Hello everyone. To those I have not seen in a while, I hope you are well. I am writing to give you my thoughts on the current pandemic. As of the date of this letter, 03/19/2020, people are extraordinarily concerned about the Corona virus, otherwise known as SARS CoV-2. The disease it causes is called COVID-19 which is short for Corona Virus Disease 2019. In some parts of the country especially on the West Coast in Seattle, many people have contracted the virus and it is starting to put a strain on their medical systems. Relatively few people have been confirmed to have it in Delaware at this time, but many are starting to be tested.
The virus itself is from the family of corona viruses, thus the name. It has made 2 other appearances. The first in 2003 that resulted in SARS (severe acute respiratory syndrome) in China and MERS (Middle Eastern Respiratory Syndrome) in 2012 in Saudi Arabia. In both cases about 800 people died from the viruses. Evidence does not support the theory that this Corona virus is a man-made virus, but the product of evolution. It jumped from its present form from an animal to a human host. The most likely source for this is bats as it is very close in structure to the Corona virus found in bats. The other theory is it jumped from an animal host to human in a less virulent form, and then mutated to the dangerous form we are dealing with today. So far, there have been a reported 9310 deaths so far from COVID-19. This number though is probably far smaller than the actual numbers for this is only the numbers of confirmed COVID-19 deaths. There is also great suspicion that we are not getting accurate information from China, North Korea, Iran and other countries who at least initially did not handle the outbreak well. In the US so far, there are 157 confirmed deaths from Corona Virus and confirmed cases of 9486. Again, as is the case in the worldwide numbers, these numbers are far smaller than they actually are because widespread testing has not yet been done. Now to put this in perspective, the CDC, Centers for Disease Control, estimate 34,200 people died in the US during the 2018-2019 flu season from the typical seasonal flu’s we experience every year. So, it is not yet time to panic. But we still need to be very concerned and here is why.
The reason this bug is different is it’s highly contagious but only mildly symptomatic to asymptomatic in the young and healthy. The vulnerable population are those over the age of 65, those immuno-compromised (auto-immune disease, those taking medications for auto-immune disease, HIV patients, cancer patients and those who have undergone cancer therapy) and those with pre-existing pulmonary conditions. People in these groups are far more likely to develop the severe form of Corona virus which includes massive inflammatory responses in their respiratory tracts, with cytokine storm, leading to pneumonia and unfortunately death. There are also multiple reports of people in the supposed safe categories getting the severe form of the virus and even dying. Frankly, we do not yet completely understand this virus.
Unfortunately, we have set ourselves up to ignore this threat. Social media, including those who should know better in the Functional Medicine and Alternative Medicine Communities have created an atmosphere where many thinks this is just one more false alarm. People and groups with political affiliations have also exaggerated the severity of the crisis or have minimized it depending on what they are trying to accomplish. Those who minimize should be reviewing the reports from northern Italy which is in real crisis with hospitals overflowing and people dying because of it. Those who exaggerate it should review the fairy tale about the boy who cried wolf.
So, what to do about it? First, from a preventative standpoint, social distancing must be utilized. This is especially important for people in the vulnerable populations. Significant research is already proving that social distancing works and greatly slows the spread of the disease. South Korea, Singapore, Hong Kong have all been very successful at this.
The symptoms of COVID-19 are much the same as the flu. Fever, cough and shortness of breath are the main 3. Some people have also experienced digestive issues with COVID-19. These would include loss of appetite, vomiting, diarrhea and abdominal pain. But the respiratory symptoms are more common. If you experience the following emergency symptoms, please go to the ER or call 911. These include difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse or wake up and bluish lips or face. If you see someone with these conditions, call 911.
But if you have symptoms that do not fall in the emergency category, should you go to the doctor? Not necessarily. You do need to call your primary care doctor and report your symptoms. They will evaluate if it is better for you to just ride it out as you would with the flu, or if there is a need for you to come into their office. In the next few days, tests for the virus will become more available. Beebe Hospital last weekend had a drive thru testing site. Stay tuned to local TV and radio for that information. These tests are only for those who have symptoms at this point in time. That may change.
From a preventative treatment perspective, these are my suggestions. These recommendations are based on case studies and case reports coming from Doctors who have been treating very ill patients for the last two months in other countries and from my own immunological understandings on viral illness in general and Corona Viruses in particular. These are not just my own conclusions but are consistent with many Functional Medicine providers I am in contact with. Finally, they are not based on double blinded controlled trials because this is a novel (new) virus and it has not yet been possible to do that. Here are my recommendations.
Zinc Picolinate or zinc gluconate 30mg/ twice per day.
Vitamin A – 10000 IU’s per day for the first month and then 5000 IU’s per day for the second month on.
Vitamin D – 10000 IU’s per day.
NAC (n-acetylcysteine) 500 mg/day.
Selenium 200 mcg/day.
C 4-5 grams/day to bowel tolerance. Ramp up slowly and back off 1 gram on tablet, capsule or powder if bowels become loose.
For those that contract the virus and are significantly symptomatic, from a Functional Medicine perspective, I am hearing IV Vitamin C at high doses 12 grams in 50ml sterile water at 12ml/hr., twice per day for 7 days. IV Glutathione is also being used in places with reported good results. Anti-malarial medications like Plaquenil, at 400 mg twice per day the first day, then 200mg twice per day for 4 days, have all been effective and are saving lives. Plaquenil acts as an ionophore to get zinc inside the cells where it stops viral replication. Of course, medical management of the acute respiratory symptoms if they develop is paramount. There are trials being done on pre-existing anti-viral medications and some off label anti-viral use, but I have not heard of any firm conclusions. They are rushing thru vaccines, but it will be most likely a year before one is available for use in the general population.
I am advising my current patients with symptoms of the Corona Virus to stay home. For my patients who are symptom free, but are part of a vulnerable group, I am cancelling maintenance appointments and will only handle acute painful conditions. I will schedule them at a time where no one else is in the office but me. I am dis-infecting and cleaning my office multiple times during the day. In my office, I have a sign posted at my front door and front desk, that if someone has a fever, is coughing, sneezing or has any signs of a cold or flu, to please go back to the car and call us for further instructions. Once there, I will ascertain the need for the visit, reschedule at a time without other patients present and if necessary, refer to medical facilities or simply have you go home. Obviously if you are in distress, call 911 and be taken to the hospital.
My paramount concern is that you my patients, your friends and family, all come thru this safe and sound. As always, I am available to answer questions are talk with you on the phone. Good luck to us all and be smart and safe. Corona Virus – Part 2
Hello everyone. To those I have not seen in a while, I hope you are well. I am writing to give you my thoughts on the current pandemic. As of the date of this letter, 03/19/2020, people are extraordinarily concerned about the Corona virus, otherwise known as SARS CoV-2. The disease it causes is called COVID-19 which is short for Corona Virus Disease 2019. In some parts of the country especially on the West Coast in Seattle, many people have contracted the virus and it is starting to put a strain on their medical systems. Relatively few people have been confirmed to have it in Delaware at this time, but many are starting to be tested.
The virus itself is from the family of corona viruses, thus the name. It has made 2 other appearances. The first in 2003 that resulted in SARS (severe acute respiratory syndrome) in China and MERS (Middle Eastern Respiratory Syndrome) in 2012 in Saudi Arabia. In both cases about 800 people died from the viruses. Evidence does not support the theory that this Corona virus is a man-made virus, but the product of evolution. It jumped from its present form from an animal to a human host. The most likely source for this is bats as it is very close in structure to the Corona virus found in bats. The other theory is it jumped from an animal host to human in a less virulent form, and then mutated to the dangerous form we are dealing with today. So far, there have been a reported 9310 deaths so far from COVID-19. This number though is probably far smaller than the actual numbers for this is only the numbers of confirmed COVID-19 deaths. There is also great suspicion that we are not getting accurate information from China, North Korea, Iran and other countries who at least initially did not handle the outbreak well. In the US so far, there are 157 confirmed deaths from Corona Virus and confirmed cases of 9486. Again, as is the case in the worldwide numbers, these numbers are far smaller than they actually are because widespread testing has not yet been done. Now to put this in perspective, the CDC, Centers for Disease Control, estimate 34,200 people died in the US during the 2018-2019 flu season from the typical seasonal flu’s we experience every year. So, it is not yet time to panic. But we still need to be very concerned and here is why.
The reason this bug is different is it’s highly contagious but only mildly symptomatic to asymptomatic in the young and healthy. The vulnerable population are those over the age of 65, those immuno-compromised (auto-immune disease, those taking medications for auto-immune disease, HIV patients, cancer patients and those who have undergone cancer therapy) and those with pre-existing pulmonary conditions. People in these groups are far more likely to develop the severe form of Corona virus which includes massive inflammatory responses in their respiratory tracts, with cytokine storm, leading to pneumonia and unfortunately death. There are also multiple reports of people in the supposed safe categories getting the severe form of the virus and even dying. Frankly, we do not yet completely understand this virus.
Unfortunately, we have set ourselves up to ignore this threat. Social media, including those who should know better in the Functional Medicine and Alternative Medicine Communities have created an atmosphere where many thinks this is just one more false alarm. People and groups with political affiliations have also exaggerated the severity of the crisis or have minimized it depending on what they are trying to accomplish. Those who minimize should be reviewing the reports from northern Italy which is in real crisis with hospitals overflowing and people dying because of it. Those who exaggerate it should review the fairy tale about the boy who cried wolf.
So, what to do about it? First, from a preventative standpoint, social distancing must be utilized. This is especially important for people in the vulnerable populations. Significant research is already proving that social distancing works and greatly slows the spread of the disease. South Korea, Singapore, Hong Kong have all been very successful at this.
The symptoms of COVID-19 are much the same as the flu. Fever, cough and shortness of breath are the main 3. Some people have also experienced digestive issues with COVID-19. These would include loss of appetite, vomiting, diarrhea and abdominal pain. But the respiratory symptoms are more common. If you experience the following emergency symptoms, please go to the ER or call 911. These include difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse or wake up and bluish lips or face. If you see someone with these conditions, call 911.
But if you have symptoms that do not fall in the emergency category, should you go to the doctor? Not necessarily. You do need to call your primary care doctor and report your symptoms. They will evaluate if it is better for you to just ride it out as you would with the flu, or if there is a need for you to come into their office. In the next few days, tests for the virus will become more available. Beebe Hospital last weekend had a drive thru testing site. Stay tuned to local TV and radio for that information. These tests are only for those who have symptoms at this point in time. That may change.
From a preventative treatment perspective, these are my suggestions. These recommendations are based on case studies and case reports coming from Doctors who have been treating very ill patients for the last two months in other countries and from my own immunological understandings on viral illness in general and Corona Viruses in particular. These are not just my own conclusions but are consistent with many Functional Medicine providers I am in contact with. Finally, they are not based on double blinded controlled trials because this is a novel (new) virus and it has not yet been possible to do that. Here are my recommendations.
Zinc Picolinate or zinc gluconate 30mg/ twice per day.
Vitamin A – 10000 IU’s per day for the first month and then 5000 IU’s per day for the second month on.
Vitamin D – 10000 IU’s per day.
NAC (n-acetylcysteine) 500 mg/day.
Selenium 200 mcg/day.
C 4-5 grams/day to bowel tolerance. Ramp up slowly and back off 1 gram on tablet, capsule or powder if bowels become loose.
For those that contract the virus and are significantly symptomatic, from a Functional Medicine perspective, I am hearing IV Vitamin C at high doses 12 grams in 50ml sterile water at 12ml/hr., twice per day for 7 days. IV Glutathione is also being used in places with reported good results. Anti-malarial medications like Plaquenil, at 400 mg twice per day the first day, then 200mg twice per day for 4 days, have all been effective and are saving lives. Plaquenil acts as an ionophore to get zinc inside the cells where it stops viral replication. Of course, medical management of the acute respiratory symptoms if they develop is paramount. There are trials being done on pre-existing anti-viral medications and some off label anti-viral use, but I have not heard of any firm conclusions. They are rushing thru vaccines, but it will be most likely a year before one is available for use in the general population.
I am advising my current patients with symptoms of the Corona Virus to stay home. For my patients who are symptom free, but are part of a vulnerable group, I am cancelling maintenance appointments and will only handle acute painful conditions. I will schedule them at a time where no one else is in the office but me. I am dis-infecting and cleaning my office multiple times during the day. In my office, I have a sign posted at my front door and front desk, that if someone has a fever, is coughing, sneezing or has any signs of a cold or flu, to please go back to the car and call us for further instructions. Once there, I will ascertain the need for the visit, reschedule at a time without other patients present and if necessary, refer to medical facilities or simply have you go home. Obviously if you are in distress, call 911 and be taken to the hospital.
My paramount concern is that you my patients, your friends and family, all come thru this safe and sound. As always, I am available to answer questions are talk with you on the phone. Good luck to us all and be smart and safe.