News to Use: A Commentary on COVID-19 by Dr. Adrian den Boer

• Posted on 2 April 2020
• By Dr. Adrian den Boer
• Posted in coronavirus, immune system
• 1

There are still a lot of unknowns surrounding COVID-19.  Data is rapidly emerging but largely preliminary.  Medical journals and researchers are publishing things with less scrutiny than usual due to a need for quick answers.  However, I have been reading all the information available, have listened in on teleconferences between doctors in New York City – the U.S. epicenter of the pandemic – and gathered thoughts from specialists in infectious diseases, and there are a few pieces of information I feel are worth conveying at this point. 

It’s still unclear exactly how deadly the novel Coronavirus is.  This is largely because many people who become infected with the virus suffer mild or no symptoms, and so never get tested for the virus.  This means most of our information comes from those who develop symptoms serious enough to warrant medical attention.  We do know that it is killing people at a faster rate than the flu, though this could be due to the very fast-moving nature of the bug – that is, more people are simply getting it all at once.  It tends to spread very quickly, in part because there tend to be few or no symptoms the first few days after infection, allowing people to spread the virus without realizing they have it.

It’s widely agreed that the virus spreads via respiratory droplets.  These are tiny drops of water that we put into the air when we sneeze or cough, or even when we speak.  These droplets can stay in the air for a short while, or come to rest on surfaces like tables, chairs, or countertops.  The virulence of the diseases has led some to speculate the virus can be airborne as well, increasing the area and time viruses can remain in the air, but this has not been proven. 

There are a few unique factors to this virus that come into play once the virus gets into someone’s system.  First, the virus binds to cells using receptor sites that are already cleaved, giving it direct access into the cell.  This makes the virus more virulent, making it easier to infect someone in the first place.  Second, they possess a spike protein which is attracted to ACE-2, a receptor which lines cells in the lungs, kidneys, GI tract, and artery linings.  This makes these tissues particularly vulnerable to infection or severe damage by the virus.

Once exposed to the virus, symptoms can show within 48 hours, though it often takes 4-7 days for symptoms to appear.  Symptoms vary but typically feature fatigue, muscle pain, fever, digestive disturbance, sore throat, loss of smell or taste, a dry cough, and shortness of breath.  Most people recover in 10-14 days, though those that ultimately require emergency care and intubation take at least 6-8 weeks to fully recover.

Your body’s immune response is the key factor in how COVID-19 progresses in each case.  The inflammatory response to the virus starts with Interleukin-1, Interleukin-6, and TNF Alpha, which lead to a Th1 response specific to the virus.  If the immune system is successful in clearing the virus, the inflammation resolves and your body retains antibodies that make you immune to the virus.

However, the virus also activates a protein called NLRP3 inflammasome in the cells it infects, which in turn triggers NF-kB – a master regulator of the immune response.  In some cases this can lead to a runaway inflammatory effect called a ‘cytokine storm.’  This out-of-control immune attack is likely what causes some cases to become critical or even fatal, as the immune system attacks infected tissue – typically the lungs and circulatory system - causing massive damage.

People with diabetes, obesity, and cardiovascular disease are at greater risk of infection.  Oddly, smokers and asthmatics do not seem to be at a higher risk of contraction.

Because of the virus’s affinity for ACE-2 receptors, it is important to be very careful with certain medications.  Ibuprofen increases ACE-2 receptor expression, which may increase the virulence of the bug.  Acetaminophen is not much better as it can deplete glutathione – a crucial component for neutralizing a cytokine storm.

Of course, there is huge interest in finding medicines that help to treat the virus.  Unfortunately, research into anti-viral drugs such as Tamiflu have not been promising so far.  AIDS medications are not proving promising either, nor are drugs used against Ebola.  There was some thought at first that antibiotics might help against opportunistic bacterial infections in the lungs that could be causing the pneumonia of more serious cases, but such infections appear to be mainly viral, limiting the usefulness of antibiotics.  This may be because, curiously, the periphery of the lungs appear to be the most affected.  Because none of these medications have so far been working, the medical system can mostly just support affected patients as well as they can while their immune systems work to clear the infection.   

There has been some early promise, however, with certain antimalarial drugs combined with antibiotics (See our blog on that here). This is what some doctors in New York City are using.  We are very lacking in data just yet – mostly anecdotal accounts and a single small, poorly-done study from France – but what data we have gives some cause for optimism.  We hope to have more and better data on this very soon, as doctors in the United States begin to use this regimen in studies as well as active patient care.

Is it possible to bolster or protect yourself against the virus beforehand?  Though we don’t have studies regarding this specific virus, there are a variety of things that are known to protect against viruses and illness in general.  Getting daily exercise, especially outside in the sun (if available), making sure to get enough sleep, and eating a healthy diet low in sugar are all important, common-sense things we should all be doing.  Reducing toxic stress as much as possible also helps to keep the immune system strong and well-balanced. 

I was listening to a well-known infectious disease specialist who was looking at possible herbs and nutraceuticals that may be protective.  For prevention, she was looking to astragalus, goldenseal, and elderberry.  Vitamin C showed promise as well; I have heard that some ER doctors are turning to it also.  In cases where a more major infection is present, she feels it is necessary to reduce inflammation, using herbs such as rosemary, melatonin, lemon balm, and sage.  To normalize the Th1 response, garlic extracts and especially certain mushrooms have good research.  She most liked shiitake, maitake, cordyceps, and turkey tail.  Zinc and high dose Vitamin D also have a broad effect on the immune system, modulating and enhancing its effect.  Finally, Specialized Pro-Resolving Mediators (SPM’s) enhance response to microbial threat in case of any secondary infection.

I’m continuing to keep a close eye on the state of the information as we learn more.  There’s a lot we don’t know yet, but there’s also a lot you can do to avoid infection and stay as healthy as possible!  This topic bridges the allopathic medical world with my world of preventive, functional medicine – and the healthy lifestyles all of you can have.  Stay healthy out there!