COVID-19 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 COVID-19, 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

  2. Have been in contact with someone with a confirmed COVID-19 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 COVID-19 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 the COVID-19 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.   

SARS-Cov-2 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 is a better choice over Ibuprofen to manage fevers associated with COVID-19 due to the potential interaction with ACE-2 receptors.  Remember a fever is an important part of your immune system fighting the virus.  

  4. COVID-19 infections can have up to a 3 week life cycle. If you have symptoms of fever, sore throat or cough, please make sure to self quarantine. 

Below are some important statistics on fever and flu shared by our colleague in Portland, OR.  Dr. Eric Blake, Naturopathic Physician and Diplomate of Acupuncture. We felt this was important to share as he has been lecturing on this topic for almost 20 years.

Why is there so much concern about the flu and other viral epidemics? 

The flu has become a fearful annual infection since the pandemic of 1917-1918. There have been about 7 of these pandemics in the last 120 years. A pandemic is determined by the large number of persons affected around the world and the high loss of life. However, research is showing that the large losses may be due to the nature of the treatment and management once infections occur and that the methods of prevention centered around the vaccine may be misguided. 

What was the track record of natural treatment in flu epidemics? 

The death rate in the 1917-1918 Spanish Influenza epidemic under regular medical care was upwards of 20%. As we have pointed out, current regular medical care management is such that the flu and pneumonia are still the leading causes of infectious disease death. In 1918, Naturopathic Physicians (ND) Osteopathic Physicians (DO), Chiropractic Doctors (DC), and Homeopathic MDs, worked in a similar comprehensive natural fashion to treat the flu. The mortality rate of patients under conventional MD care surpassed 20%, the loss of life under DC’s and DO’s 2-3%, and the Homeopathic MDs and Naturopathic Physicians less than 1%. The reports from the Naturopaths on their loss of cases indicates that they were seen after the patient had already tried regular medical care. In Chicago at the Lindlahr Hospital for example, they treated 300 in-patient cases naturopathically and 1200 out-patient cases. They saved every life. The nearby Cook County Hospital mortality was 20% - 1 in 5. A key element of treatment was not suppressing the fever with anti-fever medications. 

Why avoid using anti-fever medications? 

Anti-fever drugs are those such as Tylenol (acetaminophen), paracetamol, aspirin, ibuprofen and those other medicines like Nyquil, Dayquil, and numerous others that contain them. This is frequently the first intervention over the counter and in hospitals and doctors’ offices. Research has shown they do not shorten infections but even worse, that they can prolong infections. More troubling is that they can prolong the time of it being spread. Importantly, anti-fever drugs could be associated with a higher loss of life in infections than when not using them. Naturopathic clinical principles have been confirmed by research that has shown that fevers are associated with better outcome in viral and bacterial infections.  Therefore – we harmonize our treatment to ease the discomfort of fever in ways that assist the goals of the fever – which in itself is an attempt by the body to heal. This is the secret to the effective and successful Naturopathic approach to infections.

Please speak with one of our doctors if you are wanting alternative ways to support your fever.  We recommend not treating fevers below 102.5 unless there are complicating health factors that make this dangerous.  

Remember fever is an important component of our immune system response to fight bacteria and viruses.  SARS-CoV-2, along with the yearly flu viruses, cannot replicate at higher temperatures and cells of the immune system are activated by higher temperatures. Mild fever is associated with better prognosis in both viral and bacterial infections. 

What are the key components to lifestyle in preventing and treating infection?

  1. Sleep: Good sleep hygiene is essential.  Sleep supports your immune function.  We are also seeing that people with higher melatonin (your sleep hormone) correlates with less COVID-19 infection risk.  Quality sleep has also been shown to decrease inflammation, which could provide you with more resistance to infection.  

  2. Low Inflammatory Diet:  Reduce sugar, alcohol, gluten and dairy during this pandemic.  This will lower your risk of the cytokine (inflammatory) storm that causes most of the Severe disease symptoms like Acute Respiratory Distress Syndrome (ARDS). 

  3. Lower Stress: Stress is shown to increase Interleukin-6, which has been shown to make the COVID-19 disease pattern more severe.  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. 

Important  Antiviral Preventative Measures:

1. CNM Special Symptomatic Herbal Antiviral Tincture and/or Preventative Antiviral Tincture:  We have listed the specific ingredients below because this is available only for current patients of the clinic.  If you are not a current patient of the clinic and would like a tincture prescribed for you, you would need to become a patient of the clinic.  If you are only interested in an immune protocol designed for you, we are offering a special 30 minute initial office visit in order to put this treatment plan together for you.  Please email frontdesk@cnmhealth.com or call 650-323-7345 if you are interested in this option. Due to safety reasons, please understand that we do not dispense supplements to individuals who are not current patients.  

      Andrographis paniculata, which has been used in the current pandemic with good results in China. A review and meta-analysis on Andrographis showed a statistically significant improvement in overall symptoms of acute respiratory tract infection symptoms when compared to placebo and also suggested that Andrographis shortened the duration of cough, sore throat, and sick leave/time to resolution when compared to western medical care.

      Licorice (Glycyrrhiza glabra) is a potent antiviral herb. A study published in Lancet, 2003 showed glycyrrhizin was the most potent of 5 antiviral compounds tested in inhibiting replication of the SARS coronavirus.  Caution must be taken if an individual has hypertension, as licorice can cause a slight increase in blood pressure.

      Ban Lan Gen (Isatis Root) is a traditional Chinese medicinal herb. Isatis Root supports respiratory health, the throat and supports digestive health. Natural inhibitors against the SARS-Cov enzymes, such as the nsP13 helicase and 3CL protease, have been identified as well and include myricetin, scutellarein, and phenolic compounds from Isatis Root. 

      Cordyceps sinensis extract for it support of liver, kidney and immunomodulatory effects.  It has also been shown to have potent antiviral effects.  

      Sweet Wormwood (Artemisia annua) has been shown in clinical trials to be effective against coronavirus. Compounds have been shown in research to effectively prevent the early stage of HCoV-22E9 infection, including viral attachment and penetration.  Sweet wormwood has been shown to be effective in treatment resistant cases of malaria, which is an infection that resides within human cells.  

      Black Elderberry (Sambucus nigra) has long been used in antiviral herbal formulas.  It has been shown to effectively prevent viruses from penetrating human cells.

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:  L-ascorbic acid (vitamin C) is one of the well-known antiviral agents, especially influenza virus. Vitamin C reduces NLRP3, an important inflammatory mediator in the COVID-19 infection inflammatory cascade.  Liposomal vitamin C can be used for those individuals who have gastrointestinal upset with the regular version.  

4. Vitamin A (NOT beta-carotene):  Vitamin A is very important for normal immune function of the lining of the respiratory system and helps to protect your cells from viruses attaching to the cell membrane. We recommend 5,000 to 20,000 IU for prevention and acute symptoms. Sometimes a larger dose can be used for individuals who are very deficient and/or have a genetic mutation that causes them to have a lower level of Vitamin A in the body.  If this is the case, please work with your doctor in order to find the dose that would be best for you.If you are trying to get pregnant or are currently pregnant do not take over 5,000 IU daily. 

5. Juice Plus 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.  Check out the clinical research.  The research shows improved immunity, lower inflammation and protection of our cardiovascular system.  This is important because COVID-19 works on the ACE2 receptors and can potentially cause cardiac implications.  Flavonoids have shown to be potent support to our immune system and to inhibit SARS-Cov virus. 

6. Intravenous Vitamin C:  According to Global Research, 3 clinical trials are currently underway studying IV Vitamin C for possible effect in patients with COVID-19. Doses range from 12,000 to 24,000 mg/ day by IV. Oral vitamin C is not currently being studied, but the researchers have called for additional studies to see if oral dosing could have a similar effect

Be Safe, Be Well,

Drs. Bryan & Destia

References 

Jo, Seri, et al. “Inhibition of SARS-CoV 3CL Protease by Flavonoids.” US National Library of Medicine National Institutes of Health, 14 Nov. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6882434/.

Cinatl, J, et al. “Glycyrrhizin, an Active Component of Liquorice Roots, and Replication of SARS- Associated Coronavirus.” PubMed, 14 June 2003, www.ncbi.nlm.nih.gov/pubmed/12814717.

Chen, F, et al. “In Vitro Susceptibility of 10 Clinical Isolates of SARS Coronavirus to Selected Antiviral Compounds.” 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. “Antiviral Natural Products and Herbal Medicines” 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, “Dr. Heather Zwicky Discusses Research on COVID-19” March 20, 2020. https://nunm.edu/2020/03/dr-heather-zwickey-discusses-research-on-covid-19/

Kluger MJ, Wieslaw K, Conn CA, et al. The adaptive value of fever. In: Mackowiak PA, editor. Fever: basic mechanisms and management. 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, Fever: beneficial and detrimental effects of antipyretics. 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.Antipyresis: its effect on mortality rate of bacterially infected rabbits.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/