Different viruses can be most transmissible (able to spread) at different times. For instance, influenza (flu) is most transmissible at or just before the onset of symptoms. Whereas SARS is most transmissible at 7-10 days after symptom onset.
A team from Wuhan China created models based on data from two different studies of patients with COVID-19.

The researchers found that the highest viral loads on throat swabs collected were when symptoms started. The loads rapidly declined during the next 7 days. They concluded that about 44% of secondary cases among people in close contact (households) were infected in the 2 days prior to the onset of symptoms. Now this is based on modeling since no samples were collected in patients prior to onset of symptoms.

But if this is correct, then aggressive tracing of contacts will be even more critical than quarantining!

References: He X et L. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020 April 15; [e-pub]. (https://doi.org/10.1038/s41591-020-0869-5)

This is a great article from a physician and anthropologist who has experience with fighting pandemics and developing a plan to transition people back to a virus-free future.

He calls it: Five Elements, five weapons: social distancing, testing, contact tracing, isolation and treatment.

Read more…

Transitioning To Safety

A new survey right in the heart of silicon valley looked for antibodies for COVID-19 in over 3000 residents of Santa Clara County. What was found was that the infection was more widespread and less deadly than we believed.

What does that mean?

Well, with limited testing available in the beginning of this pandemic, county’s were only testing those that were sick with moderate to severe symptoms. This doesn’t give us the true picture of the prevalence of the disease since over 80% of people had mild or no symptoms at all and were not tested. But now we have more testing available so we can test more people to get a sense of the numbers that really had COVID-19. This survey in Santa Clara Country tested immune system antibodies to the virus  which tells us if  people had been infected at some point even if they had no symptoms. The larger the number of people who had the infection but went unnoticed, the lower the death rate may be.

There are some biases in the survey which needs to be considered.

Even if this virus is less deadly than we once thought, we still need to be diligent in taking precautions to avoid spread of the virus and follow “shelter-in-place” orders until we hear otherwise. Overall there are more than 30,000 COVID-19 deaths in the U.S. so it’s hard to find good news in that. People are still getting infected and getting sick. We need to hang in there…

More testing will continue to be done and we just need to wait and see how deadly this virus really is.

Covid-19 Testing Shows More People Infected But Less Deadly Than Thought

In a bid to continue to limit the spread of COVID-19, many states are now issuing a strong recommendation to wear a face mask whenever you leave your home for essential functions.  A “stay-at-home” order is becoming increasing popular in each state and we are starting to see more and more people wearing DIY masks when out in public. But now I’m seeing runners and those riding their bikes also wearing masks? What’s the deal?

This is a great article from our hometown pulmonologist in Boulder (a huge riding community) that explains why wearing masks may be a good idea…

Masks while biking

This pandemic has turned our lives upside down and most of us are looking for things to do to keep us healthy, both physically and mentally. It’s brought a certain degree of tension and anxiety to all of us as we grasp to find a new “norm”.

We can protect ourselves in many ways to raise our resilience physically, mentally and emotionally.

Lets talk supplements…

I tell my patients to simplify their supplements at this time to what you can take consistently. We have enough to be overwhelmed with that we don’t need handfuls of supplements to swallow everyday!

1. Take the supplements you would normally take if you are coming down with a cold. Those might be “kick-ass immune”, Vitamin C or Chinese herbs. Whatever usually works for you…take it.
2. Vitamin D enhances the immune system. Take 1000-5000IU daily with food.
3. Zinc Picolinate- about 50mg daily. It is responsible in activating hundreds of enzymes involved in cell regulation, immune function, DNA and protein synthesis, fat metabolism and digestion.  See my full article from February 19, 2013.
4. Vitamin C- I can’t talk enough about this amazing vitamin. It works as an important antioxidant and it helps to stop viral replication in the cell. That’s right…it’s an anti-viral. It also has anti-inflammatory features to reduce oxidative stress. It recycles an essential intracellular antioxidant known as Glutathione. Which brings me to my last recommendation…
5. NAC-known as N-acetyl cysteine. It is an amino acid that is used by the body to build antioxidants. It replenishes glutathione. It has been shown to protect the liver but also is very protective to lung and sinus tissues. It can work as an expectorant loosening mucous in your air passages. I recommend 500 mg twice daily.

Did someone say Anxiety?  Yup!

We are all there. Even if your situation is not as dire as your neighbors and you can work from home and still get a paycheck, there are many who cannot. This is what you are feeling…the pain, struggle, the loss of jobs, and financial security of other people. Of course there are many that are severely sick or hospitalized too. We are literally all connected. We all feel the pain being manifested in this current crisis of total strangers in the community and the world.

Even though we live in a time of uncertainty, we need to stop making assumptions about the future. Living in the future produces anxiety. It’s a future-oriented state of mind. Living in the past produces depression. Stay in the present, take a deep breath and take care of what’s in front of you.

Other suggestions…

1. NAC (N-acetyl cysteine)- I mentioned this before in how it can replenish glutathione and neutralize free radicals that can damage cells and tissues in the body. It enhances immune function and protects lung and sinus tissues. But it also helps balance important neurotransmitters in the brain, primarily glutamate. Too much glutamate without enough glutathione can contribute to mental health conditions such as bipolar, schizophrenia, obsessive-compulsive disorder (OCD) and addictive behavior.
2. Eat healthy protein and limit sugar, caffeine and alcohol (if you can).
3. Thank God it’s SPRING!! Get outside and walk or exercise. Sit outside in your favorite chair and close your eyes and let the sun shine on your face. It is sooo healing…the sun raises serotonin and helps reset your clock to help with sleep.
4. Sleep
5. Journaling really helps for some people
6. Stay connected. Call a friend, text or email.
7. Listen to your favorite music
8. Gratitude- list at least 3 things you’re grateful for
9. Know that we are all in this together and we will all get through it!!

Reference: Goodson, A. Top 9 Benefits of NAC (N-Acetyl Cysteine). Healthline.com. Nutrition, Sept. 26, 2018.

I walk my dog daily on an open trial to get outside and exercise. My Goldens love getting petted so they will walk over to other dog owners and try to encourage some love back with good pets and calming words. But then I asked myself, “Is this safe to do not knowing if that person may be a carrier of COVID-19?” So I went to some good sources and this is what I found…

1. According to the World Health Organization there is no indication that dogs-or any other pets-can transmit this virus to humans through droplets. If an infected owner sneezed on its pet and you petted that dog, the dog’s fur or skin could potentially be contaminated by the virus. If you then petted the dog soon afterward and touched your nose or mouth, then it’s possible it could be transmitted.
2. People infected by the coronavirus should stay away from pets, as they should from people. It’s best to refrain from touching others’ dogs because its owner could be asymptomatic.
3. According to the American Veterinary Medical Association (AVMA), there is lack of evidence to be overly concerned about people contracting COVID-19 through contact with dogs or cats.
4. Airborne transmission is the primary route whereas environmental contamination via surfaces is a secondary route of transmission. This virus survives best on smooth surfaces such as countertops and doorknobs. Porous materials, such as pet fur, tend to absorb and trap pathogens, which makes it harder to contract the virus through touch.
5. Always wash your hands before and after dog petting.
6. I contacted my vet, and she suggested that I try to avoid people petting our dogs because of the uncertainty of knowing whether they are an asymptomatic carrier or not. She suggests using a shampoo wipe or waterless shampoo wipes on their fur after someone has touched them to be safe.

I recommend getting the advice of your vet. They may have more research on the subject. We need our pets more than ever during this time of uncertainty and isolation. The human animal bond is extremely important for animal health so hug your pets but keep that social distancing with other humans.

You have probably read or heard about the drug hydroxychloroquine as a potential treatment for COVID-19.  A french study called The Marseille Study looked at 25 positive COVID-19 patients and was a non-randomized, unblinded study but showed an impressive reduction in viral load with hydroxychloroquine. After 6 days, the percentage of patients testing positive for COVID-19 who received the drug fell to 25% verses 90% for those who did not receive the treatment. Those who received hydroxychloroquine plus Azithromycin showed an even further reduction with the percentage of cases still carrying the virus as no more than 5%.

Even though this sounds like the perfect treatment we’ve been looking for, we must be cautious. This study was small with only 25 people and non-randomized and unblinded which means participants could choose which group to be in and are fully aware if they are receiving the treatment drug or not. This can cause alot of bias in the analysis. We need to remember the goal of good research is to ensure objective results as well as unbiased analyses of said results.

There have been some positive results in a preliminary Chinese study in 100 patients which showed that hydroxychloroquine reduced the viral load, and reduced the length and severity of symptoms. So this could reduce the number of carriers. Hydroxychloroquine is being examined in a number of clinical studies in China and some in France following Dr. Prof Raoult’s findings in the Marseille Study. It is being used in almost all (about 50) hospitalized patients except those who refuse it or who have contraindications.

So how does this drug work?

Hydroxychloroquine can alter the acidity of the intracellular compartment where viruses enter the host cell. So this can interfere with the ability of the virus to get into the cell and start replicating. This drug also has subtle effects on a variety of immune cells and one of these effects may help stimulate the body’s ability to fight off COVID-19 according to Robin May, Professor of Infectious Disease at the University of Birmingham in England.

The clinical trial in Marseille is a promising start. But science requires larger unbiased studies that can be repeated several times to say whether or not it works. Studies are on-going so we will undoubtedly get more information as it comes in.

Reference: Lecrubier, A. COVID-19Could Hydroxychloroquine Really Be the Answer? March 18, 2020. Medscape.com

We have learned that in temperate climates humidity can control airborne viruses. With the overwhelming introduction and spread of COVID-19, keeping a healthy humidity rate in your home is another way to significantly reduce the risk of contracting this virus.
The flu and common cold are seasonal viruses. SARS (Severe acute respiratory syndrome) is a coronavirus very similar to COVID-19 which was discovered in China in 2002 during the winter months. It faded away at the end of the flu season by May of that year. If COVID-19 is seasonal, then we would expect the worst outbreaks to be in regions currently in their winter season. This is true in that the highest outbreaks are in China, Korea, Northern Italy, Iran, and the U.S. which are all now in their winter season.

We spend 90% of our time indoors in the winter. In cold weather, the air humidity is low and warming up that dry air when we have our heat on doesn’t raise the humidity. According to this article, most buildings do not raise the humidity to 40-60%  at room temperature which provides the best protection against airborne viruses.

There are two main reasons why higher humidity is better and more protective. First, humidity cuts the survival rate of airborne viruses from coughing or even talking. The second reason is due to an improved immune system. At low humidity, the immune system has trouble filtering out pathogens including viruses. This allows the virus to enter our bodies. In low humidity (less than 23%), our mucous membranes in our sinuses and lungs are dried out and damaged which allows our body to be more vulnerable to viruses.

Start by finding out what the humidity is in your home, especially your bedroom by purchasing a simple humidity gauge. Don’t depend on home installed humidifiers to give you what you need.  I have seen plenty of people with dry mucous membranes that have whole house humidifiers. A small humidifier in your bedroom and work space will vaporize the air in your personal space best.

We are doing everything we can to reduce the transmission of this virus to ourselves, our families and community. Why not add one more simple thing besides washing our hands and social distancing.

Covid-19 Will Be Defeated By… Water

update on coronavirus

With the continued updates on the circulating coronavirus, COVID 19, we still need to be careful about which news sources we read and listen to. This news source by Johns Hopkins University has a panel of experts that are well informed about pandemics and public health preparedness.
Unfortunately, in the U.S. only 45 out of 50 states have the ability to administer coronavirus tests. That is irresponsible and unacceptable. Increasing testing raises the number of confirmed cases, but it may also give us an upside and lead to more public calm. For instance, severe cases that end up in the hospital are easy to track and it can skew the mortality rate upward. But the more we diagnose mild cases, the more we can drive down the overall case mortality rate. Here is a case in point…

“In South Korea, for example, where an ambitious and expansive testing strategy has resulted in more than 140,000 people tested for the disease, only about .6% of cases have resulted in death—much lower than the fatality rates seen in China and Italy, where testing efforts were more limited, Inglesby said.”

Some Universities have closed and are conducting classes on-line. In some community hot-spots where a cluster of disease is found, they are considering closing elementary, middle and high schools. Fortunately, young children are not the most vulnerable in getting sick, but they can still spread the virus to other children, teachers and of course to their parents. Then parents go to work and this can lead to another source of how the infection can proliferate.

I’m not here to give you advice on supplements to take to prevent or treat this virus, mainly because nothing has been tested that provides effective treatment. But I will tell you to stay calm, keep informed with good news sources, but don’t read or watch the news too much. Stressing ourselves out with fear and worry weakens the immune system.

Do things that you would normally do if you had a cold. Eat healthy fruits and veges, soups and drink lots of fluids. Avoid sugar, alcohol and too much caffeine. Vitamin C, Zinc, Vitamin D, and Glutathione all strengthen the immune system. Get outside in the warmer weather and breath some fresh air. The sun is incredibly healing and it calms the nervous system!

We will all get through this…

As the British Government said so appropriately, “Keep Calm and Carry On”

COVID-19 Hopkins update