November 17, 2020
In the spring, as this pandemic unfolded, we provided biweekly updates to a blog that we posted on various aspects of COVID-19. Most of the information that we had previously published has not changed, but some of it has evolved. This update provides current information on two topics: testing and prevention/illness severity reduction.
There are now generally available three types of testing:
- Molecular PCR Testing. This uses specimens obtained by swab from the nose. This test determines whether a person has fragments of viral RNA in the upper airway, and is the gold standard for whether there is active infection and hence contagiousness – having the lowest false positive and negative rates. Although results can be available within a day, in practice it generally takes a couple of days before they are reported. The test usually remains positive for about two to three weeks following the onset of infection
- Rapid Testing. This also uses nasal swab specimens, to determine if a patient has active infection and is contagious. It looks for proteins that the virus makes, and has the advantage of immediately available results, but has a slightly higher rate of false positives and false negatives.
- Antibody Testing. This test assesses whether a person’s blood has evidence of immune system (typically IgG) reaction to one or more viral proteins. This test is not used to diagnose active infection, but to seek to identify whether a person has had infection and has persistent immunity. There are higher rates of false positives and false negatives associated with this test, and it is unclear whether a positive test indicates that a person is protected from infection, and if so for how long that is the case.
LabCorp and Quest do both molecular and antibody testing, but the former requires a nasal swab, and as at IHP we do not allow patients in the office with potential COVID-19 symptoms, it is generally preferable to go to a facility where the testing is either done by a clinician or where you can do your own nasal swab and hand it off to the tester. Currently the best source of information on local testing availability is the State of Maryland site: https://coronavirus.maryland.gov/pages/symptoms-testing.
IHP physicians and PAs order antibody testing where that is relevant; the blood drawing is done in LabCorp and Quest facilities for patients without current potential COVID-19 symptoms.
Preventing and Reducing Disease Severity
The currently accepted methods for preventing COVID-19 are wearing a mask and social distancing. It has recently been emphasized that the latter method includes more than just keeping at least six feet away from others, but is also involves other factors:
- Minimizing the duration of exposure
- Being in a place where there is greater circulation of air – e.g. outdoors or a large indoor space is preferable to a small indoor space
- Avoiding contact with persons whose behaviors are risky; giving preference to contacts with people who are careful in their own exposures or who have self-quarantined for a couple of weeks prior to exposure, or who have been tested for contagion
At IHP we are often asked about specific situations/behaviors and whether they are safe, such as attending a social gathering, or allowing family members into the home. In our view, there are three factors to have in mind when considering the risk involved.
- How high is your biological risk? Patients who are young and healthy and non-obese are at lowest risk, and patients who are elderly, with chronic medical problems and/or obesity are at higher risk, with a continuum of risk for patients with some of the higher risk characteristics.
- How high is the situational risk? Situations in which mask-wearing or the various forms of distancing are difficult are higher risk, as are situations involving interaction with people who do not limit their contact with others to low risk situations.
- How important is it to you to be involved in the situation? Family situations that happen once in a lifetime are likely to be more important than casual interactions that are readily available.
When considering whether or how to engage with others in a specific situation, we recommend that you consider these three factors. If you decide to go ahead with it, try to maximize the use the above methods of distancing to minimize the risk.
In our view, there has been insufficient attention paid to minimizing biological risk and the severity of infection. Increasingly, it is known that COVID-19 involves an initial period of a few days of generally low symptoms, which in some individuals then gives rise to an immune response that has the potential for life-threatening illness and post-illness long-term complications (fatigue, cognitive and mood issues, respiratory or cardiovascular deficits). In other words, like some other infections such as Lyme (which we see a lot of in our practice) the “host response” (individual biological health) is important in determining the course of the illness.
Although there is no evidenced research basis for the following interventions, they have been suggested as having the potential for enhancing biological capabilities for ameliorating the COVID-19 severity:
- Antioxidants such as Vitamin C 1000 mg twice daily prior to illness, or 1000 mg hourly to the point of diarrhea early in the course of illness
- Avmacol, which includes sulforaphane (an active immune-enhancing ingredient in broccoli sprouts) and increases the availability of glutathione, a powerful antioxidant, daily prior to illness, or three times daily early in the course of illness
- Zinc 30 mg daily prior to illness or four times daily early in the course of illness
- Inhalation of nebulized hydrogen peroxide 3% solution several times daily prior to illness, or hourly early in the course of illness; a video demonstrating this technique is at https://archive.earthclinic.com/remedies/hydrogen_peroxide_inhalation.html
- Melatonin 3-5 mg once daily prior to illness or early or two to four times daily early in the course of illness
- Vitamin D3 5000 units daily prior to illness to reach 25 OHD levels of 50 or above and 20,000 units or more early in the course of illness
- Avoidance of electromagnetic fields (EMFs), such as are generated by wi-fi, cell phones, and other devices as much as possible prior to illness and more aggressive early in the course of illness
- Caution in taking folates or ACE inhibitors
- Use of hydrogen water, such as Quicksilver H2 Elite, once daily prior to illness and three times daily early in the course of illness
- Use of ozone water or other methods of administration of it; this involves purchase of an ozone generator (see, e.g. https://www.simplyo3.com/collections/generators/products/stratus?_ga=2.87899931.2018403127.1586138178-2043708408.1586138178); a liter of ozone water daily prior to illness and three times daily early in the course of illness
- Use of a broad spectrum herbal treatment approach, including one by Stephen Buhner whom many know as a prolific American herbalist with perhaps the broadest experience with use of herbs in treating Lyme disease; summary of Buhner’s recommendations can be found at https://highgardentea.com/herbal-treatment-for-coronavirus/
We have been fortunate in not having many patients with COVID-19, and we hope that you and we will continue to avoid such illness. If you develop symptoms, we recommend that you consider the information in this post and consult with your IHP physician or PA on your specific situation. We are now beginning to see patients coming to our practice seeking guidance on how to deal with long-term sequelae of the illness.
In the near future, the first of the COVID-19 vaccines will become available, initially likely to high risk subpopulations. As more information becomes available on the efficacy and safety of such immunizations, we will communicate further about this prevention strategy. At present, we are often asked about flu immunization. The use of masks and social distancing should also reduce the risk of influenza infection; the flu vaccine may add further preventative effect, which may be important in reducing the likelihood of coinfection by COVID-19 and flu, but the extent of this additive effect and of risks associated with such immunization have not been assessed to our knowledge.