As SARS-CoV-2 virus spread throughout the globe and caused the largest amount of COVID-19 cases and deaths in the US, there is hardly a person on this planet who is unaware of the coronavirus.
While ending the lockdowns across the country with safety precautions and making sure hospitals are not overwhelmed, public officials and physicians alike are waiting to see the way coronavirus behaves in the next several months. Will we see a substantial increase in the cases during the summer or will the hot weather keep it at bay? Rising number of cases in Florida and Arizona despite the heat is certainly concerning and our eyes are on them, waiting to see how the situation progresses. Will SARS-CoV-2 return in the fall and winter months causing another spike in cases in New York and New Jersey?
With each day we learn more about the virus and about the ways to treat it.
Doctors gain experience, share knowledge and are now better prepared to treat the sick. There are many treatment protocols used in various countries, different hospitals, medical wards and intensive care units, although uniformed guidelines are still lacking.
The controversy about the Hydroxychloroquine, the drug to treat malaria and rheumatoid arthritis, continues, with some randomized studies about it withdrawn from the most respected medical journals (NEJM and Lancet), but some others still ongoing. New medication Remdesivir recently received emergency use authorization by FDA. Old medicine Dexamethasone (a familiar glucocorticoid) was recently shown in a UK-based trial to improve survival of hospitalized patients on mechanical ventilation by 30% and of hospitalized patients on oxygen by 20%. Some other off-label medications include Ivermectin, colchicine, antibiotics, antiretrovirals, immunoglobulins, convalescent plasma, and Toclizumab (an IL-6 inhibitor which can prevent the cytokine storm).
We discovered that COVID-19 not only affects the immune system, gastrointestinal and respiratory systems, causing bronchitis, pneumonia, and acute respiratory distress syndrome. It also produces hematological complications causing widespread blood clotting. Specifically, COVID-19 has been shown to cause dysfunction in the inner lining of the arteries (endothelium) and the treatment for blood clots (anti-coagulants) is now used to avoid life threatening complications. An important observation, shared by many physicians across several states, has been that in the newly diagnosed cases of the last several weeks, including June of 2020, we see that patients are not as sick, outcomes are better even with hospitalized patients. We also observe better survival rates. It is too early to say if the reason behind it is mutation and weakening of the virus or if there are other factors contributing to improved outcomes. Infection fatality rate (defined as deaths among all diagnosed, undiagnosed and asymptomatic individuals) seems to be between 0.4-1% according to various epidemiological reports. While it is still higher than influenza which carries about 0.1% death rate, the risk of dying from COVID-19 turns out to be much less than initially feared and estimated in March-April of 2020 when the case mortality rate (defined as deaths among those who were diagnosed with disease) was thought to be up to 5%.
Traditional medicine still does not recommend much for mild to moderate disease, as the majority of people will recover from COVID-19 without intervention. However, learning that there are delayed complications, such as prolonged fatigue, lingering cough, blood clots, and rashes, maybe we should be paying more attention even to the seemingly mild and moderate cases, those which do not require hospitalization. It is not uncommon for the patients to have persistently elevated levels of inflammatory and blood clotting markers and develop depressed mood and anxiety. The latter two can happen with any serious medical illness. Some physicians treat mild and moderate cases with off-label medications and supplements based on experiences with MERS and SARS and anecdotal reports from colleagues all over the world. We have observed a lot of positive progress with the use of off-label medications and natural supplements based on collective experience of many physicians, but without a gold standard randomized control trial it is impossible to definitely state whether these patients would have recovered by themselves without any intervention.
It is currently believed based on epidemiological models, that during the pandemic, the novel virus will continue to infect the world's population until about 70-80% of people are infected and herd immunity is achieved. Short of a rapidly produced vaccine or natural weakening of the SARS-CoV-2, it will mean that most of us will be exposed to the coronavirus at some point, regardless of the length of the quarantine. If and when that happens, one of two things will take place. If our immune system is stronger than the virus, we will be able to inactivate it with our own immune cells. Those people may become infected but be asymptomatic or have very mild symptoms. If our immune system is weaker than the virus's ability to enter our cells and replicate can overwhelm our defenses, leaving a person very sick, possibly progressing to life threatening complications. Research on hospitalized patients with COVID-19 revealed that older individuals, people with pre-existing conditions, such as hypertension, obesity, diabetes and cancer develop more severe disease and are at higher risk of death.
In the absence of a vaccine or a proven cure, strengthening one's immune system and practicing social distancing may be the only preventative strategies we have while the pandemic runs its course. Much like people have been preparing and stocking up on groceries and household supplies, we should be taking care of our immune system and prepare now. Our immune system is very complex and the process of becoming the healthiest version of yourself is not overnight, but simple steps can be employed right away to start the journey.
Getting adequate sleep, about 7-8 hours, will improve the body's response to illness. Decreased sleep duration has been linked to increased inflammation. Even mild sleep deprivation can cause elevation in pro-inflammatory markers, such as c-reactive protein, and cause immunodeficiency, thus decreasing the response of our body to several antigens. For example, only six days of restricted sleep tends to decrease immunity against influenza vaccination and enhances susceptibility to the common cold.Getting adequate sleep improves not only our cellular function and immunity but also helps to eliminate toxins from our body.
Eating a diet rich in fruits, vegetables, lean proteins, which constitute a healthy antiinflammatory diet, provides minerals, nutrients, and vitamins for proper cellular function. Studies show that only one meal full of refined sugars and trans-fats produces abnormal insulin response which, in turn, decreases function of macrophages. Targeted supplementation with vitamins and minerals which may specifically improve immunity can also be helpful. Zinc helps decrease viral replication, Vitamin D helps immunity, Vitamin C works as an antiviral and an antioxidant, Vitamin A helps the cells in the respiratory tree, flavonoid quercetin is also a potent antioxidant. Prior studies have shown the efficacy of Zinc in reducing colds caused by other coronaviruses. Antioxidant, antimicrobial and antiviral roles of Vitamin C are also well documented. Many of these supplements can be taken orally and some can be given intravenously, such as Vitamin C, which has decades of research showing its safety and efficacy. Higher doses of vitamin C have been given by doctors in Wuhan when the outbreak started and some hospitals and clinics in the US have also followed suit. Longer term preparedness would include seeing your doctor for a check up, getting routine blood work done, including immune markers, microbiome markers and micronutrients in order to target supplementation for deficiencies appropriately and to monitor optimal levels for the future.
Keeping mental health a priority is another important aspect of our daily activities during pandemic. With pandemic and economic uncertainties, physicians are seeing more complaints of anxiety and depression. In addition, breaking daily news around the country and the world creates negative emotions that impact hormones, releasing adrenaline and cortisol which can impair immune cells. Taking control of the information overload and limiting TV and social media to a daily minimum of 20-30 minutes can help balance our thoughts, increase parasympathetic nervous system response which will, in turn, improve mood, sleep and health.
Breaking the tradition of making health resolutions for the New Year's, we should take a closer look at what we can do this summer to help nurture our emotional resilience and strengthen our immune system. As we tame our anxieties, safely ending the lockdowns, these health optimizing strategies, whether holistic or medically supervised, can prove to be lifesaving. Going outside for a walk, normalizing sleep hygiene, enjoying the sun for a natural dose of Vitamin D, practicing mindfulness, swimming in the ocean or going for a hike for a minimum of 150 minutes per week are tools in our wellness toolbox which can allow us to ride the wave of COVID-19.
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Excerpt from:
COVID - 19: Is There Healthily Thereafter? - Patch.com
