Concise, Commonsense Info from an MD on Covid 19

by | Mar 19, 2020 | Coronavirus

Additional article: In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)


March 9, 2020

Many of you have been contacting the office about Coronavirus disease 2019 (COVID-19), a respiratory illness that can spread from person to person. Symptoms can include fever, cough, and shortness of breath (due to pneumonia). There appear however to be certain differences between the presentation of COVID-19 and other viral infections that circulate at this time of year. One of the healthcare workers with a master’s degree who worked in Shenzhen Hospital (Guangdong Province, China) highlighted certain differences. I have included these differences along with reports from health care agencies:

Symptoms: A runny nose and sputum, is more indicative of the common cold. Coronavirus pneumonia is a dry cough generally with no runny nose. A runny nose shows up in only 4 percent of individuals, and that may be people who also happen to have a cold or a flu.The nasal congestion is particularly severe, and not like the normal kind experienced with viruses. If you experience this, it’s important to get tested and seek medical attention. Testing kits are now being made available (the FDA [U.S. Food and Drug Administration] cleared the way to let people use in-house testing kits).The virus will first infect the throat, causing a sore throat lasting 3-4 days.It may then enter the trachea and lungs, causing pneumonia. This may take another 5-6 days and is associated with high fever and difficulty in breathing. Any symptoms such as the ones experienced above should alert you to contact your health care provider for further instructions.Overall, 90% of people get a fever, 80 % get a dry cough and 30 % get shortness of breath and malaise/fatigue. 80 percent of these cases however are “mild” including pneumonia, not requiring hospitalization.Of utmost importance is to keep calm. Highest risk individuals are the elderly (70-75 or older) with underlying medical problems (cardiac, pulmonary issues like emphysema). As per Dr Marguerite Neill an infectious disease expert at Brown University: “The mantra is, ‘Keep calm and carry on’”. The illness seems to be very mild in children, younger people, and young adults. Data from the largest study conducted in China, suggests that of coronavirus patients receiving medical attention, 80 percent had mild infections, about 15 percent had severe illnesses, and 5 percent were critical. From the China CDC  we understand that the virus is most dangerous to those who are immunocompromised, elderly, and those who have cardiovascular disease, diabetes, hepatitis B, chronic obstructive pulmonary disease, chronic kidney disease, and cancer. China CDC’s analysis of 44,672 patients found that the fatality rate in patients who reported no other health conditions was 0.9%. In addition, 81% of all diagnosed cases were considered mild or asymptomatic.

Protection: There are differences in reports of how far the virus can travel by airborne route. Reports vary between 6 feet and 10 feet before it drops to the ground and is no longer airborne, and if it drops on a metal surface it will live for at least 12 hours – so if you come into contact with any metal surface – wash your hands as soon as you can with a bacterial soap. If the virus comes into contact with fabric, it can survive for 6-12 hours. Normal laundry detergent will kill it.Wash your hands frequently with soap and water for at least 20 seconds, as the virus can only live on your hands for 5-10 minutes, but a lot can happen during that time – you can rub your eyes, pick your nose unwittingly and so on. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.You can gargle as a prevention. A simple solution of salt in warm water will suffice. Also drink plenty of warm water (not liquids with ice).If you’re sick and coughing, and you have to be out (for example, going to a doctor’s office) that’s when you should wear a mask. A mask at home would be recommended if you are sick and quarantining yourself in your bedroom, so others in the household do not get sick.  If you will be on an airplane, take some sanitizing wipes with you to wipe the tray table and the hand rests and the areas that you might come into contact with on the plane. In general, extra cleanliness is recommended (bathroom surfaces, computer keyboards, etc.). If you are using a hand sanitizer (vs washing your hands for 20 seconds) apply the gel to the palm of one hand and then rub your hands together for 20 seconds. The CDC has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.When meeting people, consider the Asian custom of putting your hands together and bowing as a sign of respect, instead of shaking hands. As of March 9, 2020, the disease is spreading from the East to West Coast. I am therefore forwarding to you basic information which comes from our local Rep. Antonio Delgado from NY District 19, links to the CDC and NYS DOH as well as some nutritional support that we have been recommending from our medical office:

Prevention  The best way to prevent infection is to avoid being exposed to the virus that causes COVID-19. There are simple everyday preventive actions to help prevent the spread of respiratory viruses, including:  Avoid close contact with people who are sick.Avoid touching your eyes, nose, and mouth with unwashed hands.Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available. If you are sick, to keep from spreading respiratory illness to others, you should: Stay home except to get medical care. Phone consults can be arranged with our office. Call ahead before visiting your doctor.Wear a facemask.Cover your coughs and sneezes in the crook of your arm or in a tissue, not in your hands.Avoid sharing personal household items.Clean and disinfect frequently touched objects and surfaces.Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

Further Information:  The Centers for Disease Control provides updates on the virus and safety information for the public. You can find a fact sheet with what you need to know here: https://www.cdc.gov/coronavirus/2019-ncov/index.html The New York State Department of Health provides updates on the disease’s spread within our state, and other useful information: https://www.health.ny.gov/diseases/communicable/coronavirus/ The State Department provides a list of travel advisories for those who are planning to fly outside of the United States: https://travel.state.gov/content/travel/en/traveladvisories/ea/novel-coronavirus-hubei-province–china.html Experts have been working hard to understand this new strain of coronavirus. Because new information is coming out every day, please visit the sites above to stay up to date. The safety of you and your loved ones is of the utmost importance.

General Recommendations from Dr Horowitz’s medical office
10 Nutritional support items for Coronoavirus: Apart from the above recommendations, there are nutritional supplements that support immune function and have been shown in the scientific literature to be of benefit in helping the immune system to fight infection. Keep in mind, none of these have been tested against COVID-19 but may be of benefit as they have antiviral and immune supporting properties.

1. Immunotix: mushroom derivatives including 3,6 Beta glucan can help to support Natural Killer (NK) cell function which are involved in helping the body to fight cancer and viral infections. I have personally been on Immunotix for over 10 years. One a day, up to two a day is recommended. Other products that raise NK cells include transfer factors. 2. Zinc: between 40-50 mg/day. Zinc has been shown to have beneficial effects in fighting infections. Zinc lozenges can also support immune function and have also been proven to be effective in blocking coronavirus and other viruses from multiplying in the throat and nasopharynx. These can be taken several times a day once you begin to feel symptoms.
3. Vitamin C: up to 1 gram three times a day. (There are currently 3 clinical trials in China using IV vitamin C to treat COVID-19 and our colleagues in the integrative medical community, Dr Tom Levy MD and Dr Jeanne Drisko MD, are involved in the protocol. In addition, Dr Richard Cheng MD PhD, head of the IV C studies is also suggesting oral vitamin C for prophylaxis).
4. If upper respiratory symptoms appear, Viragraphis (Andrographis/licorice extract) can be added at one capsule a day. This herbal supplement also supports healthy immune and respiratory function and is ONLY for short term use. A typical dose of one capsule a day equals 5 mg/kg of Andrographis (the dose for a 70 kg/150 lb person). Two capsules per day would be for a larger individual and for more aggressive treatment at the acute onset of illness. Since this formula works by increasing proliferation of lymphocytes, production of interleukin-2, tumor necrosis factor-alpha, and cluster of differentiation (CD) marker expression, Lyme disease patients with active disease could have a Herxheimer reaction and should therefore adjust the dose accordingly.
5. If typical flu symptoms appear (runny nose, sneezing, cough), elderberry extract has also been shown to help fight the flu virus. We are using a product called Immunoberry, 4-6 times per day if symptoms appear. This again, is for short term use at the earliest sign of the flu (aches and pains, sneezing, runny nose, fatigue..) and can be used with classical antivirals like Tamiflu.
6. Silver: silver has been shown to have a broad range of antibacterial and anti-viral effects. We are suggesting products such as Argentyn 23 (nano-silver), as patients taking it have measurable levels of silver while using this product. Dosage would be up to a teaspoon 7x per day if viral symptoms appear. This should not be used long term due to potential side effects (argyrism).
7. General recommendations: get enough sleep, regular exercise, eat a healthy diet with vitamins and minerals (vitamin A also has positive effects), use spices like garlic and ginger with extra citrus fruits and red peppers for vitamin C. Fermented foods can be helpful for the GI tract (not if you have histamine sensitivity and mast cell disorder) and make sure you are getting adequate vitamin D intake (minimum 2000IU/day, up to 10,000 U/day).
8. Propolis: Dr. Ramzi Asfour, an infectious disease physician, likes Beekeeper’s Naturals propolis spray. Propolis increases cellular immune response and acts as an antiviral. Other drugs being tested, which have not yet been proven to work for COVID-19: There is no approved antiviral drug for the coronavirus, though several are being tested. The CDC has a site however discussing antiviral medications for the flu: https://www.cdc.gov/flu/treatment/whatyoushould.htm We have prescribed Tamiflu in the past which has been effective, but it should only be used for the flu (testing is available).
9: HIV medication: Coronavirus patient in Spain reportedly recovers after being treated with HIV drug. (Yaron Steinbuch, March 5, 2020 | 11:05am | Updated) https://nypost.com/2020/03/05/coronavirus-patient-in-spain-reportedly-recovers-after-being-treated-with-hiv-drug/?utm_campaign=applenews&utm_medium=inline&utm_source=applenews
10. Alinia : Nitazoxanide, is a new drug candidate for the treatment of Middle East respiratory syndrome coronavirus. Nitazoxanide is a broad-spectrum antiviral agent undergoing clinical development for treatment of influenza and other viral respiratory infections. Nitazoxanide exhibits in vitro activity against Middle East respiratory syndrome coronavirus (MERS-CoV) and other coronaviruses, Having been used extensively in clinical trials and in post-marketing experience, nitazoxanide is an attractive drug candidate for treatment of Middle East respiratory syndrome. Future research should include in vitro mechanism studies, animal models of MERS-CoV infection, clinical trials, including dose-ranging trials, and evaluation of combination therapy with other potential MERS-CoV antivirals. Journal of Infection and Public Health Volume 9, Issue 3, May–June 2016, Pages 227-230 https://www.sciencedirect.com/science/article/pii/S1876034116300181 Office Update: To be clear, if you are suffering from any flu-like symptoms (fever, cough, chills, fever, body aches, etc.) we ask that you please do not come into the office for your in-office appointment.  Please contact the office if you are not feeling well with any of these symptoms as we would be happy to convert your appointment to a phone consultation or a telemedicine appointment. I hope this has been helpful as an update for COVID-19. I will share any new important information as it becomes available.  Stay healthy,        
Copyright © 2016 Richard Howowitz, MD, All rights reserved.

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Additional article: Additional article: In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)