on March 8, 2020[xxii]. Again, younger adults got the disease, proven by throat swabs. Many had no underlying health problems. One person who tested positive had no symptoms at all!
Another noteworthy study came out of China[xxiii] this February 2020 in The Lancet. Eighty-one patients with coronavirus pneumonia and severe acute respiratory syndrome, were assessed by CT scans. Forty-two were men (52%) and 39 women (48%), with a mean age of 49.5 years old! Some patients had mild symptoms; some had no symptoms of any kind, but their imaging by CT showed COVID-19 pneumonia present!
COVID-19 pneumonia with proven chest CT imaging abnormalities, can occur in asymptomatic patients!
People who have pneumonia from this virus might not have symptoms and yet be walking around infecting you and others.
You have to take this to heart when you consider how we all need, just for this time, to isolate from groups of people. People who don’t know they have the virus can infect you. People who were talking in one part of the store an hour ago, and now only you are there, may infect you.
This Virus Proliferates Fast
SARS-CoV-2 viral copies replicate faster than the older SARS-CoV virus. Viral swabs of COVID-19 are one thousand times higher than those of SARS-CoV from 2003[xxiv].
This means this new virus spreads fast, especially in the first five days in the throat when you might not even know you have it. These “spikes of rapid viral growth” are one of the reasons for this virus’s high rate of contagion and ability to infect a lot of people, even young adults. Even in infants.
A study published in JAMA[xxv] on March 11, 2020, collected specimens from 205 COVID-19 patients. The mean age of patients was 44 years, between 25 to 67 years of age. Again, younger than we have been led to believe. Sixty-eight percent of the patients were male. But this data is from China where men were smokers and women not so much, hence they were more susceptible due to smoking, perhaps not due to being male.
The Viral Mystery
The coronavirus is certainly confusing. How panicked, or not, and how many action steps, or not, should we be taking? I practice part-time in Naples, Florida, where the demographic is mostly in the high risk group. We had a meeting with the owners and physicians are worried this will hit Florida and its retirees hard. All of us doctors are working via phone.
We don’t know how long this will last.
But we worry who might die.
Fatality Number Issues
WHO reported that the time between symptom onset and death ranged from 2 to 8 weeks[xxvi]. We have one closed community with COVID-19 exposure. This was the Diamond Princess Cruise Ship.
- 3,500 people were tested.
- 706 tested positive for COVID-19.
- Six died.
That’s a 0.85% fatality rate where we knew all the numbers of those infected.
No country at this time has that luxury.
So let’s look so far as of April 2nd, 2020. Remember, fatality rates take time to come down long after numbers of cases start to decrease.
- China has reported 81,589 cases and 3,318 fatalities. But U.S. Secretary of State, Michael Pompeo has urged for transparency as more and more many experts do not believe the statistics coming out of China, and fear they are much, much higher. The Lancet Infectious Diseases[xxvii] calculated 5.5% (I calculate 4.05%) fatality rate over all for China, but could be 5.8 to 20% in Wuhan (estimates have varied greatly). Fatality rates are tricky since it’s so impossible to know accurately the total number of all infected Things appear to be slowing down there due to their containment diligence and community altruism. For example, 31 new cases occurred as of March 30th.
- Italy: 110,574 confirmed cases, 13,155 deaths (7-11% death rate compared to the global average of 3.4% fatality rate but again epidemiologists think these numbers will be less when more testing is able to be done). Italy is a “touchy, feely” country and it took a long time to get social distancing in place. The cases are starting to slow down and it will then take a while for the slowing down of fatalities to catch up.
- France: 56,989 confirmed cases, 4,032 deaths
- Iran: 50,468 cases with 3,160 deaths.
- United States 215,344 confirmed cases with 5,112 deaths
- Globally: 950,063 confirmed cases, 48,259 deaths
- The numbers are frighteningly rising on all fronts; cases and fatalities. But slowing down in some countries.
The fatality percentages suggested globally was estimated by the WHO on March 3rd, 2020, to be approximately 3.4% (compared to 0.05% with most flus) yet are hard to judge or predict in the U.S..
Testing in America was initially inadequate. And still is. Even though most doctor’s offices do not have kits, some individuals can obtain prescriptions to use drive-through testing locations or go to Quest and LabCorp for testing.
Since many symptomatic people have not been able to be tested, we don’t really have an accurate count of how many people have been infected. Therefore we don’t have the comparison of those who survived versus those that didn’t, thus the fatality stats of who might die are not clear. So the final fatality statistics may change. You need to understand this when you hear fatality statistics.
As of April 2nd 2020, Germany has 77,981 cases with 931 fatalities. That gives Germany one of the lowest fatality rates in the world, making it an outlier compared to places like Italy, where 11.0% of confirmed patients have died from COVID-19.
Why does Germany have fewer deaths? Many believe this is because Germany rapidly rolled out testing. They are then intervening earlier so they can save lives. In the U.S. most of the people they are testing are those with symptoms.
It’s all about identifying the “asymptomatic carriers” so they don’t infect someone who is likely to get COVID-19 and go on to die.
On March 20, Lothar Wieler, the president of the Robert Koch Institute—Germany’s main public health body—reported that German laboratories are now able to conduct some 160,000 tests per week, about as many as they performed in the entire two months prior to March 15th.
South Korea has been very advanced in both containment and testing, their case fatality rate stands at around 1.6%.
Kit Issues in the U.S.
Why have we had all these issues with testing?
When the coronavirus epidemic started late last year in China, the World Health Organization (WHO), in collaboration with German researchers, rapidly developed a test for the coronavirus. This is the test used by every other country except the U.S.!
The CDC insisted that only its test, not the one developed by the WHO, could be used on suspected cases, and these CDC “designed and approved” tests would be administered under limited circumstances[xxviii].” Dr. Robert R. Redfield is the head of the C.D.C. The test his agency developed failed in February.
Aggressive screening might have helped contain the coronavirus in the United States. But technical flaws and regulatory hurdles made the U.S. lose about a month of concentrated response.
Dr. Anthony S. Fauci told members of Congress that the early inability to test was “a failing” of the administration’s response to a deadly, global pandemic.
In contrast, test kits are widely available in many other countries, including Iran, Japan, South Korea, Germany, and China because they are using the WHO kits. In fact, hundreds of thousands of coronavirus tests have been run in other countries.
Fatality statistics in Italy are showing us that this virus is serious.
This virus started to hit in late December. It’s now the end of March. Recently we have been told drive-through testing would be available at Target and Walmart, but I’ve called a number in Austin and none have this capability and didn’t know what I was talking about. They didn’t say we will have them next week. They were clueless. This is changing rapidly as our country responds.
Naples, Florida, now allows a patient with a doctor’s order to go to hospital drive-ups where they can swab their nose and throat and not get out of the car. Just this week at the Naples’ Center for Functional Medicine, we were able to order blood tests looking for antibodies, made possible by Quest and LabCorp but a paper put out by the WHO in consort with over 500 Chinese scientists and epidemiologists say that more in-depth tests are needed than only IgG and IgM viral antibody testing.
Test results are taking too many days to come back with results while potentially contaminated people mingle with society.
In the U.S., up till now, medical offices have mostly been running blind. No fault of the doctors or clinics. They were told they had to call health departments to get permission to get kits and for some reason some clinics report being denied kit access when they called. Hopefully we are seeing changes but testing is a huge issue.
At a government inquiry, senators asked health officials who was in charge of the American COVID-19 kits. No one could be named! This was in early March, months after the Chinese outbreak. Dr. Anthony Stephen Fauci said, “Let’s be candid… We do not have anyone in charge. We are not prepared to deal with this situation.”
The U.S. had a department set up to prepare for pandemics like this. But the U.S. pandemic response team was eliminated in 2018 to cut costs. In March 2018, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, left the administration and this global health security team was disbanded.
Also, in 2018 the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak also due to pulled funds.
We are in a WHO-proclaimed pandemic. Pandemic does not mean everyone will get devastatingly ill. Most will recover within about two weeks.
But some are getting very ill. Some are dying. The CDC guesstimate is that between 160 million and 214 million people in the U.S. “could,” in a worst case scenario, be infected over the course of the epidemic, which could last many more months to possibly a year.
No one is sure. Taking functional medicine action steps for protection makes sense.
Social distancing, which in China and other very pro-active countries means keeping approximately 6-feet from others, is not being done here in the States. In fact, many young people are defiantly going out to packed bars and partying it up.
Kids are at less risk. In China, 2.1% of cases were children. Children can be exposed to the virus but not get ill, or get an extremely mild case. Most recover in two weeks. But LA had a death of a child under 12 years of age from COVID-19, and two infants, one in China and one in Illinois have died from COVID-19.
In most children, COVID-19 rarely goes into the lungs[xxix]. But kids and young adults can be carriers. The scientific thought as discussed by Dr. Birx is that part of the rapidity of growth is the ability to have no symptoms but still pass it forward.
Health Care Workers
Front line health care workers like ER doctors, even younger ones, are getting sicker from the corona virus than the rest of the population, other than the elderly. Two doctors with COVID-19 are in critical condition at the time of writing this article. One is a Washington physician in his 40’s and another is a 70-year old in New Jersey.
Dr. Li Wenliang, the Wuhan Central Hospital physician who is hailed as a hero for trying to sound the alarm about this virus after diagnosing and treating seven quarantined patients in December, died within weeks of being exposed.
One theory is that front line medical personnel are exposed to higher doses of virus. Add exhaustion and possibly poor dietary choices as these folks often work hard and eat fast. We don’t know yet. But I hope they or someone that loves them, reads this article and shares some of the suggestions. Too bad they don’t have IV anti-viral nutrients available to try to help as you will learn below.
The elderly seem to be most at risk. If you are 65 or over, with underlying health issues, you’re at increased risk. Over 70 years old, the risk starts increasing, and possibly triples (if not more than that) when people are in their 80’s. The highest fatalities occur in the 8th decade.
As we age, so do our immune systems. And more so if there is an underlying illness. Or if the person does not regularly exercise, eat healthy food, get enough sleep, etc.
Science demonstrates that older immune systems have less natural “killer cell” activity, which protects against foreign invaders. Seniors have thinner mucous membranes, so immune cells have less healthy “fight” in them. Elders often are insufficient in basic nutrients that act as natural anti-virals, such as Vitamin A, Vitamin D, and Vitamin C. More on these later.
Those with underlying health conditions are also very susceptible. They too often have poor immune systems and inadequate killer cell function. People with chronic health conditions are especially at risk especially if their illness involves the lungs, kidneys, heart, esophagus, or bladder issues. This is because the virus can rapidly attach to specific cells inside these tissues and then proliferate and render havoc.
I think if you are 60 years or older, stay out of all stores, even grocery stores. Stay home. Get curbside. Many towns have free delivery services for those over 60. Call and ask the grocery stores to give you their phone numbers. Be safe.
Underlying Mechanisms of Viral Attack: ACE2 Receptors
A major theory of how COVID-19 attacks and invades the body explains why certain people are at risk and perhaps gives us some other speculative (not yet tested) ideas of protection besides washing your hands with soap, not touching your face, or practicing social distancing, which in my book are not big enough guns for this battle. In February 2020, an article[xxxii] out of Greece, published in Current Medical Chemistry, which explained how the coronavirus is able to invade the body. COVID-19 goes into the body by “binding” to a receptor called the angiotensin-converting enzyme II, or the ACE2 receptor[xxxiii] [xxxiv].
ACE2 is expressed (lives) in a variety of tissues in your body. For example, it lives throughout the mucosal lining of your mouth (oral cavity). When someone with the virus sits in a seat and touches the metal arm frame, where you might then sit, you can touch the virus or inhale “viral sheddings” or virus droplets that can then gain entrance into your body by binding to the ACE2 receptors inside your mouth. And then into your respiratory tract.
The tissue with the next highest ACE2 receptors are your lungs. Extremely high levels of ACE2 expression occur throughout all lung cells[xxxv]. This is why one of the severe complications of COVID-19 is acute respiratory distress. In fact, the exact pattern of COVID-19 pneumonia matches the distribution of ACE2 in the lungs.
The COVID-19 gets into the lungs by binding to ACE2 receptors and this damages normal lung function and puts the infected person at risk of pneumonia, one the most serious complications.
ACE2 receptors are robustly found throughout the entire cardiovascular system. In the heart. In your lungs. Your lungs have air sacs and they are encircled with ACE2 receptors. It’s this fact that makes COVID-19 pneumonia different from pneumonia you get after a typical flu.
ACE2 is an enzyme with strong beneficial effects in the organs that produce it. The healthier and the more ACE2 receptors you have, the healthier these organs. Young humans have lots of healthy ACE2 receptors. As we age or get more unhealthy from obesity to type2 diabetes, we have less numbers and less healthy ACE2 receptors.
Once COVID-19 attached to ACE2 receptors, it damages them.
COVID-19 virus inactivates or “exhausts” ACE2 receptors. So, part of our nutritional suggestions down below are to enhance the stability or resilience of ACE2 receptors. Which, remember, are damaged by COVID-19.
ACE2 receptors are high in healthy individuals. Kids have lots of ACE2 receptors. People with chronic health conditions such as obesity, cancer, type 1 or 2 Diabetes, autoimmune diseases etc. have much less ACE2 receptors or more poorly functioning ones.
The healthier and higher number of ACE2 receptors you have, the more likely to be less adversely affected by COVID-19. Hmmmm. There is presently an NIH study looking at the possible use of the blood pressure medicine Losartan’sã possible protective action on COVID-19[xxxvi].
We know that being hypertensive seems to be a risk factor for getting a more aggressive case of COVID-19. Knowing what kind of blood pressure medications they were on would be very helpful.
How do dangerous corona viruses bind into ACE2?
These viruses have Spike (S) proteins. These S proteins are like cars that drive the virus into parking spaces (ACE2). They have high affinity, meaning they love ACE2 parking spaces. It’s almost as if the car gets “pulled” in magnetically.
Interestingly, the HIV virus[xxxvii] also used similar spike proteins to invade humans. Dangerous viruses have similar dangerous portals of damage!
When virus S proteins bind to ACE2 your and my cells have natural proteolytic enzyme action (proteases-TMPRSS2) which could possibly block the virus’s entry. Some people may have better enzymatic action at this level than others, so they don’t get ill or get less ill.
The viral ability to park into ACE2 appears to be blocked by some blood pressure medications (such as ACE inhibitors and ARBs), which also improves lung function[xxxviii].
There is the possibility of looking for vaccines that block viral Spike proteins, or drugs that block ACE2 receptors, or delivering more ACE2.
Both mice and pediatric human reports[xxxix] show that giving more ACE2 in patients with severe respiratory distress have improved outcomes. So, more ACE2 might be good.
In 2008, Austrian scientists discussed a possible treatment for the severe acute respiratory syndrome caused by SARS-coronavirus (SARS-CoV) which spread rapidly from China throughout the world. It caused more than 800 deaths due to the development of acute respiratory distress syndrome.
What treatment did they recommend in this peer review article[xl]? ACE inhibitors. Also, Angiostensin II Receptor Blockers (ARBs). These are both common blood pressure medications.
Keep in mind this is speculation but it’s being actively looked at[xli].
These above authors wrote: “Interestingly, a novel homologue of angiotensin converting-enzyme (ACE), termed angiotensin converting enzyme 2 (ACE2) has been identified as a receptor for SARS-CoV.”
ACE2 is a negative regulator of the many cells in the body, keeping the “peace” among tissues, so to speak. When the virus binds to ACE2 receptors, that physiologic peace is lost.
Using ACE2 knockout mice (mice genetically raised to have no ACE2 receptors), these mice had severe lung issues. The Austrians demonstrated that ACE2 protects lungs from respiratory distress. Severe viral infections like SARS-CoV and most likely COVID-19, reduce ACE2 expression. This puts lungs and whatever other tissues are high in ACE2, vulnerable to catastrophic reaction to the viruses and severe illness.
ACE2 Protects Tissues
These Austrian researchers suggest that ACE inhibitor medications will be great new treatments against these nasty viruses. So much so they titled this peer review article: Lessons From SARS: A New Potential Therapy for Acute Respiratory Distress Syndrome (ARDS) With Angiotensin Converting Enzyme 2 (ACE2)[xlii]. I love it when scholarly titles tell you what’s inside.
They injected the nasty SARS-CoV virus into mice. These mice developed severe lung failure. But if the mice were first given ACE inhibitors, lung damage from the virus stopped cold.
However, some experts wonder if ACE along with ARB blood pressure medications elevate the numbers of ACE2 receptors and worsen the disease. I don’t agree with this. Some articles suggest that people with hypertension (who are thus on medication) are more at risk of COVID-19.
High blood pressure appears to be a striking underlying health condition in those with the virus who develop severe disease versus those who do not[xliii]. However, this link has not panned out. Association has only been shown in animals and not in humans[xliv] [xlv].
What we do know is the virus uses the renin-angiotensin system. For you geeks (ACE2 and type II transmembrane serine proteases). Thus, it makes sense to look at this link for protection and/or treatment.
The questions become, do blood pressure medications like ACE and ARBs upregulate more parking spots for viral attack or provide protection? In reading the literature it seems to me that these meds could be protective.
I have spoken at long length with my dear colleague Dr. Mark Houston and we have been madly sending peer review articles back and forth to each other (we teach together for CMEs for MDs and he has designed the world’s oldest and best functional cardiology course). Dr. Houston wants me to be clear in this article that the use of these blood pressure medications has not been thoroughly tested in large human studies.
Both animal models and human studies have looked at human patients with viral pneumonia with continued ACE blood pressure medication use. It appears that these patients are not “as sick” as patients in which these meds have been discontinued[xlvi].
We know that ACE binding sites are critical to coronavirus infection and lung injury.
Decreased ACE2 and normal ACE levels are seen in lungs of mice infected with SARS-CoV.
We know ACE2 is route of entry. But more, less, blocked, boosted; studies are a bit all over the place. In my opinion the research suggests that meds that address ACE2 appear protective.
I am on a very low dose of ACE inhibitor meds now as I am in a high-risk group even though I do not have hypertension. You need to discuss this with your doctor and especially if you have chronic lung illness and have high blood pressure.
Dr. Houston wrote to me, “This is all still theory. No proof in humans. But I think either (ACE or ARB) will work but, ARB may be better.”
In the last two decades, two serious coronavirus infections manifested—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). They had elevated death rates. They both could bind to the ACE2 receptors in the lungs[xlvii].
Since part of COVID-19’s damage occurs by damaging ACE2 receptors, nutrients, foods or drugs that stabilize and enhance ACE2 receptors make sense. We will share some possibilities below.
ACE2 Receptors and Smoke
ACE2 has also been identified in other areas of the body, including the esophagus, heart, kidney, and bladder. All these organs are at potential risk of COVID-19 infection because they have more ACE2 receptors than other tissues.
Smoke exposure to rats caused an increase in ACE2 lung receptors, lungs, when compared with controls not exposed to smoke.
The more ACE2 receptors in any tissue, the more vulnerable it is to COVID-19.
Smoke increases that vulnerability.
Anyone exposed to excessive smoke, like smokers, or folks exposed to severe air pollution, have increased numbers of ACE2 receptors in their lungs. Thus, they have more terrain for the COVID-19 to “dig in” for invasion and attack.
Smokers will be more prone to having more ACE2 receptors in their lungs. You can be a primary smoker, if you smoke yourself. Or a second-hand smoker, if you are environmentally exposed. In China, there is a huge dose of both.
A third of the world’s smokers live there. There are over 350 million cigarette smokers there. So many Chinese (mostly men) smoke, that their culture has been referred to as suffering from “a pulmonary health crisis[l].”
China also has increased levels of smoke pollution. Inhaling smoke in the air literally increases numbers of ACE2 receptors. The Chinese might have had such a huge outbreak because they have more primary smokers and secondarily are exposed to more smoke air pollution, so they are much more vulnerable to COVID-19 than non-smokers in the U.S. .
Italy is also a country with lots of smokers. They had a slight decrease for a while, but there have been no changes in smoking rates since 2007[li]. Approximately 21% of their population smoke, while 14% of U.S. citizens smoke. This may partially account for Italy’s mass epidemic of COVID-19.
In China, 60% of males smoke compared to 4% of females. COVID-19 has been reported to be more deadly in males from the information coming out of China. U.S. smokers are 16% men and 12% of women. This should be a great inspiration to give up smoking.
Get your kids and young adults to stop smoking and/or vaping.
Additional Entry Players: Furins, Inflammasomes and Viroporins
Once we can see the players that enable COVID-19, we can look to nutrients, foods and/or medications that block each one.
So let’s first look at how this virus grows so fast? Another theory that dove tails into the ACE2 theory, are furins. Furins are enzymes that control traffic into cells. They are found throughout our bodies. Especially our lungs and other tissues prone to COVID-19 attack.
What is very unique about the COVID-19 virus is that it also contains “furin-like” cleavage sites [liv] that lock the “S” protein into ACE2 receptors. Furins help “push’ the virus deeper into cells. By the way, these furin-like sites were not found in the older SARS-like CoVs virus.
Furins are robustly found in lung tissue. Furins help push COVID-into lung cells. Furins may also help the virus enter into cells without ACE2 receptors, but this remains to be seen.
Once the COVID-19 virus enters the cell, enabled by furins, “inflammasomes” appear.
Inflammasomes are part of our innate immune system. Most inflammasomes are part of what is called the NLR family.
Inflammasomes are platforms of protein, referred to as scaffolding, that boost the release of more inflammatory molecules such as pro-inflammatory molecules called cytokines such as (IL)1β and IL18. Suddenly inflammatory storms start to erupt at cellular levels.
The SARS-CoV virus gains entry assisted by another player. The virus can boost viroporin[lv] production (proteins that allow all this nasty virulence to unfold), that then activates inflammasomes.
The University of Michigan (my alma mater) Zhang’s lab, has shown that the SARS-CoV-2 virus happens to do a great job of binding to furin enzymes that start the process and also binds to two viroporins that make the process very aggressive[lvi].
Summary – COVID-19’s Potential Routes into Your Body
Viral spike (S) proteins bind to ACE2 and/or furins > allowing virus inside cells > release inflammasomes, which release more inflammatory molecules > and/or binds to viroporins > whole process gets more aggressive and more virus gets inside more cells > tissues get inflamed, fiery and you get ill.
All this takes place in ACE2 receptors.
But ACE2 receptors may not be the only way in.
Thus, these serious coronaviruses have four players enhancing entry and damage:
- ACE2 receptors
These nasty viruses have a lot of possible support to enter your cells and create havoc.
The good news is that the major inflammasome found to cause extensive lung distress is the NLRP3 inflammasome[lvii].
And there is a natural hormone that stops it.
Good News: Melatonin!
Let me paint the back-copy.
- There are no COVID-19 fatalities under the age of 9[lviii].
- If young kids get COVID-19, they often don’t get very ill and the symptoms tend to stay away from the lungs[lix].
- What’s a huge difference between youth and adults? The day and night sleep hormone, melatonin. Kids have a lot more melatonin.
- The rise of melatonin starts in the third trimester of pregnancy[lx] and continues to be highest at ages one through five. Then melatonin blood levels start to slowly decline[lxi] and become very low in the elderly. Low melatonin levels in adulthood cause many to suffer with insomnia. The most severe cases are in nursing homes where elders suffer with the “sun-downers” syndrome: they are awake at night and sleep during the day.
Enter the mighty multi-tasking hormone, melatonin.
Most people think of melatonin as a sleep hormone that keeps us in sync with light and dark. It is higher in the blood when it is dark, and we should sleep. And it is lower in the blood when it is light, and we should be awake.
But there’s more.
Of all things, melatonin binds to NLRP3 inflammasomes and blocks their fiery actions.
Melatonin protects against the downstream negative results of NLRP3 inflammasomes. For example, NLRP3 inflammasomes damage the Golgi apparati that make mitochondria and hormone receptors. So, when melatonin stops the inflammatory actions of NLRP3, it protects mitochondria and hormones. Mitochondria are the energy organelles (factories) inside cells that give energy to cells to function optimally.
Melatonin is also one of the most powerful antioxidants in the body. It’s a “clean” antioxidant, meaning it doesn’t make more damaging molecules as it’s metabolized, as most antioxidants do.
So, melatonin lowers production of proinflammatory cytokines. Melatonin inhibits NLRP3 inflammasomes[lxii]. When it’s given to experimental mice with severe heart issues (myocardial septic conditions), it transforms the life-threatening condition into a milder one while enhancing the survival of the mice[lxiii] [lxiv].
Melatonin supplementation counteracts severe inflammatory responses such as pro-inflammatory cytokines and NLRP3 inflammasomes.
Melatonin Fights Deadly Inflammation
It seems reasonable that melatonin supplementation in” high sustained-release dosages” will prevent or reduce acute respiratory issues caused by COVID-19 by suppressing NLRP3 inflammasomes[lxv] .
In an animal model of acute lung injury, melatonin markedly reduced lung damage. How? Melatonin inhibited NLRP3 inflammasomes[lxvi].
In rodent models of acute respiratory distress syndrome similar to what these dangerous coronaviruses can do, melatonin treatment (with added mitochondria) significantly slowed down the lung aspect of the disease[lxvii] .
I have been using high-dose melatonin in breast cancer survivors for years. It tamps down the nasty actions of estrogen and acts like a natural aromatase inhibitor. So much so, a number of drug companies tried to get it added to pharmaceutical aromatase medications. This has become a well-accepted functional oncologic protocol. So, we know one can take high doses of melatonin safely. I wrote about melatonin’s amazing job descriptions in Safe Hormones, Smart Women[lxviii]. Now melatonin’s usefulness shines again.
A study released on March 6, 2020, demonstrated that by increasing melatonin (with the use of a melatonin receptor promoter or agonist) the damaging effects of ventilator-induced lung injury could be prevented in rodent models[lxix]! It’s in mice, but it holds out hope for what melatonin can do in humans in these COVID-19 times.
What else blocks sepsis in mice by inhibiting NLRP3 activation: nitric oxide[lxx] as well as vitamin C (Ascorbic acid)[lxxi]. Taking these supplements prophylactically or as adjunctive treatment makes sense. I’m on them myself.
Melatonin is an amazing hormone. Years ago, I was a hormone scholar at an environmental estrogen think tank at Tulane (The Center for Bioenviromental Research) headed by the world-famous estrogen scientist John McLachan PhD. I was lucky to attend brown-bag lunch lectures where I learned all about melatonin from Dr. David Blask, an MD, PhD. He is one heady scientist with a total focus on melatonin. Dr. Blask’s life-long work uncovered melatonin’s ability to suppress tumor uptake of glucose. Melatonin has many protective actions in the human body. Now here we add another critical one. Thank you, Mother Nature!
Keep in Mind
If you suffer from an autoimmune disease, it may not be advisable to use melatonin, or other immune supporters such as mushrooms, iodine, elderberry and prebiotics or probiotics. These all stimulate innate immune function. If you become sick with symptoms of COVID-19, you should stop the use of immune boosters, some examples being medicinal mushroom extracts, elderberry and immune-enhancing pre- or probiotics.
Two Stages of COVID-19 and Nutrient Use
According to Dr. Leo Galland, an internist and immunologist practicing in NYC this illness has two stages. Dr. Galland and I are colleagues; a number of decades ago we lectured together and collaborated on digestive formulations. (An interview with Dr. Galland is published on Dr. Berkson’s Best Health Radio at www.drlindseyberkson.com and iTunes, Spotify, etc.)
- The 1st stage is approximately the first 5 days when your “innate immune system” needs to react. Immune boosters such as you will learn below, Vitamins A, C, and D, for example, are helpful. They boost your innate immune system’s response so immune boosting actions makes sense. This is when you may or may not have a fever (only half of COVID-19 patients seem to get a fever), you get fatigue, muscle aches, and possibly GI symptoms.
- The 2nd stage is about a pro-inflammatory response, or cytokine storm. Your body is flooded with molecules that in a sense cause “fire” and thus, damage, to many tissues. Many immune boosters would “feed” this fire, so now you want tools that block fire. You want anti-inflammatories. You don’t want high-dose immune boosters that can feed the fire.
It’s all about “immune balance” – doing what is best at each phase of the illness.
Initially, COVID-19 mimics the flu—higher fever than is typical with the “usual” flu, headache, cough, fatigue, and less muscle aches than a typical flu with onset of lung congestion and/or cough.
Some of the unique symptoms of this virus compared to most other viruses are shortness of breath and nausea, as the ACE2 receptors are rich in the lungs and esophagus, where the virus can bind. And reversible loss of taste and smell can occur.
GI symptoms like diarrhea can occur. Outcomes for these patients may be worse.
COVID-19 can occur with NO symptoms.
Remember, anyone can have this virus and not have the above symptoms because we are all unique, so our symptoms are unique. Also, this virus is alive and has “consciousness,” so it is evolving and mutating and the newer forms may have different presenting symptoms.
- First five to seven days of milder symptoms of which 80% of people will get well within two to three weeks.
- Second stage – about 20% of people will go on to develop pneumonia and a quarter of these patients will need intensive care. During this stage there is much greater lung involvement, literally gasping for air, as a storm of fiery molecules rages within the lungs and starts to travel throughout the body.
What To Do
Mask: Wearing masks when you go out to stop touching your face and to block inhaling contaminated droplets. I am so high risk due to my health issues in the past, especially my lungs, I am hunkered down at home. I have purchased so many glasses from Costco’s optometry center that I’ve become good friends with the staff. One of them brought over a gift of a mask yesterday and left it in my open garage where I will leave it for 5 days before opening the plastic package.
Washing hands: Wash your hands often with soap and water for at least 20 seconds. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 70% alcohol.
If you are at high risk consider the following (as prevention, immune boosters are science-based sensible to take).
Melatonin: 10 to 20 mg time-release for adults. Kids make their own. If your child gets ill with a documented case of coronavirus, ask your doctor about adding in 1 mg of melatonin to their mix.
Anti-viral nutrients: Get your blood flowing with healthy levels of natural anti-viral nutrients. No one really knows the extent of this virus, but better safe than sorry and why not use natural answers. The focus here is on vitamins A, C, and D.
Many people have insufficient blood levels of vitamin A and C. These nutrients have antiviral abilities and are able to support the immune system when it is under viral attack.
Vitamin C: If you are not ill with the virus but want protection, take 3-5,000 mg/day of vitamin C. At the first sign of an illness, take 1,000 mg/hour until diarrhea develops, then back off for a time period. If and when you get the virus, IV vitamin C has three studies approved for treating COVID-19 mentioned below in the tools for when infected section[lxxii]. Functional doctors have been using high dose vitamin C IV, along with supportive nutrients, successfully for many years.
Vitamin A: 5,000 Units/day if you are not sick and 100,000 Units/day for four days at the first sign of an illness.
*Pregnant women cannot take these doses.
*Take vitamin A, not beta carotene. If you are a smoker, stay away from high dose beta-carotene, which is linked to increasing the incidence of lung cancer in smokers.
Vitamin D: is also very important for fighting infections. At the onset of an illness, taking 50,000 IU of vitamin D3/day for four days. Then go back down to your normal much lower levels. Do not stay on high levels of any of the vitamins. It’s best to work with a physician that knows how to monitor high-dose nutrient anti-viral intake.
Iodine: is essential to fight off infections and for proper immune system functioning. There is no bacteria, virus, parasite or fungus that is known to be resistant to iodine. Dr. David Brownstein is a colleague and dear friend. Dr. Brownstein has written in his amazing book, Iodine: Why You Need It, Why You Can’t Live Without It, that most of our population is low in iodine.
When I test patient’s serum iodine (which we do on every single new patient), 90% are way at the low end if not below it. Iodine levels have fallen nearly 60% over the last 40 years. The Recommended Dietary Allowance (RDA) for iodine is inadequate to supply enough iodine for all the bodily tissues.
For protection: taking half of a 12.5 mg iodine caplet twice a week makes sense. At the first sign of illness, increase to 25 mg of iodine for 4 days and then reduce the dose to ½ of a 12.5 mg caplet three times a week.
Please keep in mind that iodine can cause adverse effects; it is best used under the guidance of an iodine-knowledgeable doctor.
Nitric Oxide: Neo-40 was co-formulated by Dr. Nathan Bryan and Dr. Janet Zand, who are old friends and colleagues of mine. Dr. Bryan and I did an NO/dialysis study[lxxiii] together and published it in peer review. Neo-40 contains beet powder and a Chinese herb, which both boost the production of NO. One lozenge twice a day seems prudent for protection.
Zinc: Zinc is a powerful anti-viral mineral[lxxiv] [lxxv][lxxvi]. Zinc is part of the zinc finger proteins that help the body stop growth (replication) of invading viruses. Zinc has been tested and shown to have anti-viral activity against a number of viruses, even Ebola, though it’s not specifically been tested on COVID-19. Sufficient zinc stores inside cells are needed help successfully fight viruses.
Zinc has been shown to help shorten the duration of the common cold[lxxvii] if taken early in the course of the illness. The common cold virus is a member of the corona family. It’s a good idea to test your stores of zinc once a year. This is done by running plasma, white and/or red blood cell levels of zinc. It should be in the upper quartile of the reference range of the lab. Taking about 25 mg/d of zinc for most people, with a small amount of copper like 2 to 3 mg in a backup multi-mineral, is immune supportive. Although, the body works best in optimal ranges and excessive zinc is immune-suppressive. So don’t go overboard.
Zinc’s highest amount in the body is in the brain where zinc “allows” many hormone signals and neuronal actions to protect the brain. Zinc during a viral outbreak helps protect brain tissue from some of the collateral damage.
Mushrooms: Mushrooms contain, in their cell walls, natural polysaccharides called beta-glucans. These substances increase host immune defense by several mechanisms, such as activating a part of the immune system called the complement system, enhancing macrophages (a protective traveling white blood cell that does cellular surveillance), and boosting natural killer cell function. Ill patients, more at risk of the virus, along with the elderly, often have “lower killer cell activity” and thus more viral vulnerability.
Medicinal and dietary mushrooms both contain polysaccharides that can stimulate innate anti-viral immunity.
The most studied mushrooms are turkey tail (Coriolus or Trametes versicolor), maitake (Grifola frondosa), shiitake (Lentinula edodes) and reishi (Ganoderma lucidum).
Using mushroom supplements and adding them as whole foods to your diet seems smart.
Stages of Nutraceutical Support
Immune boosters listed above are helpful. The lung damage of advanced COVID-19 pneumonia is due to an “overactive” immune response, so immune boosting therapies should be used for prevention or early infection only, and not for severe illness.
You get much more ill. You need to lower immune boosters and add anti-inflammatories. You can stay on Vitamins A, D and C but at lower daily dosages. Stop high dosages of immune boosters. Minerals are still good but in low protective ranges. Mushrooms should be stopped as they great enhancers of innate immunity. You now want anti-inflammatories that naturally reconstitute ACE2 receptors.
Melatonin high dose still makes sense. Taking 10 mg 3 to 4 times a day.
Adding curcumin, anthocyanins, quercetin and resveratrol may be helpful. Keep in mind that these nutrients are not easy to absorb or to increase blood levels. Ideally we consume a diet rich in these healthy compounds, over our life-times that slowly raises our tissue stores of these nutrients. It’s not so easy to get them into cells within short periods of days or in times of duress.
This screams out loud why it is critical to live mindfully much of the time.
Curcumin blocks fiery cytokine release[lxxviii]. Curcuminoids (flavonoids of turmeric) inhibit the key pro-inflammatory cytokines, interleukin-1, interleukin-6 and tumor necrosis factor-α attack the lungs, kidney and heart in stage two COVID-19 patients.
The suppression of cytokine release by curcumin correlates with clinical improvement in experimental models of disease conditions where a cytokine storm plays a significant role in mortality.
The author’s concluded of the above study concluded that curcumin should be investigated to help patients with Ebola or suffering from a variety of cytokine storms. Intravenous formulations may allow achievement of therapeutic blood levels of curcumin. This is something for the functional medicine community to look into.
Some curcumins are much more bioavailable than others. Using Doctor’s brands that address bioavailability issues makes a lot of sense or consider IV (but I don’t know anyone doing that at this time). Just recently, the FDA removed the “compoundability” by compounding pharmacists to use curcumin in compounds. Sad.
Ang-1-7 peptide is a booster of ACE2 physiologic activities. It appears it can be compounded. Ask your local compounding pharmacist if they make this available. I have no experience with this peptide. I just wrote Las Colinas Pharmacy in Dallas where I get a lot of my compounded meds, and they just had ordered some to make it available to physicians and patients.
There is an enzyme that allows the virus to proliferate fast and possibly “correct” itself to keep making copies of itself without milder mutations. It’s called the 3CL protease enzyme. It breaks down cells and thus “lubes” the pathway for viruses by COVID-19 to flow throughout your body. So you want to take, especially in this second phase, 3CL protease inhibitors. Many of which are flavonoids and colorful polyphenoloic compounds found in purple, blue and black foods as well as flaxseeds[lxxix].
Coronaviruses (CoVs) have been rising targets of some flavonoids. The anti-viral activity of some flavonoids against CoVs is presumed directly caused by inhibiting 3C-like protease (3CLpro). Korean scientists tested a whole batch of flavonoids for their inhibitory effect against SARS-CoV 3CLpro. Herbacetin, rhoifolin and pectolinarin were found to efficiently block the enzymatic activity of SARS-CoV 3CLpro.
Herbacetin[lxxx] is found in flaxseed meal. In fact, this is one of the compounds that helps flax fight tumors. It also fights the ability of the virus to move throughout the body creating havoc. So it makes sense to consume flaxseeds if you are getting really ill from COVID-19.
Anything with lots of purple, blue and black color, will be rich in anthocyanins that are able to fight back the virus. Anthocyanins[lxxxi] themselves have anti-viral activity. Purple grapes, blue corn, pomegranates, purple carrots, black lentils, black rice, sprouted black lentils, are helpful foods.
Standardized elderberry contains high amounts of 3CL protease blocking protective anthocyanins. You want to purchase brands that state standardized amounts on the label.
Resveratrol is a great second stage anti-viral agent. In one cell study resveratrol was found to be a potent inhibitor of the MERS-CoV virus[lxxxii]. So much so, the authors stated that we should consider this agent if another dangerous virus shows up. Well, here we are!
Resveratrol helps block viral replication and other pathways of viral invasions. But this compound is not easily absorbed by the body. Use brands that have standardized amounts on the label and ideally come from professional lines that physicians utilize.
Quercetin is a flavonoid that blocks the 3CL-protease enzyme[lxxxiii] thus inhibiting the pathway of COVID-19 through you. It has been shown to be effective against dangerous viruses such as SARs[lxxxiv]. A number of studies show it to be an anti-viral agent helpful when the fire of cytokines is damaging tissues[lxxxv].
N-acetylcysteine (NAC) is an amino acid, N-acetyl-l-cysteine (NAC) that protected lung injury from acute injury against the H9N2 swine influenza virus[lxxxvi]. NAC has been shown to block viral replication, and it also blocks viral carditis. The heart can and often is, in the second stage, adversely effected by COVID-19[lxxxvii] so this makes sense with our present pandemic scenario.
ACE and ARB Meds
This class of blood pressure-lowering meds bind to the same receptors as the COVID-19 virus, so they act as inhibitors, meaning they stop the virus from binding with the ACE2 receptors. There is controversy over those who already taking these types of blood pressure meds, are they more or less protected from the virus. (This would make a good study in those already affected for you epidemiologists out there.)
I have a few elderly patients with chronic lung issues, who are also on blood pressure medicine. I am recommending they and their primary care docs consider substituting their present medication with ACE inhibitors (and/or ARBS), or adding a very small amount of ACE inhibitor to their present blood pressure mix, as long as they don’t get their blood pressure lowered too much.
ACE inhibitors have long been known to protect renal function by binding to these receptors in the kidneys, which protects renal tissue from damage by a variety of possible assaults to these receptors. It’s also why some folks start to cough on these meds as it activates so many lung ACE2 receptors and some folks have more than others.
I don’t have high blood pressure, but am a high-risk person. I decided to take 2 mg daily of Enalapril (an ACE inhibitor) as a protective measure. I’m tracking my blood pressure to make sure it stays at healthy levels.
You cannot make this decision without conferring with your primary healthcare doctor who knows your health history. This is a speculative protocol, not a CDC or medically-proven protocol. It’s physiologic common sense.
This may lower your blood pressure somewhat, which may not be appropriate for you, or it may have little effect other than being a super protective measure for you. But it’s trial-and-error, and you must work with a medical practitioner, as it is a prescription.
Nonsteroidal inflammatory meds have been shown to be “immunosuppressive”[lxxxviii] and this is a time when you want your immune system as strong as possible. However, in the U.S. the F.D.A. and other medical authorities have recently examined this issue over the past few weeks. The consensus has been that there is insufficient data to condemn the use of ibuprofen and related drugs in relation to COVID-19.
Stress, like sugar, depresses the immune system. Make as many decisions as possible by looking at all your options and taking the path of least stress. Mindfulness practices also help you move through stress. Stress, after all, is the perception of lack of control. Mindfulness puts us into a “present” that seems more controllable, no matter the circumstance. That builds resilience even to viruses.
If all the above seem too much or you feel you don’t need to cover all your bases, choose what makes most sense for your body. Perhaps do one or two protective measures. I would say put melatonin high on the list. I took 15 mg time-released last evening and had a terrific sleep! Feel like a million bucks this AM to finish this article for you.
The French Marseille’s Study
A renowned research professor in France has reported successful results from a new treatment for COVID-19, with early tests suggesting it can stop the virus from being contagious in just six days. However, a patient of Dr. Galland’s, positive with COVID-19 that finds herself presently in Paris, could not gain access to this treatment. Keep that in mind.
Professor Didier Raoult is an infectious disease specialist in Marseille, France. Professor Raoult was tasked by the French government to research possible treatments of COVID-19.
His team gave chloroquine, which is normally used mainly to prevent and treat malaria as well as rheumatoid arthritis, administered via the named drug, Plaquenil.
The treatment has now tested up to 90 patients, but the first 24 were among the first to become infected in the south east of France. They had voluntarily admitted themselves for this process.
Patients were given 600 mg per day for 10 days. They were closely monitored, as the drug can interact with other medication and cause severe side effects in some cases.
Professor Raoult said: “We were able to ascertain that patients who had not received Plaquenil (the drug containing hydroxychloroquine) were still contagious after six days, but of those that had received Plaquenil, after six days, were only 25% still contagious.”
Chloroquine phosphate and hydroxychloroquine have previously been used to treat coronavirus patients in China, in ongoing COVID-19 clinical trials.
In another study these researchers found that patients on a combination of Plaquenil along with the antibiotic Zithromax (Z-packs) had a 95% reduction in viral load by day 6.
However, some ER doctors in the U.S. have tried this treatment and found it not to be helpful.
Food, Water, and Lifestyle
You want a humming immune system. Avoid things that ding it. Eat lots of colorful veggies and fruits and, during this time, avoid refined sugar completely. For a few hours after consuming refined sugar, white blood cells don’t perform optimally. This is proven, replicated science.
Dehydration worsens any infectious process. Remember to drink water. I am going to take a short break and go get a glass right now.
Work out regularly, sleep well, and take prescribed meds regularly as directed.
The countries that have kept this coronavirus under control acted fast and aggressively toward containment. The U.S. has gotten off to a slow start.
This is a virus. A protein bag filled with RNA whose only purpose is to replicate. To do this it must have a host. The more it replicates the more its virulence. The less it can replicate we reduce its virulence.
- Flattening the curve is reducing our exposure and not overwhelming our health care system and our amazing frontline providers.
- But social distancing is also about reducing the viral aggressiveness!
Keep this in mind. Social distancing flattens the curve, reducing the rate of the increase in numbers of cases. But it also reduces the aggressiveness of the virus itself. This information does not seem to me to be getting out to our political and medical leaders[lxxxix].
If you pass this on, this factoid may help more people comply with isolating.
Data from abroad suggest that 10% to 20% of those that get ill, can end up in a more serious condition. This could translate into potentially hundreds of thousands who may need hospital care. To avoid this we need to take individual and social action.
We can’t be cavalier Americans thinking we can do whatever we want. South Korea and Taiwan kept people safely at a distance that lowered their fatality rates or at least the ones reported.
People flying into countries now must be in a holding area until they have medical evaluations. America has not been doing this consistently. Folks land and blend and stand in long lines with each other and even share pens to fill out forms.
It is good that schools are closed. Don’t go to church; pray at home.
Volunteers in other countries go around with thermometers checking for fevers.
Some countries have closed their air and seaports to foreigners. This makes sense. Act aggressively now and stop this, so we can soon go on with our lives.
If you are young, realize you can still get ill or be a vector of infection. Keeping away from others if you have been exposed for at least 14 days can help “flatten” this potential catapulting curve.
Don’t go to large gatherings and only go out when you must.
We need collective civic responsibility.
Be smart. This has not peaked yet, but you can help it slow down.
Instead of restaurants cook at home or order in and let them leave the food at the doorstep. Open up the containers with gloves and don’t put the containers on your kitchen counter, throw them away.
Don’t forget to spend some healthy time outside because sunlight and fresh air are part of staying well.
If You Get COVID-19
If you become ill with a viral infection, I suggest these viral protocols that have been used for viruses in functional medicine clinics for many years:
- IV Vitamin C[xc] if you can get it. Intravenous vitamin C is already being employed (successfully in a number of cases) in China against COVID-19. You can go to a functional medicine doctor or some cities have walk in IV rooms where they have doctors on site. This looks like one of the best options to start right away. If you can’t get IV vitamin C, try Vitamin C to bowel tolerance as described earlier in this article.
- Melatonin (30 mg time-release – at this time is my best guesstimate) before bed for one week, you may feel groggy during the day, but you need to sleep anyway and this will give you deep healing sleep; then reduce to 20 mg the next several weeks.
- Vitamin D3 (50,000 IU) for four days. After the four days, resume your previous dosing.
- Vitamin A Palmitate (100,000 IU) for 4 days, then reduce to 50,000 IUs for 4 days, and then down to 25,000 IU.
- Zinc (30 mg 4/day). Go down to 30 mg each day till at only one 30 mg. While doing this protocol make sure you have a multimineral on board with a bit of copper in it. But do not take too much zinc as, in excess, it is immune-suppressive. Most natural compounds in the body work best at Goldilocks “just right”. Never stay at a dose that causes nausea.
- It is best to work with a holistic doctor who can monitor your levels as both vitamin A and D can become toxic.
- Ozone whole blood irradiation[xci] [xcii] is a powerful tool against viruses (and everything else). Hydrogen peroxide IVs are helpful, too. I have not used these, but Dr. Brownstein swears by them. I use ozone regularly at home for prophylaxis as well as treating specific conditions.
- Consider clearing nasal passages with a Neti pot (with purified water).
- Consider Afrin nasal spray (3 sprays in each nostril, 3 days at a time, and then 3 days off). This could potentially keep your sinuses clear and prevent the symptoms from spreading to your lungs.
Thinking of getting the flu shot? This is what Dr. Brownstein says and I agree. “It won’t help coronavirus infections. There was a study that found an increased risk in non-influenza infections, including coronavirus, in those that received the trivalent flu vaccine”.
Death is a tragedy, but the death rate from this new coronavirus strain is most likely not going to be as severe in the U.S. as the recent statistics are suggesting.
We don’t smoke as much as China or Italy. Our air is less smoky.
Plus, we have some heavy-hitting nutritional and drug options.
Personally, I’m on all of the suggested items.
Keep In Mind
- Present viral numbers outside of Italy correlate to a 2-3+% death rate.
- Which means… 97-98% of those infected survive!
Remember that these reports aren’t completely accurate as we do not know the total number of cases.
Be mindful that viruses can mutate. So symptoms can morph.
That’s why during these times it makes sense to take some of the action steps mentioned above, especially if you are over 70 years old or already ill with a chronic underlying condition.
If You Must Fly (start all this two days ahead of time and day of flying)
- Melatonin 15 mg time release before bed. (Some people do better with much lower dosages and do not in higher dosages (over .5mg) if you have auto-immune illnesses, or work with a savvy physician).
- 4,000 IU of vitamin C
- 40,000 IU of vitamin A
- 5,000 Vitamin D
- Mushroom supplements
- Colloidal silver is a consideration but the FDA is blocking clinics and sites that discuss this so I am leaving this out of this article but am on it myself.
People are stepping up. Some grocery store workers are working double-shifts to keep food on the shelves. Some health care workers have sent their families home (transfamilial transference is over 80%[xciii]) while they go to work exposing themselves seven days a week.
As the sane voice in the middle of this epidemic, Andrew Mark Cuomo, governor of the hardest hit state, New York, “This is not a sprint this is a marathon. It’s not over quickly.”
Doctors, nurses, pharmacists (some have lines going out the doors, some are driving all day to deliver medications to folks at home), grocery store workers, police persons, fire fighters, transportation workers and on and on. Even the next door neighbor that calls or writes on the sidewalk in chalk, “How can I help?” and scratches out their cell number.
“Yes” said Governor Cuomo, “We are tired but look what others among us have to do and the challenge they are under and how they are stepping up. Who are we to complain about being tired when so many have done so much monumental efforts?”
We Will Get Through This
We are not in this alone, the world is united as one connected potential set of hosts for this virus.
Now we will see what we are all made of. Crisis is the “great make-over”. Often making us better after we have lived through it.
Our children have not lived through crises such as the Great Depression or World Wars or Vietnam.
They are living with world crisis now. They will not be the same.
On the other side of this pandemic, let’s hope we are more compassionate and mindful in our own lives and with each other. Perhaps even as the UN chief called for, less war.
The earth is a being.
She has become toxic and ill. Yet her ozone layers are healing[xciv]. Healing can take place on Mother Earth just like it can with you and me.
We have seen over the past few decades an increase in virulent viruses. Being a functional practitioner I look for “root cause”. Perhaps our earth has become a more toxic terrain to “allow” more virulent viruses.
What if part of our increasing pandemics is a “call to change” like disease can often be for humans to access how their bodies “allowed” themselves to be vulnerable to illness.
May we learn how to caretake the earth and each other with more thoughtfulness toward our children, our future and our health as a world community.
Note: Some of the information in this article may have changed after publication.
[i] COMMENTARY ‘Stealth Transmission’ of COVID-19 Demands Widespread Mask Usage Eldad Einav, MD MEDSCAPE March 29, 2020
[iii] Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study : American Journal of Roentgenology : Ahead of Print (AJR) https://www.ajronline.org/doi/10.2214/AJR.20.22976
|[iv] CORRECTION: 20% OF US COVID-10 DEATHS Were Aged 20-64 March 20th Medscape Analysis: Who is getting coronavirus in the Houston area? Health KPAC Channel 2 Aaron Barker, Senior Digital Editor March 29, 2020|
|3 3Analysis: Who is getting coronavirus in the Houston area? Health KPAC Channel 2 Aaron Barker, Senior Digital Editor March 29, 2020|
[vii] WHO-China-Joint-Mission-on-COVID-19-final report Feb 2020.
[viii] Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 [published online ahead of print, 2020 Mar 17]. N Engl J Med. 2020;10.1056/NEJMc2004973. doi:10.1056/NEJMc2004973
[ix] A Decade After SARS: Strategies for Controlling Emerging Coronaviruses – PubMed https://pubmed.ncbi.nlm.nih.gov/24217413-a-decade-after-sars-strategies-for-controlling-emerging-coronaviruses/
[xi] Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. The New England Journal of Medicine. DOI: 10.1056/NEJMc2004973 2020
[xii] Inhibitory effect of grapefruit seed extract (GSE) on avian pathogens. J Vet Med Sci. 2019;81(3):466–472. doi:10.1292/jvms.18-0754
[xiv] Identification of a Novel Coronavirus in Patients With Severe Acute Respiratory Syndrome – PubMed https://pubmed.ncbi.nlm.nih.gov/12690091-identification-of-a-novel-coronavirus-in-patients-with-severe-acute-respiratory-syndrome/
[xvi] Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia | Radiology https://pubs.rsna.org/doi/10.1148/radiol.2020200370
[xvii] A furin cleavage site was discovered in the S protein of the 2019 novel coronavirus https://www.researchgate.net/publication/338804501_A_furin_cleavage_site_was_discovered_in_the_S_protein_of_the_2019_novel_coronavirus
[xviii] Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study [published online ahead of print, 2020 Mar 3]. AJR Am J Roentgenol. 2020;1–6. doi:10.2214/AJR.20.22976
[xix] The Lancet Respiratory Medicine https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext,
[xxii] Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497–506. doi:10.1016/S0140-6736(20)30183-5
[xxiii] Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study [published online ahead of print, 2020 Feb 24]. Lancet Infect Dis. 2020;S1473-3099(20)30086-4. doi:10.1016/S1473-3099(20)30086-4
[xxiv] Detection of SARS coronavirus in patients with severe acute respiratory syndrome by conventional and real-time quantitative reverse transcription-PCR assays. Clin Chem. 2004;50(1):67–72. doi:10.1373/clinchem.2003.023663
[xxv] Detection of SARS-CoV-2 in Different Types of Clinical Specimens [published online ahead of print, 2020 Mar 11]. JAMA. 2020;10.1001/jama.2020.3786. doi:10.1001/jama.2020.3786
[xxvi] Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).
https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf Date: Feb, 2020 Date accessed: March 5, 2019
[xxvii] Real estimates of mortality following COVID-19 infection
Published:March 12, 2020DOI:https://doi.org/10.1016/S1473-3099(20)30195-X
[xxviii] Estimates of global seasonal influenza-associated respiratory mortality: a modelling study [published correction appears in Lancet. 2018 Jan 19;:]. Lancet. 2018;391(10127):1285–1300. doi:10.1016/S0140-6736(17)33293-2
[xxix] Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement [published online ahead of print, 2020 Feb 7]. World J Pediatrspet. 2020;10.1007/s12519-020-00343-7. doi:10.1007/s12519-020-00343-7
[xxx] Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia | Radiology
[xxxi] Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study : American Journal of Roentgenology : Ahead of Print (AJR
[xxxii] Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem. 2011;18(23):3506–3515. doi:10.2174/092986711796642562
[xxxiii] Structure analysis of the receptor binding of 2019-nCoV Biochem Biophys Res Commun. 2020;S0006-
[xxxiv] The emerging role of ACE2 in physiology and disease. J Pathol. 2007;212(1):1–11. doi:10.1002/path.2162
[xxxv] Angiotensin-converting enzyme 2 in lung diseases. Curr Opin Pharmacol. 2006;6(3):271–276. doi:10.1016/j.coph.2006.03.001
[xxxvi] Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics [published online ahead of print, 2020 Mar 4]. Drug Dev Res. 2020;10.1002/ddr.21656. doi:10.1002/ddr.21656
[xxxvii] Protein Structure and Sequence Reanalysis of 2019-nCoV Genome Refutes Snakes as Its Intermediate Host and the Unique Similarity between Its Spike Protein Insertions and HIV-1 [published online ahead of print, 2020 Mar 24]. J Proteome Res. 2020;acs.jproteome.0c00129. doi:10.1021/acs.jproteome.0c00129
[xxxviii] The Corona Conundrum: ACE2 and Hypertension Edition March 14, 2020, NephC updated March 15th 2020
[xxxix] Angiotensin-converting enzyme 2 inhibits lung injury induced by respiratory syncytial virus. Sci Rep. 2016;6:19840. Published 2016 Jan 27. doi:10.1038/srep19840
[xl] [Lessons From SARS: A New Potential Therapy for Acute Respiratory Distress Syndrome (ARDS) With Angiotensin Converting Enzyme 2 (ACE2)] 2008;57(3):302–310.
[xli] The Corona Conundrum: ACE2 and Hypertension Edition March 14, 2020, NephC updated March 15th 2020
[xlii] [Lessons From SARS: A New Potential Therapy for Acute Respiratory Distress Syndrome (ARDS) With Angiotensin Converting Enzyme 2 (ACE2)] 2008;57(3):302–310.
[xliii] Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published online ahead of print, 2020 Mar 11] [published correction appears in Lancet. 2020 Mar 12;:]. Lancet. 2020;S0140-6736(20)30566-3. doi:10.1016/S0140-6736(20)30566-3
[xliv] Angiotensin converting enzyme 2 activity and human atrial fibrillation: increased plasma angiotensin converting enzyme 2 activity is associated with atrial fibrillation and more advanced left atrial structural remodeling. Europace. 2017;19(8):1280–1287. doi:10.1093/europace/euw246
[xlv] Elevated plasma angiotensin converting enzyme 2 activity is an independent predictor of major adverse cardiac events in patients with obstructive coronary artery disease. PLoS One. 2018;13(6):e0198144. Published 2018 Jun 13. doi:10.1371/journal.pone.0198144
[xlvi] Impact of angiotensin-converting enzyme inhibitors and statins on viral pneumonia. Proc (Bayl Univ Med Cent). 2018;31(4):419–423. Published 2018 Oct 26. doi:10.1080/08998280.2018.1499293
[xlvii] Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem. 2011;18(23):3506–3515. doi:10.2174/092986711796642562
[xlviii] Lung Microbiota Is Related to Smoking Status and to Development of Acute Respiratory Distress Syndrome in Critically Ill Trauma Patients. Am J Respir Crit Care Med. 2018;197(5):621–631. doi:10.1164/rccm.201702-0441OC
[xlix] Hypersensitivity Pneumonitis and Acute Respiratory Distress Syndrome From E-Cigarette Use. Pediatrics. 2018;141(6):e20163927. doi:10.1542/peds.2016-3927
[l] Tobacco smoking in China: a pulmonary health crisis. Curr Opin Pulm Med. 2019;25(2):188–191. doi:10.1097/MCP.0000000000000556
[li] Smoking in Italy 2013-2014, with a focus on the young. Tumori. 2015;101(5):529–534. doi:10.5301/tj.5000311
[lii] Activation of the SARS coronavirus spike protein via sequential proteolytic cleavage at two distinct sites. Proc Natl Acad Sci U S A. 2009;106(14):5871–5876. doi:10.1073/pnas.0809524106
[liii] Activation of the SARS coronavirus spike protein via sequential proteolytic cleavage at two distinct sites. Proc Natl Acad Sci U S A. 2009;106(14):5871–5876. doi:10.1073/pnas.0809524106
[liv] The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade. Antiviral Res. 2020;176:104742. doi:10.1016/j.antiviral.2020.104742
[lv] Severe acute respiratory syndrome coronavirus E protein transports calcium ions and activates the NLRP3 inflammasome. Virology. 2015;485:330–339. doi:10.1016/j.virol.2015.08.010
[lvi] “Protein structure and sequence re-analysis of 2019-nCoV genome does not indicate snakes as its intermediate host or the unique similarity between its spike protein insertions and HIV-1.” doi: http://dx.doi.org/10.1101/2020.02.04.933135
[lvii] The NLRP3 inflammasome is required for the development of hypoxemia in LPS/mechanical ventilation acute lung injury. Am J Respir Cell Mol Biol. 2014;50(2):270–280. doi:10.1165/rcmb.2013-0087OC
[lviii] Coronavirus Age, Sex, Demographics (COVID-19) – Worldometer https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/
[lix] Frequently Asked Questions and Answers: Coronavirus Disease-2019 (COVID-19) and Children https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/children-faq.html
[lx] Melatonin the “light of night” in human biology and adolescent idiopathic scoliosis. Scoliosis. 2007;2:6. Published 2007 Apr 4. doi:10.1186/1748-7161-2-6
[lxi] Fall in nocturnal serum melatonin during prepuberty and pubescence. Lancet. 1984;1(8373):362–365. doi:10.1016/s0140-6736(84)90412-4
[lxii] Melatonin alleviates acute lung injury through inhibiting the NLRP3 inflammasome. J Pineal Res. 2016;60(4):405–414. doi:10.1111/jpi.12322
[lxiii] Melatonin administration to wild‐type mice and nontreated NLRP3 mutant mice share similar inhibition of the inflammatory response during sepsis – Rahim – 2017 – Journal of Pineal Research – Wiley Online Library
[lxiv] Melatonin attenuates sepsis-induced cardiac dysfunction via a PI3K/Akt-dependent mechanism. Basic Res Cardiol. 2016;111(1):8. doi:10.1007/s00395-015-0526-1
[lxv] Same molecule but different expression: aging and sepsis trigger NLRP3 inflammasome activation, a target of melatonin. J Pineal Res. 2016;60(2):193–205. doi:10.1111/jpi.12303
[lxvi] Melatonin alleviates acute lung injury through inhibiting the NLRP3 inflammasome. J Pineal Res. 2016;60(4):405–414. doi:10.1111/jpi.12322
[lxvii] Systemic combined melatonin-mitochondria treatment improves acute respiratory distress syndrome in the rat. J Pineal Res. 2015;58(2):137–150. doi:10.1111/jpi.12199
[lxviii] Safe Hormones, Smart Women Berkson DL Awakened Medicine Press 2010.
[lxix] Melatonin receptor agonist protects against acute lung injury induced by ventilator through up-regulation of IL-10 production. Respir Res. 2020;21(1):65. Published 2020 Mar 6. doi:10.1186/s12931-020-1325-2
[lxx] Nitric oxide suppresses NLRP3 inflammasome activation and protects against LPS-induced septic shock. Cell Res. 2013;23(2):201–212. doi:10.1038/cr.2013.6
[lxxi] COVID-19 Mutations, Vaccines & Nitric Oxide – The Vitamin C Connection – EvolutaMente.it https://www.evolutamente.it/covid-19-mutations-vaccines-nitric-oxide-the-vitamin-c-connection/
[lxxii] Three Intravenous Vitamin C Research Studies Approved for Treating COVID-19 Orthomolecular Medicine News Service, Feb. 21, 2020
[lxxiii] Acute effects of hemodialysis on nitrite and nitrate: potential cardiovascular implications in dialysis patients. Free Radic Biol Med. 2013;58:46–51. doi:10.1016/j.freeradbiomed.2013.01.020
[lxxiv] TRIM25 Is Required for the Antiviral Activity of Zinc Finger Antiviral Protein. J Virol. 2017;91(9):e00088-17. Published 2017 Apr 13. doi:10.1128/JVI.00088-17
[lxxv] Zinc: A Potential Antiviral Against Hepatitis E Virus Infection?. DNA Cell Biol. 2018;37(7):593–599. doi:10.1089/dna.2018.4175
[lxxvi] The antiviral role of zinc and metallothioneins in hepatitis C infection. J Viral Hepat. 2018;25(5):491–501. doi:10.1111/jvh.12845
[lxxvii] Zinc for the common cold. Cochrane Database Syst Rev. 2013;(6):CD001364. Published 2013 Jun 18. doi:10.1002/14651858.CD001364.pub4
[lxxviii] Curcumin suppression of cytokine release and cytokine storm. A potential therapy for patients with Ebola and other severe viral infections. In Vivo. 2015;29(1):1–4.
[lxxix] Inhibition of SARS-CoV 3CL protease by flavonoids. J Enzyme Inhib Med Chem. 2020;35(1):145–151. doi:10.1080/14756366.2019.1690480
[lxxx] Herbacetin Is a Novel Allosteric Inhibitor of Ornithine Decarboxylase with Antitumor Activity. Cancer Res. 2016;76(5):1146–1157. doi:10.1158/0008-5472.CAN-15-0442
[lxxxi] The Signaling Pathways, and Therapeutic Targets of Antiviral Agents: Focusing on the Antiviral Approaches and Clinical Perspectives of Anthocyanins in the Management of Viral Diseases. Front Pharmacol. 2019;10:1207.
[lxxxii] Effective inhibition of MERS-CoV infection by resveratrol. BMC Infect Dis. 2017;17(1):144. Published 2017 Feb 13. doi:10.1186/s12879-017-2253-8
[lxxxiii] Flavonoid-mediated inhibition of SARS coronavirus 3C-like protease expressed in Pichia pastoris. Biotechnol Lett. 2012;34(5):831–838. doi:10.1007/s10529-011-0845
[lxxxiv] Synthesis and antiviral evaluation of 7-O-arylmethylquercetin derivatives against SARS-associated coronavirus (SCV) and hepatitis C virus (HCV). Arch Pharm Res. 2012;35(1):77–85. doi:10.1007/s12272-012-0108-9
[lxxxv] Binding interaction of quercetin-3-beta-galactoside and its synthetic derivatives with SARS-CoV 3CL(pro): structure-activity relationship studies reveal salient pharmacophore features. Bioorg Med Chem. 2006;14(24):8295–8306.
[lxxxvi] N-acetyl-l-cystine (NAC) protects against H9N2 swine influenza virus-induced acute lung injury. Int Immunopharmacol. 2014;22(1):1–8. doi:10.1016/j.intimp.2014.06.013
[lxxxvii] N-Acetyl cysteine effectively alleviates Coxsackievirus B-Induced myocarditis through suppressing viral replication and inflammatory response [published online ahead of print, 2019 Dec 26]. Antiviral Res. 2019;104699. doi:10.1016/j.antiviral.2019.104699
[lxxxviii] Promising Cure to URTI Pandemics, Including the Avian Flu. Townsend Letter for Doctors and Patients 2006 April
[lxxxix] Virulence attenuation during an influenza A/H5N1 pandemic. Philos Trans R Soc Lond B Biol Sci. 2013;368(1614):20120207. Published 2013 Feb 4. doi:10.1098/rstb.2012.0207
[xc] Three Intravenous Vitamin C Research Studies Approved for Treating COVID-19 Orthomolecular Medicine News Service, Feb. 21, 2020
[xci] Kinetics of Inactivation of Waterborne Enteric Viruses by Ozone. Environ Sci Technol. 2018;52(4):2170–2177. doi:10.1021/acs.est.7b05111
[xcii] Inactivation of human immunodeficiency virus type 1 by ozone in vitro. Blood. 1991;78(7):1882–1890.
[xciii] Presumed Asymptomatic Carrier Transmission of COVID-19 [published online ahead of print, 2020 Feb 21]. JAMA. 2020;e202565. doi:10.1001/jama.2020.2565
[xciv] Emergence of healing in the Antarctic ozone layer. Science. 2016;353(6296):269–274. doi:10.1126/science.aae006