COVID-19 Defense: More Prevention and Treatment Considerations

Coronavirus information flows at levels comparable to the number of cases – more each day. This is what I found interesting since the last two installments on this pandemic (see them here; 1, and 2).

Status

Good news may be surfacing.

We continue to see case counts climbing with images of exponential growth on the news. While those are accurate, my focus has been on the number of new cases and new deaths/death rate.

Potential effects of social distancing appear to be manifesting – new cases are showing signs of slowing.

Using a new data source with programmatic access¹, I set up an excel sheet and database to monitor new cases by state. Why? Most of the websites show the days new cases, but not historically by date at the state level. These are the new cases, deaths, and check out how many NEW tests are performed each day.

NY is around half of the new cases being reported each day – they will struggle with this for a substantial time. Florida, Louisiana, and the Great Lakes areas also are places to watch

Additional testing looks to be driving much of the increased case numbers – FDA even approved a new 15 minute point-of-care device this week².

The death rate is remarkably low, and getting lower³ as the testing increases – we are only testing certain at-risk symptomatic people now. As long as hospitals and health care workers (thank them) remain inside of their capacity, this trend should continue. NY again will be the challenge here.

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Bottom line, the new daily positive test curve looks less exponential. Even Washington, where it all began stateside, is leveling off ⁵. Further, Italy’s new deaths are also flattening. Let’s hope this continues.

Prevention

I saw a few additional prevention items to share, in addition to previous articles (see them here; 1, and 2).

Humidity

Higher humidity protects against viral infection. From David Sinclair⁶, a great researcher, 40-60% humidity is ideal. He tweets “Animal & human studies show that 50% relative humidity (RH) is optimal to maintain our airways & protect from viruses. Low humidity (20–35%) greatly increases rates of infection. In winter, homes & workplaces sampled in NY & Midwest were around 24 RH”.

I checked my office humidity upon arriving to work recently, it was in the upper 20’s. Opening the window allowed an increase to 40 RH shortly. Small changes can make relevant differences.

Breathing through your nose carries great importance for many things, including cardiovascular health (increased nitric oxide). It also provides added heat and humidification compared to mouth breathing⁷.

Heat

If you have access to a sauna, daily use may help mitigate infection. Coronaviruses hangout in your sinuses for about three days prior to moving toward the lungs⁸. Sauna temperatures appear to destroy them, potentially preventing access to the lungs.

Exercise also raises core body temperature, so count this as another reason to get some kind of exercise in during quarantine.

Heat and Humidity combined are effective weapons against Covid-19, thankfully summer is coming (R values refer to viral replication)

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More On The Mucus Layer

Lectins, a plant defense mechanism I have written about extensively, reduce the viscosity of this mucus layer. Ever noticed your nose running after a meal? That could be from lectins in wheat, whole grains, nightshade vegetables (Tomatoes/potatoes/peppers/etc), and more. From the BMJ¹⁰

“The mucus stripping effect of lectins also offers an explanation for the anecdotal finding of many allergists that a “stone age diet,” which eliminates most starchy foods and therefore most lectins, protects against common upper respiratory viral infections: without lectins in the throat the nasopharyngeal mucus lining would be more effective as a barrier to viruses”¹¹. Elimination of starchy foods benefits blood sugar status, which we will see below is a risk factor if unmanaged.

I too have noticed benefits to lectin avoidance. When you can’t eliminate entirely, lectin blocking supplements are useful tools (see how they help my daughter here).

Melatonin

We discussed sleep in the previous article. Melatonin plays an important role in sleep health. We can foster health melatonin levels behaviorally with proper light exposure – low light in the evening, bright light during the day.

Why does melatonin help in COVID-19?

A new article¹² asserted two reasons. First, melatonin levels fall with age. This curve matches precisely with the COVID-19 death rate by age – less melatonin, higher COVID-19 death rate. Second, melatonin suppresses NLRP3 Inflammasomes. These are activated in the over-response seen to the virus in critical cases. Part of the lethality is this inflammatory storm that grows in an uncontrolled fashion – in part signaled by these NLRP3 Inflammasomes.

So, melatonin supplements are worth considering for most – at least on the low end of the available doses. Coupled with good light management, it is a win-win. Make sure to take your melatonin about 3 hours after eating to mitigate blood sugar elevation. Read more in my Optimizing Sleep paper.

Black Tea

Theaflavin-3,3′-digallate, or more simply theaflavin, is a component of black tea. Researches found theaflavin impaired SARS-CoV (the previous SARS virus, COVID-19 is SARS-CoV2) viral replication ¹³. If you aren’t a black tea fan, supplements are available.

ACE2

In the previous article (relevant for background in that article for this section), I highlighted the theory that certain blood pressure medications may increase receptors SARS-CoV2 attaches to. This is concerning. While the science is not clear on this, I would still encourage working with your doctor to evaluate how to proceed – do NOT change your medication on your own. It may be docs don’t want to discontinue, which is understandable. Some researchers even assert they may be protective, not harmful.

I lean toward concerns surrounding these meds during this pandemic being valid – most of the hospitalized people have hypertension/diabetes/cardiac disease and would likely be on either and ACE inhibitor or an ARB, and they are not being protected – contrarily, they are most at risk for death. If your doc wants you to maintain current therapy of either an ACEi or and ARB, one consideration would be to add the other class. This way your are now on an ACE-i and an ARB. This combo was shown to reduce ACE2 receptors as opposed to either alone where receptor counts rose. This combo has been studied¹⁴, so docs have data to reference. The most common side effect difference in the combo treatment arm was low blood pressure, so a dose modification is worth considering.

Ibuprofen was postulated to increase ACE2 as well¹⁶, I recommend avoiding this medication – if possible – during this period of time. The World Health Organization said no ibuprofen, then changed their guidance to not recommending avoidance¹⁷. Again, check with your doc.

My Mindset Around ACE2

It seems like an eternity since I heard about ACE2 (about 14 days give or take). Didn’t learn about it in pharmacy school, or any continuing education. Turns out, ACE2 is largely positive and a counterbalance to ACE¹⁸. Now, it is the gateway to this pandemic. It will be fascinating to see how fast the research guides us, stay tuned.

For now, I prefer simple – a rising tide lifts all boats.

ACE2 is part of the Renin Angiotensin Aldosterone System (RAAS), again see previous article. RAAS is our tide. If your RAAS is at high tide, you will likely have more ACE and ACE2.

Medications can alter ACE/ACE2 expression, sure. But, the impact seems drastically less if your RAAS tide is lower.

What causes high tide? Dehydration, salt deficiency, and high blood sugar¹⁹.

Lower your RAAS tide with good hydration, sufficient salt intake (Low Salt is Fake News), and supporting healthy blood sugar²⁰

Might I have the virus?

Every chill or cough causes quite a storm of concern for many.

Sure, you might have it, but between 80- 90% of the tests taken still come back negative.

CDC has established the symptoms, please reference their page.

Even though many are negative, but don’t be overly comfortable in that stat.

Why?

A high number are asymptomatic, up to 30% potentially²¹. Beyond that, around half of the Wuhan patients presented with GI symptoms as their chief complaint²² – not cough. We saw this recently in a local case as well, only GI. Further, red eyes are entering as another observation in Covid-19 patients²³. ACE2 receptors are prominent in the eyes and GI tract.

Bottom line, if you feel off, double down with efforts to self-quarantine. This virus brings a real ability to spread. Work with your doc – starting by a phone call versus a walk-in visit – to determine appropriateness of testing and next steps.

Ok, I now I have it!

Dang.

Ok, remember, the death rate is low. Lower that what is reported since we are only screening those with certain symptoms and of a certain age. This happens to be those most likely to have complications. As testing expands, we will see the death rate fall.

Much of damage with this virus comes from the body’s exuberant inflammatory response. In advanced Covid-19, we see this manifest as a cytokine storm²⁴. Cytokines are inflammation messengers. Inflammation works to bring healing in the short term. Long term, unresolved inflammation, is quite harmful. This is what we see often in the hospitalized patients.

Below is not a complete list, but things I think about which aren’t reported frequently.

Glutathione

Glutathione is the body’s major antioxidant. It has many roles, including with our immune response. A prolonged Covid-19 response can lead to glutathione depletion. Some are more susceptible to this genetically and nutritionally (especially high alcohol consumers).

Liposomal glutathione supplements are worth considering if you are dealing with Covid-19.

Ibuprofen / AntiInflammatory Drugs

In the previous article, we saw suppressing fever is not a good strategy in many cases. Your doctor can decide how high is too high, but we want to allow as much room as possible for the fever to do its work.

Acetaminophen

Commonly known as Tylenol, we often reach for this with fever. As above, we don’t necessarily want to artificially suppress fever.

Additionally with acetaminophen, it depletes glutathione. We don’t want this.

If you were taking N-acetylcysteine (NAC) for Covid-19 prevention, your glutathione status may be better. NAC is an antidote for acetaminophen toxicity. It helps restore glutathione.

Further, both acetaminophen and aspirin appear to prolong virus shedding²⁵.

Again, work with your doc, but consider acetaminophen avoidance.

Vitamin C

Vitamin C supports immune function, and appears to treat and prevent respiratory infections²⁶ – which fits with Covid-19 nicely.

Many reports of vitamin C and Covid-19 have surfaced. Start with a good liposmal vitamin c product. If you are hospitalized, I would request from your doc IV vitamin C²⁷.

High blood sugar competes with vitamin C, so ease up on that and refined carbohydrates. More in this article here.

Melatonin

The article cited above recommends higher doses of melatonin if you contract Covid-19. Work with your doctor, but increasing to the higher dosage forms available is worth considering. Melatonin can provide help dialing down inflammation. Further, it can protect lung injury from mechanical ventilators²⁸. Higher doses are used in many cancer protocols as well.

Turmeric/Curcumin

Turmeric is a popular natural anti-inflammatory. Researchers saw potential for its role in cytokine storm suppression in Ebola and other viral diseases ²⁹. So, while you should avoid ibuprofen, turmeric can be a worthwhile consideration.

Omega 3 Fish Oils

Omega 3’s are known anti-inflammatories. As with turmeric, omega 3’s can target cytokine storm³⁰. Coupled with their numerous health benefits, adding these in relatively higher doses while battling Covid-19 may confer benefits.

Hydroxychloroquine / Chloroquine +/- Azithromycin

These two anti-malarial medications hold promise to combat Covid-19. Some protocols add the antibiotic azithromycin.

Reson for optimism?

For the most part, it appears where malaria and therefore antimalarial medications are used, covid-19 is sparse.

Other evidence exists to support the combination. A France study³², China Study³³, along with growing posts on pubmed³⁴. New York trials are underway as well³⁵.

A protocol

A doctor treating 500 patients shows zero deaths, zero hospitalizations, and zero intubations³⁶. Only mild GI upset in 10% of this patients.

His out-patient treatment regimen is as follows:

Hydroxychloroquine 200mg twice a day for 5 days
Azithromycin 500mg once a day for 5 days
Zinc sulfate 220mg once a day for 5 days

Azithromycin

Yes, it is an antibiotic while Covid-19 is viral.

Many who develop pneumonia from the virus could also contract bacterial pneumonia.

Further, azithromycin provides two other potential mechanisms.

Researches found it lowered inflammatory messengers during acute lung injury³⁷.
It appears to preferentially target zombie (senescent) cells, at a rate of 97%³⁸! These zombie cell are a tax on our good cells as they compete for resources.
More importantly here, senescent cells can enhance viral replication ³⁹.
Senescent cells are also thought to be precursors to cancer and are a commonly increased in aging. Fasting/caloric restriction is a great way to knock off senescent cells.

Side Effects / Drug Interactions

The malarial drugs side effects documented after decades of use. The doc cited above observed nothing significant in his patients. Further, this course is fairly short. Arthritis users may take this regularly for months on end.

Heart rhythm disruptions are part of the picture with this treatment. A documented drug interaction between azithromycin and hydroxychloroquine generating an increased risk of QT prolongation (electrical indication of rhythm disturbance). A doctor must asses the risk for each patient, but many continue. Ensuring proper hydration and electrolyte balance is very important here.

Prevention?

Most organizations are recommending NOT using hydroxychloroquine as a preventative agent, understandably. The medication is in short supply, due to increased demand.

However, I believe it is worth considering prophylactically for healthcare workers on the front lines – if they fall sick, who will take care of the sick? The more exposure, the more viral load, the higher risk for infections with complication. I have seen stories on social media of younger healthcare workers in NY and other areas get sick and even die.

For malaria, the dose is 400mg (2-200mg tabs) once weekly. I have no idea if this correlates to Covid-19 or not.

As I was drafting this article, an interview came on the TV. Check out what this NY critical care doc said:

He references taking Plaquenil, which is the brand name of hydroxychloroquine. Is it one reason why he hasn’t contracted the virus? Maybe…

India is now recommending hydroxychloroquine for prophylaxis of healthcare workers and asymptomatic household contacts of positive cases⁴¹.

If I was on the front lines seeing covid-19 patients all day, I would ask my doc about prophylactic options. Again, thank your frontline healthcare workers.

Bottom line

While politics has entered the evaluation of this treatment – unfortunately – I think will prove to be a valuable treatment, especially for those hospitalized. Hopefully we will see results trickle in from NY’s trials. If I had a friend/relative approaching hospitalization, I would recommend working with your doctor to evaluate the risks with an eye toward using it.

UPDATE:

Twenty four hours after posting this article, the FDA approved hydroxychloroquine and chloroquine for Covid-19 treatment under an Emergency Use Authorization.

Take Home

New case growth appears to be leveling off in much of the country, and many worse case scenario forecasters are re-analyzing. We are not at the end of the tunnel, although we may see the light – at least outside of the NY/NJ metro area. This virus will be with us for a while at some level.

Social distancing has helped, as painful as it has been. Restrictions will likely relax in the coming weeks across less effected parts of the country. Even when/if that happens, we MUST continue to protect the elderly and those with underlying medical conditions. These groups may be recommended to wear a mask in public, and of course keep the hand washing up!

In the meantime, the lesson at some point will be to avoid being in the high risk category. Don’t be diabetic. Don’t have high blood pressure. While you can’t help but count birthdays, you can have your cells present like they were younger.

COVID-19 Defense: More Prevention and Treatment Considerations

Status