March 24, 2020
This is an update to the post that we placed on our website on March 17. Several things have changed – these are highlighted in bold font.
Q: Is COVID-19 a more serious illness than the usual yearly influenza?
A: The virus that causes COVID-19 is SARS-CoV-2. It is like the coronavirus that during the 2002-2003 SARS epidemic infected 8000 people worldwide, with a 10% mortality rate. The earlier virus has continued at a very low level of infection, with a mortality rate over a year’s time that is twice that of the usual flu. The mortality rate of COVID-19 is unclear, but is estimated between 1 and 4%. Currently the US mortality rate is running around 5%; this is based on a restricted denominator based on testing that has been limited. As most adults have limited or no immunity to the disease and those who have immune or respiratory disease are at increased risk, there is the potential for the pandemic to overwhelm existing capacity for treatment, as has occurred in China and Italy.
Q: What symptoms raise suspicion of the COVID-19?
A: Although there may be illness that is caused by this virus and is typically not recognized, generally COVID-19 presents with mild illness for a few days that is followed by more severe symptoms that includes fever, myalgias, and lower respiratory symptoms (cough and shortness of breath); a few people have diarrhea only. At this later stage, patients may become very ill and require hospital care. Mortality results typically from ARDS – respiratory distress and damage caused both by the virus and by the immune response to it.
Q: How is the disease transmitted and how can transmission be reduced?
- A: Although there is controversy, it appears that transmission occurs mostly based on large droplets from the lower respiratory tract, rather than via small droplets that are airborne, which is the usual mode of transmission with the flu. As such, if a mask is used, a standard mask (rather than the special N95 mask) is likely to be sufficient to interrupt transmission outside the hospital. Because the droplets survive for a week on surfaces, and are capable of being picked up by manual contact and then cause infection if transmitted by touching the mucous membranes of the face. For this reason, de-infecting surfaces, hand-washing, and avoiding touching the face is recommended. Furthermore, the amount of person-to-person spread of the illness is also important. When on average a patient with the disease spreads it to more than one other person, the disease spreads rapidly in the population, so restricting contact (“social distancing”) may slow or reduce transmission and as a result reduce the likelihood of overwhelming hospital treatment capacity or the number of deaths that the pandemic is responsible for, although the effectiveness of this strategy is a subject of discussion (see, e.g. a recent post arguing that this “horizontal” containment strategy should be replaced by a more targeted “vertical” strategy: https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html
- On March 17, The President issued a new document with new guidelines on preventing the spread of the illness, The following people are urged to stay home: those who are ill, those with family members who test positive for COVID-19, those who are “older”, and those who have a serious underlying health condition (affecting the heart, lungs, or immune system). The link to this statement is here: https://www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf
- On March 22, Maryland Governor Larry Hogan ordered non-essential businesses to close, and the Maryland Department of Health ordered medical providers to seek to see patients virtually rather than in person to limit the amount of physical exposure of patients with each other and with providers.
Q: How can the disease be prevented, severity be reduced, or severe infection be treated?
A: Points to consider:
- The antiviral prescription medications have not been shown to be effective.
- There is work being done to test vitamin C and other substances given by IV infusion, and to test other prescription medications including hydroxychloroquine and azithromycin – it is unclear if this is effective in prevention, severity reduction, or treatment of severe disease.
Q: What should I do to reduce the likelihood of getting the illness?
A: Points to consider in preventing the illness:
- Follow the national prevention guidelines: disinfect surfaces that might have been exposed to the virus, wash hands, avoid touching the mucous membranes if there might have been exposure, and stay home if you are ill, exposed to a documented case, older, or have a serious underlying condition (affecting heart, lungs, or immune system). If you are in the presence of someone with possible illness, wear a standard mask. A challenge here is obtaining disinfectants or masks. You can make your own disinfectant with a mixture of 2/3 rubbing alcohol and 1/3 aloe gel (see https://www.cbsnews.com/news/hand-sanitizer-coronavirus-make-your-own/ ), or use any commercial product (multi-surface cleaner or sanitizer) that is at least 60% alcohol (see https://www.wtae.com/article/here-s-a-list-of-disinfectants-you-can-use-against-coronavirus/31250157 ).
- Avoid contact with people who may be infected—people with respiratory symptoms, or situations in which you might have exposure to those who may have the virus; this may include large public gatherings or travel to areas where the illness is prevalent, or public (e.g. air) travel in which other passengers may be coming from areas of prevalence.
Q: Are medications, nutrients, herbs, and supplements helpful?
A: Points to consider:
- Medications have not been shown to be helpful, and the current influenza vaccine is not effective against COVID-2.
- We don’t know whether nutrients, herbs, or supplements are helpful in prevention, reduction in severity, or treatment of the illness, although Vitamin C has been used in treatment of patients with resulting pneumonia in China. IHP patients might consider an approach that includes the following:
- An antioxidant such as Vitamin C 2000 mg two to three times daily; and lipsomals such as Quicksilver Liposomal Vitamin C 1000 mg twice daily – many of these products are currently out of stock; IHP has no access to them
- As an alternative, supplements that increase availability of glutathione, a much more powerful antioxidant than Vitamin C, such as Avmacol Immune (includes both sulphoraphane from broccoli sprout and reishi mushrooms for immune support) which IHP has
- One or more antiviral herbs such as elderberry, olive leaf extract, or monolaurin; IHP has both of the latter two, and they and other products are on Fullscript (reachable on our website at: https://integrativehealthpractices.org/portal/)
- IV Vitamin C 25-50 g; IHP provides Vitamin C infusions ($180 for 25 g, $230 for 50 g) – patients must not have active disease and must have a prior lab test for G6PD
Q: Should I come in to IHP for appointments or urgent care visits?
A: If you are ill with symptoms that are suggestive of the flu (fever, achiness, cough/shortness of breath), call us and we’ll give you guidance on whether and how to be seen; current COVID testing is in short supply but is being done in some urgent care and emergency rooms. If you have a scheduled appointment with us, we encourage you to see us virtually using telemedicine, which most insurers are now covering. We are calling patients prior to appointments to arrange this, or to confirm an in-office visit, or to reschedule for another time. You may also confirm or make changes to your appointment by calling our office (410-648-2555).