Friday, March 13, 2020
2019 Novel Coronavirus (CoVID-19): Part VIII
2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:
DON’T PANIC, be concerned, but don’t panic. It just makes everything worse.
March 11, 2020 update Part 8
Paul Herscu ND, MPH
This is the eighth piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, Part 5 Part 6 and Part 7 for context and also, please read my other writing on this site for a larger context on the overall topic of public health and epidemics. At the end of this update, I describe how to think about homeopathy and its use at this time.
2019 Novel Coronavirus (2019-nCoV; COVID-2019):
WHERE WE ARE NOW.
The Use of the Word Pandemic
Ten minutes ago, the WHO called the current COVID-2019 situation as a pandemic. This is a milestone. The prior Pandemic of H1N1 influenza, as you may recall, was the last pandemic, though I believe calling it that was a mistake. This time it is not.
Why Use The Word Pandemic Now?
There are people walking around with COVID-2019 without knowing it since they are not tested. And at this point understandably, there is widespread anger that there are not enough test kits, to allow us to have accurate information about incidence. And I think this is important, ultimately this is one of the most important reasons why WHO finally called this a pandemic. There are numerous countries that are not taking timely, essential actions; defining COVID-19 as a pandemic will hopefully implore nations and communities alike to work in a more aggressive and coordinated fashion to stem the spread of this virus. Most importantly, even today, correct public health actions can stop this pandemic from turning into a real tragedy on a scale not experienced for a century. Even now, we still can turn this situation around, even without any advancements in new science, just by good governmental public health processes. We are all part of the solution.
Examples of Countries that Have Early, Consistent and Effective Response
In many respects the best example of this is Taiwan. While it is geographically close to mainland China, there are hardly any COVID-2019 cases (50) and very only one death. While it is the same virus, the main difference is the processes the Taiwanese government put in place since the SARS epidemic in 2003. Bottom line, it really is the time to just settle on what can be done, today, that we already know works, that can change the course of spread of disease. Though I should mention, also, one has to overlay the actual numbers to a standardized number. For example, in the number of cases per million. Taiwan is 2.1 per million, Italy is 292.1 per million, USA is 5.7 per million.
Regarding the current numbers in the USA, we have confirmed 1,832 cases and, sadly, 41 deaths. Personally, I believe at this point, the number is most likely closer to 7,000-8,000 infected. Until there are better tests available and widespread testing of everyone, we will not have accurate numbers. As an estimate of incidence, you could double numbers each week. For incidence rate, you could take the number who have died and multiply it by 200. That might be a close approximation of the actual numbers in the USA for the coming period of time.
Transmission. Regarding the question I posed about how contagious a person remains once they are feeling well, there have been a number of papers asking the same question. We now know that such people still carry a low viral load, they still show as carrying the virus, and potentially may still be able to infect others, but we do know at what rate such lowered levels of viral load will transmit to others. I personally think this is very low and mostly unlikely, but we do not know the actual levels that this occurs at.
Modes of Transmission: Droplets vs. Aerosolized Particles
News outlets use the terms droplets and aerosols interchangeably, but there is a crucial difference here, both in terms of transmission and what we need to do to fix it. There is an enormous difference between contact and non-contact transmission. Within the contact type of transmission, we have large droplets that only go so far, about one yard more or less. Non-contact aerosolized particles, can travel throughout a large room and beyond. You can think of the aerosolized germs almost like perfume, able to travel a great distance. At this moment we understand that this corona virus spreads via the large droplet contact version of transmission. You are likely to read how a group recently was able to show that they can aerosolize the virus into much smaller particles. However, this was done artificially. There is still no evidence that this happens in nature. We keep an eye on this topic. We do not want to do anything that inadvertently causes this virus to aerosolize. With aerosol transmission and no other changes we might see a 60%-70% infection rate. But with good public policy, and if we have the real numbers now, and if transmission is only through contact via droplets, it is still very likely that most people will never get this virus. I still believe that the effective and urgent steps forward lie with good public health policy.
On Quarantines and Social Distancing
Regarding quarantines and social distancing. As mentioned before, the creation of public health policy will evolve with local needs. The size of groups allowed to congregate will likely continue to go down to the point of cancellations which are now mounting. This potentially lowers the transmission rate, though by itself this may be a little too late in some isolated locations, if it were the only change made. While many people in the service industry might find this a discomfort, those who work with their hands and bodies, those providing direct care of others, will find this as something that may push them into poverty. The potential economic realities of the current situation are dire and will push on our national, state and local government to help support people in need. (Oddly, and I know this may sound odd, if the larger population becomes exposed, what you will hear is that the concept of quarantines and social distancing will end. There is good reason for that to occur then, but for now, at this stage, this is still one of the most important steps you can take.)
Why Aggressive Action Now is Essential
There are around 340 million Americans that currently do not have the virus, and there are perhaps 8,000 that do. Yes, this number might grow exponentially, if not checked. But the entire country is suffering now. The math simply does not work out. As a consequence, trillions of dollars are lost, the country is headed into a recession, with many jobs lost. It would be better for the country, as a whole, and everyone in it, to put in whatever amount of money and resources now, to pull us out of it. This is why I thought testing, early and often was and remains so central to addressing this epidemic. Even if we spent a trillion dollars on this public health challenge, in the long run it will be less expensive while also helping reduce morbidity and mortality. Reducing the induction time, developing quicker tests, testing everyone, repeatedly, is the best way to end this first wave.
Regarding the virus itself, I made comments about how viruses adapt over time. They change. They evolve. Here is an image I found of the changes that have occurred to the current COVID-2019. As you can see it is changing. Let’s hope it changes in a beneficial way, making it less lethal. While there are MANY silly conspiracy theories right now about how this bug evolved to what it is today, I hope there is a shift to about spending more time and resources on scientific research in the effort of changing this coronavirus to be less lethal, or less likely to spread.
The Weather Impact
I had focused on the likelihood that this first wave will diminish in spread when the weather becomes warmer. We now have some evidence that this might happen. Studies have concluded that at this time, the bug is sensitive to heat. This would be a good thing, as it tells us that it is behaving in a more typical manner to other similar viruses. And I still believe that the first wave will slow down in the warmer months.
Presentation of Illnesses. Do I Have COVID-19?
There are several viruses that are prevalent at this time, besides the Coronavirus. For example, when I was recently in Seattle, the most concerning virus to many was the Coronavirus, but the most prevalent infection on the ground was RSV, a real health challenge for many of the children sick with it. Likewise, how do you know if the virus you have is coronavirus versus a simple cold? Well, the only real way to know is to get checked with a test kit. But until then, there is a pertinent clue. Most often a cold will impact the upper, upper airways, with a runny nose, sneezing and perhaps watery eyes. With coronavirus, the target is more so in the lower airways. As a result, most of the times there is no sneezing or runny nose at the start.
Who Falls Severely Ill?
As I mentioned, I believe there are two large groups that are susceptible to falling severely ill. The first we have all heard about--the elderly, frail group. It is important to highlight that in this group, the definition of ‘old’ is dropping from 80 to 60 to now 50. And also to highlight that this is the most common group to develop the worse version of this disease. The other group was not yet described, but we are hearing, primarily from Italy, but elsewhere as well, that people in their 20-40s, are presenting with severe acute pneumonias and ARDS, and some have unfortunately succumbed to the disease. I expect we will hear more of this group as time goes by. And as always, I still believe that everyone, or nearly everyone, who died has succumbed to sepsis, which is why I think they should test C1-INH levels.
THERAPIES ASIDE FROM THE CONVENTIONAL ONES BEING TESTED.
I would like to reaffirm the previous comments I made about the judicious use of supplements both nutritional and botanical. Of course, this is in addition to all the public health efforts, hand washing, social distancing as delineated by the CDC. And to repeat, while these have not been tested to see if they work in the version of the virus, the suggestions are inexpensive, found in a variety of stores by a variety of companies, and have been shown to help in other viral infections. Bring that list to your doctor and ask him/her about them? Get their recommendation on this.
Important Thoughts on Homeopathy for COVID-19:
Find here first some general thoughts and then specific comments on the homeopathic presentation of those who are unwell. I am NOT focusing on the severely ill/pneumonia, ARDS patients at this time because I have not yet seen those patients and have not had direct correspondence to those on the front lines. That said, I have been involved with many patients who have tested positive and are currently ill with COVID-19. At this moment, there are no known effective, consistent pharmacological treatments for COVID-2019. I think this will change soon. For now, care is supportive only. We know that people do not start with pneumonia as a first symptom, they begin by feeling unwell. Homeopathic remedies are extremely inexpensive, do not cause side effects and are readily available. Due to these considerations and the fact that some who are unwell go on to suffer severe illness, everyone, even those skeptical about homeopathy should consider using appropriate, individualized (see below) homeopathic remedies. I present those clinical pictures below for the health care provider, to aid in her decision-making on matching the symptom picture of a COVID-19 patient to the correct homeopathic remedies.
The following comments are directed at the homeopathic physician only.
For the homeopathic Physician,
Dear homeopath, I have been busy constructing a Clinical Prediction Tool, which is not really the easiest thing in the world, but until I do, remedies to Consider:
I discuss here several remedies, again for those patients with milder symptoms, as they present at this time. These are likely to change over time. The idea here is yes, to help with those symptoms, but more urgently, to help these patients not progress to more serious ailments. I have previously written on how to deal with epidemics in Herscu Letter #33-38, which you can read at some point, but aside from making sure that the constitutional remedy is acting well, there are a few additional things to mention.
At this time, there seem to be primarily 4 main effective remedies that have a broad sphere of influence and one more narrowly focused acute remedy. The symptoms I list here are the ones that people have described. These symptoms are not generally written here because they are ‘known’ to be helped by that remedy, or that somehow ‘fit’ the disease, but rather because patients articulate these complaints. For those of you that take this material and pass it along, PLEASE DO NOT ADD OTHER SYMPTOMS KNOWN FOR THE REMEDY, unless you actually see them in the person and you prescribe the remedy and the symptom goes away. Many times, the person does not have the common symptoms of the remedy and adding other symptoms known for the remedy but not seen in practice, distorts reality, misguides practitioners and does not in the end, help patients. Unless you see the actual symptoms, please do not add or distort any to this information.
In terms of the larger remedies, the main effective homeopathic remedies have been, in order of likelihood: Sulphur, Lycopodium, Bryonia, and then less likely Phosphorus, and Arsenicum album. By far, at this moment, the most common remedy is Sulphur. The more acute remedy seems to be Bryonia.
Here are the most important symptoms the individuals describe:
1. Feeling of heat, warmth in the body overall and also in a hot face, eyes, ears, with or without fever. Just a sense of warmth. They may describe burning pain and burning sensations.
2. As a consequence, they want cool air, feel better in the cool air, and are very thirsty for cool, cold, or icy drinks (but discourage the patient from having ice, see below).
3. Dryness in the nose, mouth, throat, bronchi. Limited perspiration.
4. If they have a cough, the cough is felt as dry. If they have a cough, it comes later in the process, not as a first presenting sign.
5. They are extremely tired, fatigued, and/or sleepy.
6. They want company, and talk more than the other remedies listed here. As a matter of fact, they feel very comfortable and want to talk to doctors and others about their symptoms.
7. That said, they may become slightly irritable. Disgusted by the idea of picking up germs from other people.
8. If they have digestive complaints, which are rare, there may be vomiting or diarrhea or disordered stomach. And while the keynote of the remedy is these discharges being excoriating or acrid, in this instance, at this time, discharges are actually more bland.
1. Feeling of heat alternating with chills. They may feel warm originally, but become more chilly over time.
2. They may still want cool air, but the thirst here has changed clearly for a preference to warm drinks.
3. Here too there is dryness in the nose, mouth, throat, bronchi with scant sweat.
4. Here too, extremely tired, sleepy, and fatigued.
5. Here the openness found in Sulphur is missing. They become easily irritable early on, perturbed, or annoyed in a ‘flat’ sort of way (the way we sometimes think of Sepia). Here, they do not want to be talked to, do not want to be disturbed or interrupted. They want to just be alone and yet want someone around. But there is this ‘unfeeling’ sensation in their emotions.
6. They become slightly anxious, mostly around how strange they feel and the dire news, but anxiety is not the predominant feature here, as they are too ‘flat’ for that.
1. Feeling of heat, warmth in the body overall or only as a hot face, eyes, ears, with or without a fever.
2. Regarding temperature comfort, they may desire cool or warm air
3. The thirst is very high for cool drinks.
4. Dryness in the nose, mouth, throat, bronchi, with scant sweat.
5. Extremely tired, sleepy, fatigued.
6. Very fearful, wanting very close company, wanting to be held and clearly ameliorated by the comfort of others.
7. They are restless from the anxiety but easily consoled.
Arsenicum album: While this is the remedy that everyone mentions, in fact this is less common as the others.
1. Feeling of heat, warmth in the body overall and also a hot face, eyes, ears, as well as a fever.
2. However, their desire is warmth.
3. They have a thirst for warm or room temperature drinks.
4. Dryness in the nose, mouth, throat, bronchi. No perspiration.
5. Extremely tired, sleepy, and fatigued.
6. They are very frightened and anxious and more so from the news when they hear how many died.
7. They are internally restless, tossing in bed or pacing, and worried about how bad this infection really is.
1. Feeling of heat, warmth in the body overall and also a hot face, eyes, ears, as well as potential fever.
2. The want cool air and great thirst for cool drinks.
3. Dryness in the nose, mouth, throat, bronchi, with scant sweat.
4. Extremely tired, sleepy, and fatigued.
5. They are very ‘actively’ irritable. They really do not want to move or be bothered, yet people bother them. They really do not want to talk. They are monosyllabic, and do not move much.
6. They are not very restless.
As this is a helpful guide to the symptoms seen thus far, for the homeopath, at this time, I have two requests. The first is, if you interact with a person who has a confirmed COVID-19 case, could you please send me their symptoms, paying most attention to the modalities of the case. And second, as an observation, over the past three decades, when I highlight a specific remedy and indication for that remedy, others take that information as their own, and then sort of add symptoms from the materia medica that are keynotes of that remedy. As mentioned above, most of the time this is both incorrect, and not helpful and actually misguides other prescribers. If those symptoms were present, I would have included them. By doing this you introduce errors into the literature. Can I ask you to keep the data flow as clean as possible. If you want to add anything, can you at least write something like, ‘Paul Herscu ND, MPH gives these indications only, though I want to add this or that.’ Help me try to keep the inaccuracies and noise down and the data clean, as this helps limit confusion and helps the homeopath, but more importantly, the patients in our care, most.
Clinical Prediction Tools
I am in the intense process of developing a Clinical Predication Guideline, but this takes a great deal of time to get accurate. As soon as I have completed this, I will send it out.
As you can see, this observation of dryness of the mucous membranes is a common feature for many people with COVID-19. Encourage your patients to drink often, to stay moist and hydrated. This will help keep the viral load down. Sips of warmer water through the day. The virus is sensitive to heat. Try to cut out ice, or very cold drinks. Let’s make it a bit more difficult for it to take hold and set up shop. I still believe that summer warmth will slow this virus down, end the first wave, but the slower we pass it from person to person, the more time we have to come up with a more permanent fix. This is why from the very beginning, we underscored the public health hygienic habits to adopt.
Stick to the Public Health Recommendations!
Lastly, I know the news is very dire. And I know that if nothing changes and we go about as before, well, things will likely get worse. But I do not see things going that way. I really don’t. Good government action, people taking proper precautions, mixed with luck of the season change, alongside advances in science, lead me to believe that a workable solution will arise before the world falls into chaos.
Hysteria can end just as soon as it begins, with fatal casualties kept low when considering the overall population, though of course, each death is tremendously sad and impacts families far and wide, until that time, doing your part, encourage those around you at home, through social media, at your work place to: take the proper hygienic habits, consider the supplements suggested in update #7 and other lifestyle approaches to enhance immune function as delineated in Dr. Rothenberg’s writing, and consider seeing a homeopath! You might enjoy this (somewhat) lighter piece about the current epidemic from my wife & partner, Dr. Amy Rothenberg:
In health to you and your loved ones,
Paul Herscu ND, MPH