Tuesday, April 7, 2020

COVID-19 Thoughts and Recommendations: April 1, 2020

Dear family, friends, patients and colleagues,

We continue to hear from many of you wanting guidance at this time. Paul is publishing his ongoing work tracking the pandemic and sharing his public health and science thoughts. If you want to receive those as written, you can sign up here.

The bottom line is: the virus is ubiquitous, so it’s ever important to try to prevent exposure as much as possible by observing physical distancing, keeping your children and teens close and following all public health directives. Wear a mask and gloves when in a public. Wash your hands when you arrive home, and know that good old soap and water may be better for all of us in the long run.

It has become increasingly clear than many of us have become asymptomatic carriers and we may be inadvertently putting all sorts of people at risk without intending to. So! Please do not become paranoid, but put effort into being careful just as you would want others to do for you.

And we also know that when and if you fall ill, the better shape you are in beforehand, the better. Most people will have only a mild form of this illness, but working to build a resilient immune system now, will serve you well should you become exposed or do become sick.

In order to create the most resilient immune system possible, here are my recommendations for you and yours. Please know that for those with underlying or chronic disease, or who have compromised immunity (for whatever reason), or have an autoimmune disease, I would want to work with you individually as not all these recommendations apply. If you’re not sure, please schedule a time to “come in.” We are seeing patients via telemedicine and have had the chance to work with people from all over the globe. Linda, at our “front desk,” can help you schedule (860.763.1225).

Here we go, with regard to prevention:

Thursday, March 19, 2020

2019 Novel Coronavirus (CoVID-19): Part XI

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 19, 2020 update Part 11
Paul Herscu ND, MPH
Herscu Laboratory

This is the eleventh piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, Part 5, Part 6 Part 7, Part 8, Part 9 , and Part 10 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.


Well, That Was Quick

It has been only 24 hours since the last update and I just wanted to sort of breathe a sigh of relief. Finally! Yesterday, I mentioned that I think the government should rush through the vaccine and not wait 18 months. And I also said that I have really high hopes on a few drugs, especially chloroquine. Today President Trump said that he is going to rush through the vaccine AND rush through the testing for chloroquine. I mentioned from the start that this should be thought of as waves, and that we can really stop this first wave, which is how they began to discuss it this time. That, and a few other indications, make me feel like the White House is now reading these updates. And I am very happy with that. Primarily, as they describe in a simple manner where we are, why people are doing what they are doing, and the future direction of what could and should be done. This is really the fastest changeover I have seen. And if things continue as I think they could, and think they should, with fast action from now on, I still stick to my initial comments. If we do things right, from now on, instead of seeing 2-3 million dead as predicted, we will see in the hundreds, or a few thousand, in this first wave. Much, much less than others predict, much, much less than the flu, etc. But what I said at the start. I know this seems ridiculous to many right now, and really out of touch with the numbers given the feeling that since we have over let’s guess 30,000-50,000 infected (11,236 official confirmed) now and 161 that have died, that we would overrun the hundreds to thousands in the next week or two. But I do not believe this has to be the case. We still have enough time to implement well and divert a massive tragedy. So, whoever is giving the White House these updates, thank you, THANK YOU, and keep going!! To be clear we are not out of the woods, even by a long-shot. Decisions still need to be made and enacted properly and efficiently, but it does seem like that may be finally occurring. As they say, ‘We have all the time we need, if we start now!’

Wednesday, March 18, 2020

2019 Novel Coronavirus (CoVID-19): Part X


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 18, 2020 update Part 10
Paul Herscu ND, MPH
Herscu Laboratory

This is the tenth piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, Part 5, Part 6 Part 7, Part 8, and Part 9 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.


Person/Place and Time
When I teach on this topic of epidemics, I focus on the very important variables of Person/Place and Time. For example, if I mentioned west Africa 2014, you would say Ebola virus, and if I said early 1980s, San Francisco younger gay men, you would say AIDS crisis. In other words, when dealing with epidemics, we have to contextualize our comments, plans, and processes to the moment (the exact time we find ourselves in) place (are we talking about a city, a state a region, or the country?) and people you are talking about (and with COVID-19, thus far, the main variable has been old age, though, as I mentioned you will start to hear more about younger people soon).


Place and Time
As I mentioned originally, this whole epidemic could have been over before it started with proper local testing. Sadly, that time has passed. And where we are now is, for the most part, with local outbreaks throughout the country. But because of the extent and seeding that has occurred, I believe we will soon move from local to regional outbreaks as a way to think of it, and if we still do not work together properly, we’ll then have a national epidemic. More on this below. The main point is: what sounded like good public health procedures and recommendations before, will not necessarily work now. As of this writing, we have in the US 7,339 confirmed cases, and 116 deaths. I am guessing that the number is actually closer to 30,000 cases at this point (meaning that 340 million do not yet have this illness). Proper action now can still stop a galloping epidemic with most people not even knowing anyone that has fallen seriously ill, but soon this possibility may pass.

Sunday, March 15, 2020

2019 Novel Coronavirus (CoVID-19): Part IX


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 15, 2020 update Part 9
Paul Herscu ND, MPH
Herscu Laboratory

This is the ninth piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, Part 5  Part 6 Part 7 and Part 8 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

How the 2019 Novel Coronavirus (2019-nCoV; COVID-2019) ENDS:

Well, at this point from what we know:

 
Current Statistics
Regarding the current numbers in the USA, we have in less than a week confirmed cases went from 1,832 to 3,400 and, sadly, from 41 to 63 deaths. Personally, I believe at this point, the number most likely went from 7,000-8,000 to 12,000-14,000 infected. Until there are better tests available and widespread testing of everyone, we will not have accurate numbers. As an estimate of incidence, I suggested that the numbers might double each week. As you can see from official numbers that is what is being reported. My suggestion, is for approximating incidence rate, you could take the number who have died and multiply it by 200. That might be a closer approximation to the actual numbers in the USA for the coming period of time. We will know more when widespread testing is more available.

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
Herscu Laboratory


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.

Monday, March 9, 2020

2019 Novel Coronavirus (CoVID-19): Part VII

2019 Novel Coronavirus
(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
Herscu Laboratory


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.

Thursday, March 5, 2020

2019 Novel Coronavirus (CoVID-19): Part VI

2019 Novel Coronavirus
(2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019):

DON’T PANIC

March 4, 2020 update Part 6
Paul Herscu ND, MPH
Herscu Laboratory 
 
This is the sixth, a short piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, and Part 5 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.

LASTLY, I am going to deliver a presentation this coming Saturday, March 7th at 3:30 pm at Bastyr University in Kenmore, Washington. This topic is part of a broader course we teach there, but this lecture will be on how to understand and address epidemics in general and this one in particular. Due to the current environment, this lecture is open to all. For more details and to keep up to the moment, please RSVP: http://tinyurl.com/herscu

 2019 Novel Coronavirus (2019-nCoV; COVID-2019):

Comments I shared here over the past weeks remain true. I want to highlight a few things here, with the hope that a bit of knowledge will calm the nerves. That said, this will be short so that you can get through it efficiently.

There are five specific points.

First, as I mentioned a few days ago, I was very worried about the exposure of the gentleman who worked in the nursing home. Really, it worried me because of the likely mortalities that would follow, which sadly have come to pass. I want to get back to this point just below, but first let me continue with the points from before.

Second and related, I finally had contact with both the CDC and with the quarantine area in Nebraska which is housing and treating the folks that were on board the Diamond Princess, to recommend they test for C1-INH levels as part of the immune system/inflammatory testing conducted. Hopefully, they will do this, as I believe such information is crucial as a way to save lives. I am not sure this will come to pass, so PLEASE, if you have contacts in the medical world, pass on the request to test patients in critical care for C1-INH.

Monday, March 2, 2020

2019 Novel Coronavirus (CoVID-19): Part V

2019 Novel Coronavirus
(2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019):

DON’T PANIC

March 1, 2020 update Part 5
Paul Herscu ND, MPH
Herscu Laboratory


This is the fifth, and so far, shortest, piece of writing on this current epidemic. Please read Part 1, Part 2, Part 3 and Part 4 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.

LASTLY, I am going to deliver a presentation this coming Saturday, March 7th at 3:30 pm at Bastyr University in Kenmore, Washington. This topic is part of a broader course we teach there, but this lecture will be on how to understand and address epidemics in general and this one in particular. Due to the current environment, this lecture is open to all. Join us if you can. For more details and to please RSVP: http://tinyurl.com/herscu

 2019 Novel Coronavirus (2019-nCoV; COVID-2019)
:

Comments I shared here over the past weeks remain true and are seen in the writings coming from across the globe. I want to focus on why this is of utmost importance to you and your patients!

There are three specific short points.

First, I am both really sad to hear that someone died of this disease in the United States, and that the gentleman who passed away yesterday worked at a nursing home. The highest mortality rate is in the older population and while he was only in his 50s, the folks he worked with are older, putting them at more risk. This is one of the first times I am very worried for them. Related, it is highly likely that many more people in that community will test positive for the virus over the next weeks. This places importance on healthcare worker knowledge and appropriate action.

Friday, February 28, 2020

2019 Novel Coronavirus (CoVID-19): Part IV


2019 Novel Coronavirus

2019-nCoV (first named); COVID-2019 (later- named disease); SARS-CoV-2 (final name of the virus causing COVID-2019): 

DON’T PANIC

February 27, 2020 update Part 4
Paul Herscu ND, MPH
Herscu Laboratory

This is the fourth piece of writing on this current epidemic. Please read Part 1, Part 2, and Part 3 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. For this epidemic, I will keep the sections consistent. Also, please be aware that I am keeping the same sequence of comment topics, for ease of read from one installment to the next.

LASTLY, I am going to deliver a presentation next week, Saturday March 7, 2020 at 3:30 PM at Bastyr University in Kenmore Washington (just north of Seattle). This topic is part of a broader course we teach there, and I will discuss how to understand and deal with epidemics in general and this one in particular. Due to the current environment, this lecture is open to all. Join us if you can. Details & RSVP here.

 2019 Novel Coronavirus (2019-nCoV; COVID-2019):

Comments I shared here over the past weeks remain true and are seen in the writings coming from across the globe. I want to focus on why this is of utmost importance to you!

Thursday, February 20, 2020

2019 Novel Coronavirus (2019-nCoV): Part III

2019 Novel Coronavirus
2019-nCoV (first named); COVID-2019 (later- named disease); SARS-CoV-2 (final name of the virus causing COVID-2019):
February 19, 2020 update Part 3
Paul Herscu ND, MPH
Herscu Laboratory


This is the third piece of writing on this current epidemic. Please read Part 1 and Part 2 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. For this epidemic, I will keep the sections consistent. Also, please be aware that I am keeping the same sequence of comment topics, for ease of read from one installment to the next.

2019 Novel Coronavirus (2019-nCoV; COVID-2019):

Comments I shared here over the past weeks remain true and are seen in writings coming from across the globe. I want to focus on why this is of outmost importance to you!

Official Numbers: First, I applaud the Chinese government’s response to pressure to recalculate and reclassify patients to share data that is closer to what is likely the truth of the matter related to incidence of cases. As I mentioned last time, learning the true numbers out of China is always tricky. That said, the number of cases are clearly growing, as Chinese official numbers are approximately 70,000 cases, as we read, with at least 1,800 deaths. These are close to the numbers I mentioned before, 75,000. I still have real questions around this number, but let me pass on that for a moment. And to the more official numbers from the WHO as of today, inside China we hear 74,280 infected, with 2,006 deaths, or a mortality rate of 2.7%. If this were the case, that would be really bad for all of us. However, I think this number is still really wrong, maybe by as much as eight to ten times. From the WHO, as of today, there are 924 confirmed cases in 25 countries outside of China, with 3 deaths, or 0.32% mortality rate. Please note that what I mentioned 2 weeks ago was a 0.3% fatality rate, which is what we have now outside of China. A bad number for sure, but MUCH less severe case fatality ratio than a horrific epidemic would have. I think the case fatality number will settle around 0.2% to 0.5%, again much less than what China is reporting.

While I am still not sure what the current Ro number is for real, it does seem like we can start to draw a proper epidemic curve and it looks like we might just miss another scary global epidemic here. Let me say, right now, here, that I believe there is good news finally, though not yet reported.

As before, knowing the real number of infected is essential so that descriptive analysis can lead to mathematic modeling of how average or how highly infectious this epidemic is. With this information in hand, better predictions from those infected outside China can be made. I mentioned that the mortality rate and disease burden outside China is the one that really matters to science and to us as it is more likely accurate.

Monday, February 3, 2020

2019 Novel Coronavirus (2019-nCoV): Part II

2019 Novel Coronavirus (2019-nCoV):
February 2, 2020 update Part 2
Paul Herscu ND, MPH
Herscu Laboratory

This is the second piece of writing on this current epidemic. Please read Part 1 for context and also, please read my other writing in this site for a larger context on the overall topic of public health and epidemics. For this epidemic, I will keep the sections consistent.

First Things First. The Immune System with Relation to the 2019 Novel Coronavirus (2019-nCoV)

Over this period of days, we have seen more and more articles from medical journals moving in the direction previously highlighted. Both focusing on your immune system, and highlighting that people who had worse outcomes were people who already had a disease burden that made them susceptible. This will remain true. Supporting your immune system to be the most efficient and effective it can be remains important and is a place where you and your patients have some control. Today! Read what Dr. Rothenberg and I mentioned here last time.

2019 Novel Coronavirus (2019-nCoV):

Comments I shared here last week remain true and are seen in the writings coming from across the globe. I want to focus on why this is of outmost importance to you!

Wednesday, January 29, 2020

2019 Novel Coronavirus (2019-nCoV):

January 27 2020 update Part 1
Paul Herscu ND, MPH
Herscu Laboratory

In writing about epidemics over the past 3 decades, my first goal has been to create information scaffolding for readers so that you have sound context to receive and understand the bombardment of information about any epidemic. If you want a broad and deep understanding of the concept of epidemics, which I strongly suggest, take some time to review the highlights here.

First Things First. The Immune System with Relation to the 2019 Novel Coronavirus (2019-nCoV)

In understanding a patient’s reaction to the 2019 Novel Coronavirus (2019-nCoV), it helps to think of the challenges it presents as twofold. First there is the damage that the virus causes by itself upon the body. Secondly, and perhaps more importantly, there is the damage, which may be lethal, which is caused inadvertently by one’s own immune system responding to the virus.

This is a very important point to highlight. Though the virus is particularly virulent at this moment, not everyone dies. It is thankfully, only a very small fraction of those exposed who perish. There is an additional small fraction that become quite ill, and the rest become ill in a usual flu manner. And for some people, the damage that the immune system causes upon the individual, is perhaps worse than the insult caused by the bug itself.

There are different professions that have focused, since their inception, on supporting the immune system, and helping patients develop an appropriate immune response. Naturopathic physicians form one such profession. To be clear, this is not to claim that we have experience with the killing of this virus. What we do have, for over a 100 years, is a great deal of experience with helping the immune system respond appropriately, read: not over-respond or under-respond, to certain situations. And while the germ has its own virulence, which I discuss below, what I want to highlight is that helping the immune system develop an appropriate response is paramount. This is something we can support our patients doing and do for ourselves. While on the one hand this is a lifelong exercise for everyone, there are some things to do right now. 

The simplest one is to make sure that your immune system is not being stressed by other illnesses. In other words, try to get other chronic ailments under good control. In most years, those with prior chronic illnesses are more at risk of a lethal form of any influenza or virus than those that were previously healthy. Please see Dr Amy Rothenberg’s writing on how to help here, including diet, botanical, nutritional supplements, sleep, etc. By so doing, if exposed to this virus you will hopefully suffer a lesser course of the disease rather than the lethal course. This part is within our control. To be sure this will not be enough by itself, absolutely not enough, but it will help! It’s not nothing!

While this has been the main domain of naturopathic physicians, most other medical professions have also taken up this call. Homeopaths since the time of Hahnemann, osteopathic physicians, chiropractic doctors and increasingly medical doctors are offering whole-person, natural medicine modalities  as non-pharmaceutical interventions for some of our most troubling chronic conditions, focusing on appropriate immune response. This is important work overall and becomes even more important during times of epidemics.

Highlights of Writing on Epidemics by Paul Herscu ND, MPH

In 2004, I wrote that I was taking a hiatus from epidemic updates, until and if there were to be a serious reason to write again. I was running myself down with work and family and late night reading and research on epidemics. To say that I had to stop my hiatus almost as soon as it started is not an exaggeration. I have followed these world and local events closely for three decades and most often delineated the steps that should be taken, often weeks to months before they were finally adopted. We have so much to understand about the way epidemics arise and what best strategies for treatment are. 

Naturopathic Recommendations

The 2019 Novel Coronavirus (2019-nCoV)
Amy Rothenberg ND

The 2019 Novel Coronavirus (2019-nCoV) was first identified in the Wuhan province of China late in 2019. Genetic analysis of 2019-nCoV is in process to confirm the origin of this virus, likely from animals. Historically, SARS, another coronavirus, originated with civit cats. MERS, which also impacted humans, arose from camels. There has also been noted person to person spread of these various Coronaviruses. For the current germ, symptoms vary greatly from mild respiratory illness, fever and cough, to more severe symptoms like difficulty breathing and death. According to the CDC, symptoms can develop 2-14 days after exposure. There is currently no vaccine for 2019-nCoV.

Here are basic concepts to help avoid exposure and exposing others to any virus including this one:
  • Avoid large crowds and places with poor ventilation.
  • If you cannot avoid such places, use a properly fitted mask, though research on some more commonly used masks lacks efficacy. Regardless, if using a mask, change frequently as they harbor bacteria. 
  • Prioritize handwashing more often, with soap and water for twenty seconds, especially before eating. 
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Use alcohol-based hand sanitizers when handwashing is not possible.
  • Limit handling doorknobs and other public surfaces without gloves. If in the midst of a severe epidemic, consider using gloves whenever outside to limit contact. Wash gloves daily. 
  • Avoid people who are sick.
  • Cover your cough or sneeze with a tissue and discard or sneeze into your bent elbow.
  • Please stay home if you are sick!

Monday, January 6, 2020

Upper Respiratory Tract infections during the first week of 2020 (Part II)

January 6, 2020 
Paul Herscu ND, MPH 
Herscu Laboratory

These three observations involving the current viral illnesses follow last week’s observation. Please read those first here: http://paulherscuepidemics.blogspot.com/2019/12/upper-respiratory-tract-infections.html