• Brian Rudman

COVID19: Update and deep dive into what we know


I wanted to put some more information out there from a medical source for our patients that adds to what I wrote about 10 days ago. That last post focused mostly on what the virus was, where it came from and how to try to prevent spread. Since that time, we know a lot more, and before when I said it is not if but when it would be a pandemic, we now know that the when is NOW. At the same time, we know more, there is a lot of disinformation out there – so I am going to go in depth to dispel as much of it as I can.


Like last time, this is going to a long post – and at some points pretty in depth on some medical and science things that may simply cause some of you to fall asleep while reading or at least have your eyes glaze over. Like last time I will spell out from the start what the primary questions I will be answering, and the take home points up front, so you have them if you decide to tap out while reading. Questions we will be discussing:


  • Biology of this Coronavirus and how it differs scientifically from Influenza

  • R value, spread, social isolation, prevention, and risk groups

  • Symptoms, diagnosis, lab / imaging findings and clinical course

  • Prevention Tip # 1: HOW to wash your hands

  • Treatment and Prevention – Traditional Medical therapies

  • Treatment and prevention - Alternative therapies and why you should not biohack


Summary of recommendations:


  1. This is NOT the Flu. It is most definitely more serious, and far more deadly. It attacks different cells in your body and if you are in the severe group, much more difficult to treat and deadly.

  2. WASH YOUR HANDS. A LOT. Wash them the right way. Use antimicrobial gel. Consider the use of gloves during travel, or while in very populous areas. This helps remind you to not touch an object and not touch your eyes, nose or mouth. Don’t worry about wearing a mask UNLESS YOU HAVE THE VIRUS.

  3. Social isolation is important to flatten the curve – it’s not mostly for your prevention, it’s for you to do your part so others don’t die.

  4. Tank up (judiciously) on Vitamin C, Vitamin B12, Zinc, Glutathione (orally and or IV). Every Day orally. Weekly on IV.

  5. Take Thymosin Alpha 1 as an injectable peptide to boost your immune system.

  6. If you get it get tested. If positive get additional blood tests. If you feel you are getting better, then get worse or have trouble breathing – call your doctor – you may be in the severe group. Consider Chloroquine

  7. Don’t try and BIOHACK your way through this. Maintaining good health is key but it is not the time for extended fasts, extreme diets, extreme workouts and extreme supplements. Often times these therapies LOWER your immune response before it increases it. Note: a low carb diet is NOT an extreme diet and is still recommended (glucose impairs white blood cell response)


Biology of SARS-CoV-2


This virus is an RNA virus (a virus that has a small piece of protein that it inserts into healthy cells) that is in the Coronavirus class. In this class there are 2 divisions- one that is really common and causes the common cold. The other class causes epidemics – SARS and MERS that have high transmission rates AND higher death rates. This virus is in the latter category.


The influenza virus works by creating a large viral load and then generating a huge immune response (it’s this immune response that makes you feel “sick”) and then you are very quickly left with a weakened and burned out immune system and susceptible to other infections. Unlike the flu which causes this immediate strong immune response, this Coronavirus virus binds to a specific receptor called the ACE2 receptor and inserts its viral load into cells that contain this receptor. This is important for two reasons. First, one of the types of cells that have this receptor are the small cells in your lungs (called pneumocytes) that produce a fluid, surfactant, that KEEP YOUR LUNGS OPEN and keeps you able to get oxygen in the blood. Women who have been at risk of Preterm labor may know about this because these are the cells that they newborn hasn’t quite fully became functional, thus the breathing / lung issues of the 20-week newborn. More on this ACE2 and pneumocytes in the clinical course section.


ACE2 also explains why a nontraditional group is added into the higher risk category – those with Hypertension and heart disease. ACE2 is shorthand for Angiotensin Converting Enzyme number 2 and it is a binding receptor for a hormone produced in the kidneys called Angiotensin. Not to go far down that physiology tangent but a common underlying finding in people with high blood pressure is a problem in this hormone pathway and its binding of Angiotensin with the receptor. In short, the virus works at the same site as this hormone that affects blood pressure (as well as other things). That is VERY different from the influenza which is less about attacking pneumocytes and more about vigorous immune response.


Pandemic and US spread


The virus is transmitted from person to person via droplet and likely airborne transmission. It is most definitely hardier than first expected – with the ability to live in particles in the air that can be breathed in and for prolonged time (up to 3 days) on surfaces.

Asymptomatic carriers who don’t show disease certainly exist and spread the virus. Once you contract it you probably can infect others for the first 8 days after receiving it. Likely once you enter the adaptive immunity phase (where you are either getting much better or getting much worse) you are probably not spreading the virus anymore.


So, you can spread it when you don’t know you have it and for about a week later. This brings us to why self-quarantine and social isolation are so important. To explain why we are going to discuss something called the R value (or reproductive value) in the spread of viruses.


The R number is the number we need to focus on to know where we are in this cycle of pandemic. R is the average number of people that an infected person transmits the virus to.


So, if the R value is less than 1, the pandemic is dying out because there will be fewer and fewer cases. For example, in China right now the R value is less than one. If R = 1 the pandemic continues at a steady controlled pace. If R > 1 the epidemic increases EXPONENTIALLY. Right now, the R value is between 2 and 3 in the USA, which is HIGHER than the typical influenza virus during the height of flu season. The R value on the Diamond Princess cruise ship was 15.


R value is determined by 4 factors known as DOTS: Duration, opportunity, transmission possibility, and susceptibility. Let’s take each of those individually as it relates to Covid-19.


  • Duration – as mentioned above the virus has a 2-week typical course but we are probably only infectious on average for 8 days so 8 days would be the infectious duration. This is a bit LONGER then colds and flu and thus raises the R value.

  • Opportunity – How many people an infected person comes in contact with. The more people the higher the opportunity number. Hence the need for social isolation. The cancelling of basketball games, remote working, limitation of human interaction simply lowers the opportunity of one person spreading it to another. It is the only one of the 4 ways that we can have an active input in lowering the R value and remove the pandemic.

  • Transmission – how likely after an interaction another person contracts the virus.

  • Susceptibility – how likely the other person is to get the disease after being infected. Higher risk individuals (in the case of coronavirus) those with Hypertension, cardiac disease, type 1 or type 2 diabetes, history of lung disease all have greater susceptibility. Note I have removed immunocompromised from the list – although it is frequently thrown around in the media, that group is NOT showing to be at higher risk for COVID-19. It was a surprise to have Hypertension in this group as they are not in a higher susceptibility group for flu but are for this virus. This is most likely due to its infection spot on the ACE2 receptor mentioned above.


(Note: Duration and Opportunity and Transmission explain the difference between the viral diseases we know a lot about. Influenza has short duration (only lasts a week) but lots of opportunity (you spread it to whoever you come in contact with) and high transmission (touching droplets then touching your eyes). HIV is a disease with very long duration but due to its sexual transmission it is much lower in opportunity as well as lower Transmission (not every sexual encounter leads to infection) hence a much lower R value.)


Symptoms, Diagnosis, Lab/imaging findings, Clinical Course


Again, there are some subtle differences in the flu or strep versus Covid-19. With Covid-19, Fever is the hallmark sign with over 90% of people having a fever. However, unlike the flu where runny nose, productive phlegm cough and a sore throat is common, Covid-19 has a LOW incidence of these and the throat 98% of the time is NOT red and swollen. Covid-19 is more marked by a DRY COUGH, SHORTNESS OF BREATH and DIFFICULTY BREATHING. Subtle but important difference since we are still in flu season. There can be GI (stomach) symptoms as well but it is less than 10% of people that experience that. It is important to note however that a carrier (asymptomatic) state does exist.


The typical disease course is about a 4 days incubation period (with a range of 2-7 days) – time from when you are infected until you start showing symptoms. That is followed by around 6 days of fever and cough. This is where the clinical course seems to split into two groups – the mild vs severe course.


Mild responders tend to begin improving at this one-week point and stay improved.


Severe responders seem to get a little better from fever then start getting acutely worse in terms of difficulty breathing. Those on this path tend to seek hospital admission around day 8 and if continues to worsen, ICU by day 10. People on this path tend to have a vigorous pulmonary response where their lungs don’t have a pneumonia (infection and inflammation of the lung tissue) but more of a stiffening of the lungs – a condition that in medicine we call ARDS. This condition since it is affecting not just the air passageways but the actual end “sacks” where the oxygen gets into the blood is incredibly serious and needs medical support. Although pneumonia’s can be serious and life threatening, in general they are easier to support and treat than ARDS. Difficulty in getting oxygen across these stiffened lungs and into the bloodstream is the cause of the severe respiratory failure and need for extreme measures of medical intervention and support.


Lab findings – First and foremost is the PCR test to see if you have the virus. As you most likely have heard these have been in short supply but that supply chain to testing should open up this week. Of note we CAN test our existing patients at Formula Wellness, or we can come to you to test at home.


If you think you are infected, we should run several lab tests. The CBC or complete blood count we usually review with you on every blood exam, tends to show NORMAL white blood cell counts (instead of elevated like with the flu or strep throat). Despite being a virus, which usually RAISES the number of a certain type of white blood cells called lymphocytes these tend to be LOWER than average. Also, if the platelets – our blood clotting and repair cells, tend to be low – this is a poor prognostic sign meaning you may be progressing to the severe group. CRP, a marker for inflammation, goes up and super high levels may also be a poor prognostic sign.


If you are having more shortness of breath or difficulty breathing a chest x-ray and maybe a CT scan of the chest may be important. The ARDS mentioned above has very typical findings that are different from pneumonia and can lead to earlier treatment.


Prevention tip number 1: Hand washing (and how to do it)


EVERYONE is advising the same thing – hand washing is key to prevention of infection. The problem is most people don’t wash their hands correctly. You may be thinking the same thing I thought my 3rd year of medical school when, on our pediatric rotation they had several of us go the sink and wash our hands in front of all the students on the rotation. Us cocky medical students rolled our eyes thinking we have been washing our hands for 20 years and we know how to do it. The attending physician said every single one of us did it wrong. It's worth going over the proper steps (btw – these should be done not just during a pandemic, but every day).


Hand washing is an act of a detergent that physically removes foreign particles from your skin. For it to work you need to think of 3 critical factors: how to best get the particles and detergent to mix, how long to wash for, and how to not re-infect post washing.

Think of the steps involved in hand washing your car. Would you put soap/detergent on your car before wetting it first? No. Wetting the surface makes the particles more likely to be removed. So, step 1 is to turn on the sink (side note: temperature of water DOES NOT matter) and THOROUGHLY wet your hands – not just your palms. Step 2 apply soap AND lather. Again, would you just put soap on your car and not lather it or physically scrub off the particles? Make sure you are doing your nails and back of your hands and between your fingers as well (there is a common tendency to just do your palms). Lathering also assures you are doing it for an adequate amount of time - at least 20 seconds – which is a LOT longer than you may think. Step 3 rinse. Step 4 is critically important. Think about everything you (or worse someone who hasn’t washed their hands) touched BEFORE you washed. The faucet is something you touched with “dirty” hands. Don’t turn off the faucet with your clean hands re-infecting yourself. Take a paper towel or a towel and turn off the faucet. Use the same towel to open the door if there is a door. The door handle is probably as laden with foreign substances as any surface you may touch (especially from those who did NOT wash their hands).



Treatment and Prevention: Traditional Medical Therapies

First and Foremost, this is a virus not a bacterium. Z-packs, Augmentin or Cipro does nothing. Also, Tamiflu works on a specific enzyme on the influenza virus. Does nothing for Coronavirus.


I would (and am) doing weekly higher dose Vitamin C IV’s (our Super Immune IV). Although some of my traditional colleagues don’t mention it, there are studies, not just in viral infection in general but one specifically on Ascorbic acid (Vitamin C) and Covid-19. It is small and limited but there was a positive correlation with decreasing severity. Vitamin C therapy is benign, and very safe and has benefit. It should be a mainstay during this time.


Second, I am progressively convinced of protection with the peptide called Thymosin Alpha 1 (TA1). TA1 is a naturally occurring compound that is produced by our Thymus gland that helps BALANCE AND REGULATE our immune cells. It shifts the balance to the side of our immune system that is better able to respond to foreign threats like viruses. It has FDA safety studies completed and all studies showed minimal to no side effects. The only downside is it cannot be administered orally. It has to be via Subcutaneous injection – using a small insulin needle to inject it below the surface of your skin. Powerful stuff, no side effects and safe it’s a pretty great choice to make.


Not as a preventive but if you get the virus and are possible progressing to the severe group, I would start on an anti-malarial drug called chloroquine. It has a good balance in the safety profile (although can have some rare side effects /reactions) and works in part by interfering with the ACE2 receptor mentioned above. Thus it might limit the damage to those lung cells and decrease the lung damage and possibility of ARDS.


Although above we mentioned that Tamiflu does not work at all with coronaviruses, there is a combination cocktail of HIV medicines (Lopinavir/Ritonavir) that may slow the virus replication inside your body, giving your immune system time to catch up. Far from a cure or a magic bullet treatment, it is something to consider if you are in the severe group.


Treatment and Prevention: Alternative Therapies


Covid-19 is a medical, infectious disease. A lot of my patients come to us because we are able to balance traditional medicine and be open minded to alternative therapies. Where that is completely true in not only healthy and optimizing wellness strategies, I think this balance is super effective in diseases ranging from heart disease, diabetes and Alzheimer’s.

Infectious disease is however something we are really good at treating with traditional medicine and even better when going into the severe group. I say this because I follow a lot of the same bloggers, podcasters and famous “biohackers” out there that most of y’all do. I want to be clear that although adding in some alternative therapies are great – IT IS CRITICALLY IRRESPONSIBLE TO THINK YOU CAN AND SHOULD BIOHACK YOUR WAY THROUGH THE COVID-19 PANDEMIC.


This disease is deadly and yes young people can die from it. Seek medical attention and stay aware.


That being said I would continue to do things – red light therapy, infra-red sauna, ozone therapy, silver hydrosol that have proven to have some immune boosting affects. However, I would NOT OVERDO any of them.


It is critical to understand that most things in the wellness space make us stronger by a concept called hormesis. That is, we are putting our body under additional stress – in the very short term weakening it to make it stronger. The classic example is exercise. You are sore and feel not great after a hard HIIT session because you have weakened yourself – only to make yourself stronger a few days later. Almost every wellness intervention works this way. A study done a decade ago of first-time marathoners found that the rate of people who got a cold within 14 days of marathon approached 50%. Stress weakens us. This is not the time for that.


That is why it is NOT the time for prolonged fasts, extreme diets, maxing out training sessions or double dosing the sauna. Don’t over weaken yourself and expose yourself to too much stress.


That being said all of the interventions I mentioned above - in moderation – I am a HUGE fan of.


Conclusion


I want to finish where I started. This is not the flu. Although hoarding toilet paper and bottled water is ridiculous, this should be taken seriously even for the young and fit. If you have High Blood Pressure, heart disease or diabetes – do more than take it seriously. If you get COVID-19 have a high index of suspicion if you start having more trouble breathing that you are going into the severe group. Seek traditional medical care. Use good nutrition but don’t biohack your way through this. Just like the economy is on hold, your journey to your optimal self should be right now too. Be safe. Most importantly, don’t think of social isolation as punishment look at it as an opportunity - Reconnect with those in your immediate family. Break out that cookbook and try a new recipe at home. Take the opportunity with no sports on TV to play old school board games, talk and connect. My guess is you will remember that some of those things are pretty awesome – and will help you on a different side of wellness.


Stay well my friends,

BR

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