Coronavirus Update: April 13
This week, as the pandemic continues its course and we remain homebound, I would like to focus on two areas of discussion: antibody testing and additional treatments and preventive strategies to combat SARS-Cov2 virus infection.
As mentioned in last week’s email, we are beginning to hear more about antibody testing. This is very important and plays a big role in our ability to slowly return to normal activities.
Those who recover from COVID-19 infection develop protective antibodies which render them immune to additional infection. They also cannot transmit infection to others.
What we do not know, yet, is how long that protection lasts.
25 to 50 percent of coronavirus infections are asymptomatic, meaning many of us may have been infected with the virus without ever knowing it. This makes it important to identify those of us who have developed antibodies. The presence of these antibodies can help us identify anyone who has been infected, even if they showed no symptoms. In theory, this would allow a population of immune individuals to begin resuming a normal lifestyle.
We have heard a lot about the limitations of coronavirus testing — it takes a long time to obtain results, it’s not readily available, it only tells us about active infection, and it even has a false-negative rate of up to 30 percent! As such, lots of people have experienced what they think might have been a COVID-19 infection but were unable to get tested. These people would like to know if they are now immune.
In light of this situation, it is prudent that we learn about those who have been exposed and now possess antibodies. Plus, people with these antibodies can donate blood plasma to hospital centers to help treat patients struggling with severe COVID-19.
We do not know how long antibodies remain in the blood following infection, but early indicators suggest that immunity lasts at least 6 months and possibly more. In essence, until there is a vaccine available, antibody testing may be our best bet at returning to a life of normalcy.
Antibody tests are now becoming available, and it only takes about 15 minutes to administer and receive results. We are in the process of obtaining the test for our office. If you are interested in taking one, contact us to schedule an appointment.
Preventive Treatment Strategies
We have all learned how to protect ourselves from contracting the coronavirus — social distancing, hand washing, use of face covers and masks, sanitizing surfaces, avoiding face touching, and staying at home except for essential activities.
Now, many are wondering what else they can do to prevent infection. People are looking to medications, vitamins, and supplements, hoping that one of these options can help.
Let me start by stating clearly that there is no medication, vitamin, or supplement that has been proven to protect against or treat COVID-19 infection. There are, however, many unproven and experimental treatments that some doctors are recommending, and I believe some of them are worth considering.
Ordinarily, in order to prove that a treatment is effective, experts use properly conducted clinical studies to demonstrate efficacy and safety. But because these studies can take a long time, it’s become appropriate for some people to consider treatments that may not have been tested as thoroughly. Even if there is risk involved, some of these treatments might be very effective, and worth considering.
Several principals are important when considering unproven treatments:
- Will the intervention be safe?
- Are the resources required for treatment available and/or affordable?
- Is there at least some evidence to suggest that this treatment can be effective?
- How robust and reliable is that evidence?
Some treatments are intended as preventive, others are used to treat infection. The timing of the intervention is also important.
With thousands of scientists and physicians all over the world seeking solutions, the number of agents under investigation is exhaustive. So, my discussion here is limited to some selections and is far from complete.
Disease Prevention with Vitamins and Supplements
Many people are wondering what they can do to strengthen their immune system in order to reduce their infection risk. But because the immune system is complex, the notion of “strengthening” it is rather complicated. For instance, an overactive immune system can actually be detrimental to our health. As such, it’s wise to consider immune modulation to enhance antiviral protection. Immune modulation means that certain parts of the immune system are enhanced.
Viruses, like SARS-Cov2, are initially fended off by what’s called the innate immune system— our first line of defense when the body has not previously encountered the virus and is unfamiliar with it.
While there are a number of vitamins and nutraceuticals that can enhance your innate immune system responses — and thus improve your viral resistance — it is far more effective to focus on good lifestyle habits like balanced nutrition, daily exercise, healthy sleeping habits, and stress management. More than any supplemental product, these lifestyle strategies are the most important for immune system support!
That being said, here are some of the most effective vitamins to boost immune system health:
Vitamin C has been used for years as a general immune system enhancer and antiviral agent. There are plenty of scientific studies regarding its use for preventing infection, although not specifically for the coronavirus. It is being used in high intravenous doses to treat seriously ill COVID19 patients on ventilators, although it is unknown whether it is effective in this setting. 500-1000mg taken once or twice per day is a safe dosing schedule.
Vitamin D is an immunomodulator and is required for the production of natural antimicrobial peptides. Several studies have indicated that supplementation reduces the risks of respiratory infections. Vitamin D is best taken with food and in doses of 2000-4000 I.U. per day.
Zinc is an essential mineral that is integral for immune system function. Zinc has been demonstrated to reduce upper respiratory viral infections and is often taken as a lozenge during cold seasons. A recent study suggested that nearly 30 percent of the elderly US population is deficient in Zinc. Vegetarians are also more at risk for Zinc deficiencies. As such, I recommend taking a daily dose of 15-30mg elemental zinc (avoid higher doses).
Elderberry is a frequently recommended herbal nutraceutical often used during cold and flu season. It has been shown to decrease the risk and duration of the common cold and has demonstrated antiviral activity. It is unknown whether it helps to prevent COVID-19. Some have advised against its use in this setting since one study suggested that it can increase the production of cytokines (more on this later), which could make the infection worse. It is probably fine as a preventive agent but not for use to treat coronavirus infection.
Selenium is an essential dietary element that is important for innate immune system function. It also acts as a potent antioxidant. It has been shown to reduce the severity and duration of influenza and other respiratory viruses, although there is no data on its impact on COVID-19, I still recommend taking about 50mcg per day.
Mushrooms possess numerous potent substances that potentiate immune function and have anti-inflammatory activity. These are usually offered as supplements, tinctures, or teas with a combination of mushroom extracts, such as maitake, lion’s mane, reishi, and Cordyceps.
The “Cytokine Storm”
Why is it that some people who contract coronavirus become asymptomatic carriers while others become gravely ill?
We know that certain risk factors such as advanced age and the presence of chronic medical conditions increase the chance of severe COVID-19 illness, but even some healthy and young people get very sick. Some have proposed that this may result, in part from the viral load (innoculm) to which a person is exposed. But surely, other factors are also at play.
One thing we do know is that severe illness is often associated with the cytokine storm — an excessive immune system reaction to viral infection. In this circumstance, the virus triggers a reaction in which heavy production of inflammatory chemicals (cytokines) are released. This leads to tissue injury, particularly in the lungs. Stopping or limiting this reaction is essential in order to overcome the illness and prevent organ damage. It is unknown why some people experience such an exaggerated immune system response, while others dampen the infection without overreaction.
Some of the treatments that are being used experimentally in very sick COVID-19 patients are directed towards shutting down the cytokine storm. Interestingly, some of these are biologic medications used in the treatment of autoimmune and rheumatic diseases! The idea is to quiet down the immune system response in order to restore physiological balance. This is exactly why the concept of immune system strengthening is overly simplistic — if the immune system reacts too strongly, the patient may become gravely ill and require immune suppression to recover!
There are several nutraceutical supplements that can help prevent a cytokine storm, and also help to prevent viral replication within the host cell. Once again, these supplements have not been proven to be effective in coronavirus infection, but there is growing evidence of their benefit. Plus, they are generally safe.
Here are several nutraceuticals worthy of consideration:
Curcumin is the active ingredient in Turmeric spice and has a number of desirable activities. It has anti-inflammatory activity, anti-tumor activity, and inhibits excessive immune system reactions. The dose is 500-1000mg per day.
Melatonin is well-known as a “sleep hormone” but it also has immunomodulatory activity and can dampen excessive immune reactions. Dose:3-10mg before bed.
Quercetin is a polyphenol present in fruits and vegetables with a wide range of biological activities. It has recently been shown to block the ACE2 receptor, which is the site at which the coronavirus attaches and enters our cells. It also has antioxidant and immunoregulatory properties. There are no studies yet demonstrating its benefit in COVID-19, but investigations are ongoing. The usual dose is 100-500mg once or twice per day.
EGCG (Epigallocatechin gallate) is a flavonoid present in green tea that possesses many biological actions and health benefits. It can inhibit cytokine storms and prevent viral replication by inhibiting the action of M protease, an enzyme required by the virus for reproduction. A cup of green tea has 50-100mg of EGCG. The recommended supplemental dose is up to 400mg per day. Excessive dosing has been associated with liver injury.
Several peptides have direct immunomodulatory activity and antiviral benefits, meaning they can be helpful in preventing infection. Peptides have been extensively studied in animal models and experimental settings, but clinical evaluation remains mostly anecdotal. Only a few have been reviewed by the FDA, so many are considered investigational.
If you’re still wondering whether taking vitamins and supplements can help prevent coronavirus infection, consider that there are endless schools of thought on the matter. While it’s true that there is a shortfall of proven clinical studies that demonstrate the efficacy of certain supplements, there is also a good deal of scientific evidence supporting their potential benefits. So at the end of the day: it’s a personal decision whether or not you’d like to try them for yourself.
Speaking for myself, I have been taking most of the supplements and peptides listed above. I also re-evaluate them on an ongoing basis as more data become available. But I stress that the most important way to stay safe is to practice social distancing, stay at home as much as possible, to wash, wash, wash your hands, eat properly, and get sufficient rest and exercise.
Next week, I will discuss some of the pharmaceuticals that have been talked about with regard to treating COVID-19.
Until then, Stay Safe!!
If you’d like to talk in more depth, please schedule an appointment with my office.