Covid-19: Illness, Prevention, Severity Reduction March 1, 2020

March 1, 2021

COVID-19:  Illness, Prevention, Severity Reduction

March 1, 2021

As this pandemic has unfolded, we have provided periodic updates to a blog on COVID-19 diagnosis and prevention/severity reduction.  Most of the information that we have previously published has not changed, but some of it has evolved.  This update provides current information.

Testing

There are 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 continues to be 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 immunization and 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.

COVID immunizations have been selectively available since late December.  The State of Maryland has a new website, https://covidlink.maryland.gov/content/vaccine/ , that has information on staging and vaccine types.  IHP is not a provider of COVID vaccines, and at the current time, there is no process by which a note from our physician facilitates access to immunization for our patients.  We are often asked for our advice on whether to vaccinate.  In our view, this is an individual decision, and one that may evolve as there is more experience with the safety and effectiveness of the vaccines.  Patients at higher biological or exposure risk may be more likely to immunize as soon as access is available. Patients at lower biological risk may be more likely to defer immunization to allow more time for experience with the vaccines in the population.  Population use data from the first month of adverse event monitoring of the Pfizer and Moderna vaccines showed a very low level of serious reactions; longer-term data are not yet available, nor are population use data on the new Johnson and Johnson vaccine.

Alongside of this, it may be helpful to take steps to minimize biological risk and the severity of infection.  Maintaining or achieving a healthy body weight and optimizing blood sugar, nutrition, and physical fitness are the cornerstone of this approach.  Additionally, 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 evidence is evolving regarding interventions that may have the potential for ameliorating COVID-19 severity, among integrative and other practices an approach that includes the following has been used:

  • Antioxidants such as Vitamin C 1000 mg twice daily prior to illness, and 2000-3000 mg three 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 5,000-10,000 units twice daily early in the course of illness
  • Zinc 30 mg daily prior to illness and four times daily early in the course of illness
  • Quercetin 250 mg daily prior to illness and four times daily 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, and three times daily early in the course of illness
  • Melatonin 3-5 mg once daily prior to illness and two to three 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
  • 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/

Over the past several months, the number of IHP patients with COVID-19 diagnosis has increased.  Should you develop symptoms, we recommend that you consider the information in this post and communicate with your IHP physician or PA on your specific situation.  We are now also seeing patients coming to our practice seeking guidance on how to deal with long-term sequelae of the illness; thus far, there is not much experience with an integrative approach to this condition.

Osteoporosis and Low Bone Density

Bone is a dynamic structure, constantly being remodeled by cells that remove it (osteoclasts) and renew it (osteoblasts).  Once adulthood is reached, these two processes should stay in relative balance, but as hormonal status changes over time, the removal process predominates.  For some people, hormonal-mediated bone removal may be predated or augmented by other conditions.

Predominance of bone removal results in low bone density (sometimes referred to as osteopenia).  When bone density declines, the structure of bone is altered and it loses some of its strength and flexibility.  Severe bone loss is referred to as osteoporosis; osteoporotic bone has thinner outer cortex and trabecular supporting structure.

Low bone density and osteoporosis are associated with increased risk of fracture.  Other factors, however, are also important in predicting fracture risk:  age, smoking status, body size, alcohol use, etc.  The FORE Fracture Risk Calculator (https://americanbonehealth.org/bone-health/introducing-the-fore-fracture-risk-calculator/) can be used to calculate fracture risk.  Importantly, the radiographic assessment of bone density by DXA scanning, which is the most widely used method of predicting fracture risk, does not take into account all of the factors that are relevant to this prediction.  The quality of bone (how it is structured and what its mineral composition is), as well as its density, is also important.  Bone quality is not generally assessable through non-invasive testing.

It is common for patients to undergo DXA scanning, be told that their bone density is low, or that it is declining rapidly based on serial scans, and that as a result prescription medications are recommended to reverse the process of bone loss.  Although for some patients this may be appropriate – particularly when the risk of fracture is very high – for others it may not be for several reasons:

  • DXA scanning is subject to error, particularly if the patient is not properly positioned during the scan
  • Factors that are causing the imbalance of bone resorption and bone renewal have not been identified and addressed
  • Risks resulting from the use of the medications may be significant, particularly with bisphosphonates, which are associated with osteonecrosis of the jaw, and with spontaneous fractures owing to their effect on bone, which is to block the removal process such that bone formation predominates, which increases bone density but alters its quality (making it structurally more brittle).

When a DXA scan shows low bone density, it is appropriate to do lab testing to assess for conditions that are associated with bone loss (imbalance between removal and renewal).  Testing includes the general assessment that we use for most patients in integrative care (for hormonal status, nutrients, gut health/celiac status, and inflammation), as well as assessment of factors that are more specific to bone, including PTH, serum calcium, Vitamin D levels, 24 hour urine calcium, C Telopeptide (CTX) and osteocalcinin.  The latter three factors assess balance between bone removal and renewal, and are used in initial assessment of causes of low bone density and to monitor impact of treatment over the short run, with biannual DXA scanning and fracture risk prediction over the long run.

There are multiple causes of low bone density from imbalance between resorption and formation of bone:

  • Nutrient deficiency, either dietary or due to poor absorption from the gut
  • Hormonal imbalance: hypothyroidism or its overtreatment, hyperthyroidism, hyperparathyroidism, insufficient or excess insulin/diabetes, low growth hormone/IGF-1
  • Chronic inflammation and oxidative stress: infection or leaky gut-based
  • Heavy metal toxicity: cadmium, lead, mercury, aluminum, iron

The approach to treatment is as follows:

  • Healthy diet and weight-bearing exercise
  • Nutrient supplementation with magnesium, calcium, Vitamin K2, Vitamin D3, strontium, and trace minerals
  • Address issues identified through history and diagnostic testing: nutrient deficiencies, hormonal gut health, inflammation/oxidative stress, heavy metal toxicity

Helpful resources are:

 

IV Nutrient Infusions

Nutrients given by intravenous infusion have been used by many alternative and integrative medicine practitioners for decades.  The rationale for their use is that the blood levels of such nutrients when given orally is limited by the ability of the gut to absorb them, whereas with IV nutrients blood levels can be substantially increased.  This has been confirmed by clinical studies.

In considering use of IV nutrients, two questions must be asked:  are they effective in achieving their intended therapeutic purpose, and are they safe.  Ideally, the answers to these questions would be based on clinical research, but unfortunately the amount of such research is limited.

Four types of IV nutrients are in common use:  Vitamin C infusions, glutathione infusions, multinutrient (Meyers’) infusions, and phosphatidylcholine infusions.

Vitamin C infusions are the best studied.  Vitamin C has many effects:  it is an antioxidant that protects against damage caused by free radicals, boosts the immune system’s effect on wound healing and infections, and is toxic to some types of cancer cells.  There is some evidence that such infusions are beneficial in cancer patients in improving quality of life, and possibly that there are effects on tumors that reduce size and increase time to relapse.  It may also have benefit in patients with infection, shingles, and with chronic fatigue.  Used in patients without contraindicated medical conditions, IV Vitamin C is safe.

Like Vitamin C, glutathione is an antioxidant.  Most literature on its use is not based on clinical research, but instead based on case reports.  It may be effective in increasing the effectiveness of manual therapies in patients with musculoskeletal conditions, in reducing symptoms of parkinsonism, and in improving symptoms associated with autoimmune or other inflammatory response.  It appears to be safe.

Multinutrient infusions were popularized decades ago under the name Myers infusions, based on the work of a Baltimore physician named John Myers, and a modified version of this infusion has been used with thousands of patients across the country.  The infusion includes Vitamins C, B complex, B12, B5, B6, calcium, and magnesium.  It has been shown to have some benefit for patients with fibromyalgia, and based on case reports may result in improvement in fatigue, pain, and depression in patients with such issues.  Multinutrient infusions are safe.

Phospholipids are a key component of the membranes that surround all of our cells.  When such membranes are disrupted by toxicity or injury, particularly in nerve cells, illness results.  IV phospholipids are widely used in Europe, and based on experience, may be of benefit to patients with brain injury and inflammatory/degenerative conditions.  They are safe.