Pandemic Update 3/22/20

World Love

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/