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We have now had the SIP (shelter-in-place) order in effect for over 6 weeks.  What has been glossed over in the media, is that there are other more insidious health dangers that exist at this time besides striving to prevent the spread of this novel virus.  As our time in isolation increases, this can be a particularly difficult time for those individuals prone to anxiety and depression.  This article is not only for those who are sheltering by themselves, but also for families who are just trying to keep some semblance of sanity, while homeschooling their kids and trying to stay on top of their job requirements from home.  In my experience, it is far easier to provide support for anxiety and depression when the onset was relatively recent versus waiting until symptoms have been more entrenched. 

Please note that these recommendations are educational and not considered a replacement for consulting with your doctor.  In a majority of cases, it is suggested that you work with your doctor in order to create a personalized plan based on your specific needs.  It is also important to know that some of these suggestions may be contraindicated if you are currently on prescription psychiatric medications. 

​At Home Strategies:

1. rRest®️ (Rapid Reprogramming of Emotional Stress Technique):  This powerful technique performed between you and your practitioner can be used in order to effectively resolve and change the way that you normally react under acute and chronic stress.  This technique works just as effectively over video conferencing as it does in-person. Consider rRest®️ if you are experiencing any of the following:

• You are easily triggered into reactions that are not serving you, or your family
• You have a general sense of agitation and your buttons are easily pushed by others
• You frequently find yourself focused on scarcity, fear, and helplessness, which may even wake you at night

What is rREST®️?

rREST®️ is an innovative, mind-body technology that is easily accessible through an online process from the comfort of your home. 

rREST®️ is a fast and effective tool helping you break through emotional obstacles currently holding you back. This process can quickly and permanently eliminate subclinical stress response patterns that were generated early in your life and were reinforced by adversity throughout your lifetime. 

2. Meditation:  30 minutes once to twice per day.  There are many resources available that you can find online and there are also a number of free meditation apps that you can download to your device.  No matter what meditation you choose, all of them will heavily rely on breath work.  It is important to take deep, diaphragmatic breaths in order to promote the parasympathetic nervous system (responsible for relaxation and a sense of increased well-being).

Here are some great meditation apps:

https://www.headspace.com/

https://www.calm.com/

Another under appreciated technique is that of gratitude.  It is incongruent for your mind to feel fear, anxiety, anger, or sadness when you truly feel grateful for something or somebody.  This can be something small, like the spring flowers blooming or watching a hummingbird in flight, or a strongly positive memory where you felt unconditional love for someone.  The trick is that you have to feel it in your body.  This is not a mental exercise, it is an emotional exercise.  You need to find the grateful thought with your mind, but then pull it down into a heart-centered feeling.  Think about times like when you saw your child take his or her first steps and how you felt.  Or, think about how you feel when you see a young puppy exploring the world.  

There are also some good apps that can help you below:

https://gratefulness.me/

https://365gratitudejournal.com/

3. Exercise:  Even with the SIP order in effect, in most counties it is allowable to travel up to 5 miles for exercise.  I feel that it is very important to get outdoors, especially since the air quality has been better than I have ever seen it.  Hiking and mountain biking are my favorite outdoor activities and really work as a reset from the monotony of sheltering in place. 

There are also many different Tabata type workouts that can be found for free online. These exercises typically include using only your bodyweight for short, intense workouts that can definitely change your mental and emotional state in a hurry.  Below is an excellent resource for efficient and effective workouts that can be done at home.

https://healthylivingrevolution.com/home-fitness-series/

https://7minuteworkout.jnj.com/

https://vimeo.com/402813484

https://vimeo.com/248443523

4. News:  If you absolutely have to stay informed, I would suggest only looking at the news once per day, preferably in the morning to prevent sleep issues.  It would also be a good idea to set a timer for 15 – 30 minutes so you don’t get sucked down the media rabbit hole.  

5. Light Therapy:  Full spectrum light boxes have become very affordable since they first were shown to be an effective therapy for SAD (seasonal affective disorder). Light Therapy has been shown to be 50-80% effective for those diagnosed with SAD.  In order to support SAD, the light box needs to have a power rating of at least 10,000 lux.  The therapy includes exposure to the light box for 30 minutes once per day, preferably in the morning in order to help burn off melatonin levels.  You do not look directly at the light box, but instead have it off to the side of what you are doing, whether that is working on your computer, reading, or having a cup of tea.  You can find light boxes with 10,000 lux by Verilux for under $100. 

Even though we are in the beginning of Spring, do not underestimate what light therapy can do for depression.  Since the SIP order went effective, I have found that many people are outside of their house far less than they ordinarily would be.  On top of that, I have also found that people are spending more time on their phones, televisions, and/or computers.  If you have an iPhone, check your daily average under settings if you do not believe me.  This constant onslaught of blue light can cause problems with your circadian rhythm leading to excessive melatonin levels and persistent sleepiness, not to mention the adrenal issues it can cause. 

Here are some links to some good choices:

Verilux HappyLight VT22 Lucent 10,000 Lux LED Therapy Light

Miroco LED Bright White Therapy Light 10,000 Lux

6. Drugs:  Every person copes with stress in an entirely different way, but alcohol, caffeine, and marijuana seem to be the most common.  It is especially important now to evaluate whether your use of these substances has increased since the SIP order.  Abuse of any of these substances can create anxiety and depression.  Even during the SIP, please note that most therapists and psychiatrists are still working and offering telehealth visits in order to support their clients from home. 

7. Create Routine / Create Purpose:  It is interesting, before now I would only have to discuss this strategy with patients who were retired.  Now, I see it as an important strategy for everyone.  If the SIP has made anything blatantly obvious, it is that most people had very clear routines before this began.  Setting a routine creates a sense of duty and accountability and with that duty comes purpose.  Do you ever notice that the most effective people that you know are the ones with the most on their plate?

8. Eat for blood sugar balance.  Did you know that low blood sugar can look like anxiety? Yes it can.  This is one factor we do have control over. We recommend small frequent meals and not going long periods of time in between meals to help maintain a balanced blood sugar.  

Nutritional Supplementation:

1. L-Tryptophan and/or 5-HTP:  Both of these substances support an increase in serotonin and melatonin synthesis, leading to decreased feelings of sadness, easier sleep initiation, and an increased sense of wellbeing.  Both of these substances need to be used with extreme caution, and oversight by your doctor is strongly suggested to prevent serotonin syndrome if being used in conjunction with SSRI’s or SNRI’s. 

When an individual is under higher stress levels (whether emotional, mental, or physical) there will be a rise in stress hormones such as cortisol and epinephrine.  These substances are basically fire alarms telling your body to jump into action to address an imminent danger.  This is what is called the sympathetic nervous system response.  When your body is in this mode, it is incongruent for you to feel relaxed with a general feeling of wellbeing.  Your body will then prevent the formation of serotonin and actually speed up the breakdown to ensure that your nervous system will be hypervigilant, on edge, and ready to act on any perceived danger.  If the real or perceived stressor continues over time, you can become serotonin deficiency leading to depression and anxiety.

Typical dosage for L-Tryptophan ranges from 500mg – 3000mg at bedtime, while the typical dosage for 5-HTP is from 50mg – 300mg at bedtime.  Please note that both of these compounds work on the same pathway, so it is unnecessary to use both of them in your plan at the same time.  It is always suggested that an individual start at the lowest dosage for both of these supplements. 

2. L-Theanine:  This compound is derived from the tea plant (Camellia sinensis) and is one of the safest remedies for anxiety and anxiety-related depression.  This is one of my favorite supplements to prescribe because of its overall effectiveness and because it is one of the few therapies for anxiety that will not cause drowsiness.  I have found that this stand-alone supplement works particularly well for kids to promote calmness. Typical dosage ranges from 100mg – 600mg twice to three times per day. 

3. Magnesium Threonate:  This compound is the only oral magnesium that can cross the blood brain barrier.  By doing so, it creates a relaxation response on the central nervous system.  This supplement works well for insomnia, nervous exhaustion, anxiety, or depression caused by prolonged anxiety.  It will also aid in restoring stress-induced memory loss and increase general energy levels.  The typical dosage is 1000mg – 2000mg two to three times per day. 

4. Ashwagandha (Withania somnifera):  This medicinal herb has been used by humans for centuries in Ayurvedic medicine.  It works extraordinarily well for individuals who suffer from prolonged anxiety or neurasthenia (fatigue and other physical complaints caused by a prolonged emotional disturbance) and is extremely safe.  One of my favorite aspects of this supplement is that it has been shown to bind to GABA receptors, which reduce anxiety and promote relaxation.  This herb will also work as an adaptogen, aiding in moderating adrenal function for those under pronounced stress for long periods of time.  Typical dosage is 500mg – 1000mg once to twice per day. 

5. Valerian Root (Valeriana officinalis):  This root is one the strongest anti-anxiety medicines in natural medicine.  This supplement is particularly suited for individuals with very high anxiety that also causes insomnia.  Dosage is typically 300-600mg at once per day at bedtime, but for severe anxiety it can be given two to three times per day. Drowsiness and sleepiness are common side effects of this supplement, so use caution if you are going to use it during the daytime.  Also, due to the action of this supplement, it could be contraindicated if the individual is currently taking prescription medications for anxiety, such as benzodiazepines. 

We apologize in advance for the length of this post - it's around 3000 words, which will take about 15 minutes for most people to digest.  There is a lot to review and it is changing every day. As time goes by, more light is shed on the science of this novel coronavirus, and more complexity is required to explain the actions.  The more we understand how the virus works, the more effective we can be from both the treatment and prevention perspective. There is a lot of information out there regarding this novel virus, much of which is confusing and contradictory.  We see it as our responsibility to sort through as much of the incoming data as possible in order to provide our community with as clear and unbiased understanding as possible.

While taking the “Shelter in Place” directive and world pandemic seriously, our team is committed and dedicated to the health of our patients and community.  Researching data from other countries that are ahead of the U.S. in this crisis allows us to gain perspective on the path of progression of SARS-CoV-2 (the virus responsible for COVID-19).  In a recent chart by Johns Hopkins, it shows that the U.S. is following a very similar path as Italy. In fact, the U.S. has more confirmed cases on day 18 of the virus than Italy did after the same number of days (18 days after each country reported at least 100 confirmed cases).  

We cannot overstate how important the next 3-4 weeks are in regards to the containing and slowing the spread of this virus.  Stay home! What we have seen in countries who had the ability to offer early and widespread testing, is that those countries were able to significantly reduce the spread of the virus, thereby minimizing the time required under quarantine or a “shelter in place” order.  Please remember that during this time, the priority is slowing the spread as much as possible, as upwards of 70% of individuals will experience this viral infection in the coming months. The slower the progression, the more treatment options will come to light. As of now, prevention is paramount in this process, which means that our communities have to work together in a cooperative fashion to abide by the social distancing rules.  At our clinic, we felt the need to move to Telehealth for a majority of our visits in order to ensure that we are not promoting the spread of this very virulent virus. 

Since this is a novel virus, no person has immunity to it, and nothing has yet been proven to treat or prevent this specific virus in either the pharmaceutical or natural medicine arenas. SARS-CoV-2 has never been seen before in humans.  That leaves us doing our very best to extrapolate from prior research on similar viruses, such as other coronaviruses, since very little is known about this specific strain of virus.  

Why is SARS-CoV-2 so much more virulent than other viruses?  

We do have patients who do want to know more detailed information on how this virus actually works, so we will explain and try to keep it as simple as possible based on the current understanding.  If you do not want this level of information, please scroll down to SARS-CoV-2 Basics.  

SARS-CoV-2 is different from other coronaviruses, and other viruses in general, for 2 specific reasons.  To understand this more completely, you need to know that viruses are dependent on the machinery within human cells in order to replicate and become more virulent, which is different from bacteria, parasites, and fungi that live outside of cells.  Basically, viruses need to take over your cells in order to make copies of themselves to be able to take over more of your cells. Viruses have a specific spike protein (s protein) that determines which human cell receptors it will target and bind, thereby determining which organ systems will be affected.  The spike protein of SARS-CoV-2 has a specific affinity for a receptor on our cells known as ACE2. ACE2 receptors are located primarily on cells within your arteries, kidneys, lungs, gastrointestinal tract, testes, and the brain. These receptors play a significant role in the management of blood pressure among other processes.  

Previous coronaviruses had a more difficult time entering human cells because our cells have other specific mechanisms that are used to deter the entrance of a virus, which in turn makes them less virulent.  In the case of SARS-CoV-2, the viral spike protein has a site that is recognized and activated by furin, which is an enzyme produced by our own cells. Furin causes SARS-CoV-2 to bind 10x more strongly to our ACE2 receptors than previous coronaviruses.  Basically, when SARS-CoV-2 comes close to its binding site (ACE2) on human cells, it is activated by our own enzymes, which makes it bind more tightly to our own cells causing the virus to then more easily enter into our cells. Once the virus is inside of our cells it stimulates chemicals known as inflammasomes, which causes uncontrolled inflammation through interleukin-1beta and interleukin-18.  As the inflammatory process goes out of control, fibrosis (scarring) occurs, leading to higher mortality rates related to acute respiratory distress syndrome (ARDS). 

In 2017, there were a total of 105 million prescriptions for the medication Lisinopril, making it the third most prescribed medication in the United States.  Lisinopril, and other ACE inhibitors, are used to treat high blood pressure. Patients who are currently taking these medications have been shown to have a higher viral load of SARS-CoV-2 in their system and it is speculated that it is easier for these patients to become infected.  The drug class of ACE inhibitors work by blocking the receptor site on the cell. The body, in turn, increases the number of ACE2 receptors on the outside of each cell as to compensate. If you are currently taking medication within this class, it might be a good idea to consult with your doctor to see if a change is required.

In a recent scientific journal, it was shown that Ibuprofen (Advil, etc) could be associated with higher rates of COVID-19 because the medication increases ACE2 receptors on the cell surface.  There is not a clear understanding of this relationship, but it might be worth considering avoiding its use until more information is known.

We are open and here to support you with Telehealth and very limited in-office visits.  Dr. Destia, Dr. Bryan, and Dr. Mimosa are available Monday through Thursday for Telehealth visits from the comfort of your home, whether that be through videoconferencing or telephone.  Our front office staff is still working to ensure that you get the care and support you need to be as healthy as possible through this pandemic. Please call the office to schedule your visit at 650-323-7345 or email our staff at frontdesk@cnmhealth.com. If you are also utilizing our computerized scanning technology, we only have a limited number of devices at the clinic to loan out to patients for use during virtual visits from the comfort of your own home. Due to the low supply of these devices and because many of our patients do not have a Windows-based PC,  we will be creating a room at the clinic for patients to have a Telehealth visit with your doctor. Please call the clinic for details. All Osteopathic and Craniosacral visits have been cancelled until further notice due to the “Shelter in Place” directive. We will reassess the pandemic regulations weekly and notify you when we will again be offering these services.

There are 3 important exceptions that would prevent individuals from being able to come to the clinic over the next few weeks. 

1. If you have shortness of breath, a high fever, cough, severe respiratory symptoms.  Our clinic is not equipped to treat patients diagnosed with COVID-19.  
2. Have been in contact with someone with a confirmed infection in the past 14 days
3. Have travelled to China, Japan, Korea, Iran, or Italy within the previous 14 days 

What do we know about this Pandemic?

The Cycle in the U.S. is projected to peak in about 3 weeks. This means that the next two weeks are critical to lower the spread in our community.  Physical distancing is a key component to this spread because of the fact that this virus is so virulent. If the directives set by the CDC are followed consistently over the next 3-4 weeks, it is highly likely we can have better control of this epidemic.   

Novel VIrus Basics:

1. Spreads more easily than most other viruses seen in our history.  This means it can easily infect a larger part of the population, faster. 
2. It has a tactic to get more easily into our cells by cleaving feron receptors and using ACE receptors.  Other coronaviruses along with other viruses have not shown this ability. This means we need to use other novel herbal remedies that can have an impact on these functions.
3. The infection has a virulent protein that stimulates an overproduction of cytokines leading to a massive inflammatory reaction (Cytokine Storm). This most likely is leading to the intense respiratory distress seen in infected individuals. Tylenol may be a better choice over Ibuprofen to manage fevers associated with this novel virus due to the potential interaction with ACE-2 receptors.  Remember a fever is an important part of your immune system fighting the virus.  

What are key life lifestyle components?

1. Sleep: Good sleep hygiene is essential.  Sleep supports your immune function.   Quality sleep has also been shown to support healthy immune response, which could provide you with more resistance to microbes.  
2. Healthy Diet:  Reduce sugar, alcohol, gluten and dairy. This helps to balance your immune system and support a healthy response to inflammation.  
3. Lower Stress: Stress is shown to increase Interleukin-6.  How do we lower stress?  Set your timer to take deep abdominal breaths 3 x day for 5 min. Get outside. Watch something funny - Dr. Bryan loves animal meme videos for this purpose. We will be writing a follow up post on reducing stress during this time. 

Promising Supportive Measures:

1.  Herbal Medicine:  Due to the fact that this is a novel virus (it has never been encountered before) there is little to no evidence showing an effective treatment, whether natural or pharmaceutical.  The history of herbal medicine dates back at least 5,000 years, when the Sumerians compiled the first known list including hundreds of medicinal plants.  Since then, there have been thousands of published research papers studying the efficacy of specific herbs or herbal formulas on disease process.  

2.  Vitamin D3:  People with low vitamin D3 levels were shown to be 40% more likely to get a respiratory infection than those with normal levels.  Levels can be easily tested with a simple blood test and should be in the range 60-80 ng/ml. Based on research out of Finland, infants less than 1 should have 1000 IU daily, toddlers and children 2000-3000 IU daily, and teenagers and adults more than 5000-8000 IU daily.

3. Oral Vitamin C: Vitamin C reduces NLRP3, an important mediator found in the inflammatory cascade.  Liposomal vitamin C may allow higher doses to be used without the gastrointestinal side effects found associated with ascorbic acid.

4. Vitamin A (NOT beta-carotene):  Vitamin A is very important for normal immune function of the lining of the respiratory system. Please work with your doctor to find the specific dose for you. If you are trying to get pregnant or are currently pregnant do not take over 5,000 IU daily. 

5. Whole Food Concentrates:  We double the daily dose during cold and flu season as our first line of defense.  Even when we are eating like champs, the variety of different plants in these whole foods concentrates cannot be replicated with eating. 

Be Safe, Be Well,

Drs. Bryan & Destia

References 

Jo, Seri, et al. US National Library of Medicine National Institutes of Health, 14 Nov. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6882434/.

Cinatl, J, et al.  PubMed, 14 June 2003, www.ncbi.nlm.nih.gov/pubmed/12814717.

Chen, F, et al.  Science Direct, Sept. 2004. www.sciencedirect.com/science/article/pii/S1386653204000551.

Acta Pharm Sin B. 2015 Jul; 5(4): 310–315. Published online 2015 June 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629407/

Liang-Tzung Lin, et al.  Journal of Traditional and Complementary Medicine, Jan-Mar 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032839/#

Lecture Series from National University of Natural Medicine, March 20, 2020. https://nunm.edu/2020/03/dr-heather-zwickey-discusses-research-on-covid-19/

Kluger MJ, Wieslaw K, Conn CA, et al. 2nd ed. Philadelphia: Lippincott-Raven; 1997. pp. 255±266. https://www.medicalnewstoday.com/articles/why-does-sars-cov-2-spread-so-easily#Spike-protein-on-the-new-coronavirus

https://www.ncbi.nlm.nih.gov/pubmed/8801180

Lisa A. Greismana and Philip A. Mackowiak, Current Opinion in Infectious Diseases 2002, 15:241±245 http://www.ufrgs.br/fisiologiacelular/site/arqs/ENSINO/artigos%20em%20PDF/Fever%20-%20beneficial%20and%20detrimental%20effects%20of%20antipyretics.pdf

Brain Res Bull. 1980 Jan-Feb;5(1):69-73..Vaughn LK, Veale WL, Cooper KE. https://www.ncbi.nlm.nih.gov/pubmed/7363103

https://www.statista.com/statistics/779771/lisinopril-prescriptions-number-in-the-us/

This is an update to our previous pandemic article.  Let’s first address the unfounded insanity that is currently being spread throughout the media.  Please remember that fear sells and it inspires people to return to the original source of the information in order to stay updated.  This is another rendition of the old news saying, “If it bleeds, it reads!” It is a better option to fight fear with knowledge. 

The current is a novel virus, meaning this is the first time we have seen this particular strain in the human population.  We have encountered other novel viral infections in the past, but there is a lack of direct knowledge of this specific virus.  We are able to somewhat extrapolate information from these past outbreaks to aid in the support of your body during this pandemic. 

World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus recently said:

… We’re not just fighting an epidemic; we’re fighting an infodemic …

This is a time for facts, not fear.

This is a time for rationality, not rumours.

 Please remember that google is not your doctor and that the news and other media sources do not necessarily have your best interest in mind.  The best way to protect yourself and your family is being aware of how this infection spreads and by taking steps to minimize exposure.  

Viruses spread within large respiratory droplets via coughing and/or sneezing. This means all surfaces where these droplets have landed can be potentially infectious for about 1 week on average.  They also spread with direct contact to your mucosal surfaces.  

One of the most important preventative steps you can take is to avoid touching your mouth, nose and/or eyes while you are out in public places or wear a mask.  Second, be sure to vigorously wash your hands several times a day for at least 30 seconds per time in order to promote removal of any viruses. The length of hand washing combined with scrubbing have been shown to be the two most significant factors involved. To reduce your risk of acquiring the virus, avoid such “high-touch surfaces” as doorknobs, handles, stair rails, pens, keypads, touch screens, point of sale terminals, etc. Use your knuckle to push bush buttons and antimicrobial wipes to hold handles and clean your phone, and/or use gloves. 

As this viral pandemic is changing quickly, check the CDC for current up to date information on the current incubation periods and symptoms. 
 

Is there a vaccine for this novel virus? 

To date, there is no vaccine and no specific antiviral medicine to prevent or treat this current virus. However, those affected should receive care to relieve symptoms. People with serious illnesses should be hospitalized. Most patients recover thanks to supportive care. 

Your best support is a balanced immune system. Supportive immune formulas can encourage good innate immune function. 

While information so far suggests that most illness is mild out of China suggests serious illness occurs in 16% of cases. Older people and people with certain underlying health conditions like heart disease, lung disease and diabetes, for example, seem to be at greater risk of serious illness.

"Globally, about 3.4 percent of reported COVID-19 cases have died," WHO Director-General Tedros Adhanom Ghebreyesus said. This number includes cases in China, which seem to have a higher death rate than other countries.

Interestingly, South Korea has been very proactive with testing its population, which has been extremely effective.  Journalist Kim Kyung-Hoon reported in Reuters on 3/5/20 that: 

• South Korea has tested more than 140,000 people for the new coronavirus and confirmed more than 6,000 cases. Its fatality rate is around 0.6%. This is lower than the yearly flu fatality rate at .78%
• This suggests that, as many health experts have predicted, the virus' fatality rate seems to decrease as more cases are reported.
• That's because more widespread testing leads more mild cases to be included in the count.
• The US, by contrast, has tested around 1,500 people. The country has 221 confirmed cases and 12 deaths, suggesting a death rate of 5%.
• The US' testing capacity has been limited.

Plan to Support  your Innate Immunity 

1. Get adequate sleep
2. 30 minutes of outside movement each day.  This will activate lymphatic flow in the body, which will support your immune function.
3. Wash your hands multiple times a day.  Use vigorous scrubbing and make sure that you wash your hands for at least 30 seconds.  
4. Avoid sugar as much as possible.  Sugar has been shown to lower your immune function for 7 hours after ingestion of even a small amount.  
5. Eat plenty of fruits and vegetables in the rainbow of variety.  The colors and flavors help protect different organs. We take a wide variety plant concentrates every day and in this season we are taking a double dose to support our immune system
6. Check to make sure that your vitamin D3 level is optimal.  A simple blood test can be ordered to ensure that your levels are between 60-80 for optimal protection of your immune system.
7. Licorice and elderberry are two good herbs for immune support.  
8. If you are over 65, and are immunocompromised, you may want to consider adding S-Acetyl Glutathione or Liposomal Glutathione to your support plan.  Glutathione is a strong antioxidant and can support lung and mucosal membranes. 

News Sources:

Santa Clara County public health officials are now recommending employers: suspend nonessential travel; minimize or cancel large in-person meetings/conferences; urge sick employees to stay home and not require a doctor’s note; and consider telecommuting options for appropriate employees.

“It’s good to remember that when H1N1 influenza came out in 2009, estimates of case fatality were 10 percent,” David Fisman, an epidemiologist at the University of Toronto, told Reuters last month. The actual mortality rate turned out to be well under 1 percent when all the data was in.

• WHO: Coronavirus disease (COVID-19) outbreak https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• CDC  Coronavirus Disease 2019 page https://www.cdc.gov/coronavirus/2019-ncov/index.html
• WHO COVID-19 Situation Reports: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
• CDC’s COVD-19 travel advisory page https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html