(2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019):
DON’T PANIC, be concerned, but don’t panic. It just makes everything worse.
March 8, 2020 update Part 7
Paul Herscu ND, MPH
This is the seventh piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, Part 5 and Part 6 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.
2019 Novel Coronavirus (2019-nCoV; COVID-2019):
WHERE WE ARE NOW.
Well, there are things we know now, and things we still do not know. I want to start with the most striking comment, which I started with in the last update. Strong and clear public health measures greatly impact epidemic progression. I made this point numerous times, when discussing the predictive use of epidemic curves, as well as other tools that we have at our disposal. The clearest example was with the Ebolavirus in Western Africa where it was modeled that high death rates occur if public health measure go in one direction, nearing 30,000 death, and much lower rates occur when good public health measures occur, modeling out 3,000 dead. Same bug, different outcome. The solution is not a scientific one but a public health one. The best and strongest variable or actions that hasten containment are strong political leadership at the highest level, early detection and response, stepped up surveillance, public awareness of the facts, and international partnerships to help with both resources and to learn experience from success and failure using differing strategies.
Needless to say, some of this fell really short. In the USA, especially short. Of my prior ‘wish list’ items that would help hasten containment that I mentioned, most did not happen. Which sadly changes the equation. The best example I have of this, that I mentioned in an interview 2 weeks ago is that testing, as bad as it is (more on this below), is a fraction of what it should be. The example I used is that South Korea was reaching the number of 100,000 people tested, where the USA had only tested 200-300 people. The difference there should be stark to all of us. As of today, we have still only tested a very, very small number, whereas South Korea has tested nearly 110,000. Put differently, the USA has tested about 1 person per million whereas South Korea has tested 2,000 per million. A stark difference. At this moment 19 people have been identified as having died as a result of this virus, with 534 confirmed cases, but I think the actual carrying virus number, right now is most likely closer to 3,800 in the USA.
The reason this is important has to do with early treatment, but as importantly, early detection leads to lower transmission rates. Here’s a slide that demonstrate this important point.
Any number below 1 means that the epidemic will end soon. Any number above one means the epidemic is spreading. As you can see the numbers are all over the place, with the average being around 2-2.5. That said, look at South Korea. It is being contained and controlled, and looks like it will drop away. It is the same bug, more or less, with the main difference being that the controls at the public health level are working well there. This really goes to show that what we have control over, right now, is creating and enforcing proven protocols that would help curtail the spread. Perhaps this number is an aberration due to local variables, such as weather interfering with number collecting, for example, but looking at the differing countries one can see protocols matter.
The USA could and should emulate what South Korea or other countries did to mitigate this infection. I talked about this in my last update, but it is becoming increasingly evident that this is important now. Early and continuous repeat testing in an area testing, is important. But also it is important to test everyone in a epicenter and not just people with fevers. Even asymptomatic people, in order to begin to limit transmission. This can be done! Now! The bad news is that since this has been delayed there are ever more index cases in new locations. And I guess this is a good to mention what I mean by this. When an infected person lands in a new country, if you can identify them early, you can isolate them and thereby prevent that local outbreak from taking off. In other words, it might be easier to think of this large epidemic as many local epidemics and if you stop new areas from starting, then you can focus on lowering the transmission in the current areas. That is the idea of early and successful surveillance. As I mentioned before, China sort of made that difficult for the world that way, and the USA’s surveillance protocols were pretty inefficient to the task, which let many index cases, spread all over the country. That said, while it is MUCH harder than before, it is not too late for good choices to be made here.
Transmission. We still have not confirmed all transmission modes. At the moment, we are acting as if transmission is only through contact, being Direct/Indirect/Droplet. We need to confirm that there is no easy Non-Contact transmission, as in Airborne/Vehicle/Vector. If it is truly contact form, then, as I mentioned, we dodged a real bullet, as airborne transmission would probably impact a very large proportion of the population. Contact transmission is very, very difficult, but it is manageable, if we and the government take proper action. This is the good news. Even without any other changes in science, we have a sense or a strategy to stop this thing. It is just a question of political will. And I hope that this can be done. We have all the time we need, starting now, if we make good choices. This is good news. (By the way, as I mentioned from the start, wash, wash, wash. It really is one of the most important ways to stop this virus spread for now).
Another very important question that has to be answered is post recovery transmission. As with most infections, once you are ‘well’ you are still probably carrying some of the virus, a certain amount. We do not know whether that amount that one is carrying is still contagious or not. In other words, those that are ’cured’, are they done with it all or are they still able to transmit the virus to others and therefore should still be quarantined. Careful surveillance should answer this, but we do not know this yet.
Just to clarify the current numbers. Coronavirus cases at this moment are listed as 109,967, with 3,827 dead. Of these, 62,240 recovered, 3,827 dead, and 43,900 that have it currently still. My question is around the 62,240 people that are thankfully past the disease, are they still infectious and if so for how long are they infectious? The good news, is that the number you have to think about of active cases is in the 40 thousand range. The bad news is that science is not keeping up with the epidemic.
Regarding quarantines. As mentioned before, mostly the meeting of thousands are pretty much canceled in the country now, and in sporadic places so are meeting of hundreds, and in local epicenter even meeting of more than 10 people meeting is canceled. Shifting realities depending on local needs.
Regarding the virus itself. I had mentioned that I have several beliefs about the bug itself, SARS-CoV-2. The main one is that I really do believe that it will wane the way other coronaviruses wane, in the heat of summer. I still believe this. The slower we can have this epidemic grow the more time it buys us for summer to come, which would end the first wave. In the North. I believe that means that the Southern hemisphere will then carry the burden, until the autumn/winter when this virus will return here. This does buy us time to develop more pro-active strategies.
Also related to the virus. Viruses, like bacteria, and every other living thing can change, they evolve to be different. That is what happened here in the first place with this virus. There is an evolutionary change that makes this virus more lethal. But it will keep on evolving. I think it would do well to have us force a change upon it to make it less lethal. But it is also possible that over time it will become less lethal all by itself. The best recent example of this is the Zikavirus (remember Zika?). There was a great of fear and predictions around how horrible and how many birth defects there will be from this infection. But that did not work out as predicted. When looking more carefully, recently, it was found that the virus itself in Brazil (hardest hit with birth defects) was more virulent, worse, caused more defects, then the same virus from other locations. Testing this in rodents we found that the rates of birth defects from the Brazil Zikavirus were much higher than the other form of Zikavirus. In other words, the virus changed over time. With regard to this coronavirus, we can let nature do its thing, and let the virus evolve by itself to become less lethal, hopefully, in a week or month or year, or decade, or we could encourage the needed change. Fatalities. I believe the original case fatalities for Covid-19 were nearing 50% and have dropped to where they are now. (We still do not really know that number, even though it is reported as 3.4%, since we are not testing everyone and do not know how many are asymptomatic carriers there are, making this number unknown at the moment.) This decrease could be due to better treatments, but it could also be the changes occurring to the virus itself. As I said originally, I believe in coevolution, meaning that I believe that over time this virus will become less severe. But why wait!
Presentations of illness. I would like to offer a suggestion here. While we know that, in the short term, the vast majority of people have a mild illness, I think of the remaining folks, there are at least two separate, different large groups of people that become severely ill. On the one hand is the one that we have heard so much about. These are the people who are immune compromised, old, frail, smokers, etc. The elderly. OK. We know that type. But I think there is another group that seems sporadic but is nevertheless consistent, that has not yet been mentioned. These are younger people, more robust, in their 20-40s. In this group I am fairly sure that it is their own immune response that is hurting them the most. This part has not yet been described yet by others, but I think this will be found to be true soon enough. Here I think it is somewhat like Damage-associated molecular patterns (DAMPs) that get us into a sort of vicious cycle that puts our lives in danger. And regardless of the reason, we may end up in pneumonia, severe pneumonia, ARDS, and sadly, potentially death. And it is here that I believe that C1-INH might be of great use to lessen this danger. Easy enough to test, by just comparing the C1-INH levels to other inflammatory markers such as CRP.
THERAPIES ASIDE FROM THE CONVENTIONAL ONES BEING TESTED.
Until we find a predictable successful treatment to the folks that have this illness, I at this point do have a fair amount to say about what else we can do for these folks, based on the contact with these people. And let me start by saying that while I have treated ARDS in the past, I have NOT YET spoken to anyone who has been in the severe state due to this infection. I suppose I will have something to say about this in the future after experience with them but for now I want to describe the those who are not gravely ill, and what we might consider doing here. And just to stop the trolls that, at this point seem heartless, let me say that these therapies are all inexpensive, and have been used in other viral infections and make sense, and do not seem to harm the person. So, in the light of compassionate care, why not try these, and after the epidemic is over, you can go back to disliking them. AND AGAIN, everything I said before about precautions and prevention is still number one!
I would like to describe now some therapies you might want to try out during this crisis. That said, try to get high quality versions of these items. I divide the below into things to consider if you are trying to prevent, if exposed, or if symptomatic. And again, this is all aimed at the people who have the light version of the illness.
Lastly, there are many articles coming out on the use of Chinese herbs in this epidemic. I have no direct experience with that and so will not comment on it.
PREVENTION STRATEGIES TO CONSIDER (aside from all the good public health measures you should be doing)
- Perfect time to cut down on alcohol and sugar and refined foods
- Vitamin C 1,000mg
- Vitamin D, 2,000IU-5,000IU depending on your status
- Zinc 10-15mg
- Elderberry (Sambucas nigra) one teaspoon syrup daily
- Mushroom Immune Formula that has several mushrooms, 2-3 times a week
- Resveratrol (may work with MERS-Cov) 500mg
- Good rest, and enough sleep
- Stay hydrated
- Don’t panic
STRATEGIES TO CONSIDER IF IN CONFINED SPACE (Ship/airplane/triage center with close proximity to others/jail, etc) (aside from all the good public health measures you should be doing)
- Same as above, but double everything
- Use of Zinc/propolis lozenges during confinement
- There are any number of throat sprays that that contain antiviral antibacterial herbs, to take when you board the confined space. These can contain Echinacea angustifolia & purpurea, Propolis, Hyssopus officinalis (hyssop), Zanthoxylum clava-herculis (southern prickly ash bark), Monarda fistulosa (wild bergamot/beebalm), Ligusticum porteri (osha),
STRATEGIES TO CONSIDER IF EXPOSED OR IF MILD SYMPTOMS (aside from all the good public health measures you should be doing)
- Same as above, at the same dosage as above.
- Elderberry teaspoon syrup three teaspoons daily
- Mushroom Immune Formula that has several mushrooms, 2 times a day
- Resveratrol (may work with MERS-Cov) 500mg, three times a day
- Vitamin A 10,000IU
- Ligusticum ½ dropper or 30 drops three times a day
- Throat sprays
- Add more medicinal antivirals that contain any number of the following:
A. Medicinal Mushrooms (species Royal Sun Blazei, Cordyceps, Resishi, Maitake, Lion’s Mane, Chaga and Mesima) 150 g each
B. Andrographis paniculata, Sambucas nigra, Zingiber officinale: 800 mg
C. Echinacea Extract Blends: 100 mg
D. Elderberry fruit extract 4:1 (Sambucas Nigra) 500-600mg
E. Larch Arabinogalactan 100mg
F. Don’t forget the very important one of Resveratrol.
A short update on the homeopathy side of this in 2 days.
In any case, stay tuned!
Paul Herscu ND, MPH