COVID-19 and the Coronavirus Pandemic
Written by: Alejandra Carrasco M.D. and Christine Maren D.O.
We are facing a challenging and uncertain time. COVID-19 has thrown us for a loop, and you may be feeling vulnerable and overwhelmed.
If you are in fear, you aren’t alone.
But we want to encourage you to fight fear with facts, and find strength in taking prudent and empowered steps toward protecting yourself, your family and your community.
As physicians, moms, and community members – we want to share what we know, what we’re doing for our families, what we have researched, and what might help.
Please understand the following is not medical advice. Please consult your trusted physician regarding COVID-19 treatment, especially if you have comorbidities like heart disease, hypertension, diabetes, respiratory disease or cancer. If you think you might have COVID-19, the recommendation at this point from the CDC is to call ahead before going to the doctor,1, and call 911 if you have a medical emergency. Many states also have drive through testing options.
What is COVID-19?
As you likely know, COVID-19 is a coronavirus.
Coronaviruses are a family of viruses that cause disease in mammals and birds.
In humans, coronaviruses can cause respiratory tract infections that are sometimes very mild, or more aggressive such as SARS, MERS, and COVID-19.
COVID-19 symptoms can range from asymptomatic to complete respiratory collapse, so it’s throwing us all for a loop.
Reportedly, symptomatic people have low grade fever, cough, shortness of breath or body aches. Hypoxia (low oxygen), hypothermia (low body temperature) and confusion have also been reported as presenting symptoms in the elderly. Diarrhea2 may also be a presenting complaint, and reports say it indicates possible worse prognosis if present.
In its most aggressive form, it can cause pneumonia that destroys the lungs and calls for intensive support in the ICU with isolation and ventilator support for breathing.
But here’s the kicker – what we might be missing is all of the asymptomatic people who are unknowingly spreading this virus.3
Those (but not all) who tend to get seriously ill include people over 60; those with lung problems like sleep apnea, COPD or asthma; and those who are immunocompromised. We’d bet if you take a look around, you are either in that high risk category yourself, or surrounded by people you love who are at high risk.
Though “even young patients without comorbidities have been observed with severe pneumonia that required intensive care in ICUs.”4
What can you do right now to slow the spread of COVID-19?
Let’s start with this: CANCEL EVERYTHING. Stay home and practice social distancing.
The important issue to recognize right now is that COVID-19 is spreading exponentially, and it’s important that we take drastic measures to slow this down so that the healthcare system is not overburdened.
From Yascha Mounk for The Atlantic “The coronavirus could spread with frightening rapidity, overburdening our health-care system and claiming lives, until we adopt serious forms of social distancing… If you feel even a little sick, for the love of your neighbor and everyone’s grandpa, do not go to work.”5
But let’s just keep it simple: everyone should stay home, whether you feel a little sick or not, because asymptomatic people may be unknowingly infecting others. And while there is a lot that we don’t know, one thing is certain: social distancing works.
This can go one of two ways.
Let us explain a healthcare worker’s biggest nightmare: In the United States, we do not have enough critical care beds (or healthcare workers like nurses, doctors, and respiratory therapists) to care for a mass influx of people who need ventilator support. If we do not prevent the rapid and exponential spread of this virus, healthcare workers will need to literally turn people away, which is what is happening in Italy. “A shortage of medical supplies and hospital beds in Italy is forcing doctors to choose which coronavirus patients to save — and they’re said to be choosing the young.”6 We repeat, this is a doctor’s worst nightmare.
Here’s our vote: we do our civic duty, practice social distancing, stay home, and cancel all events, travel etc. We applaud the many schools and organizations who have done this already. This helps contain the spread of the virus so that the healthcare system is not overburdened. Thus hospitals and doctors are able to take care of the people who need it the most. This is what we call flattening the curve.
This is a real threat, and it’s time to take it seriously.
But for the love of our kids, try to remain calm and maintain routines. As our friend and colleague Elisa Song, MD says “even though the structure of our lives is different, we can maintain routines which help our children (and us!) feel safer.”7 Worry and panic is not good for psyche or for the immune system, so try to keep freak out moments to yourself.
Remember these precautions as recommended by the CDC8 to cut down on the spread of the virus:
- Wash your hands for at least 20 seconds each time
- Use hand sanitizer that contains at least 60% alcohol when hand washing is not available (or maybe both, like surgeons do?)
- Clean and disinfect frequently used surfaces like phone, tablet, keyboard, countertops, doorknobs, light switches, faucets, etc daily
- Avoid touching your face/eyes/nose
- Don’t eat with your hands until you have washed them
- Avoid public transportation, ride chairs etc. as much as possible
We also wonder about the use of UV light. Hospitals and operating rooms employ UV light to help disinfect the rooms. China is starting to use these on public transportation. “Ultraviolet light is being beamed through public buses and lifts in China to wipe out any possible germs as part of efforts to clear the country of the deadly coronavirus epidemic.”9 Note that UV light is NOT SAFE when people are present because it can burn eyes/ skin etc.
What can you do to support your immune system against COVID-19?
While there isn’t a cure for COVID-19, we advocate for taking proactive steps and focusing on your health during this time.
This is where lifestyle changes, good nutrition, herbs and supplements can really shine (but remember, this doesn’t mean you can ignore all the advice above).
First, start with the basics:
- Sleep at least 8 hours a night
- Stay hydrated – drink at least 8 glasses of water a day
- Don’t eat sugar or junk food – it suppresses the immune system
- Eat healthy foods, rich in antioxidants and micronutrients. You can download our complete nutrition tips at www.heymami.com.
- Get some sunlight every day
- Get some fresh air every day
- Spend time grounding daily (touching the earth with your skin)
- Move your body every day
- Practice gratitude
- But give yourself permission to feel some sadness and grief – because this is not easy.
Supplements That Can Help Support a Healthy Immune System
There are some natural compounds that have been studied and show promise in coronavirus inhibition. Most of these studies are small in-vitro studies that have shown promising effects against MERS-coronavirus, SARS-coronavirus, IBV-coronavirus in cell cultures.
Other nutrients are not specifically studied with COVID-19 but have been shown to support the immune system during viral infections and/or pneumonia.
The reality is that we don’t know a lot for sure, and things change every day. We read and hear a lot of contradictory information, so we will return to this post for updates, but as of now, this is where we are.
#1 GUT IMMUNE SUPPORT: In functional medicine, we believe that a healthy gut is foundational for our overall health and immune response. Technically speaking, this is at least in part related to endotoxins, or large lipopolysaccharides (LPS), which are a component of gram-negative bacteria in the gut. When in excess (dysbiosis, obesity, insulin resistance etc) endotoxins can drive metabolic endotoxemia10 and systemic inflammation. LPS may also impair ACE2 production, leading to inflammation in the lungs.11
Best sources: Some of our favorite ways to support the gut (aside from a healthy, whole foods diet) are spore forming probiotics and serum-derived immunoglobulins. These are supplements we take regularly, which are relatively safe.
#2 VITAMIN C: There is currently no available data to show vitamin C can prevent or successfully treat COVID-19 infections. However there is a current clinical trial12 studying this.
Vitamin C 13deficiency results in impaired immunity and higher susceptibility to infections. Vitamin C has been demonstrated14 to help support the production of nitric oxide, regulate hypoxia (low oxygen) signaling, modulate the immune defenses to temper cytokine storms, and reduce oxidative stress.
Oxidative stress is an important one to note. Vitamin C – along with Vitamins A, E and others – are important antioxidants that can help reduce oxidative stress. Reducing oxidative stress15 caused by viral infections could potentially reduce the consequences of viral pathogenesis. This paper16 demonstrates the relationship between severity of adult community-acquired pneumonia and impairment of the antioxidant defense system.
Best sources: Chili peppers, sweet peppers, guavas, kiwifruits, strawberries, oranges, kale, spinach, broccoli, grapefruit, potatoes, tomatoes, papayas, strawberries, rose hips, acerola cherry, leafy greens. Can also be taken as a supplement in pretty high doses (i.e 1000 mg 2-3 times a day or more), however some people have GI distress with too much.
#3 ZINC: Zinc allows the body to produce and activate T-cells (t-lymphocytes), which are some of the white blood cells that respond to infections. Zinc17 was shown in a laboratory study to inhibit the replication of coronaviruses in cell culture. Zinc supplementation in the elderly18 might decrease to incidence of pneumonia and associated morbidity.
Best sources: Oysters, beef, crab meat, dark-meat chicken and turkey, pork, yogurt, milk, cashews, chickpeas, almonds, peanuts, pumpkin seeds. Zinc can also be taken as a supplement, typically 15 mg-30 mg daily, preferably as a lozenge.
#4 FLAVONOIDS, LIKE QUERCETIN: Flavonoids are a group of plant compounds thought to provide health benefits through cell signaling pathways and antioxidant effects. Some flavonoids,19 like quercetin, have been shown to inhibit MERS- CoV. Quercetin might also be helpful for getting zinc into the cell.20
Best sources: Citrus fruit, berries, red cabbage, red wine, apples, legumes, red and purple grapes, onions, scallions, kale, broccoli, parsley, thyme, celery, hot peppers, capers; teas – especially white, green, oolong, and black; dark chocolate. Quercetin can also be taken as a supplement, and per WebMD up to 500 mg twice daily for 12 weeks.21 It is not known if long-term use or higher doses are safe.
#5 MELATONIN: Melatonin22 has been reported to be effective in animal models of acute lung injury. Melatonin exerts its beneficial effects by acting as a direct antioxidant and via melatonin receptor activation which has been shown to protect against myocardial ischemia/reperfusion injury. It also inhibits NFkB activation and NLRP3 inflammasome activation23 and is postulated to be the reason why children do not seem to have severe symptoms as compared to the elderly.
Best sources: Daily exposure to natural light, avoidance of screens at night, and supplementation. One of our favorites is Quicksilver Scientific Liposomal Melatonin.
#6 GLUTATHIONE: Glutathione is known as the mother of all antioxidants. Low glutathione levels24 have been used as a marker of inflammation in patients with pneumonia, and associated with multimorbidity development in older adults.25
Best sources: Garlic, onions, and other alliums provide organosulfur compounds and allicin26 which can increase glutathione. Broccoli, cabbage, cauliflower, kale, and other cruciferous vegetables are rich in glucosinolate-derived isothiocyanates27 (like sulforaphane) which increase glutathione and induce the glutathione S-transferase (GST) enzymes. High quality protein and foods rich in glycine like gelatin, collagen and bone broth. High quality whey protein may also help. Glutathione can also be taken as a supplement, but this is one where we prefer a liposomal preparation which protects it from breakdown in the digestive system and improves bioavailability and intracellular delivery. Also, we would not recommend high doses.
#7 VITAMIN A: Vitamin A deficiency has been shown to cause pathological alterations in the epithelium of the respiratory tract,28 and is associated with lower-respiratory-tract infections. Vitamin A29 has demonstrated a therapeutic effect in diseases transmitted through the respiratory system, such as pneumonia, especially in children. It is also an important antioxidant.
Best sources: Organ meats, pastured egg yolks, grass-fed butter, cod liver oil. Beta carotene is a precursor to vitamin A and can be found in sweet potatoes, pumpkins, carrots, cantaloupes, mangoes, spinach, broccoli, kale, collards, butternut squash. Supplemental vitamin A is also a good option for some people, but not safe in women who are pregnant or breastfeeding. Vitamin A is a fat soluble vitamin and at high doses can cause liver damage.
#8 VITAMIN D: Vitamin D deficiency has been shown to increase susceptibility to infection.30 Vitamin D plays a big role in the complex immune response,31 and maintaining optimal serum levels is thought to support our fight against diseases. However, vitamin D may also modestly increase an inflammatory cytokine32 called IL-1B, so should be used with caution – or perhaps discontinued – during active covid infections.
Best sources: The best way to get vitamin D is to spend time outdoors daily and get some sunlight on your skin. Most people need to supplement with vitamin D, but levels should be monitored as too much can be toxic. We find that most people can safely supplement with 5,000 IU a day. There are limited foods with vitamin D and they include fish (especially salmon, tuna, herring, sardines, and mackerel), cod liver oil, eggs, mushrooms (exposed to UV light).
#9 MONOLAURIN AND LAURIC ACID: A 1982 study showed that lauric acid and monolaurin33 were able to reduce infectivity of 14 human RNA and DNA enveloped viruses in cell culture by >99.9%, and that monolaurin acted by disintegrating the virus envelope. COVID-19 is an RNA virus. There is a proposed clinical trial34 to evaluate the potential of monolaurin as an effective and safe antiviral agent against COVID-19 but no results have been published as of yet.
Best sources: extra virgin coconut oil, or we prefer a supplement called Lauricidin.
#10 RESVERATROL: Resveratrol is a naturally occurring polyphenol. Resveratrol35 significantly inhibited MERS-CoV infection and prolonged cellular survival after virus infection.
Best sources: grapes, red wine (1 glass max, we are not advocating a lot of alcohol as it can suppress the immune system), blueberries, cranberries, and even cocoa and dark chocolate. Can also be taken as a supplement.
What Should I Avoid During the COVID-19 Pandemic?
- Possibly ibuprofen and other NSAIDs – These are said to upregulate ACE2, which is a factor in viral infection. According to the French Ministry of Health “the taking of anti-inflammatory may be a factor for aggravation of covid-19 infection.”36 This is also based on an article in The Lancet: Are patients with hypertension and diabetes mellitus at increased risk for COVID–19 infection?37 However, based on currently available information the World Health Organization38 does not recommend against the use of ibuprofen. We don’t know the answer for sure, but it’s probably prudent to avoid when possible.
Ways to Support Your Nervous System and Stress Response
As we said before, stress is not good for the psyche or the immune system. Right now is an important time to focus on mental health – if not for you than for the sake of your children. They feel the stress around us and respond to it, too.
Here’s what we recommend:
- Creative work
- Spend time in nature
- Helping neighbors in need by dropping off food, supplies at their doorstep
- Heart Rate Variability
- Positive affirmations
- Gratitude exercises
- Avoid too much screen time (we know it’s hard, that is how people are connecting, but try not to veg out in front of the TV, laptop, tablet etc)
- Try to stick to a routine
Potential Emerging Medical Treatments for COVID-19
These are not intended to imply there is a cure, but rather to advance thought and research among colleagues and thought leaders. One of the medications we have researched is Chloroquine and Hydroxychloroquine (also known as Plaquenil).
There is an in vitro study39 evaluating this right now, which concludes “Hydroxychloroquine was found to be more potent than chloroquine to inhibit SARS-CoV-2 in vitro.” Another study evaluates Chloroquine and hydroxychloroquine as available weapons to fight COVID-19.40
The current thought is that hydroxychloroquine potentially has an immunomodulatory effect that “may be useful in controlling the cytokine storm that occurs late-phase in critically ill SARS-CoV-2 infected patients.”
Also “there is a strong rationality for the use of chloroquine to treat infections with intracellular microorganisms. Thus, malaria has been treated for several decades with this molecule.”
The study used a loading dose of 400 mg twice daily of hydroxychloroquine sulfate given orally, followed by a maintenance dose of 200 mg given twice daily for 4 days.
Although there is a lot of uncertainty, we hope that you find this time with your immediate family a blessing and consider this as an opportunity to focus on your health and make your body more resilient.
This is a defining moment in our history – and clearly we are all interconnected. The better we are able to care for ourselves, the greater the impact in the world at large.
All of this information is constantly evolving. We will update this post, as able.
Stay strong and feel free to share.
Doctors Alejandra Carrasco M.D. and Christine Maren D.O. are board-certified through the American Board of Family Medicine, and certified in functional medicine through the Institute for Functional Medicine. They are co-founders of HeyMami.com, and on a mission to help support other women as they navigate mamihood—from preconception through pregnancy, postpartum, and beyond.