How Can I Keep From Getting COVID-19 ?
Posted by Warm Southern Breeze on Tuesday, July 21, 2020
Preventing COVID-19 Infection
Of necessity, the introduction is somewhat wordy, simply because it’s necessary for the purposes of clarification, and understanding the topic, which can be complex to the average layperson. While it is outside the scope of this blog to treat patients, per se, the purpose in sharing this and other information, is to inform of the latest valid scientific findings. Those who read are free to treat themselves as they see fit, as is everyone. Again, the purpose in sharing these findings is to inform. –Ed.
Among professional scientific, medical, and research cadre the novel coronavirus is properly known as, and is called SARS-CoV-2. Colloquially, it’s known as COVID-19. SARS is the abbreviation for Severe Acute Respiratory Syndrome, while CoV is the abbreviation for coronavirus, thus COVID is shorthand for COronaVIrus Disease, while the number 19 refers to the year in which is was first discovered. If you’re froggy enough, here’s a great read on the nomenclature.
But the point of this entry is not about the name, but about the disease, and more specifically, about preventing the disease.
And suffice it to say, that while there are naysayers who (in some cases) loudly proclaim that COVID-19 is no worse than the flu or (insert your choice of disease here _X_), or that it doesn’t affect (_X_ – insert your choice of category people group(s), young, old, middle-aged, people who live in the tropics, in Scandinavia, etc.), none of the bizarre comments or nonsensical off-the-wall “justifications” such naysayers use, none of it’s true.
Remember: Despite the unambiguously incontrovertible and overwhelming evidence that the Earth is shaped like a ball, there are some who insist that the Earth is flat.
Point being, is that there will likely always be nut cases in the world, and practically nothing that anyone says or does will change their warped, demented minds… which are like concrete – thoroughly mixed, and permanently set.
When used in the scientific medical sense, the word “novel” means new. So this coronavirus is a new type of coronavirus, meaning one which has never been seen before.
Again, not to go off the deep end (for there are plenty of people who do), but simply because a virus is new, doesn’t mean that it was “man-made” or that it was an existing virus which became “weaponized.” To make such preposterously absurd claims is not only ignorantly stupid, it is false, simply because humanity does not know everything about anything, much less everything about everything. There are plenty of things in the world that we do not know about, and there are principles in the world about which we do not now know. And in fact, there are more things about which we know little, or nothing, than there are things about which we do know.
Again, point being, is that humans aren’t “know-it-alls,” and to claim that we know practically anything the novel coronavirus is false, because we do not. Hell… we don’t even know how to treat it! The only thing we’re doing now is treating symptoms. We do the exact same thing with the common cold, for which we also have no cure, and no vaccine to prevent it.
And as regarding prevention – an ounce of which is worth a pound of cure (as the saying goes) – the only thing we can do now with the coronavirus is to MECHANICALLY prevent its spread, simply because (that we now know of) we have no ability to prevent it with a vaccine. And to be certain, when we say “mechanically” prevent its spread, we mean by physical means, by actions, not by medicine.
And that is precisely why the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other public health groups have recommended maintaining a distance of 6 feet from others while in public (aka “social distancing”), wearing a face & nose covering (mask), disposable gloves, avoiding groups of people, minimizing public outings to as great an extent as possible, along with increased hand-washing, surface cleanings (disinfecting), etc.
Because we have learned that people infected with the novel coronavirus are at least 30-50% asymptomatic (meaning that they show NO signs or symptoms of infection, not even one – which also means temperature checks at certain public places are therefore effectively USELESS at preventing spread), it is critically important to maintain the physical (mechanical) precautions (preventions) at all times when out in public.
And, because 30-50% of all persons infected with COVID-19 are asymptomatic (they do NOT show even one sign or symptom of infection), that is why 100% testing of ALL people (aka “universal testing”) is critically important.
Again, EVERYONE is on a “learning curve” with the novel coronavirus, and that means EVERYONE – all scientists, all physicians, all nurses, all researchers… EVERYONE. So no one knows it all.
Now, let’s move along toward treatment.
We’re working our way toward the topic – unlike some, or even many articles, which say nothing of any value about anything. Such articles are like saying “how to lower the death rate – prevent drowning in bath tubs,” and then talking about building and installing tubs, why you should take a shower, and how expensive it is to operate swimming pools. Utter nonsense.
So, as we know, the only thing that we can do now is treat the symptoms of COVID-19 infection. And when it comes to treating the symptoms, if the symptoms are severe enough, someone will likely be in hospital, rather than at home. Thus, they’re pretty sick. And if they’re in an ICU (Intensive Care Unit), they’re really sick. And if they’re on a ventilator, they’re seriously critically sick. So there are levels of sickness with this, and other diseases, and the severity of sickness is determined by several factors, including how many signs and symptoms are being experienced (exhibited), and how much those symptoms are interfering with their ability to maintain homeostasis – our bodies’ innate ability to maintain proper function (circulate oxygenated blood, maintain proper operating temperature, utilize nutrients in food, and excrete waste by-products from digestion).
The human body is a series of complex mechanisms, all of which work together in harmony with other body systems to continue and maintain life (homeostasis).
What we do know about the more severe cases of COVID-19, is that it affects the lungs. We’re learning also that it quite likely affects other body systems, and may also have long-term implications, but the most notable, and most immediately life-threatening, is the damage done to the lungs.
We know also that COVID-19 is characterized by inflammation of the lungs, which is, in effect, a proper response mechanism of the body gone haywire. Imagine, if you will, a huge firetruck – even the whole Fire Department – responding to a small backyard barbecue fire which is nothing more than a flare-up, and easily (and most often) extinguished by you, the cook, or someone else. No drastic measures are required.
But, imagine if, in response to that minor, and inconsequential backyard barbecue fire flare-up, the entire Fire Department rushed into your backyard with a dozen high-volume, high-pressure hoses and began indiscriminately spraying everything and everyone in sight until there was a pool of water 2 feet deep in the backyard.
Of course, the fire would be out, but that’d be way overkill, wouldn’t it?
In essence, that’s what’s happening with COVID-19.
You see, our bodies have Emergency Response Systems just like we do in real life. There’s a communication system, and Emergency Responders who communicate the threat (emergency) to the appropriate agency, and the agency then responds with the number and type of responders necessary – just like calling 9-1-1.
So again, imagine a scenario in which kids playing baseball accidentally broke a window on your house, and 1000 police, 1000 firefighters, and 1000 EMTs showed up. It’d be a response that would be so over-the-top that it’s unimaginable that it could ever occur. And yet, that’s exactly what’s happening with people who have a severe case of COVID-19 infection. Their bodies’ Emergency Response System (ERS) is – for some unknown reason – overwhelmed with an excessive number of number of Emergency Responders – overkill. And for those who experience such overkill… it can be deadly.
Our body’s ERS is comprised of messengers called “cytokines” (sigh-tow-kines) which communicate the nature, type, and extent of the threat, whether infection or injury, minor or severe, and where it’s located. In turn, those cytokines communicate to the body what’s necessary – how many, and where – to be sent to begin to heal or repair the injury, including pain relief.
In the body, the over-reaction is called a cytokine storm – an extreme over-reaction to an insult or injury to the body which itself can be, and often is, life-threatening.
With COVID-19, in the lungs, it appears as the accumulation of excess fluid in the lungs, as well as death of tissue (necrosis), and other severe and really nasty injury, events and problems.
So again, because we do not know why or what causes that extreme overreaction (cytokine storm), nor how to prevent it, the only thing we can do is to aggressively treat the symptoms after it occurs. (See? That’s where the introductory statement “There are plenty of things in the world that we do not know about” becomes important.)
There is an approved treatment of cytokine storm which is a filter – a physical filter – that removes cytokines from the blood, but not every case requires such a treatment. Some cases can be managed aggressively with other medications which perform certain functions, such as reducing inflammation. Medications that reduce inflammation are called “anti-inflammatories.” One such anti-inflammatory medication is called dexamethasone, which is a corticosteroid, often called “steroid.” Dexamethasone is a prescription medication. Patients who are very sick with COVID-19 infection are sometimes given dexamethasone, and it is an approved mode of treatment for those who need extra (supplemental) oxygen.
The National Institutes of Health (NIH) has published treatment guidelines for COVID-19 which are updated regularly, and the CDC also has published treatment guidelines for COVID-19 which are not substantially different.
It’s important to understand that guidelines are not hard-and-fast rules, they are professional suggestions. Because each patient and case is different and unique, the care and treatment of the patient and case must be custom-tailored to fit and meet each patient’s needs. That is why they’re called “guidelines” – they’re broad parameters of care. Such guidelines are based upon evidence, and can be modified as necessary to meet the specific needs of the patient, or case, simply because no two people are alike. Understand also that while guidelines are established to meet the needs of patients, they can be, and often are (depending upon the case and need), modified as necessary.
Dr. Paul Marik, MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA
There are other researchers and clinicians who have also published treatment guidelines which are also based upon evidence. It’s equally important to also understand that because one group’s guidelines may include or exclude certain treatments, does not mean that the treatment, or lack thereof, does not warrant consideration. It only acknowledges that one group of researchers had a different – though not substantially different – opinion about treatment options. The nature of medicine as a science, is that the healing arts are continually expanded by someone doing something new and/or different, and experiencing (hopefully good) results from the effort, and is then continued and solidified when others repeat the process and obtain the same, or very similar results. That is called the validation of the scientific process.
Eastern Virginia Medical School (EVMS) has also published COVID-19 treatment guidelines.
On the EVMS page COVID Care for Clinicians, Dr. Paul Marik, MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, has established a protocol which he has found successful in practically every severely ill COVID-19 patient which he has treated, and in other patients who were treated by different physicians using the same protocol and treatment modality.
Seven U.S. physicians have joined together to promote a controversial treatment for seriously ill COVID-19 patients. As the death toll mounts in a desperate struggle against the virus, they are urging hospitals everywhere to try their strategy — one they believe saves lives and reduces dependence on increasingly scarce ventilators.
The physicians, who jointly established the “Front Line COVID-19 Critical Care Consortium,” recommend a treatment that primarily involves the intravenous combination of vitamin C and corticosteroids. The protocol calls for the treatment to start as soon as a patient enters the emergency room and continue every six hours during the course of the illness.
Paul Marik, MD, Professor of Internal Medicine and Chief of Pulmonary and Critical Care Medicine at EVMS, conceived of the treatment as a way to battle runaway inflammation in the lungs — the real killer in most COVID-19 patients.
“It’s not the virus that’s killing the host, it’s the host’s response to the virus,” Dr. Marik says, describing the excessive levels of inflammation that result from an overly aggressive immune system.
The immune system responds to an infection by releasing proteins known as cytokines that initiate inflammation. Inflammation is a natural part of the healing process, but an overreactive immune system can trigger a “cytokine storm” that can send inflammation spiraling to dangerous levels.
The vitamin C/steroid protocol is not widely used in the U.S. because large sectors of the medical community doubt its effectiveness, says consortium member Pierre Kory, MD, Critical Care Service Chief at the University of Wisconsin School of Medicine and Public Health in Madision, Wisconsin.
“Whenever you make a strong claim around a vitamin, I think most doctors are very conservative and skeptical of such claims,” Dr. Kory says in the video. “So, it’s very hard for most physicians to adopt the therapy fully.”
The treatment is controversial but not unconventional. Vitamin C has been used widely in China’s treatment of COVID-19 patients, and a clinical trial of high-dose vitamin C is underway there now.
Veteran emergency physician and consortium member Howard Kornfeld, MD, says standard protocols are not working in places like New York. “It’s a disaster,” he says. “And that disaster is coming to other cities.”
Consortium members believe their treatment can help thwart the disaster.
“People are dying needlessly,” Dr. Marik says. “This protocol will save lives.”
The protocol is available at EVMS.edu/Covidcare.
UPDATE: On May 6, 2020, Consortium member Pierre Kory, MD, Critical Care Chief at the University of Wisconsin School of Medicine and Public Health, testified at a hearing of the Senate Committee on Homeland Security and Governmental Affairs. The roundtable event was titled COVID-19: How New Information Should Drive Policy. Watch the testimony.
ref: https://www.evms.edu/pulse/archive/physicianssaytreatmentcankeepcovidpatientsoffventilator.php
While it is outside the scope of this blog to treat patients, per se, the purpose in sharing this and other information, is to inform of the latest valid scientific findings. Those who read are free to treat themselves as they see fit, as is everyone. Again, the purpose in sharing these findings is to inform.
The word “prophylaxis” means to prevent a disease from occurring. And while there is no sure-fire prevention against COVID-19 available, research is rapidly ongoing by numerous groups to find one which will be effective in preventing COVID-19 infection.
At this point in time, the only accepted method of preventing COVID-19 infection are the measures endorsed by the WHO, and the CDC, which are mechanical means – social distancing, mask wearing, proper sanitation & hygiene, etc. There is no vaccine against COVID-19.
However… that does not mean that other means or methods of preventing COVID-19 infection are not presently available. It only means that they’re not now known to science. Science is the act of discovery. And we’re discovering new things continuously.
As stated above, Dr. Paul Marik, MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, has developed a protocol and treatment guidelines for those whom are hospitalized with COVID-19, and has extrapolated a portion of that treatment to include a modality of prevention of infection from COVID-19.
Again, it’s important to emphasize that while the protocol he uses has shown success, and is evidence-based, it is not by any means an “accepted” modality of treatment for prevention of COVID-19 infection for the reasons cited above.
Not having wide-spread acceptance in the medical community doesn’t mean that something (a treatment) doesn’t work. It only means that it hasn’t enjoyed widespread acceptance. That is all. And that is part of the unique (quirky, and weird to some) aspects of science – it is often very narrow in approach.
It’s much like having an unripe orange – they’re not orange, they’re green. So there you have it, a green orange. You can (should) eat oranges when they’re orange. And though you could eat an unripe (green) orange, you probably would be well-advised to avoid doing so, simply because it’d prolly be a most unpleasant experience. But again, you could eat it. It just wouldn’t be good (enjoyable).
So to say “any orange” would include all oranges, even green (unripe) ones, and so because of that, science must include the words “fully ripe orange” or something to that effect, to specifically clarify that they mean to refer to a “fully ripe orange which is orange in color,” and hopefully would be sweet to eat.
Even though his treatments and protocols are valid scientific evidence-based findings, however, does not mean that they’re fool-proof. It just means that many others who performed the same treatments the same way on the same type patients got the same results. It’s kinda’ like following a recipe.
So… all those things must be borne in mind as you read the following.
Prophylaxis
While there is extremely limited data, the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease. This cocktail is cheap, safe, and widely available.
•Vitamin C 500 mg BID and Quercetin 250-500 mg BID [1 -7]
•Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1 month, reduce the dose to 30-50 mg/day. [1,8-12]
•Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 2 mg at night [13-16]•Vitamin D3 1000-4000 u/day [17-24]
•Optional: Famotidine 20-40mg/day [25]
“…Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation.”
COVID-19: Melatonin as a potential adjuvant treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102583/pdf/main.pdf
Rui Zhanga, Xuebin Wanga, Leng Nia, Xiao Dia, Baitao Maa, Shuai Niua, Changwei Liua,⁎,Russel J. Reiterb,⁎⁎aDepartment of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinabDepartment of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX 78229, USA
Therapeutic Algorithm for Use of Melatonin in Patients With COVID-19
Russel J. Reiter
Pedro Abreu-Gonzalez
Paul E. Marik
Alberto Dominguez-Rodriguez- 1Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, United States
- 2Department of Physiology, Faculty of Medicine, University of La Laguna, San Cristóbal de La Laguna, Spain
- 3Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
- 4Department of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
- 5Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Santa Cruz de Tenerife, Spain
- 6CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
https://www.frontiersin.org/articles/10.3389/fmed.2020.00226/full
EVMS Critical Care COVID-19 Management Protocol 06-17-2020 – evms.edu/covidcare
Developed and updated by Paul Marik, MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA June 17th, 2020
Click to access EVMS_Critical_Care_COVID-19_Protocol.pdf
Prophylaxis
While there is extremely limited data, the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease. This cocktail is cheap, safe, and widely available.
•Vitamin C 500 mg BID and Quercetin 250-500 mg BID [1 -7]
•Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1 month, reduce the dose to 30-50 mg/day. [1,8-12]
•Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 2 mg at night [13-16]•Vitamin D3 1000-4000 u/day [17-24]
•Optional: Famotidine 20-40mg/day [25]
1. Maggini S, Beveridge S, suter M. A combination of high-dose vitamin C plus zinc for the common cold. Journal of International Medical Research 2012; 40:28-42.
2. Colunga Biancatelli RM, Berrill M, Catravas JD et al. Quercetin and Vitamin C: experimental therapy for the prevention and treatment of SARS-CoV-2 via synergistic action. Front Immunol 2020.
3. Kyung Kim T, Lim HR, Byun JS. Vitamin C supplementaion reduces the odds of developing a common cold in Republic of Korea Army recruits: a randomised controlled trial. BMJ Mil Health 2020.
4. Colunga Biancatelli RM, Berrill M, Marik PE. The antiviral properties of vitamin C. Expert Rev Anti Infect Ther 2020; 18:99-101.
5. Khaerunnisa S. Potential inhibitor of COVID-19 main protease (Mpro) from several medicinal plant compuns by molecular docking study. medRxiv 2020.
6. Chen L, Li J, Luo C et al. Binding interaction of quercetin-3-B-galactoside and its synthetic derivatives with SARS-CoV 3CL: structure-activity relationship reveal salient pharmacophore features. Bioorganic & Medicinal Chemistry Letters 2006; 14:8295-306.
7. Yi L, Li Z, Yuan K et al. Small molecules blocking the entry of severe respiratory syndrome coronavirus into host cells. J Virol 2020; 78:11334-39
8. te Velthuis AJ, van den Worm SH, Sims AC et al. Zn2+ inhibits Coronavirus and Arterivirus RNA polymerase activity In Vitro and Zinc ionophores block the replication of these viruses in cell culture. PLos Pathog 2010; 6:e1001176.
9. Gammoh NZ, Rink L. Zinc in Infection and Inflammation. Nutrients 2017; 9.
10. Hemila H. Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. J Royal Soc Med Open 2017; 8:1-7.
11. Singh M, Das RR. Zinc for the common cold. Cochrane Database of Syst Rev 2013; 6:CD001364.
12. Hoeger J, Simon TP, Beeker T et al. Persistent low serum zinc is associated with recurrent sepsis in critically ill patients – A pilot study. PloS ONE 2017; 12:e0176069.
17. Grant WB, Lahore H, McDonnell SL et al. Evidence that Vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients 2020; 12:988.
18. Lau FH, Majumder R, Torabi R et al. Vitamin D insufficiency is prevalent in severe COVID-19. medRxiv 2020.
19. Marik PE, Kory P, Varon J. Does vitamin D status impact mortlality from SARS-CoV-2 infection? Medicine in Drug Discovery 2020.
20. Rhodes JM, Subramanian S, Laird E et al. Editorial: Low population mortality from COVID-19 in countries south of 35 degrees North – supports vitamin D as a factor determining severity. Alimentary Pharmacology & Therapeutics 2020; (in press).
21. Dancer RC, Parekh D, Lax S et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax 2015; 70:617-24.
25. Freedberg DE, Conigliaro J, Sobieszczyk ME et al. Famotidine use is associated with impoved clinical outcomes in hospitalized COVID-19 patients: A propensity score matched retrospective cohort study. medRxiv 2020
The effect of thiamine deficiency on inflammation, oxidative stress and cellular migration in an experimental model of sepsis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018973/
Critical Care COVID-19 Management Protocol(updated 6-17-2020
https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf
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