Things You Must Know About COVID-19

So How Dangerous Is SARS-Cov-2 Or COVID-19?

As previously explained, the disease COVID-19 is caused by a virus in the SARS family, a virus that can lead in some individuals to Severe Acute Respiratory Syndrome. It is easily spread through respiratory aerosol droplets. The good news is that about 80 percent who contract the virus will get a very mild to very severe cold that they will get over on their own, without hospital support. It’s estimated about 20 percent will develop pneumonia-like symptoms that need hospitalization. The bad news is that about 5 percent of all infected individuals will need intensive care in the ICU, according to a recent article in the Journal of the American Medical Association.

A recent published study from Wuhan China showed that nearly 50 percent of those admitted to ICU needed mechanical respirators. A sobering statistic was that 86 percent died even though they had been placed on a mechanical respirator; respirators are not a panacea for COVID 19. According to the Intensive Care National Audit And Research Center study in the UK, 48 percent of COVID-19 ICU patients died, and of the patients who received advanced respiratory support 66 percent died.

The Point of These Grim Statistics

As of April 6, 2020, Public Health officials are warning that a COVID-19 vaccine is still 12 to 18 months away. Before that time the states are going to have to slowly end the stay-at-home order. Social distancing has done its public health job by reducing the number of cases and deaths from COVID-19. But social distancing has not and cannot get rid of the reservoir of the SARS CoV2 virus. It is still there in our American population. Therefore, for you and your loved ones, over the next 12 months, you will want to make COVID-19 nothing more than a mild to moderate cold that lasts about two weeks and provides you with immunity. Period!

How do you do this? You do everything humanly possible to strengthen and bolster your immune system and reduce a hyperinflammatory response. The research literature out of China indicates that the severely ill COVID-19 patients and especially those who die, all have the clinical and laboratory features of a "cytokine storm”. In other words, it may not be the virus that is directly killing these individuals, but their own immune systems put in a destructive overdrive.

What Is The Cytokine Storm or CSS?

Cytokinesare a vital group of proteins secreted by cells of the immune systemthatactaschemical messengers. Cytokinesinteract with cells of the immune system in order to regulate the body's response to disease and infection. The overproduction of cytokines or Cytokine Storm is associated with a wide variety of infectious and noninfectious diseases. The term was popularized during the avian H5N1 influenza virus infection, bringing the term into popular media.

It can generate a Severe Acute Inflammatory Response in the lungs to various triggers including certain viral infections, including SARS CoV2 virus, the cause of COVID-19. This cytokine storm leads to fluid buildup in the alveoli and excessive destruction of healthy tissues in the lungs and throughout the body. This fluid and cellular damage causes an inability to bring oxygen into the body, many times leading to the necessity of a mechanical respirator. The inflammatory reaction is set in motion by the immune cells that over produce and release cytokine chemicals such as interleukin-6 (IL-6) and tumor-necrosis-factor-alpha (TNF).

Who develops a cytokine storm is dependent upon the present overall health and genetics of the individual who contracts COVID-19. For example, individuals with chronic inflammatory disorders such as hypertension, diabetes and cardiovascular disease are now known to be more prone to the development of a cytokine storm and death from COVID-19.

Very recent research study from China has demonstrated that you can detect the coming cytokine storm in a patient by measuring a simple inexpensive blood marker called serum ferritin. This is a good first screening tool for the possibility of a cytokine storm syndrome in sick patients with high fevers. I suggest to anyone who is hospitalized for COVID-19 to request that their doctor includes a serum ferritin evaluation on ongoing basis while hospitalized.

How To Reduce The Possibility of Infection and A Cytokine Storm

Again, let me emphasize one more time, because this is a new virus there is no research to show any one thing can prevent or cure COVID-19. The most important thing to do is eat a healthy plant-rich, low carb diet to maintain a post meal glucose level under 120 mg/dL. Therefore, avoid immunosuppressive sugar, alcohol and processed foods and include immune-supportive foods and spices such as onion, garlic, ginger, turmeric and if accessible, mushrooms such as shiitake and maitake. Consistently use herbs such as Astragalus and Garlic, as well as assessing Vitamin D levels and supplementing as necessary, as pointed out in Part One. Abundant sleep is also crucial. Finally, limit spread through hygiene, limited contact, social distancing, and wear a mask.

There has been some on-line debate and confusion as to whether herbal products such as Elderberry and Echinacea will stimulate increased cytokine production leading to a cytokine storm. To my patients, I have reviewed the research literature on this subject, and I do not believe there is support for this supposition. Yes, these herbal products, as well as others, do increase cytokines which is how your immune system fights off infections. Therefore, you would want to take these early on to prevent and treat viral infections. But no, there is no evidence that they will produce a cytokine storm. Furthermore, if you are one of the 20 percent hospitalized for pneumonia, I do not think they will be providing you with any herbal products in the hospital. My family and I will be utilizing these products on an ongoing basis and attempt to prevent and lessen any viral infection.

Herbs That Can Improve Immune Function

Interferons (IFN) are proteins produced by white blood cells that "interferes" with viral replication. Interferon protects cells from viral infections by increasing natural killer cells, macrophages, phagocytes and other immune cells to eradicate pathogens, not only viruses, but also bacteria. [i] Elderberry fruit extracts and Astragalus root extract enhances IFN-β response. [ii] The well-known herbal Curcumin from Turmeric (Curcuma longa) has immune-stimulatory and anti-inflammatory activities because of its ability to increase IFN. Research shows it may also be able to reduce the potential of a cytokine storm. [iii] Echinacea angustifolia is also well known to increase interferon and has anti-viral properties that were comparable with Oseltamivir in one study. [iv]

The Herbal Combination Of Inflam-95

One of my favorite products is one that combines five different herbal extracts from ginger root, Curcumin, Boswellia, Nettle leaf, called Inflamm 95. I designed this product nearly 10 years ago when I was the chief science officer at a nutrition company called BioSpec Nutritionals. I’ve used it extensively in my practice and personally over the last decade. It is an herbal combination with multiple benefits, its primary use is to reduce inflammation in the body. Because of this it is always in stock at my clinic. Interestingly, all these herbs have been shown in research to have antiviral activity. Again, this is not to say that this combination of herbs will prevent or treat COVID-19. Supplementation with these herbs is generally regarded as safe and has not been linked to any severe adverse reactions, but many side benefits.

• Ginger root extracts have been shown to have excellent antiviral activity. Specific compounds in ginger such as gingerols, shogaols and zingerone have been found to inhibit viral replication and prevent viruses from entering host cells. [v]
• Extensive research evidence indicates Curcuminoids from curcumin play an inhibitory role against infection of numerous viruses. They inhibit viral replication or suppression of cellular signaling pathways essential for viral replication. [vi] Curcumin was found to have a protective effect on cells against virus-induced apoptosis and cytopathic activity, in other words it helped to prevent a cytokine storm. [vii]
• The third herb in Inflam- 95 is Boswellia serrata. This herbal extract uniquely qualified to reduce the inflammation associated with a variety of respiratory conditions because of its ability to inhibit 5-lipoxygenase (5-LOX) inflammation, something that synthetic drugs can't do safely. [viii]
• The fourth herb, Stinging Nettle Extract or Urtica dioica (UD) is one of my favorite herbs in this formula. Stinging nettle is known to have strong antiviral activities but also anti-inflammatory. One recent study found it was effective against SARS CoV. The study stated, "Urtica dioica agglutinin (UDA) specifically inhibited the replication of live SARS-CoV or SARS-CoV pseudotyped virus when added just before, but not after, adsorption. These data suggested that UDA likely inhibits SARS-CoV infection by targeting early stages of the replication cycle, namely, adsorption or penetration. [ix] Something worth considering in this present pandemic of SARS CoV2.

Quercetin, A Food Compound With An Antiviral Punch

Quercetin is a polyphenol from the flavonoid family of compounds found in certain foods. We get about 100 mg a day or more from a healthy diet. Researchers have been searching for small molecules that block the attachment of the SARS CoV-2, the virus that causes COVID-19, to our cells. This coronavirus docks onto our respiratory cells, like a key fits into a lock, utilizing the cells ACE2 receptors. Once the coronavirus enters the cell it hijacks the cellular machinery to crank out more copies of itself.

Based on its molecular structure, computer modeling shows that quercetin could be a "key” that fits the ACE2 receptor cellular lock and blocks other keys, such as the coronavirus, from utilizing it. There is actually some laboratory evidence that this can happen; after the first SARS CoV-1 epidemic, a few studies did show that quercetin could block entry of that particular virus into cells. As of yet there has been no research on Quercetin’s ability to block SARS CoV-2 entry into our cells. However, SARS CoV-1 and the new novel virus causing COVID-19, SARS CoV-2 share about 80 percent of their genetic make-up.

Clinical research is desperately needed, and a clinical study is now being organized. The best I can say is that quercetin has a real possibility of being useful in this ongoing pandemic. It is a natural dietary supplement that is available over the counter, the usual daily dose of 500 mg to 1000 mg. Quercetin supplementation is safe and has not been linked to any adverse reactions. In one study on viral hepatitis they used up to 5,000 mg without any side-effects, and with increased antiviral activity. However, because of the increased awareness of Quercetin antiviral activity it is now very difficult to find. We try to keep it in stock at the clinic for its many wonderful uses in Functional Medicine.

The Traditional Chinese Medicine: Yu Ping Feng San

There are various Traditional Chinese Medicines that I consider important at this time. However, their discussion is beyond the scope of this article. Though the Chinese formula Yu Ping Feng San merits consideration in this paper. This formula contains Astragalus root (Huang Qi), which is regarded as the "senior of all herbs” in the Essentials of the Materia Medica (A.D. 1694). Astragalus is considered one of the most effective immune tonic herbs in Chinese medicine. The second herb in the formula is Atractylodis Rhizome (Bai Zhu). The compounds in Atractylodis have been studied for their positive effects on modulating the inflammation response. The third herb Siler Root (Fang Feng).

Researchers in China have concluded that Yu Ping Feng San has been successfully applied in a clinical setting for its antiviral and anti-bacterial effects. This included preventing Severe Acute Respiratory Syndrome (SARS virus). Research in China has also shown that this three-plant extract may help reduce the activation of a cytokine storm[x]. The researchers believe that Jade Screen builds up the immune system by both stimulating and suppressing cytokine releases. Some have called this the Goldilocks zone of the immune response; not too much and not too little.[xi] This is one Traditional Chinese Medicine that my wife and I are now taking, along with a strict healthy diet and numerous other supplements. The huge problem now is finding Yu Ping Feng San or Jade Defender; basically, it is sold out.

Warning Signs At Home In Adults and Children

Along with chronic cough and shortness of breath, fever is one of the hallmarks of COVID-19. But is fever something that should be immediately suppressed? It turns out that fevers turn on our body’simmune system and are vital in fighting infections. They should be allowed to run their course if not too high. A normal fever runs between 100° and 104° Fahrenheit. Drink plenty of fluids to prevent dehydration.

• 104 °F: upper range at which most bodily functions are not altered.
• 106 °F: threshold for possible seizure activity. Normally human body temperature does not rise above this.
• 108 °F: brain damage may occur due to protein destruction.

In infants aged 1 month, 101.4 °F may be a critical temperature. This rises to 102 °F at two months of age.

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath or bluish lips or face
• Persistent pain or pressure in the chest or abdomen
• New confusion or inability to rouse
• Flu-like symptoms improve but then return with fever and worse cough

I hope this article and the one before has been some assistance in keeping you and your loved ones safe and healthy. If you have any questions or comments you can send them to the clinic email at painandbrain@gmail.com. In my next article I will examine the role that free radical damage and oxidative stress from viral infections in our alveoli plays in this pandemic. I will examine the role that specific antioxidants can play to keep us safe and healthy in these trying times. In closing, I encourage you all to stay safe and healthy. Do all the best practices to protect yourself and your family. Please do everything possible to improve the health of your immune system to increase your chances of developing a vibrant immunity to this virus. That way we can all start return to a normal life again.

References

1. Wikipedia. Interferon. Wikipedia2018.
2. PLoS One. 2012;7(10): e47878.
3. Sordillo PP, Helson L. Curcumin suppression of cytokine release and cytokine storm. A potential therapy for patients with Ebola and other severe viral infections. In vivo (Athens, Greece). 2015;29(1):1-4.
4. Karel Rauš SP, et.al. Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double-Dummy, Multicenter, Noninferiority Clinical Trial Curr Ther Res Clin Exp. 2015;77:66–72.
5. Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 586506, 16 pages
6. Journal of Functional Foods 40(692):699 · January 2018 
7. Biomed Res Int. 2014; 2014: 186864.
8. Clin Biochem. 2010;43(10-11):887-90.
9. Antiviral Res. 2011 Apr;90(1):22-32. doi: 10.1016
10. Int J Biol Sci. 2020; 16(10): 1708–1717.
11. PLoS One. 2013; 8(11): e78622.