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3/13/20

Our Take on COVID-19 (SARS CoV-2)

Having received emails from banks, government institutions, other medical practices, supplement companies, and bloggers, we thought it may be prudent to avoid excess commentary that would further dilute the massive quantity of information coming out about what to do/expect in regard to this virus. However, upon reflection, we want our patients to know how we are perceiving this threat and what we are doing to mitigate risk of infection. Due to the exponential growth of the virus, it is unknown just how impactful it will be. It is not a linear phenomenon like the seasonal flu and thus cannot be compared to it. The uncertainty here is what is causing the media hysteria, as the curve could continue at an exponential rate. However, it is also plausible that the growth curve will reverse. Some aspects we know of that increase the risk for infection and death are age >60, chronic respiratory illness like emphysema, asthma or COPD, current smoker, and obesity. Fortunately, children, adolescents, and young adults seem to be largely unaffected. At any rate, prevention of infection is the only thing we have a modicum of control over. In that regard, there are some tried and true methods of bolstering the immune system:

  • Get sufficient sleep. Allowing a sleep opportunity* of 9 hours gives you ample time to get through enough sleep cycles to clean up cell debris, get growth hormone released, and reduce stress.
    • *Sleep opportunity is the total window of time able to be spent asleep. Sleep efficiency is the percent of time within that window that is actually spent sleeping. On average, an individual’s sleep efficiency is about 85%, which means a 9-hour window affords closer to 7.5 hours of actual sleep.

  • Drink plenty of fluids, but don’t get too dilute. Cell function depends critically on fluid and electrolyte balance along with minerals like zinc and magnesium.

  • Practice good hygiene. While the transmission of COVID-19 is primarily though respiratory droplet and evidence for the fecal-oral route is slim, maintaining good hygiene will likely reduce global pathogen burden and reduce likelihood of secondary infection by something other than this virus.

  • If you smoke, stop – cigarettes, cigars, cannabis, oil vapor, etc. all cause inflammatory reactions in the airways. This virus works by reducing the ability of the lungs to exchange air, so the more inflamed they are the less work the virus has to do, leading to increased mortality.

  • Exercise and improve body composition. This recommendation is two-fold, as exercise is a robust way to increase physical resilience and global system health. Additionally, visceral and subcutaneous fat are pro-inflammatory and cause a number of poor health effects, including high blood pressure, cardiovascular dysfunction, and dysregulated immunity.

Now, on to the less ‘robust’ recommendations. It is no surprise that every company is trying to exploit this pandemic and the public fear into buying their products. However, some of the recommendations we’ve seen are indeed relevant to immune system protection and resilience. That being said, NONE of the interventions I am about to mention have been proven to do anything with COVID-19 due to its novelty – it cannot be said that these things will prevent or treat the infection. Instead, they are recommended on immunological first-principles.

  • High dose ascorbic acid (Vitamin C) through an intravenous route. Interestingly enough, the Shanghai government has officially recommended IV vitamin C for coronavirus cases. There are currently three controlled trials utilizing high dose vitamin C for prevention and treatment.
    • Vitamin C accumulates in immune cells that are responsible for migrating to inflamed tissues, signaling that there are problems, and recruiting other immune cells to the target. Vitamin C is a required cofactor in the anti-viral immune response and results in the induction of a specific set of cytokines that mediate such action.

  • Zinc, cat’s claw, astragalus, medicinal mushroom extracts, monolaurin, olive leaf extract, elderberry, beet root extract, and many other herbal remedies have literature to support use in the plight against viral infection. However, efficacy in general cannot and should not be conflated with efficacy for COVID-19.

  • There are various peptides that have been shown to be effective at increasing the immune system’s ability to fight infection and maintain self-tolerance, which is important in infectious disease and autoimmune conditions alike. Such peptides are LL-37 (cathelicidin), thymosin alpha-1 (Zadaxin), and to a lesser degree, thymosin beta-4. These peptides are viable options, but again have absolutely no data to suggest they will be effective for COVID-19.

“The wise man sees evil approaching, and hides himself; but the fool ignores the danger, and is punished.” - Proverbs 22:3.

It is wise to be prepared in a pandemic like this, but equally wise not to panic. Preparation can be achieved to the best of our ability by integrating the first set of recommendations, while considering some if not all of the second set. If you would like to learn more about the potential therapeutics, sleep hygiene, or other parameters we can look at to gauge immune system health schedule an appointment.

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