Coronavirus Update & Integrative Natural Answers
By Dr. Devaki Lindsey Berkson (3/17/2020)
How the Virus Binds, Possible Natural Answers to Block & Protect
(If you are already well acquainted with Coronavirus/COVID-19 then scroll down to Underlying Mechanisms of Viral Attack)
We have a new form of coronavirus that is circling the planet and it’s a mystery as to the extent of the havoc it will cause. I am not an epidemiologist, but I have been practicing functional and natural interventions for many years, I teach continuing medical education courses to medical doctors, pharmacists, and nurse practitioners, write books, blogs and host a podcast, all focused on agile thinking and natural answers or integrative approaches (meds + nutrition).
We are in a war. A war with a powerful virus. At first I was writing that since so few testing kits have been available, we don’t really know the accurate extent of fatality rates. But we are seeing huge fatality rates now in countries where kits are available. For example, Italy, the second hardest hit country in the world and the most drastically affected in Europe, reported a staggering 10,000 cases in just 3 weeks.
During a press briefing at the White House on March 14th, the administration’s coronavirus coordinator, Dr. Deborah Birx, reported that people under 20 may be “asymptomatic carriers” passing this disease forward. I went to Whole Foods Monday and people, including babies, were elbow to elbow. I went to HEB, my local grocery, when the store opened. Within a half hour, literally hundreds of folks were close to each other in lines that wound around the entire store, turning it into a hot house of potential viral exposure while ironically trying to be proactive and safe.
China is showing us that you can get this illness a second time. Immunity does not appear to occur after being sick.
A report came out of China about a baby, born from a mother that had the virus, which tested positive for the virus. Pregnant? Stay home and interact with much smaller groups. Buy your groceries online and have them delivered.
I was going to try to calm us down; but after reading, listening, and diving into the science, this viral “isness” is a dangerous reality. I hope to give theories as to how this virus attacks and maims and then outline plausible natural science-based interventions. Of course, the virus is so new, some of these tools haven’t been tested by science yet, although some have been tested for other viruses. These natural tools are based on the physiology of how this virus is so far known to act.
I am known for taking diverse elements of science and physiology and connecting-the-dots to come up with natural safe answers that you and your doctor can both consider. That is what I hope to do in this article.
Mainstream medicine offers mostly washing your hands with soap and water for 20 seconds (which, of course, is a good thing) and social distancing (in countries with the best containment, folks stay separated by around 3.5 feet, but not so here in America or in line at Whole Foods or HEB). But there is oh so much more to battening down the immune hatches.
Some of my colleagues think this will be a hellish scenario going on for longer than we now realize; the peak has not yet hit of how many will be affected. Others think it’s a nothing, a virus that most will survive quite well. I thought that myself at first. But several startling studies out of China showed that young adults can get this disease, can get CT scan proven pneumonia, and not even have symptoms[1].
I was still going to travel for all the lectures and re-licensing seminars I have in April and May. But after diving deep to write a blog that would clarify and help, I’ve changed my mind and am hunkering down at home.
Let’s Get Some Facts Straight
Terms
COVID-19 is the name of the illness.
SARS-CoV-2 is the new coronavirus causing the disease COVID-19.
Routes of Transmission
COVID-19 is transmitted via droplets and from touching contaminated surfaces like furniture and clothes during close unprotected contact. Airborne spread has not been reported for COVID-19. But an infected person has some moisture in their breath. In a Zumba class with 50 sweating folks, some of that flying sweat, if contaminated, might get onto and thus into you. Fecal shedding also has been demonstrated from some patients[2].
WHO Declares an Epidemic
On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic (meaning humans world-wide are vulnerable to getting infected). On that day, 126,000 people around the world contracted COVID-19, while 122 countries around the world reported COVID-19 infections. On March 17th, globally there were 188,384 confirmed cases, 7499 deaths, and 140 countries reported cases. On March 17th, in the U.S. they are over 4,748 cases and 85 deaths. The U.S. surgeon general said March 16th that the United States was where Italy was two weeks ago so we expect the infections and deaths to rise. Growth is rapid.
Containment is critical. Countries like South Korea and Taiwan acted fast and aggressively. We in the U.S. have not. Our government did not. It is trying to catch up, but we are going to see a lot of people get ill and many fatally because doctors didn’t have test kits and we were not instructed as to the severity of this virus and how to appropriately create containment.
So let’s take a look at what we can do ourselves, since we are in for a few months of many getting ill.
Startling CT Scans of Chinese COVID-19 Patients
What really turned my head around was a study[3] looking at 101 cases of COVID-19 patients who all had pneumonia. All had imaging of their lungs, from multiple centers in China, called lung CT scans. What was startling, as scientists and government have been saying that mostly the elderly are at risk, was that 70% of these 101 COVID-19 pneumonia patients were aged 21 to 50 years old! Over two-thirds were younger than we have been led to believe are at high risk.
This study came out March 3rd 2020 in The American Journal of Roentgenologya. It was run by three departments of radiology from The Second Xiangya Hospital, the First Hospital of Changsha, and Quality Control Center, all in China, and the Changsha Public Health Treatment Center, in Hunan, P.R. China.
Thus, this virus is not only an enemy of the elderly. Anyone can get it. And get it bad enough to get pneumonia. Pneumonia then sets the scene for catastrophic lung damage and possible death.
The major issue is if your lungs get damaged enough, you can lose the ability to breathe on your own. Once a patient gets severe lung issues, such as acute respiratory distress syndrome, which requires ventilation, 86% of these patients statistically go on to die[4].
Unofficial reports from doctors and healthcare workers in China and Italy describe many very ill COVID-19 patients as having symptoms of bilateral interstitial pneumonia that require help to breathe (ventilation). That’s the issue: how many ventilators do countries have to keep up? In Italy they report they cannot. They’ve been running out of ventilators.
What has not gotten out to young adults in the U.S. is that even young patients without underlying health issues can and have been getting severe pneumonia that requires intensive ICU care and the need for ventilators[5] [6]. This virus loves the lungs. You will soon see it also has a proclivity for other tissues.
Another stunning study was released by scientists in Germany on March 8, 2020[7]. Again, younger adults got the disease, proven by throat swabs. Many had no underlying health problems. One person who tested positive had no symptoms at all!
Another noteworthy study came out of China[8] this February 2020 in The Lancet. Eighty-one patients with coronavirus pneumonia and severe acute respiratory syndrome, were assessed by CT scans. Forty-two were men (52%) and 39 women (48%), with a mean age of 49.5 years old! Some patients had mild symptoms; some had no symptoms of any kind, but their imaging by CT showed COVID-19 pneumonia present!
COVID-19 pneumonia with proven chest CT imaging abnormalities, can occur in asymptomatic patients!
People who have pneumonia from this virus might not even have symptoms and yet infect you and others.
You have to take this to heart when you consider how we all need, just for this time, to isolate from groups of people. People who don’t know they have the virus can infect you.
This Virus Proliferates Fast
SARS-CoV-2 replicates faster than the older SARS-CoV virus. Viral swabs of COVID-19 are one thousand times higher than those of SARS-CoV from 2003[9].
This means this new virus spreads fast, especially in the first five days in the throat when you might not even know you have it. These “spikes of rapid viral growth” are one of the reasons for this virus’s high rate of contagion and ability to infect a lot of people, even young adults.
A study published in JAMA[10] on March 11, 2020, collected specimens from 205 COVID-19 patients. The mean age of patients was 44 years, between 25 to 67 years of age. Again, younger than we have been led to believe. Sixty-eight percent of the patients were male. This virus seems to attack males, more.
The point is, which turned my thinking around—this virus doesn’t only attack the old and infirmed. Of course it attacks them the most, and they are most at risk of fatalities, but younger adults are also vulnerable and sometimes don’t even know they are carriers of the virus!
Much more than we have been told initially.
The Viral Mystery
The coronavirus is certainly confusing. How panicked, or not, and how many action steps, or not, should we be taking? I practice part-time in Naples, Florida, where the demographic is mostly in the high risk group. We had a meeting with the owners and physicians and they are worried this will hit Florida and its retirees hard. Patients can’t come to the office now if they have a high fever, have taken a cruise in the last month, or have traveled to China.
Part of our panic is the potential large number of folks dying once they get the disease. So let’s take a deeper dive into this aspect of COVID-19.
Fatality Number Issues
WHO reported that the time between symptom onset and death ranged from 2 to 8 weeks[11] in some people. Let’s look at the stats.
China had 80,849 cases and 3,199 fatalities. The Lancet Infectious Diseases[12] calculated this was a 5.5% fatality rate over all for China but could be up to 20% in Wuhan. Things are slowing down there due to their containment diligence and community altruism. Only 5 new cases occurred on March 15th.
Italy: 24,747 confirmed cases, 1,809 deaths (7% death rate compared to the global average of 3.4% fatality rate)
France: 5,400 confirmed cases, 127 deaths
Iran: 13, 938 confirmed cases with a huge burst recently. 724 deaths.
Globally: 188,396 confirmed cases, 7.499 deaths
The fatality percentages suggested globally (2 to 3+ percent compared to 0.05% with most flus) are hard to judge or predict in the U.S.. Testing in America was initially inadequate. Even though most doctor’s offices do not have kits, individuals can obtain prescriptions to use drive-through testing locations or go to Quest and LabCorp for testing.
Since many symptomatic people have not been able to be tested, we don’t really have an accurate count of how many people have been infected. Therefore we don’t have the comparison of those who survived versus those that didn’t, thus the fatality stats of who might die are not clear. So the final fatality statistics may change. You need to understand this when you hear fatality statistics.
Kit Issues in the U.S.
Why have we had all these issues with testing?
When the coronavirus epidemic started late last year in China, the World Health Organization (WHO), in collaboration with German researchers, rapidly developed a test for the coronavirus. This is the test used by every other country except the U.S.!
The CDC insisted that only its test, not the one developed by the WHO, could be used on suspected cases, and these CDC “designed and approved” tests would be administered under limited circumstances[13].”
In contrast, test kits are widely available in many other countries, including Iran, Japan, South Korea, Germany, and China. Because they are using the WHO kits. In fact, hundreds of thousands of coronavirus tests have been run in other countries.
Fatality statistics in Italy are showing us that this virus is serious.
This virus starting to hit in late December. It’s March. Recently we have been told drive-through testing would be available at Target and Walmart, but I’ve called a number in Austin and none have this capability and didn’t know what I was talking about. They didn’t say we will have them next week. They were clueless. This is changing rapidly as our country responds.
Naples, Florida, now allows a patient with a doctor’s order to go to hospital drive-ups where they can swab their nose and throat and not get out of the car. Just this week at the Naples’ Center for Functional Medicine, we were able to order blood tests looking for viral DNA, made possible by Quest and LabCorp but a paper put out by the WHO in consort with over 500 Chinese scientists and epidemiologists say that more in-depth tests are needed than only IgG and IgM viral antibody testing.
But, in the U.S., up till now, medical offices have mostly been running blind. No fault of the doctors or clinics. They were told they had to call health departments to get permission to get kits and for some reason some clinics report being denied kit access when they called. Hopefully we will see this change soon.
Government Leadership
At a government inquiry, senators asked health officials who was in charge of the American COVID-19 kits. No one could be named! This was in early March, months after the Chinese outbreak. Dr. Anthony Stephen Fauci, an American immunologist, both a scientist and head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said, “Let’s be candid. We are not prepared. We do not have anyone in charge. We are not prepared to deal with this situation.”
The U.S. had a department set up to prepare for pandemics like this. But the U.S. pandemic response team was eliminated in 2018 to cut costs. In March 2018, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, left the administration and this global health security team was disbanded.
In 2018 the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak also due to pulled funds.
Coronavirus Lineage
Coronavirus is a family of viruses that has been with us for a long time, affecting both animals and humans. Most corona viral infections are mild.
Coronaviruses are known for causing respiratory diseases, with symptoms ranging from common colds to pneumonia[14]. The SARS-CoV (Severe Acute Respiratory Syndrome) epidemic of 2003 infected over 8,000 people worldwide, with a 10% mortality rate[15] within 8 months[16]. The closely related MERS-CoV of 2012 also induced acute pneumonia, similar to the one caused by SARS-CoV[17].
The current SARS-CoV-2 has 79% similarity to SARS-CoV. It also can cause pneumonia of varying severity in all adult patients regardless of age! This new SARS-CoV-2 is estimated to be up to 1,000 times more infectious than SARS-CoV or other coronaviruses[18].
No one knows what will happen. The tincture of time will tell.
Risk
We are in a WHO-proclaimed pandemic. Pandemic does not mean everyone will get devastatingly ill. Most will recover within about two weeks.
But some are getting very ill. Some are dying. The CDC guesstimate is that between 160 million and 214 million people in the U.S. “could,” in a worst case scenario, be infected over the course of the epidemic, which could last many more months to possibly a year.
No one is sure. Taking functional medicine action steps for protection makes sense.
Social distancing, which in China and other very pro-active countries means keeping approximately 3.5 feet from others, is not being done here in the States. In fact, many young people are defiantly going out to packed bars and partying it up.
Kids are at less risk. In China, 2.1% of cases were children. Children can be exposed to the virus but not get ill, or get an extremely mild case. Most recover in two weeks. In kids, COVID-19 rarely goes into the lungs[19]. But kids and young adults can be carriers. The scientific thought as discussed by Dr. D. Birx is that part of the rapidity of growth is the ability to have no symptoms but still pass it forward.
If you are ill, stage 3 lung involvement can occur from days 9 to 13[20]. The China study[21] shows that SARS-CoV-2, can cause pneumonia in adult patients regardless of age.
Health Care Workers
Front line health care workers like ER doctors, even younger ones, are getting sicker from the corona virus than the rest of the population, other than the elderly. Two doctors with COVID-19 are in critical condition at the time of writing this article. One is a Washington physician in his 40’s and another is a 70-year old in New Jersey.
Dr. Li Wenliang, the Wuhan Central Hospital physician who is hailed as a hero for trying to sound the alarm about this virus after diagnosing and treating seven quarantined patients in December, died within weeks of being exposed.
One theory is that front line medical personnel are exposed to higher doses of the virus. Add exhaustion and possibly poor dietary choices as these folks often work hard and eat fast. We don’t know yet. But I hope they or someone that loves them, reads this article and shares some of the suggestions. Too bad they don’t have IV anti-viral nutrients available to try to help as you will learn below.
Elderly
The elderly seem to be most at risk. If you are 65 or over, with underlying health issues, you’re at increased risk. Over 70 years old, the risk starts increasing, and possibly triples (if not more than that) when people are in their 80’s. The highest fatalities occur in the 8th decade.
As we age, so do our immune systems. And more so if there is an underlying illness. Or if the person does not regularly exercise, eat healthy food, get enough sleep, etc.
Science demonstrates that older immune systems have less natural “killer cell” activity, which protects against foreign invaders. Seniors have thinner mucous membranes, so immune cells have less healthy “fight” in them. Elders often are insufficient in basic nutrients that act as natural anti-virals, such as Vitamin A, Vitamin D, and Vitamin C. More on these later.
Those with underlying health conditions are also very susceptible. They too often have poor immune systems and inadequate killer cell function. People with chronic health conditions are especially at risk if their illness involves the lungs, kidneys, heart, esophagus, or bladder issues. This is because the virus can rapidly attach to specific cells inside these tissues and then proliferate and render havoc.
Underlying Mechanisms of Viral Attack: ACE2 Receptors
A major theory of how COVID-19 attacks and invades the body explains why certain people are at risk and perhaps gives us some other speculative (not yet tested) ideas of protection besides washing your hands with soap, not touching your face, or practicing social distancing, which in my book are not big enough guns for this battle.
In February 2020, an article[22] out of Greece, published in Current Medical Chemistry, which explained how the coronavirus is able to invade the body. COVID-19 goes into the body by “binding” to a receptor called the angiotensin-converting enzyme II, or the ACE2 receptor[23] [24].
ACE2 is expressed (lives) in a variety of tissues in your body. For example, it lives throughout the mucosal lining of your mouth (oral cavity). When someone with the virus sits in a seat and touches the metal arm frame, where you might then sit, you can touch the virus or inhale “viral sheddings” or virus droplets that can then gain entrance into your body by binding to the ACE2 receptors inside your mouth. And then into your respiratory tract.
The tissue with the next highest ACE2 receptors are your lungs. Extremely high levels of ACE2 expression occur throughout all lung cells[25]. This is why one of the severe complications of COVID-19 is acute respiratory distress. The COVID-19 gets into the lungs by binding to ACE2 receptors and this damages normal lung function and puts the infected person at risk of pneumonia, one the most serious complications.
How do dangerous corona viruses bind into ACE2? These viruses have Spike (S) proteins. These S proteins are like cars that drive the virus into parking spaces (ACE2). They have high affinity, meaning they love ACE2 parking spaces. It’s almost as if the car gets “pulled” in magnetically.
When virus S proteins bind to ACE2 your and my cells have natural proteolytic enzyme action (proteases-TMPRSS2) which could possibly block the virus’s entry. Some people may have better enzymatic action at this level than others so they not get ill or get less ill.
The viral ability to park into ACE2 appears to be blocked by blood pressure meds which also improves lung function[26].
There is the possibility of looking for vaccines that block viral Spike proteins, or drugs that block ACE2 receptors, or delivering more ACE2.
Both mice and pediatric human reports[27] show that giving more ACE2 in patients with severe respiratory distress have improved outcomes. So more ACE2 might be good.
In 2008, Austrian scientists discussed a possible treatment for the severe acute respiratory syndrome caused by SARS-coronavirus (SARS-CoV) which spread rapidly from China throughout the world. It caused more than 8000 deaths due to the development of acute respiratory distress syndrome.
What treatment did they recommend in this peer review article[28]? ACE inhibitors. Also, Angiostensin II Receptor Blockers (ARBs). These are both common blood pressure medications.
Keep in mind this is speculation but it’s being actively looked at[29].
These above authors wrote: “Interestingly, a novel homologue of angiotensin converting-enzyme (ACE), termed angiotensin converting enzyme 2 (ACE2) has been identified as a receptor for SARS-CoV.”
ACE2 is a negative regulator of the many cells in the body, keeping the “peace” among tissues, so to speak. When the virus binds to ACE2 receptors, that physiologic peace is lost.
Using ACE2 knockout mice (mice genetically raised to have no ACE2 receptors), these mice had severe lung issues. The Austrians demonstrated that ACE2 protects lungs from respiratory distress. Severe viral infections like SARS-CoV and most likely COVID-19, reduce ACE2 expression. This puts lungs and whatever other tissues are high in ACE2, vulnerable to catastrophic reaction to the viruses and severe illness.
ACE2 Protects Tissues
These Austrian researchers suggest that ACE inhibitor medications will be great new treatments against these nasty viruses. So much so they titled this peer review article: Lessons From SARS: A New Potential Therapy for Acute Respiratory Distress Syndrome (ARDS) With Angiotensin Converting Enzyme 2 (ACE2)[30]. I love it when scholarly titles tell you what’s inside.
They injected the nasty SARS-CoV virus into mice. These mice developed severe lung failure. But if the mice were first given ACE inhibitors, lung damage from the virus stopped cold.
However some experts wonder if ACE along with ARB blood pressure medications elevate the numbers of ACE2 recptors and worsen the disease. Some articles suggest that people with hypertension (who are thus on medication) are more at risk of COVID-19.
High blood pressure appears to be a striking underlying health condition in those with the virus who develop severe disease versus those who do not[31]. This link has not panned out. Association has only been shown in animals and not in humans[32] [33].
What we do know is the virus uses the renin-angiotensin system. For you geeks (ACE2 and type II transmembrane serine proteases). Thus it makes sense to look at this link for protection and/or treatment.
The question becomes, do blood pressure medications like ACE and ARBs upregulate more parking spots for viral attack or provide protection? In reading the literature it seems to me that these meds could be protective. I have spoken at long length with my dear colleague Dr. Mark Houston and we have been madly sending peer review articles back and forth to each other (we teach together for CMEs for MDs and he has designed the world’s oldest and best functional cardiology course). Dr. Houston wants me to be clear in this article that the use of these blood pressure medications has not been thoroughly tested in large human studies.
Both animal models and human studies have looked at human patients with viral pneumonia with continued ACE blood pressure medication use. It appears that these patients are not “as sick” as patients in which these meds have been discontinued[34].
We know that ACE binding sites are critical to coronavirus infection and lung injury.
Decreased ACE2 and normal ACE levels are seen in lungs of mice infected with SARS-CoV.
We know ACE2 is route of entry. But more, less, blocked, boosted; studies are a bit all over the place. In my opinion the research suggests that meds that address ACE2 appear protective.
I am on a very low dose of ACE inhibitor meds now as I am in a high risk group. You need to discuss this with your doctor and especially if you have chronic lung illness and have high blood pressure.
Dr. Houston wrote to me, “This is all still theory. No proof in humans. But I think either (ACE or ARB) will work but, ARB may be better.”
In the last two decades, two serious coronavirus infections manifested—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). They had elevated death rates. They both could bind to the ACE2 receptors in the lungs[35].
ACE2 Receptors and Smoke
ACE2 has also been identified in other areas of the body, including the esophagus, heart, kidney, and bladder. All these organs are at potential risk of COVID-19 infection because they have more ACE2 receptors than other tissues.
But there is another confounding lung variable. Quite a bit of research[36] [37] has taken a look at another promoter of acute respiratory distress syndrome: smoke.
Smoke exposure to rats caused an increase in ACE2 lung receptors, when compared with controls not exposed to smoke.
The more ACE2 receptors in any tissue, the more vulnerable it is to COVID-19.
Smoke increases that vulnerability.
Anyone exposed to excessive smoke, like smokers, or folks exposed to severe air pollution, have increased numbers of ACE2 receptors in their lungs. Thus, they have more terrain for the COVID-19 to “dig in” for invasion and attack.
Smokers will be more prone to having more ACE2 receptors in their lungs. You can be a primary smoker, if you smoke yourself. Or a second-hand smoker, if you are environmentally exposed. In China, there is a huge dose of both.
A third of the world smokers live in China. There are over 350 million cigarette smokers there. So many Chinese (mostly men) smoke, that their culture has been referred to as suffering from “a pulmonary health crisis”[38].
China also has increased levels of smoke pollution. Inhaling smoke in the air literally increases numbers of ACE2 receptors. The Chinese might have had such a huge outbreak because they have more primary smokers and secondarily are exposed to more smoke air pollution, so they are much more vulnerable to COVID-19 than non-smokers in the U.S.
Italy is also a country with lots of smokers. They had a slight decrease for a while, but there have been no changes in smoking rates since 2007[39]. Approximately 21% of their population smoke, while 14% of U.S. citizens smoke. This may partially account for Italy’s mass epidemic of the COVID-19.
In China, 60% of males smoke compared to 4% of females. COVID-19 has been reported to be more deadly in males from the information coming out of China. U.S. smokers are 16% men and 12% of women. This should be a great inspiration to give up smoking.
Additional Routes of Entry: Furins, Inflammasomes and Viroporins
(This section discusses routes of entry without ACE2 receptors.)
How does this virus grow so fast? Another theory that dove tails into the ACE2 theory, are furins. Furins are enzymes that control traffic into cells. They are found throughout our bodies.
Furins line most cells. Viruses, first shown with the SARS coronavirus[40], contain what you learned above, “spike (S) proteins[41]”. These not only bind to ACE2, but they can also bind to furin enzymes, allowing the virus entry into cells. Even without ACE2 receptors.
Once the virus enters the cell, enabled by furins, “inflammasomes” appear.
Inflammasomes are part of our innate immune system. Most inflammasomes are part of what is called the NLR family.
Inflammasomes are platforms of protein, referred to as scaffolding, that boost the release of more inflammatory molecules such as pro-inflammatory molecules called cytokines such as (IL)1β and IL18. Suddenly inflammatory storms start to erupt at cellular levels.
The SARS-CoV virus gains entry through yet another door. The virus can boost viroporin[42] production (proteins that allow all this nasty virulence to unfold), that then activates inflammasomes.
At the University of Michigan (my alma mater) Zhang’s lab, has shown that the SARS-CoV-2 virus happens to do a great job of binding to furin enzymes that start the process and also binds to two viroporins that make the process very aggressive[43].
Here’s a summary of COVID’s potential routes into your body:
Viral spike (S) proteins bind to ACE2 and/or furins > allowing virus inside cells > release inflammasomes, which release more inflammatory molecules > and/or binds to viroporins > whole process gets more aggressive and more virus gets inside more cells > tissues get inflamed, fiery and you get ill.
All this takes place if ACE2 receptors are present. Or not.
ACE2 receptors are one way for the virus to get in. But not the only way.
Thus, these serious coronaviruses has four routes of entry.
ACE2 receptors
Furins
Inflammasomes
Viroporins
These nasty viruses have a lot of portals through which to enter your cells and create havoc.
The good news is that the major inflammasome found to cause extensive lung distress is the NLRP3 inflammasome[44].
And there is a natural hormone that stops it.
Good News: Melatonin!
Let me paint the back-copy.
There are no COVID-19 fatalities under the age of 9[45].
If young kids get COVID-19, they often don’t get very ill and the symptoms tend to stay away from the lungs[46].
What’s a huge difference between youth and adults? The day and night sleep hormone, melatonin. Kids have a lot more melatonin.
The rise of melatonin starts in the third trimester of pregnancy[47] and continues to be highest at ages one through five. Then melatonin blood levels start to slowly decline[48] and become very low in the elderly. Low melatonin levels in adulthood cause many to suffer with insomnia. The most severe cases are in nursing homes where elders suffer with the “sun-downers” syndrome: they are awake at night and sleep during the day.
Enter the mighty multi-tasking hormone, melatonin.
Most people think of melatonin as a sleep hormone that keeps us in sync with light and dark. It is higher in the blood when it is dark and we should sleep. And it is lower in the blood when it is light and we should be awake.
But there’s more.
Of all things, melatonin binds to NLRP3 inflammasomes and blocks their fiery actions.
Melatonin protects against the downstream negative results of NLRP3 inflammasomes. For example, NLRP3 inflammasomes damage the Golgi apparati that make mitochondria and hormone receptors. So when melatonin stops the inflammatory actions of NLRP3, it protects mitochondria and hormones. Mitochondria are the energy organelles (factories) inside cells that give energy to cells to function optimally.
Melatonin is also one of the most powerful antioxidants in the body. It’s a “clean” antioxidant, meaning it doesn’t make more damaging molecules as its metabolized, as most antioxidants do.
So melatonin lowers production of proinflammatory cytokines. Melatonin inhibits NLRP3 inflammasomes[49]. When it’s given to experimental mice with severe heart issues (myocardial septic conditions), it transforms the life-threatening condition into a milder one while enhancing the survival of the mice[50] [51].
Melatonin supplementation counteracts severe inflammatory responses such as pro-inflammatory cytokines and NLRP3 inflammasomes.
Melatonin fights deadly inflammation.
It seems reasonable that melatonin supplementation in” high sustained-release dosages” will prevent or reduce acute respiratory issues caused by COVID-19 by suppressing of NLRP3 inflammasomes[52].
In an animal model of acute lung injury, melatonin markedly reduced lung damage. How? Melatonin inhibited NLRP3 inflammasomes[53].
In rodent models of acute respiratory distress syndrome similar to what these dangerous coronaviruses can do, melatonin treatment (with added mitochondria) significantly slowed down the lung aspect of the disease[54].
I have been using high-dose melatonin in breast cancer survivors for years. It tamps down the nasty actions of estrogen and acts like a natural aromatase inhibitor. So much so, a number of drug companies tried to get it added to pharmaceutical aromatase medications. This has become a well accepted functional oncologic protocol. So we know one can take high doses of melatonin safely. I wrote about melatonin’s amazing job descriptions in Safe Hormones, Smart Women[55]. Now melatonin’s usefulness shines again.
A study released on March 6, 2020, demonstrated that by increasing melatonin (with the use of a melatonin receptor promoter or agonist) the damaging effects of ventilator-induced lung injury could be prevented in rodent models[56]! It’s in mice, but it holds out hope for what melatonin can do in humans in these COVID-19 times.
What else blocks sepsis in mice by inhibiting NLRP3 activation: nitric oxide[57] as well as vitamin C (Ascorbic acid)[58]. Taking these supplements prophylactically or as adjunctive treatment makes sense. I’m on them myself.
Melatonin is a frigging amazing hormone. Years ago I was a hormone scholar at an environmental estrogen think tank at Tulane (The Center for Bioenviromental Research) headed by the world famous estrogen scientist John McLachan PhD. I was lucky to attend brown-bag lunch lectures where I learned all about melatonin from Dr. David Blask, an MD, PhD. He is one heady scientist with a total focus on melatonin. Dr. Blask’s life-long work uncovered melatonin’s ability to suppress tumor uptake of glucose. Melatonin has many protective actions in the human body. Now here we add another critical one. Thank you Mother Nature!
Symptoms
Initially, COVID-19 mimics the flu—higher fever than is typical with the “usual” flu, headache, cough, fatigue, and less muscle aches than a typical flu with onset of lung congestion and/or cough.
Some of the unique symptoms of this virus compared to most other viruses are shortness of breath and nausea, as the ACE2 receptors are rich in the lungs and esophagus, where the virus can bind.
But it can occur with NO symptoms.
But remember, anyone can have this virus and not have the above symptoms because we are all unique, so our symptoms are unique. Also, this virus is alive and has “consciousness,” so it is evolving and mutating and the newer forms may have different presenting symptoms.
What To Do
Mask: Wearing a mask will not help protect you from becoming ill. If you are infected, it will protect others.
Washing hands: Wash your hands often with soap and water for at least 20 seconds. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 70% alcohol.
If you are at high risk consider the following:
Melatonin: 10 to 20 mg time-release for adults. Kids make their own. If your child gets ill with a documented case of coronavirus, ask your doctor about adding in 1 mg of melatonin to their mix.
Anti-viral nutrients: Get your blood flowing with healthy levels of natural anti-viral nutrients. No one really knows the extent of this virus, but better safe than sorry and why not use natural answers. The focus here is on vitamins A, C, and D.
Many people have insufficient blood levels of vitamin A and C. These nutrients have antiviral abilities and are able to support the immune system when it is under viral attack.
Vitamin C: If you are not ill with the virus but want protection, take 3-5,000 mg/day of vitamin C. At the first sign of an illness, take 1,000 mg/hour until diarrhea develops, then back off for a time period. If and when you get the virus, IV vitamin C has three studies approved for treating COVID-19 mentioned below in the tools for when infected section[59]. Functional doctors have been using high dose vitamin C IV, along with supportive nutrients, successfully for many years.
Vitamin A: 5,000 Units/day if you are not sick and 100,000 Units/day for four days at the first sign of an illness.
*Pregnant women cannot take these doses.
*Take vitamin A, not beta carotene. If you are a smoker, stay away from high dose beta-carotene, which is linked to increasing the incidence of lung cancer in smokers.
Vitamin D is also very important for fighting infections. At the onset of an illness, take 50,000 IU of vitamin D3/day for four days. Then go back down to your normal much lower levels. Do not stay on high levels of any of the vitamins. It’s best to work with a physician that knows how to monitor high-dose nutrient anti-viral intake.
Iodine: is essential to fight off infections and for proper immune system functioning. There is no bacteria, virus, parasite or fungus that is known to be resistant to iodine. Dr. David Brownstein is a colleague and dear friend. Dr. Brownstein has written in his amazing book, Iodine: Why You Need It, Why You Can’t Live Without It, that most of our population is low in iodine.
When I test patient’s serum iodine (which we do on every single new patient), 90% are at the low end if not below it. Iodine levels have fallen nearly 60% over the last 40 years. The Recommended Dietary Allowance (RDA) for iodine is inadequate to supply enough iodine for all the bodily tissues.
For protection: taking half of a 12.5 mg iodine caplet twice a week makes sense. At the first sign of illness, increase to 25 mg of iodine for 4 days and then reduce the dose to ½ of 12.5 mg caplet three times a week.
Please keep in mind that iodine can cause adverse effects; it is best used under the guidance of an iodine-knowledgeable doctor.
Nitrous Oxide: Neo-40 was co-formulated by Dr. Nathan Bryan and Dr. Janet Zand, who are old friends and colleagues of mine. Dr. Bryan and I did an NO/dialysis study[60] together and published it in peer review. Neo-40 contains beet powder and a Chinese herb, which both boost the production of NO. One lozenge twice a day seems prudent for protection.
Zinc: Zinc is powerful anti-viral mineral[61] [62][63]. Zinc is part of the zinc finger proteins that help the body stop growth (replication) of invading viruses. Zinc has been tested and shown to have anti-viral activity against a number of viruses, even Ebola, though it’s not specifically been tested on COVID-19. Sufficient zinc stores inside cells are needed to help successfully fight viruses.
Zinc has been shown to help shorten the duration of the common cold[64] if taken early in the course of the illness. The common cold virus is a member of the corona family. It’s a good idea to test your stores of zinc once a year. This is done by running a red blood cell level of zinc. It should be in the upper quartile of the reference range of the lab. Taking about 25 mg/d of zinc for most people, with a small amount of copper like 2 to 3 mg in a backup multi-mineral, is immune supportive.
Zinc’s highest amount in the body is in the brain where zinc “allows” many hormone signals and neuronal actions to protect the brain. Zinc during a viral outbreak helps protect brain tissue from some of the collateral damage.
Mushrooms: Mushrooms contain, in their cell walls, natural polysaccharides called beta-glucans. These substances increase host immune defense by several mechanisms, such as activating a part of the immune system called the complement system, enhancing macrophages (a protective traveling white blood cell that does cellular surveillance), and boosting natural killer cell function. Ill patients, more at risk of the virus, along with the elderly, often have “lower killer cell activity” and thus more viral vulnerability. Getting mushroom supplements is smart. Add them to your diet, too.
ACE and ARB Meds
This class of blood pressure-lowering meds bind to the same receptors as the COVID-19 virus, so they act as inhibitors, meaning they stop the virus from binding with the ACE2 receptors. Those who are already taking these types of blood pressure meds are thus most likely somewhat protected from the virus. (This would make a good study in those already affected for you epidemiologists out there.)
I have a few elderly patients with chronic lung issues, who are also on blood pressure medicine. I am recommending they and their primary care docs consider substituting their present medication with ACE inhibitors (and/or ARBS), or adding a very small amount of ACE inhibitor to their present blood pressure mix, as long as they don’t get their blood pressure lowered too much.
ACE inhibitors have long been known to protect renal function by binding to these receptors in the kidneys, which protects renal tissue from damage by a variety of possible assaults to these receptors. It’s also why some folks start to cough on these meds as it activates so many lung ACE2 receptors and some folks have more than others.
I don’t have high blood pressure, but am a high-risk person. I decided to take 2 mg daily of Enalapril (an ACE inhibitor) as a protective measure. I’m tracking my blood pressure to make sure it stays at healthy levels.
You cannot make this decision without conferring with your primary healthcare doctor who knows your health history. This is a speculative protocol, not a CDC or medically-proven protocol. It’s physiologic common sense.
This may lower your blood pressure somewhat, which may not be appropriate for you, or it may have little effect other than being a super protective measure for you. But it’s trial-and-error, and you must work with a medical practitioner, as it is a prescription.
Avoid NSAIDS if Possible
Especially if you have underlying chronic health conditions.
Nonsteroidal inflammatory meds have been shown to be “immunosuppressive”[66] and this is a time when you want your immune system as strong as possible.
Pain? Lean on acetaminophen for now. Or hugging a safe close partner as oxytocin is a pain reliever, too.
Stress
Stress, like sugar, depresses the immune system. Make as many decisions as possible by looking at all your options and taking the path of least stress. Mindfulness practices also help you move through stress. Stress, after all, is the perception of lack of control. Mindfulness puts us into a “present” that seems more controllable, no matter the circumstance. That builds resilience even to viruses.
If all the above seem too much or you feel you don’t need to cover all your bases, choose what makes most sense for your body. Perhaps do one or two protective measures. I would say put melatonin high on the list. I took 15 mg time-released last evening and had a terrific sleep! Feel like a million bucks this AM to finish this article for you.
Food, Water, and Lifestyle
You want a humming immune system. Avoid things that ding it. Eat lots of colorful veggies and fruits and, during this time, avoid refined sugar completely. For a few hours after consuming refined sugar, white blood cells don’t perform optimally. This is proven, replicated science.
Dehydration worsens any infectious process. Remember to drink water. I am going to take a short break and go get a glass right now.
Work out regularly, sleep well, and take prescribed meds regularly as directed.
Social Distancing
The countries that have kept this coronavirus under control acted fast and aggressively toward containment. The U.S. has gotten off to a slow start.
Data from abroad suggest that 10% to 20% of those that get ill, can end up in a more serious condition. This could translate into potentially hundreds of thousands who may need hospital care. To avoid this we need to take individual and social action. In Italy the number of cases skyrocketed from a handful a few weeks ago to more than 27,000 new cases and many deaths.
We can’t be cavalier Americans thinking we can do whatever we want. South Korea and Taiwan keep people 3.5 feet apart. Folks flying into many countries now must be in a holding area until they have a medical evaluation. America is not doing this. Folks land and blend and stand in long lines with each other and even share pens to fill out forms.
It is good that schools are closed. Don’t go to church; pray at home.
Volunteers in other countries go around with thermometers checking for fevers.
Some countries have closed their air and seaports to foreigners. This makes sense. Act aggressively now and stop this, so we can soon go on with our lives.
If you are young, realize you can still get ill or be a vector of infection. Keeping away from others if you have been exposed for at least 14 days can help “flatten” this potential catapulting curve. Don’t go to large gatherings and only go out when you must.
We need collective civic responsibility.
Be smart. This has not peaked yet, but you can help it slow down.
Instead of restaurants cook at home or order in and let them leave the food at the doorstep.
Don’t forget to spend some healthy time outside because sunlight and fresh air are part of staying well.
If You Get COVID-19
If you become ill with a viral infection, I suggest these viral protocols that have been used for viruses in functional medicine clinics for many years:
IV Vitamin C[67] if you can get it. Intravenous vitamin C is already being employed (successfully in a number of cases) in China against COVID-19. You can go to a functional medicine doctor or some cities have walk-in IV rooms where they have doctors on site. This looks like one of the best options to start right away. If you can’t get IV vitamin C, try Vitamin C to bowel tolerance as described earlier in this article.
Melatonin (30 mg time-release – at this time is my best guesstimate) before bed for one week, you may feel groggy during the day, but you need to sleep anyway and this will give you deep healing sleep; then reduce to 20 mg the next several weeks.
Vitamin D3 (50,000 U) for four days. After the four days, resume your previous dosing.
Vitamin A Palmitate (100,000 IU) for 4 days, then reduce to 50,000 IUs for 4 days, and then down to 25,000 IU.
Zinc (30 mg 4/day) divided into two dosages; this will probably cause a little nausea. Go down to 30 mg each day until at 30 mg. While doing this protocol make sure you have a multi-mineral on board with a bit of copper in it.
It is best to work with a holistic doctor who can monitor your levels as both vitamin A and D can become toxic.
Ozone whole blood irradiation[68] [69] is a powerful tool against viruses (and everything else). Hydrogen peroxide IVs are helpful, too. I have not used these, but Dr. Brownstein swears by them.
Consider clearing nasal passages with a Neti pot (with purified water).
Consider Afrin nasal spray (3 sprays in each nostril, 3 days at a time, and then 3 days off). This could potentially keep your sinuses clear and prevent the symptoms from spreading to your lungs.
Thinking of getting the flu shot? This is what Dr. Brownstein says and I agree. “It won’t help corona virus infections. There was a study that found an increased risk in non-influenza infections, including coronavirus, in those that received the trivalent flu vaccine”.
Most Likely
Death is a tragedy, but the death rate from this new coronavirus strain is most likely not going to be as severe in the U.S. as the recent statistics are suggesting.
We don’t smoke as much as China or Italy. Our air is less smoky.
Plus, we have some heavy-hitting nutritional and drug options.
Personally, I’m on all of the suggested items.
Keep In Mind
Present viral numbers outside of Italy correlate to a 2-3% death rate.
Which means… 97-98% of those infected survive!
Remember that these reports aren’t completely accurate as we do not know the total number of cases.
Be mindful that viruses can mutate. So symptoms can morph.
That’s why during these times it makes sense to take some of the action steps mentioned above, especially if you are over 70 years old or already ill with a chronic underlying condition.
If You Must Fly (start all this two days ahead of time and day of flying)
Melatonin 15 mg time release before bed.
4,000 IU of vitamin C
40,000 IU of vitamin A
5,000 Vitamin D
Mushroom supplements
May the anti-viral force be with you.
With love.
Be well.
Dr. B.
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