fbpx
Today's Working Hours - Closed

COVID-19: Pragmatic and Practical Actions for Staying Safe and Healthy

March 30, 2020

Wow, what a week…

In times like these, I’m reminded that the only thing that’s certain in life is uncertainty. That can be a beautiful thing, but it can also be extremely scary. I was supposed to go to Honduras this past week for a medical mission trip, but that got canceled when the WHO declared COVID-19 a global pandemic. I was looking forward to the possibility of an additional 2 week vacation (aka quarantine, I try to think positively) in a tropical climate. I can’t ignore the elephant in the room any longer. Patients have been asking me what I think about all of this COVID-19 stuff, so let’s dive in.

Here is a brief outline of the topics I’ve covered — I got a little lengthy so thought this might help. Unless noted differently this information is current as of March 17 2020.

What is COVID-19?

How many people actually have COVID-19?

How is COVID-19 transmitted?

What are the symptoms of COVID-19?

What is the COVID-19 mortality rate?

What is the difference between the flu, COVID, another virus and allergies?

How and who do you test for COVID-19?

What’s Corona Cray Cray aka Myths

What can you do prophylactically to prevent from getting sick?

Should you wear a mask?

If you or your child does get sick…

When is it safe to go back to work/school?

I know there’s a lot of fear and mixed information going around and we wanted to be proactive in making sure you have support.

Here at Well Life we see this situation not as a health crisis but a global calling to be proactive and deliberate with our health choices. There are many lifestyle factors involved in enhancing immune function and on the inverse compromising immune function. For example, one of the fastest ways to diminish your immune system is to allow fear and uncertainty to trigger elevated stress levels. This means it’s important to be aware of your fear response and how often you allow yourself to linger in this perception.

There are some projections that say 40-70% of the 7 billion people in the world will be affected and 60 million people will die, and others think this should be considered fake news. What’s the truth? Unfortunately, I think it’s going to get worse before it gets better.

The novel coronavirus, now known as SARS-CoV-2, and its disease COVID-19, has spread from Wuhan, China, to every continent on Earth except Antarctica.  Because the world has never seen this particular coronavirus (which is why it’s called “novel”), we don’t know a whole lot.

There are two ways that new viruses arise:

1. Antigenic Drift

Antigenic drift refers to incremental change in a virus’s antigens (the toxic elements that your immune system fights). Although these viruses are closely related to each other, your body may cease to recognize it. That means the antibodies that your immune system has produced no longer work. That’s why the seasonal flu is seasonal: You’re not technically contracting the same virus each year. As the flu moves from person to person, it changes just enough to evade each person’s immune system — and the previous year’s vaccine.

2. Antigenic Shift

An antigenic shift entails a major change in a virus’ protein structure. Often, this happens when a virus that affects one species mutates to be able to infect another species. For example, SARS-CoV-2 likely emerged from a bat virus that made the jump to humans.

Antigenic shifts are rare. Prior to this current pandemic, it’s only occurred four times in the past century: a new strain of H1N1 in 1918 (the Spanish Flu), a new strain of H2N2 in 1957 (Asian flu), another mutation in 1963, and a new strain of H1N1 in 2009 (the swine flu). Because the human population has little to no immunity to these viruses, pandemics often accompany an antigenic shift.

Dozens of viruses exist in the coronavirus family, but only seven afflict humans. Four are known to cause mild colds in people, while others are more novel, deadly, and thought to be transmitted from animals like bats and camels. 

Both Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) began in animals and passed into humans.

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus said:

… we’re not just fighting an epidemic; we’re fighting an infodemic … This is a time for facts, not fear. This is a time for rationality, not rumors.  

Let’s fight fear with FACTS!

What is COVID-19?

COVID-19 is the disease caused by SARS-CoV-19. The first outbreak was first reported on December 31, 2019 in Wuhan, China, where it quickly became an epidemic. The first known case of COVID-19 in the U.S. was confirmed on January 20, 2020, and on March 11, 2020, the World Health Organization declared COVID-19 a pandemic.

Terms to Know:

An outbreak a greater-than-expected occurrence of a disease in a community. For new diseases, this number can be as low as one.

 An epidemic is the spread of an outbreak to many people.

 A pandemic is an epidemic that crosses the globe.  

A coronavirus is a type of viruses, named after the Latin for “crown” because of their crown-like spikes. There are many coronaviruses, and only a few affect humans. SARS-CoV-19 is a novel coronavirus, meaning that it has not previously existed. No, the virus has nothing to do with Corona beer. Most coronaviruses cause mild illness, but some, such as the SARS and MERS strains, can cause severe disease and death.

How many people actually have COVID-19?

It’s hard to answer this question for three reasons: One, some countries are not reporting. Two, many counties have inadequate testing to determine an actual number. Three, the numbers are continuing to increase. You can look at the global Coronavirus COVID-19 tracker from Johns Hopkins, as well as the US tracker that can track by county. Both these data sources draw numbers from WHO, CDC, European Centre for Disease Prevention and Control, China’s National Health Commission, and ncov.dxy.cn, an independent data source maintained by Chinese physicians.

In all reality the actual numbers don’t really matter that much, what matters is that COVID-19 is here, and we do our best to stay calm and prepare as best we can. I do not recommend checking numbers daily – that will only serve to heighten your anxiety.

As of March 25, 2020, there have been more than 441,000 confirmed cases, with more than 81,000 in mainland China. Italy follows with more than 69,000 cases, and the US ranks third with more than 55,000 cases. Thankfully, the rate of new daily cases has been slowing in China, but other countries’ rates are increasing. Globally, there have been more than 20,000 deaths and more than 112,000 recovered.

It’s important to note that most new cases are due to community spread, rather than international travel, although travel within nations may contribute to community spread.

How is COVID-19 transmitted?

Just like influenza, SARS-CoV-2 spreads through respiratory droplets that are produced by coughing or sneezing. Transmission typically occurs within 6 feet of an infected person, or by coming into contact with these droplets on surfaces and then touching one’s face. Fecal-oral or blood transmission may be possible as well.(23) The virus has been found to endure for several hours up to several days on “fomites,” which are shared surfaces that can collect the droplets.

The virus incubates for anywhere from two days to two weeks (up to nearly three weeks in some reports), which means that even without symptoms, people might be transmitting the virus. According to recent reports, many asymptomatic people have tested positive for the virus and infected other people even though they felt fine.

So the risk of infectiousness is probably about as bad as a bad flu, perhaps a little bit more. We don’t really know. Experts have estimated that SARS-CoV-2 has an R0, or reproduction number, which estimates the number of people any given infected person spreads the virus to from 2 to 3.11(43). By contrast, the seasonal flu typically has a R0 of 1.3, (43) and the rubella virus that causes measles has an RO of 12-18, making it one of the most highly contagious viruses.

What are the symptoms of COVID-19?

More than 80 percent of those infected with SARS-CoV-19 have mild symptoms, and many have no symptoms.

Reported symptoms include:

  • Fever (however, very young, very old,or immunocompromised don’t tend to show fever)
  • General upper respiratory discomfort, e.g. cough, sore throat, congestion, headache
  • Shortness of breath or respiratory distress
  • Mild Pneumonia
  • Severe pneumonia (when caused by COVID-19, this is called severe acute respiratory infection (SARI))
  • Acute Respiratory Distress Syndrome (ARDS)
  • Sepsis
  • Death
https://ourworldindata.org/coronavirus

In a report published on March 16 in the South Korean newspaper Chosun, clinicians estimated that roughly 30% of patients who tested positive for coronavirus had temporarily lost their sense of smell. In Germany, clinicians at the University Hospital in Bonn surveyed 100 patients with coronavirus and found that up to two-thirds “described a loss of smell and taste lasting several days,” Hendrik Streeck, head of the hospital’s virology institute, told the German news site Frankfurter Allgemeine. Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells, is also a symptom for zinc deficiency. One more reason to be taking adequate zinc during this time.

What is the COVID-19  mortality rate?

Unfortunately, we don’t yet know the true mortality rate. To determine this, we need final case numbers — and on a global scale, that can be hard to obtain due to variations in healthcare and reporting systems. In fact, the rate varies widely by country. If we just look at our current numbers, the death rate appears to be quite high. The reported mortality rate is highest in Italy at 6.6%, in China it is 3.8%, in Iran 3.3%. BUT – let’s take a look at South Korea. In South Korea, which has tested more than 100,000 people,  the case fatality rate is 0.65%(45). Germany has announced that its mortality rate is 0.2%(46) – much lower than the 2-3.5% mortality rate that is currently being reported in the news. In the U.S., it’s currently about 1.4 percent. Just as a comparison the average mortality rate for seasonal flu is usually around 0.1%

For patients over the age of 80, the fatality rate is estimated to be 14.8%. The rate is much lower among patients under 50, with adults averaging about .3 to 1.3 percent. No deaths have been reported among young children.

But honestly instead of age we should be looking at a person’s health level. Age is really just a number if you are taking care of yourself. I would love to see a study that compares diet, exercise, body weight, smoking status, and stress/sleep.

In a study of 23,000 people looking at the following 4 behaviors
not smoking
exercising 3.5 hours a week
eating a healthy diet (fruits, vegetables, beans, whole grains, nuts, seeds, and low meat consumption)
keeping a healthy weight (BMI <30)
These 4 things lead to a prevention of 78% of chronic disease: 93% of diabetes, 81% of heart attacks, 50% of strokes and 36% of all cancers.(98)

We do see Italy having one of the higher mortality rates and several hypothesis, their high amount of smokers are contributing and older population. Yet we look at Germany doing the least amount of measures to try to decrease the spread, but also has one of the lower mortality rates.

https://www.washingtonpost.com/world/2020/03/13/how-countries-around-world-have-tried-contain-coronavirus/

Naturally, everyone wants to know how deadly COVID-19 is. The technical term for that is the case fatality rate — which is, put simply, the number of people who have died from the disease (D) divided by the total number of people who were infected with it (I), or D/I. As of 3/27/20, at least 27360 people have died from the disease worldwide and 597,072 people to have been infected. Which would make the Case Fatality Rate of 4.6% In Italy, the rate of infection stands at 20.62 cases per 100,000 people, South Korea 15.02, Iran 11, Germany 2.3, and US of 0.53 as of 12:59pm UTC, 11 March (73)

So even using Italy as an example, with a mortality rate of 6.6% and 20.62 cases per 100,000 that makes the mortality rate 1.36 per 100,000.

Did you know Cancer in the US has a mortality of 196.8 per 100,000 in men and 139.6 per 100,000 women? That means you are 144 times more likely to die from cancer than from COVID. What are you doing to try to prevent Cancer?

In 2018, an estimated 1,735,350 new cases of cancer was diagnosed in the United States and 609,640 people died from the disease.(75)

As of 3/19 there have been 9843 deaths worldwide due to Coronavirus, yet today, on average, 48,219 people will die of cardiac disease and only 88 from COVID (74).

Every day you drive your car and there are 12.4 deaths per 100,000 people due to Motor vehicle accidents so again you are at least 9.1 times more likely to die in a wreck than COVID. (76) So just like you wear your seatbelt to prevent fatal car wrecks we want to take steps to prevent COVID.

As of 3/14/2020 the youngest person reported to die from COVID was between ten and 19, according to a study of more than 72,000 cases in mainland China. It was not immediately clear if anyone younger had died elsewhere in the world.(22)

There have been NO reported deaths in children 0-9 years of age. One very small study of 9 infants under 1 year of age infected with COVID-19 found that none of the infants had severe illness or complications. In fact, 1 had no symptoms, 2 had mild upper respiratory tract symptoms, and 4 had fever. (1)

Pregnant women also do not appear to be at greater risk for complications. In a small study of 9 women in Wuhan in their 3rd trimester of pregnancy with confirmed and symptomatic COVID-19 infection, none developed severe pneumonia or died. All gave birth via c-section to healthy-appearing babies with normal Apgar scores. No virus was found in amniotic fluid, cord blood or breastmilk. (2)

What is the difference between the Flu, COVID-19, cold viruses, and allergies?

According to the CDC, Americans experience approximately 30 million cases of the flu per year. Adults contract two to three colds per year, with children getting six to eight colds per year (48). Although they’re often confused, there are some differences between the cold and flu.

A cold is not the flu. It is a viral infection of the upper respiratory tract. It may be caused by more than 200 different viruses, including coronaviruses and rhinoviruses (49).

The flu is a viral respiratory infection with more serious symptoms. There are four types of influenza: A, B, C, and D. Humans are primarily affected by influenza A and B, which cause the seasonal flu. Type C is less common but has mild symptoms, and type D only infects cattle. (50)

Allergies, on the other hand, are your immune system’s response to an allergen, which can be anything from pollen and pet dander to food or drugs. Like colds and flus, they often cause respiratory distress, but antibiotics and antiviral medications will not help. You can either treat the symptoms or avoid contact with the allergen.

If you are coughing a lot, having a fever, or feeling achy, it’s probably a cold or a flu, not allergies. That said, allergies can sometimes cause a post-nasal drip that can cause a cough or a sore throat.

Allergies or Cold/Flu?

What’s your mucus like? If it’s clear or watery, it’s probably allergies. If it’s green, yellow, or thick, it’s probably an infection.

How do your eyes feel? If your eyes are itchy or watery, it’s probably allergies.

Are your symptoms changing? If no, it’s probably allergies. If yes, it’s probably microbial.

How long has it lasted? An infection usually clears in a week or so, but allergies can last several weeks or even months.

Here is a great chart comparing colds, flu, COVID, and allergies.

When Should You Call Your Doctor?

When you’re experiencing allergies. At Well Life we can do allergy testing to identify the allergen(s) and help prevent symptoms from occurring.

Your fever is over 101 F. That’s typically a sign of a flu or cold, and you likely need prescription medication.

Your symptoms get to the point where you can’t breathe or eat. Your cold may have progressed into bronchitis or pneumonia, and these can be fatal if left unchecked.

How and who do you test for COVID-19?

To test for COVID-19, doctors use a nasopharyngeal swab (nasal swab) or oropharyngeal swabs (a throat swab), to collect sputum. The sample is sent to a lab to check for SARS-CoV-2 via polymerase chain testing (PCR). However, clinics usually have very limited supplies and need to reserve tests for vulnerable patients. That’s why most doctors will only test people with COVID-19 respiratory symptoms if they’d had close contact (within 6 feet) with an infected person or recent access to an affected geographic areas within 14 days of symptoms. Hospitalized patients with severe acute lower respiratory illness and no other diagnosis are also tested.

The CDC also recommends that providers test for other respiratory pathogens, like they would as part of their usual workup for anyone who comes in with fever, runny nose, and cough – like the flu! Because let’s face it, we’re still in the middle of flu season, and …

If you or your child have cold or flu symptoms,
there is a good chance that your child has a cold or the flu!

As we begin to see more domestic spread of COVID-19 in the United States, please …

Do NOT rush to your doctor’s office or hospital to get tested at the first sign of fever or cough unless your health is declining and you need urgent medical attention.

Your doctor or emergency department likely has very limited capability to test for COVID-19, and going unnecessarily to the doctor’s office or emergency department may inadvertently expose you or your child to COVID-19 or other infections and likewise expose other people to whatever illness you may have. Many cases of COVID-19 in China are likely due to uninfected people becoming infected after exposure while waiting in long hospital and clinic lines to be tested. The California Department of Public Health urges that:

If a person develops symptoms in COVID-19 including fever, cough or shortness of breath, and has reason to believe they may have been exposed, they should call their health care provider or local health department before seeking care. Contacting them in advance will make sure that people can get the care they need without putting others at risk.

What’s Corona Cray Cray aka Myths

MYTH#1 CHINESE FOOD & PRODUCTS ARE UNSAFE

There have been no cases of COVID-19 that resulted from eating Chinese food or using products made in China. In fact, many Asian-owned businesses are struggling due to people having an irrational fear of coming into contact with the business. As always, washing our hands before and after eating and shopping.

MYTH #2: THIS IS NEVER GOING TO END

I just read a headline from CNBC, “Up to 150 Million Americans are Expected to Contract the Coronavirus, Congressional Doctor Says.

Come on … if we look at the FACTS those numbers don’t add up. As COVID-19 travels the world, the imminent threat of doom looms over every nation. It’s important to keep a close eye on China as the Asian country of 1.4 billion residents has become the ideal case study for us all to learn from.

Some good news for a change…

  • Of the roughly 81,000 people infected in China since December 2019, nearly 92,000 or 85% have FULLY recovered already and that number is climbing fast.(28)
  • Plus, there are only 21 new reported cases in China as of 3/17. COVID-19 has officially lost steam in China, which is great news – the life cycle of this virus is quick!(28)
  • The last two of 16 temporary hospitals in Wuhan, China have officially been shut down. “The final group of 49 patients walked out of the Wuchang temporary hospital in the capital of Hubei province on Tuesday afternoon to cheers, according to the Xinhua news agency. (New York PostXinhua News Agency)

It cannot be stressed enough that only 56 per 1 million Chinese residents have been infected. Even in the most heavily affected countries, we’re only seeing 521 per 1 million Italians, and 164 per 1 million South Koreans infected.

Yes, it is such a tragedy for those who have lost their lives ,and our hearts go out to their families… but the total death toll of ~7500 people is NOTHING compared to the 25,000–54,000 that die from the flu every MONTH.(25) Also remember that as I discussed above you are 144-30000 TIMES more likely to die from cancer.

Now, we must keep a close watch on other countries to see if this 3-4 month COVID-19 life cycle remains a constant. If so, then this entire situation will only be a memory in the U.S. By early summer relatively few people will be affected and losing their lives.

Bottom Line: COVID-19 acts quick, in and out – kills a high number of elderly and immune-compromised people, leaves kids alone and pretty much goes away after a couple months.

Again, China has 1.4 billion residents and only ~ 81,000 have been infected since December, and (March 10) only 31 new cases were reported. (WHO)

I like that math…  

Myth#3 THE MEDIA CAN BE TRUSTED

Not trusting the media at this point should be a given. They are virtually 100% responsible for the pandemonium that is happening right now.

Fear. That’s what the media is spoon-feeding the world as coronavirus pandemonium has officially reached fever-pitch.

Let’s see what the global authorities have to say about this recent “outbreak” and whether mainstream media can be trusted…

“We’re not just fighting an epidemic; we’re fighting an infodemic. Fake news spreads faster and more easily than this virus, and is just as dangerous. That’s why we’re also working with search and media companies like Facebook, Google, Pinterest, Tencent, Twitter, TikTok, YouTube and others to counter the spread of rumours and misinformation.” 

WHO Munich Security Conference

 First off, yes, I am validating that COVID-19 is a serious threat, but it is NOT a time to panic. The current situation is being presented by the media as being unprecedented and has been greatly over exaggerated, thus causing mass chaos across the globe.

To compare with the H1N1 virus outbreak from April 12, 2009 to April 10, 2010, in the U.S. (CDC)

  • 60.8 million cases
  • 274,304 hospitalizations
  • 12,469 deaths
  • No global chaos, no national shut downs, no mass fear.

Globally, the H1N1 outbreak:

  • 151,700-575,400 deaths during the first year the virus circulated.
  • 80% of (H1N1) virus-related deaths were estimated to have occurred in people younger than 65 years of age.
  • NOTE: This differs greatly from typical seasonal influenza epidemics, during which about 70- 90% of deaths are estimated to occur in people 65 years and older.
  • Again, no global chaos, no national shut downs, no mass fear.

The main concern we should have is this irrational fear media has placed in people across the globe. This is BIG news for them and they are making TONS of money as their ratings skyrocket – advertisers are loving this.

MYTH #4: THERE ARE NATURAL CURES OR APPROVED DRUGS

Natural remedies such as oregano oil or other essential oils will not kill SARS-CoV-2 in 20 seconds. I’m as much of a proponent of natural medicine as the next guy, but let’s not go overboard. Another meme making the rounds states that gargling with saltwater will prevent the virus from moving into your lungs. This is not true. Other snake oil salesmen are peddling strange concoctions that they claim will cure Covid-19. Sadly, none of these mysterious formulae will kill anything except your wallet. A particularly dangerous idea is that fish tank cleaner can prevent infection. There has already been at least one death by someone who tried this. Currently, there are no FDA-approved drugs to treat the virus, but scientists are working round-the-clock to find suitable treatments.

What’s sad is that although not a cure, Vitamin C may be helpful, but talk of the 3 ongoing trials is being suppressed as fake news.

www.cnbc.com/amp/2020/02/14/facebook-google-amazon-met-with-who-to-talk-coronavirus-misinformation.html

As always, boosting your immune system via Vitamin C, a healthy diet, and reduced stress is one of the best “natural” cures you can use and see below for other possible ways of boosting your immune system naturally.

Remember Exposure + Susceptibility = Symptoms/Infection

What can you do prophylactically to prevent from getting sick?

Also remember an ounce of prevention is worth a pound of cure

Here are a few things you can do to try to protect yourself and those around you.

Remember to wash your hands frequently and for at least 20 seconds. Use soap and scrub your palms, knuckles, and under your fingernails. Lather thoroughly, then rinse with warm water. The act of handwashing effectively destroys any virus particles on your hands. If you need a timer, the CDC’s recommendation, is to hum the Happy Birthday song from beginning to end twice. Okay?

One study, showed that people either skip washing their hands or do so for only a few seconds, allowing contagions to linger. This study was conducted at an airport and found that only 70 percent of people washed their hands at all after using the restroom. Of those who did wash their hands, only half washed for at least 15 seconds. That’s a great way for germs to spread. (51)

And don’t forget to wash your phones as often as you wash your hands. People are constantly reminded to keep their hands away from their face, but phones are often pressed to the side of ears, tapped, swiped or are placed on unsanitized surfaces. Try to keep your phone in your pocket or purse as viruses may live up to 3 days on surfaces.

Just take a look at this picture at what the difference 30 seconds makes when washing your hands.

Use a hand sanitizer. Can’t wash your hands? Use a hand sanitizer, but be sure it contains at least 60 percent alcohol in order to kill the virus. (4)

Keep hands away from eyes, nose, and mouth! We touch our faces on average 23-50 times per hours, which is plenty of opportunity for viral particles to enter our bodies.

Keep your distance. The CDC recommends staying at least 6 feet away from people who potentially carry the virus.

Irrigate your nose. Coronaviruses and rhinoviruses try to replicate in your nasal passages, so nasal irrigation can help wash them away. One study found that those who irrigated their nasal passages daily were less likely to contract a cold (5). Try Xlear, a saline nasal spray that contains xylitol and grapefruit seed extract, which can help fight cold and flu viruses.  See our handout on our website for recipes.

Load up on foods and spices with antiviral properties. Eat a diet rich in fresh fruits and vegetables which provide lots of antioxidants, substances that may help boost your immune system, especially vitamins A and C. You may also want to add the following into your diet coconut oil, garlic, oregano, clove, thyme, cumin, cinnamon, turmeric, honey, walnut, pomegranate, green tea, apple cider vinegar and mushrooms like Reishi, Maitake, Shitake. Turkey tails. Other pungent and spicy foods — such as ginger, chili peppers, curry, hot mustard, onions, and horseradish — can ward off colds. In one study, people who took garlic for 12 weeks between November and February had 63% fewer colds than people who took placebo. Those who did get a cold recovered about 1 day faster.

Eat the rainbow. Colorful fruits and vegetables are chock-full of antioxidants, which prevent free radicals from interfering with our body’s normal systems. Having trouble getting these in your or your children’s diets? Blend and mix them into soups, pasta sauces, and smoothies.

Stay well-hydrated Drink plenty of water. No soda or sugary drinks, please! If you don’t like plain water, try coconut water or tea. Bone broth is a protein-rich alternative that you can use in soups. What’s a good estimate for how much water you need at a minimum? Divide your body weight (in pounds) in half and drink that number in ounces!

Eat fermented foods Fermented foods contain probiotics, which restore balance to your body and help fight off infection. Research has found kimchi can actually help reduce H1N1 influenza in the body! Try drinking lots of kefir and kombucha as well.

Avoid simple sugars and processed/junk food Within just half an hour of eating simple sugars, your body experiences a 50% reduction in your white blood cells.(6) That’s a huge drain on your immune system. Avoid sugar to stay healthy.

Get fresh air and moderate daily exercise Moderate exercise helps your body make more macrophages, the type of white blood cells that destroy microbes. Research has shown that people with a moderate to high level of physical activity generally get 25% fewer colds than those whose daily activities were relatively low. However, working out too hard is a form of stress that can lower your immune system, so keep it moderate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803113/

Get adequate sleep More sleep equals more white blood cells, plus lower stress. All of this can help you fight off infection. In one study participants with less than 7 hours of sleep were 2.94 times more likely to develop a cold than those with 8 hours or more of sleep. The association with sleep efficiency was also graded: participants with less than 92% efficiency were 5.50 times more likely to develop a cold than those with 98% or more efficiency.(99) Melatonin has been found to inhibit the action of an inflammasome known as NLRP3 – one of the primary inflammasomes involved in the exaggerated immune response seen in critical Coronavirus cases.(72) Melatonin’s role in suppressing the inflammatory response could be one of the reasons children under the age of 9 rarely present with severe symptoms when infected with Coronavirus. This is because young children can have up to 10 times the peak melatonin levels of older adults.

Minimize stress When we’re stressed, our immune system becomes impaired, leaving us vulnerable to infection.  Plus, it contributes to inflammation that worsens our symptoms. One study showed that job stress is a major risk factor for severe illness. Subjects were exposed to equal amounts of a cold virus, but the more stressed people were 3-4 times more likely to get sick. Reduce stress and your reaction to stress. Yoga, tai chi, meditation, prayer, or other forms of relaxation may help. William James (1884) proposed that we are afraid of the bear because we run, rather than we run because we are afraid. The same thing is happening in the world. Fear feeds more fear. You may also want to check out a great book called the Upside to Stress by Kelly McGonigal that talks about that people that were under the highest level of stress but perceived it in a positive way had the lowest health risks. So, remember to think Positive!

Regular Sauna Usage Sauna has been shown to be good for so many things, including a 61% reduction in stroke (37). 4-7x per week lowered dementia risk by 66% & Alzheimer’s risk by 65% after adjusting for diet/lifestyle. These groups were compared to men that only used a sauna 1x per week, so the benefit could be even more compared to those that never use a sauna. (38) Compared to once-a-week saunas, taking a sauna four or more times a week has been shown to reduce your risk of death from heart disease by 50 percent, high blood pressure by 47 percent, respiratory diseases and pneumonia by 41 and 37 percent respectively, and premature death from all causes by 40 percent. It is also helpful for skin health, depression, pain, detox, weight loss, stress reduction, the list goes on.

Consider Acupuncture Studies have shown that acupuncture helps the brain increase the body’s level of T-cells; cells which destroy bacteria and harmful viruses in the body.

Here are a few supplements to consider taking on a regular basis:

Probiotics Probiotics can reduce colds and flu by more than 13%(100), and if you do get sick probiotics can reduce symptoms by 19-25% and number of days with a fever was reduced by more than 50% and decreased antibiotic use by 68-84%. (101) Probiotics are the key active ingredient in fermented foods, so stock up on miso, kombucha, and kimchi!

Vitamin D3 As people stay indoors during colder months, they often become deficient in Vitamin D deficiency, which may put them at increased risk for infection and sepsis. Vitamin D3 boosts the production of cathelicidin, which helps fight microbial infections. The Vitamin D Council recommends that you obtain 1000IU of Vitamin D3 per 25 pounds of your body weight — every day. One study showed that 1,200 IU/day of vitamin D3 for 15-17 weeks during the winter reduced the incidence of influenza A infections by 64% among children who had not been taking other vitamin D supplements. It has also been shown that daily or weekly doses of Vitamin D show a 3.5 times larger reduction in the odds of Respiratory Tract Infection than those using a bolus schedule(83,87). So it is much better to be proactive than to dose when an infection comes on.

Zinc Zinc is required for the normal functioning of white blood cells. Supplementing with just 15mg of zinc per day in adults has been found to improve our immune cells’ ability to ward off infection. It showed a 27% reduction in total mortality observed in elderly subjects who received high-dose zinc in the AREDS1 multicenter trial. (27) Zinc Lozenges like Enhanced Zinc Lozenges by Life Extensions shorten the time until symptoms resolve by 42% (4.4 vs. 7.6 days) (32)

Directions: Completely dissolve 2 lozenge on symptom onset then 1 lozenge every 2 wakeful hours. Do Not exceed 8 per day. Swish and gargle to improve effect.

Fish oil Omega-3 essential fatty acids have a host of immune benefits too long to list!

Vitamin C  Vitamin C is a powerful antioxidant that humans don’t make, we have to eat it otherwise, we get scurvy. It assists our ability to ward off and deal with infection. Taking vitamin C as a prophylaxis can reduce the duration and severity of colds, but not the incidence for most people, except in a subgroup analysis that found regular vitamin C supplementation in persons under high physical stress (marathon runners, skiers, and soldiers) decreased the incidence of the common cold by 50%.(85) Doses of ≥200 mg daily shortened cold duration in children by 14% and 8% in adults.(84) It was also seen that in doses of 1 to 2 g/day vitamin C shortened colds by 18% in children.(85)

You can obtain 150 milligrams of vitamin C from one serving (100 grams, or 3-4 ounces) of any of the following foods: green chili peppers, yellow or green bell peppers, guavas, or currants.

You can obtain the same amount from two servings of any of the following: kale, broccoli, kiwifruit, red bell peppers, jalapeno peppers, red chili peppers, Tahitian taro, or mustard spinach.

n Acetyl Cysteine (NAC) In a little-noticed 6-month controlled clinical study enrolling 262 primarily elderly subjects, those receiving 600 mg NAC twice daily, as opposed to those receiving placebo, experienced significantly fewer influenza-like episodes and days of bed confinement. (26)

Frequency of seroconversion towards A/H1N1 Singapore 6/86 influenza virus was similar in the two groups, but only 25% of virus-infected subjects under NAC treatment developed a symptomatic form, versus 79% in the placebo group. Administration of N-acetylcysteine during the winter, thus, appears to provide a significant attenuation of influenza and influenza-like episodes, especially in elderly high-risk individuals. N-acetylcysteine did not prevent A/H1N1 virus influenza infection but significantly reduced the incidence of clinically apparent disease

Beta-glucans Consider taking Wholemune, 1 cap per day.  Supplementation of insoluble yeast β-glucan reduced the number of symptomatic cold infections by 25% compared to placebo (p = 0.041) with improvement of sleep difficulties caused by cold episodes (p = 0.028).(89)  In another study of healthy women (38 ± 12 years old) , Wellmune group reported fewer upper respiratory symptoms compared to placebo (10% vs 29%), better overall well-being (global mood state: 99 ± 19 vs 108 ± 23, p < 0.05), and superior mental/physical energy levels (vigor: 19.9 ± 4.7 vs 15.8 ± 6.3, p < 0.05). (86) In a group of 215 children, mostly preschoolers were given pleuran (Imunoglukan P4H® syrup)  every morning on an empty stomach for 3 months starting at the beginning of Autumn. A positive therapeutic response (more than 50% reduction of RRTI frequency) was observed in 71.2% of the studied children and the total number of respiratory tract infections declined from 8.9 episodes of RTIs/year to 3.6 episodes/year compared to the previous treatment period (p < 0.001). (88)

Selenium is an essential mineral, and a deficiency in this nutrient has even been shown to force flu viruses to mutate into a more aggressive form. Boosting the amount of this mineral can boost your immune system (53,54) During cold and flu season, you may take up to 200 mcg of selenium three to four times per week. Note that continuing to take selenium past flu season may increase the risk of prostate cancer in men.(90) Instead, let your diet do the work:

Brazil nuts, cremini and shiitake mushrooms, eggs, Cod, Shrimp, Tuna, Halibut, Scallops, Chicken, Lamb, and Turkey are all excellent sources of selenium.

Researchers have now shown that in women over the age of 65 elevated RDW on a CBC can be associated with a deficiency of selenium(55), and for every 1 percent increment in RDW, all-cause mortality risk increased by 22%(56) and that the RDW can potential be a screening marker for colon cancer and celiac disease because of its responsiveness to subtle nutrient deficiency(57,58)

Iodine Many Americans are iodine-deprived, and it’s an essential nutrient. Iodine can be hard to come by. You can obtain it from sea vegetables, fish heads, and dairy, as well as iodized salt. If you don’t consume these food, you can get about 1 mg per day of iodine by taking kelp capsules. If you have Hashimoto’s or Grave’s, be cautious about taking iodine.

Should you wear a mask?

Experts do not recommend face masks for the general public, unless you definitely have COVID-19 or are caring for someone who has it.

But is that to save masks for healthcare so people don’t hoard masks like they did toilet paper or is there good evidence to say masks don’t help? This graphic would beg to differ that masks do help.

Of course no masks, be it the tight-fitting NIOSH approved N95 respirator mask or the loosely worn surgical mask, provide perfect (“100%”) protection. But imperfect protection does not mean “completely useless”, much as a glass not full need not be empty: I would gladly accept a glass of water filled to 60 % when I am thirsty. Absence of evidence (of protection) is not evidence of absence. But in our binary world, the official message that surgical masks are “not effective” may have sent the wrong message: that they are absolutely useless.

Filtering effect for small droplets (aerosols) by various masks; home-made of tea cloth, surgical mask (3M “Tie-on”) and a FFP2 (N95) respirator mask. The numbers are scaled to the reference of 100 (source of droplets) for illustrative purposes, calculated from the PF (protection factor) values in Table 2 of van der Sande et al, 2007. Measurement was performed with a Portacount counter that registers particles in the air with sizes in the range between 0.02 and 1 micrometer at the end of a 3-hour wearing period with no physical activity. The number for the protection are medians of 7 (or 8) adult volunteers per group. Protection at the beginning of the test was similar for the Tea Cloth and Surgical mask, but for FFP2 the protection was double. Children experienced substantially less protection (see van der Sande et al 2007).

If you do have extra masks please send them our way, we need extra masks. We need to protect our healthcare workers otherwise who will take care of you when all the healthcare workers are sick. If you want to make your own mask or help make some for local healthcare workers, my good friend and great Doc Maria Hopp, MD created this video. Her templates are found on her site.

I like this quote from maskssavelives.org:

“Going in public without a mask in a pandemic is like riding a motorcycle without a helmet. You don’t look cool. People see you and think you don’t value your life.”

Ideally you’ll need a “Particulate Respirator Mask” that filters at least 95% of very small particles. It should be marked P95, R95 or N95 and be able to form a tight seal around your nose and mouth.

Experts do not recommend face masks for the general public, unless you definitely have COvid-19 or are caring for someone who has it. You’ll need a “Particulate Respirator Mask” that filters at least 95% of very small particles. It should be marked P95, R95 or N95 and be able to form a tight seal around your nose and mouth

A recent paper studied medical professionals at Zhongnan Hospital who were treating Covid-19 patients. None of the 280 staff who wore N95 respirators and washed their hands frequently contracted the disease, even though they treated more Covid-19 patients (730% MORE cases, in fact),  on the other hand, 10 of the unmasked group became infected.(7)  

The “N” in an N95 stands for “not resistant to oil” and the 95 means that during “worst case” testing, the filter was able to capture 95% of the most penetrating particles in the air (down to 0.3 microns). A “P” mask is, by contrast, “oil proof,” but that’s kind of overkill for a novel virus that is most often transmitted through coughing and close contact between people. P100 masks filter out at least 99.97% of airborne particles, while paper surgical masks don’t guarantee anywhere near the same level of protection as N95s or P100s because of their loose-fitting design.

A regular surgical mask can also provide some protection, but it is actually meant to protect others from your cough or sneeze. According to a study in JAMA, during the height of flu season over the course of four years, researchers studied flu-infection rates among health care workers at seven U.S. medical centers. Some workers were randomly assigned to wear N95 respirators and others surgical masks. The two groups showed no significant difference in flu infection rates. (59)

A properly fitted respirator mask should be worn over BOTH the nose and mouth, and form a tight seal so that you can’t smell any ambient odors. A good test is to put on the mask covering your mouth and nose, pinch the mask across the bridge of your nose, then spray peppermint or lavender essential oil in front of your face. You should not be able to smell or taste any of the oil in your nose or mouth through the mask.

G95 BioScarf

You may want to check out G95.com, they make some really slick masks, scarfs, and gaiters, that are rated better than an N95 mask. On average G95 Filtration Technology filters out 99.75% of all airborne particles 0.1 microns and larger.

G95 Biogaiter

If you or your child do get sick…

If you begin to feel symptoms, don’t panic — It is still cold and flu season, which means it most likely is not COVID-19. Avoid going to a medical clinic or hospital if possible as you could actually increase your risk of contracting the virus.

Remember, with any contagious illness whether it is COVID-19 or the seasonal flu it is smart to take a few precautions.


Call ahead.  If you do feel like you need medical attention reach out to your doctor’s office to see if any special precautions need to be set up to prevent workers or other patients from catching the virus.

Isolate yourself, by keeping away from people, including the rest of your family and any pets or farm animals, as much as possible. Wear a face mask if you must be with other people. If you have more than one bathroom in your home, designate one for the person who is ill and the other for everyone else.

Don’t share. This is the one time to be selfish, no one else wants what you have so don’t share utensils, dishes, blankets or towels and sanitize them in hot water after each use.

Become a clean freak. Have all “high-touch” surfaces including countertops, doorknobs, faucets, keyboards, remotes, etc. cleaned thoroughly and regularly.

Cough and sneeze under cover. Practice good hygiene by covering your mouth and nose with a tissue when you cough or sneeze. Throw the tissue away in a lined trash bin and immediately wash your hands with soap and water for at least 20 seconds or clean them with a hand sanitizer that contains at least 60% alcohol.

Even if you do have Covid-19, mild cases can be treated the same as the flu while your immune system does its work:

Rest. Stress and strenuous activity can lead to complications such as bronchitis or pneumonia.

Stay Hydrated. Not only is water good for you, it can loosen mucous and help you clear your lungs and nasal passages. Avoid alcohol and soft drinks. Drink hot beverages. Studies show that a hot drink provides immediate and lasting relief of cold symptoms such as runny nose, cough, sneezing, and sore throat.(91)

Peppermint tea is a good expectorant, decongestant, and is soothing for a sore throat.
Yogi Tea’s Throat Comfort is great, or make your own with 1.5 teaspoons of fennel seeds and one cup boiling water. Steep for 15 minutes, strain, and sweeten with honey to taste.
Anise Tea – one teaspoon of crushed anise seeds to one cup of hot water, and flavor with sugar, garlic, cinnamon, or honey (if desired). Sip this concoction up to three times a day.
Cold Remedy Tea Recipe: Crush one or two cloves of garlic and add them to the juice and zest of one lemon, then mix in 1/2 tea-spoon of grated, fresh ginger, a pinch of cayenne pepper (or, even better, finely chopped fresh chili pepper) and 1 teaspoon of honey. Add hot water to the mixture and drink it a few times a day until your cold is gone.

Avoid Over the Counter Decongestants, including pseudoephedrine and phenylephrine. These drugs work by reducing nasal secretions, but having dry nasal passages can actually increase your risk of infection. They also tend to cause dependence if used for more than 5 days, which means that when you cease taking them, you experience worse symptoms than you did before. People with cardiovascular disease, hypertension, diabetes, prostatic hypertrophy, and thyroid conditions should avoid decongestants because they can contribute to hypertension, thyroid imbalance, and difficulty urinating.

Use a cool-mist humidifier to ease nasal congestion and sore throat. Warm steam helps, too. Try sitting in the bathroom with the door closed and running a hot shower. You may want to try diffusing different essential oils like peppermint, menthol, eucalyptus, thyme, tea tree oil, or a combination product like doTERRA’s Breathe, or Young Living’s R.C or Raven.

Vicks Vapo-rub or essential oils should be used on chest or soles of feet, not on your face as it can cause laryngospasm.

Fever Management A fever is a temp greater than 100.4 degrees. A fever is an important clinical indicator and is generally a healthy reaction by the body to combat infection and regain homeostasis. Body temperatures can rise to 41° C/105.8° F without harm, and the degree of fever does not always correlate with the severity of illness. A fever is a good response that activates infection fighting enzymes in your body that only work in higher temperatures. If you or your child feels achy medication may help with the symptoms, but the primary goal of treating the fever is to improve overall comfort rather than to lower the temp. Lowering the fever with medication can prolong the illness by about 1 day, and in one study it claims fever suppression causes at least 1% more influenza cases of death (700 extra deaths per year).(39) Tylenol usage is also linked to an increase in asthma and other autoimmune disorders by several studies. If you chose to use medication, the dosage for Tylenol (Acetaminophen) is 5-7 mg/lb/dose (10-15 mg/kg/dose every 4-6 hours. For Motrin (Ibuprofen) the dose is 3-5 mg/lb/dose (5-10 mg/kg/dose) every 6-8 hours as needed. Don’t use Motrin for kids younger than 6 months of age.

You may want to consider a tepid bath before using medication. You can also use cold compresses by either soaking a washcloth in peppermint tea (and put it in the freezer until it’s cold), or put two or three drops of peppermint essential oil on the washcloth after wetting it down with cool water. A peppermint tea cold compress for can be helpful for headaches and congestion. A wet sock treatment is another alternative.

The questions about ibuprofen’s safety for COVID-19 patients seem to have stemmed, in part, from a letter published in The Lancet last week hypothesizing the ways various medications could, perhaps, increase the risk of infection with the coronavirus. Research has shown that the virus attaches itself to cells in the lungs by way of an enzyme — angiotensin-converting enzyme 2 (ACE2). The Lancet commentary suggested that taking ibuprofen might increase the number of ACE2 receptors on a cell, which could make someone taking the drug more vulnerable to infection.

Questioned on the study by reporters in Geneva, WHO spokesman Christian Lindmeier said that experts were “looking into this to give further guidance.”

“In the meantime, we recommend using rather paracetamol, and do not use ibuprofen as a self-medication. That’s important,” he said.

My question is if Tylenol and Motrin aren’t helping to heal and could potentially be harmful, why even consider taking them?

Food as Medicine Although there has been no evidence to suggest that milk produces mucus, many feel that it makes symptoms worse, and I generally recommended you limit your dairy consumption.

Garlic/allicin supplementation can reduce symptom duration by 70% (~ 1.5 vs. 5 days). (52) It is recommended you take Kyolic Aged Garlic Extract: 3600 mg daily in divided doses or ½ to 2 cloves several times a day – Crush and let sit 10 min, which stabilizes allicin, then cook.

Honey as needed for cough and sore throat. 1/2 tsp (2.5 mL) dose of honey before sleep has a more alleviating effect on a cough compared to dextromethorphan and diphenhydramine. (40) When selecting Manuka honey for medicinal uses, look for the “MGO” label on the jar—it should state a minimum MGO content of 83. The higher the MGO rating, the higher the level of antiviral activity of the honey. Honey is not recommended for children under 1 year because of the risk of exposure to C. botulinum spores.

Vitamin D If you don’t already maintain a blood level of Vitamin D of 50-80 ng/mL, then take 50 000 IU of vitamin D the first day and continue for three more days and slowly reduce the dose to around 5000 IU of vitamin D each day. If you already take around 5000 IU of vitamin D every day, then you probably don’t need to increase your intake and higher doses may even be harmful. More is not always better.

Pelargonium Sidoides Also called Umckaloabo, this African herb has been shown to boost macrophage activity, reduce the viral and bacterial load in the body, and help clear mucous from the lungs. This herb is available as an alcohol-free syrup, V Clear, and as Umcka ColdCare Syrup by Nature’s Way.

It has been shown to help combat human coronavirus 229E, which causes anything ranging from a common cold to severe pneumonia. (60) However, this coronavirus does not enter cells using ACE2 and is not very closely related to SARS or to the new coronavirus. Umcka increases interferon, so it might not be effective against SARS or the new coronavirus (61)

Homeopathy used during the Spanish flu of 1918 showed a significant difference in mortality from the conventional treatments, this was probably mainly due to the fact that aspirin was increasing the mortality rate, but even looking at groups that took nothing, it seemed as though homeopathy decreased the rate down to about 1%. The most commonly used remedies were Gelsemium, Bryonia, Aconite, Eupatorium. Dean W. A. Pearson of Philadelphia collected 26,795 cases of influenza treated by homeopathic physicians with a mortality of 1.05%, while the average old school mortality is 30%. In another report in a plant of 8,000 workers it was reported they had only one death. The patients were not drugged to death. Gelsemium was practically the only remedy used. We used no aspirin and no vaccines. -Frank Wieland, MD, Chicago.(92)

Oscillococcinum By now you’ve probably seen Oscilloccinum lining the shelves at Natural Grocer’s. This is THE homeopathic flu remedy, and a MUST at the very beginning of a flu or flu-like illness. Studies have shown that taking Oscillococcinum at the onset of flu significantly reduces symptoms and shortens the duration of illness(8,9).

The recommended dosage is 1 vial 3 times over a 24-hour period, preferably at the very beginning of flu symptoms or any illness. The dosage is the same for children and adults. Just down that whole vial of tasty sprinkles and suck on them until they dissolve, ideally at least 10 minutes away from food or drink. For an infant, you can dissolve the pellets in water and give with a syringe or in their bottle or sippy cup.

ColdCalm by Boiron has a combination of several homeopathic remedies which some were used during the Spanish Flu of 1918.

It contains the following remedies:
Allium cepa 3C HPUS – Relieves sneezing and runny nose
Apis mellifica 6C HPUS – Relieves nasal congestion
Belladonna 6C HPUS (contains less than 10-15 mg alkaloids per dose) – Relieves colds with a sudden onset
Eupatorium perfoliatum 3C HPUS – Relieves sinus pain
Gelsemium sempervirens 6C HPUS – Relieves headaches associated with colds
Kali bichromicum 6C HPUS – Relieves nasal discharge
Nux vomica 3C HPUS (contains less than 10-8 mg alkaloids per dose) – Relieves sneezing attacks
Phytolacca decandra 6C HPUS – Relieves sore throat associated with colds Pulsatilla 6C HPUS – Relieves colds with a loss of taste and smell

Monolaurin a monoester formed from lauric acid (medium chain fatty acids), has profound antiviral and antibacterial activity. Monolaurin appears to disrupt lipid dynamics in viral envelopes and in the cell membrane of any organism that doesn’t have a protective cell well. (62,63). As an enveloped virus, SARS-CoV-2 is probably vulnerable to monolaurin. It’s recommended to take 3 grams a day

Licorice root (Glycyrrhiza glabra) has been shown to have antiviral properties. It contains Glycyrrhizin, which can inhibit influenza replication in the body while reducing inflammation.(65) Pregnant, those with hypertension, hypokalemia, hypernatremia, or low testosterone levels should also minimize their usage of licorice. Comparing the antiviral potential of ribavirin, 6-azauridine, pyrazofurin, mycophenolic acid, and glycyrrhizin against two clinical isolates of coronavirus (FFM-1 and FFM-2) from patients with SARS admitted to the clinical centre of Frankfurt University, Germany. Of all the compounds, glycyrrhizin was the most active in inhibiting replication of the SARS-associated virus. (64)

Viracid by Orthomolecular has Vitamin A, C, Zinc, and the following herbs.
Its recommended to take 2 tab every hour for 6 hours, repeat daily until symptoms are gone (usually 1-3 days).

Vitamin A is a key player in maintaining a strong immune system, you may want to increase intake of foods such as sweet potatoes, carrots, squash, spinach, or collard greens. 112 patients with colds received a cod-liver oil concentrate. The dosage contained 150,000 units of vitamin A and 15,000 units of vitamin D on the first day and one-third of those amounts on the second day. If symptoms remained, two-thirds of the original dose was given on the third day. After the first 24 hours, 30.3% of the patients were symptom-free and an additional 51.8% were almost symptom-free, for a total of 82.1% cured or almost cured. Using this treatment, many patients have avoided colds by stopping them in their prodromal stage. No adverse effects of the treatment were seen. (34)

This is not safe for pregnant women and is not safe to continue for longer periods of time because it is a fat-soluble vitamin that will build up in your body. Incorporating orange vegetables such as sweet potato or carrots can help increase your Vitamin A (1 sweet potato may contain about 20,000 IU of Vitamin A). You don’t want to take more than 100,000 IU at one time because it can cause headaches, and it’s a good idea to get enough vitamin D with your A because it can, protect against the potential toxicity of vitamin A. 

Vitamin C Doses of Vitamin C of 2 -5 grams per day have been shown to reduce symptom days by 9% – 37 %. Patients taking a loading dose of 6 grams of Vitamin C and then 1,000 mg three times a day showed an 85% decrease in flu symptoms. (31) It is important to take regular doses as Vitamin C only stays in your blood for about 30 minutes. I would recommend 1 g vitamin C like Thorne’s Buffered Vitamin C for the first six hours, and then 1 g three times daily until symptoms subside. Lower the dose if and when you get loose stools.

1.5 grams IV every 6 hours (6 grams total daily), given with hydrocortisone and thiamine was found to significantly decrease mortality and prevent progressive organ failure in patients with sepsis. In fact, patients treated with the vitamin C protocol had an 8.5% death rate compared with 40.4% in the control group! (10) Thankfully, there is currently a research trial underway to investigate vitamin C infusions for the treatment of severe 2019-nCoV infected pneumonia (11) where patients in the treatment group will receive 24 grams of Vitamin C daily for 7 days.

Elderberry has been found to prevent invasion by viruses and bacteria, alleviate cold and flu symptoms and can significantly shorten the duration of illness by two to four days. (66,67). A study found that elderberry has the ability to inhibit H1N1 infection in vitro. The authors of the study note that “the H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu).” Elderberry is highly effective against human coronavirus NL63, one of the three known coronaviruses to enter cells through the ACE2 “back door”. There has been some talk about avoiding elderberry as it may induce a cytokine storm that is associated with poorer outcomes with COVID. Elderberry does not induce cytokine storm. The source of this rumor is from a 2001 study published in the European Cytokine Network. The study was a double-blind, placebo controlled and randomized. It showed the Elderberry extracted reduced flu symptoms to 3-4 days. Convalescent phase serum showed a higher antibody level to influenza virus in the elderberry extract group, than in the control group.(68) There was no mention of a cytokine storm but within the study there was reference to the enhancement of the pro-inflammatory cytokines after taking elderberry extract that led to the quick and very effective recovery and specifically the antibody production. The study never mentioned a warning on elderberry, or caution needing to be used because of a concern of a cytokine storm being caused by elderberry. The typical dosage for kids is 1-2 teaspoons 4x/day depending on their size, and for adults 1 tablespoon 4x/day.

L-Lysine 3-6 grams per day. This is an amino acid that inhibits viral replication.

Andrographis In a randomized, double-blind, placebo-controlled clinical trial, 107 healthy children received either Andrographis tablets (200 mg per day of extract, standardized to 11.2 mg andro-grapholide) or a placebo for three months during the winter season. Only 30 percent of the children who received Andrographis got colds, while 62 percent of those on the placebo got sick. That means that the relative risk of catching a cold was 2.1 times lower for the patients receiving Andrographis.

Astragalus  Astragalus polysaccharide (APS) treatment reduced H9N2 Avian Influenza virus replication and stimulated the immune response in animal and cell-based trials. (42)

Echinacea One randomized, double-blind, placebo-controlled study involving 282 adults examined the effect of an Echinacea formulation (0.25 mg/mL alkamides, 2.5 mg/mL chicoric acid, and 25 mg/mL polysaccharides=1 unit) or placebo for seven days from cold onset. The dosage was 10 units on the first day of cold symptoms, followed by four units per day for the next seven days. Total daily symptom severity scores, recorded on a 10-point scale (0=minimum; 9=maximum), were 23.1-percent lower in the Echinacea group compared to placebo (p<0.01).(41) In another clinical trial echinacea was shown to be as effective as the antiviral drug oseltamivir (Tamiflu) for the early treatment of influenza virus infections. However, unlike oseltamivir, echinacea does not run the risk of inducing antiviral drug resistance. (69)

Traditional Chinese Medicines have been met with significant controversy and panic stockpiling when Chinese researchers claimed that a traditional herbal formula (Shuang-huang-lian made with honeysuckle, Chinese skullcap and forsythia) could inhibit 2019-nCoV in vitro. This was a premature announcement and clinical trials need to be performed. However, if we look to prior research on other coronaviruses, there are studies showing the efficacy of various Chinese herbal agents against other coronaviruses, including SARS-CoV and CHOV-22E9. (10) These herbal medicines include: Bupleurum, Heteromorpha, and Scrophularia scorodonia (11); Lycoris radiata, Artemisia annua, Pyrrosia lingua, and Lindera aggregata (12); Isatis indigotica and Torreya mucifera (13,14,15); and Houttuynia cordata (16). There was a study of Lianhua Qingwen that showed the duration of clinical symptoms decreased by 3 days, and the disappearance time of fever, fatigue and cough symptoms decreased by 1 day, 3 days and 3 days respectively. CT improvement rate increased by 19.7%; The clinical cure rate increased by 12.7%, and the treatment group decreased by 50% compared with the control group, showing a good trend in reducing the proportion of severe cases.(102)

My hope is that researchers take interest in these initial in-vitro results and consider clinical trials that could potentially find a cure in these natural agents.

In a journal article from 2014, Therapeutic interventions in sepsis: current and anticipated pharmacological agents by Shukla P, et al (12), he highlights several potential natural treatment options for sepsis that warrant further investigation including:

Curcumin has been found to inhibit NF-κB, an inflammatory agent, as well as binding of LPS. It was shown to help improve survial in a mouse model. (13)

Quercetin also inhibits the NF-κB pathyway (14), and can reduce the effects of sepsis.(15,16)

Naringin derived from citrus, also interacted with the NF-κB, reduced sepsis and effects on the lungs(17)

Bacillus sp strain LBP32 is a probiotic with extracellular polysaccharides (EPS) that can inhibit the NF-κB pathway and suppress the LPS-induced release of many pro-inflammatory mediators.(18)

Boswellia (Frankincense) can also reduce LPS-induced inflammation in sepsis. Research has found that Casperome® (Casp), a soy lecithin-based formula with frankincense extract, helped reduce sepsis-related effects on organs. (19)

Lomatium dissectum is a root that the Washoe tribe claimed helped reduce the effects of the 1918 Spanish flu.(21) Research has shown that Lomatium dissectum inhibited CXCL10 secretion by lung cells. In SARS-CoV sepsis, a chemokines called CXCL10 causes inflammation.(20) Those with severe disease Influenza A also experience CXCL10 dysregulation.

Here was another study looking at potential inhibitors of COVID-19 Main Protease (Mpro) From Several Medicinal Plant Compounds by Molecular Docking Study. You can see that quercetin and curcumin appear to be quite effective compared to lopinavir, one of the antivirals being studied for possible benefit in COVID-19. I also find interesting that Allicin is on this graph. Allicin is the active ingredient in Garlic, and many mainstream news articles are saying there is no potential benefit of taking garlic.(103)

https://www.preprints.org/manuscript/202003.0226/v1

Osteopathic Manipulation One of the doc’s I worked with in medical school David Teitelbaum, DO, was lecturing about the history of the Spanish Flu of 1917-1918.  Did you know that 6% of all people who contracted the Spanish Flu died, but only 1/4 of 1% (0.25%) of those treated with Osteopathic Manipulation died? (77,80)

Acupuncture A randomized controlled trial explored the therapeutic effect of acupuncture for abating fever of common cold. Two hundred and sixty-one patients were assigned to electroacupuncture or a control group given antondine injection. The transient effect of abating fever within 24 h was observed. After treatment, the body temperature at all observation time points in the treatment group were lower than those in the control group (p<0.01). The effect-appearing time (1.42 hours) was shorter in the treatment group than in the control group (3.44 hours, p<0.01). The cure rate and the abating fever rate were better (27.8% and 75.9%) with electroacupuncture that with the control ( 10.9% and 55.5%) (p<0.01). The researchers concluded that electroacupuncture had a definite therapeutic effect on high fever due to the common cold, and that the treatment should be taken as early as possible.(33)  In another study 57 cases of common cold, influenza, acute tonsillitis and acute bronchitis were treated by rapid needling with filiform needles at Dazhui (Du 14), Fengchi (GB 13), and Quchi (LI 11). The indices for observation were first determined, and the 19 cases that manifested an axilla temperature drop of over 1 degree C after treatment and a ratio of < 0.3 of the main symptom scores after treatment were regarded as markedly effective; the 27 cases that manifested an axilla temperature drop of 0.5-1.0 degree C and a symptom score ratio of 0.3-0.6 were regarded as effective, and the 11 cases that manifested an axilla temperature drop of < 0.5 degrees C and a symptom score ratio of > 0.7 were regarded as failures. The results showed that in nineteen of the patients (33%) the treatment was regarded as ” markedly effective”, in a further 27 patients the treatment was regarded as “effective” (48%) and only eleven patients (19%) failed to respond to the treatment . The total effective rate was therefore 80.7%.(81)

One of the key points is the “miracle” point known as the “common cold” point on the thenar eminence, in line with an imaginary line drawn down the middle of the index finger. If a cold is present, or on the way, this point will be very sore upon palpation. The “sore throat” point is perhaps one of the most dynamic on the body for seemingly miraculous elimination and lessening of pain from sore throat almost immediately. LI 4, ST 36 and SP 6 are extremely effective points for boosting the immune system and are three of the most powerful points on the body for this purpose, when used together. Caution is urged in using these points for any female who may potentially be pregnant, as LI 4 and SP 6 are classic points known to create abortion. If there is a question of pregnancy, eliminate these two points; if not, they are dynamic. These points are historically used to promote delivery in the ninth month when the contents of the uterus are expelled. TH 5 and P 6 are, without question, two of the most effective points in affecting the immune system and building vital resistance. (93)

Possible Medications that may be helpful

Chloroquine/hydroxychloroquine In 2 studies they showed that chloroquine could reduce the length of hospital stay and improve the evolution of COVID-19 pneumonia (35, 36), leading to recommend the administration of 500 mg of chloroquine twice a day in patients with mild, moderate and severe forms of COVID-19 pneumonia. A small study of 36 patients, 26 patients received hydroxychloroquine and 16 were control patients. Among hydroxychloroquine-treated patients six patients received azithromycin. At day 6 post-inclusion, 70% of hydroxychloroquine-treated patients were virologically cured comparing with 12.5% in the control group (p= 0.001). At day 6 post-inclusion, 100% of patients treated with hydroxychloroquine and azithromycin combination were virologically cured comparing with 57.1% in patients treated with hydroxychloroquine only, and 12.5% in the control group (p<0.001).(78) Of the 26 originally receiving HCQ/HCQ+AZ, 1 couldn’t tolerate the medication and had to drop out, 4 became too sick and were transferred to the ICU (for ventilation presumably) and couldn’t continue treatment, and 1 died.

If you look at the Ct (cycle threshold), which is the number of cycles to be run for the PCR test to turn positive so the LOWER the number the more virus is present. In the combo therapy group all patients had a baseline Ct value of 24, whereas 5 patients in the monotherapy arm have values <23. That means in the monotherapy group they would need a greater antiviral effect to reach “negative” or undetectable virus. In this study negative was defines as Ct>35, which typically negative is defined as Ct>40.

Eradication rates at day 6:
HCQ monotherapy (Ct <23): 1/5 (20%)
HCQ monotherapy (Ct 23+): 7/9 (78%)
HCQ + Azithro (all Ct 24+): 6/6 (100%)

So let’s all slow down before we add an antibiotic to hydroxychloraquine, based on 6 cases. We are all trying to do the best we can for our patients and I get this, but we need to stop, read, and think through all of this before we start recommend an antibiotic for a virus.

You can read more about the debate on the study here: https://forbetterscience.com/2020/03/26/chloroquine-genius-didier-raoult-to-save-the-world-from-covid-19/

Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown, some U.S. clinicians have reported anecdotally different hydroxychloroquine dosing such as: 400mg BID on day one, then daily for 5 days; 400 mg BID on day one, then 200mg BID for 4 days; 600 mg BID on day one, then 400mg daily on days 2-5.(79) Chloroquine also seems to act as a zinc ionophore, that allows extracellular zinc to enter the cell and inhibit viral RNA-dependent RNA polymerase.(82)

Disulfiram is, respectively, a noncompetitive and competitive (or mixed) inhibitor of MERS-CoV and SARS-CoV(70)

Nitazoxanide, a commercial antiprotozoal agent with an antiviral potential against a broad range of viruses including human and animal coronaviruses, inhibited the 2019-nCoV at a low-micromolar concentration (EC50 = 2.12 μM; CC50 > 35.53 μM; SI > 16.76) (71)

Remdesivir Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19.(94) Remdesivir is a novel nucleotide analogue that has activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies.(95,96)

Favipiravir A study on 80 patients comparing it to lopinavir/ritonavir found that it significantly reduced viral clearance time
to 4 days, compared to 11 days for the control group, and that 91.43% of patients had improved CT scans with few side effects.(97)

Other Experimental Treatments
Allogenic hUMSCs (human umbilical cord mesenchymal stem cells) administrated intravenously for three times (5×10^7 cells each time) on February 9, 12, and 15. During the therapy, antibiotics were given to prevent infection, and thymosin α1 was also given.(109)

Thymosin alpha-1 (TA-1) – Thymosin alpha-1 is the most recommend peptide for immune stimulation. There was a large (361 subjects), pro-
spective, multicenter, single-blind, randomized, placebo-controlled trial that showed the twenty-eight-day mortality from any cause was 26% in the Ta1-treated group, vs 35% in control group. The relative risk of death in the Ta1 group compared to control was 0.74 (95% confidence interval. There
was a 9.0% (95% CI 0.5% to 18.5%) absolute reduction in mortality in the Ta1-treated subjects.(111)

This should be used as a treatment adjuvant and a prophylactic aid that can help with may conditions beyond viral illness! Most will dose it at 450mcg daily.

Allogenic human adult bone marrow mesenchymal stem cells A study of 7 patients that before the MSC transplantation, the patients had symptoms of high fever (38.5℃ ± 0.5℃), weakness, shortness of breath, and low oxygen saturation. However, 2~4 days after transplantation, all the symptoms were disappeared in all the patients, the oxygen saturations rose to ≥ 95% at rest, without or with oxygen uptake (5 liters per minute).

For the primary outcome in the critically severe patient 1, the plasma C-reaction protein level decreased from 105.5 g/L (Jan 30) to 10.1 g/L (Feb 13), which reached the highest level of 191.0 g/L on Feb 1, indicating that the inflammation status was alleviating quickly. The oxygen saturation, without Supplementary oxygen, rose from 89% (Jan 31) to 98% (Feb 13), which indicated the pulmonary alveoli regained the air-change function. The secondary outcomes were also improved. Considering, for example, the critically severe patient 1, the lymphopenia was significantly improved after the cell transplantation. The patient was isolated in the hospital isolation ward with a history of hypertension and blood pressure reaching grade 3 hypertension. On Feb 1, biochemical indicators in the blood test showed that aspartic aminotransferase, creatine kinase activity and myoglobin increased sharply to 57 U/L, 513 U/L, and 138 ng/ml, respectively, indicating severe damage to the liver and myocardium. However, the levels of these functional biochemical indicators were decreased to normal reference values in 2~4 days after treatment. On February 13, all the indexes reached to normal levels, namely 19 U/L, 40 U/L, and 43 ng/ml, respectively. The respiratory rate was decreased to the normal range on the 4th day after MSC transplantation. Both fever and shortness of breath disappeared on the 4th day after MSCs transplantation. Chest CT imaging showed that the ground-glass opacity and pneumonia infiltration had largely reduced on the 9th day after MSC transplantation. (110)

When is it safe to go back to work/school?

The CDC has issued recommendations on discontinuation of home isolation, which include both test-based and non-test-based strategies(104,105). The choice of strategy depends upon the patient population (eg, immunocompromised versus nonimmunocompromised), the availability of testing supplies, and access to testing.

●When a test-based strategy is used, patients may discontinue home isolation when there is:

•Resolution of fever without the use of fever-reducing medications AND

•Improvement in respiratory symptoms (eg, cough, shortness of breath) AND

•Negative results of a COVID-19 test from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens)

●When a non-test-based strategy is used, patients may discontinue home isolation when the following criteria are met:

•At least seven days have passed since symptoms first appeared AND

•At least three days (72 hours) have passed since recovery of symptoms (defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms [eg, cough, shortness of breath])

In some cases, patients may have had laboratory-confirmed COVID-19, but they did not have any symptoms when they were tested. In such patients, home isolation may be discontinued when at least seven days have passed since the date of their first positive COVID-19 test so long as there was no evidence of subsequent illness. More detailed interim recommendations on home management of patients with COVID-19 can be found on the World Health Organization (WHO) and CDC websites(106-108).

Instead of panicking please stay safe, prepare and pray that:

  1. This outbreak stops
  2. Our economies will bound back
  3. People will recover quickly

As a disclaimer, I am not in any way recommending natural treatments as a replacement for standard medical care or vaccination, but until effective medical treatments or vaccination for COVID-19 are developed and approved for use in kids and adults, I will be using all the tools that I know can work for other viral respiratory illnesses, like the flu.

Keep Up to Date on the Latest COVID-19 News:

References

  1. https://jamanetwork.com/journals/jama/fullarticle/2761659
  2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext
  3. https://msphere.asm.org/content/4/5/e00474-19
  4. https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778074/
  6. https://doi.org/10.1093/ajcn/26.11.1180
  7. https://www.medrxiv.org/content/10.1101/2020.02.18.20021881v
  8. https://www.ncbi.nlm.nih.gov/pubmed/2655683
  9. https://www.scielosp.org/pdf/aiss/2012.v48n1/105-109/en
  10. https://doi.org/10.1016/j.chest.2016.11.036
  11. https://clinicaltrials.gov/ct2/show/NCT04264533
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253453/
  13. https://www.ncbi.nlm.nih.gov/pubmed/17609337
  14. https://www.ncbi.nlm.nih.gov/pubmed/15668926
  15. https://www.sciencedirect.com/science/article/abs/pii/S1756464619301203
  16. https://www.ncbi.nlm.nih.gov/pubmed/31377749
  17. https://www.ncbi.nlm.nih.gov/pubmed/21640201
  18. https://www.ncbi.nlm.nih.gov/pubmed/24201081
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921439/
  20. https://jvi.asm.org/content/81/1/416
  21. https://journal.restorativemedicine.org/index.php/journal/article/view/46
  22. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51
  23. https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1729071 
  24. https://jamanetwork.com/journals/jama/fullarticle/2762028
  25. https://www.cdc.gov/media/releases/2017/p1213-flu-death-estimate.html
  26. https://erj.ersjournals.com/content/10/7/1535.short
  27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473208/
  28. https://www.worldometers.info/coronavirus/
  29. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812681
  30. https://www.ncbi.nlm.nih.gov/pubmed/17636648
  31. https://www.ncbi.nlm.nih.gov/pubmed/10543583
  32. https://www.ncbi.nlm.nih.gov/pubmed/10929163
  33. https://www.ncbi.nlm.nih.gov/pubmed/17432639
  34. Crampton CW. Vitamin A in the treatment of colds. NY State J Med 1944;44:162-166
  35. https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01047/_article
  36. http://rs.yiigle.com/yufabiao/1182323.htm
  37. https://n.neurology.org/content/90/22/e1937
  38. https://academic.oup.com/ageing/article/46/2/245/2654230
  39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906934/
  40. https://www.ncbi.nlm.nih.gov/pubmed/20618098
  41. https://www.ncbi.nlm.nih.gov/pubmed/14748902
  42. https://jasbsci.biomedcentral.com/articles/10.1186/2049-1891-4-22
  43. https://www.vox.com/future-perfect/2020/3/12/21172040/coronavirus-covid-19-virus-charts
  44. https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/
  45. https://www.nytimes.com/2020/03/09/science/coronavirus-is-very-different-from-the-spanish-flu-of-1918-heres-how.html
  46. https://www.tagesspiegel.de/wissen/italien-kaempft-gegen-coronavirus-so-leben-die-menschen-in-der-roten-zone/25621354.html
  47. https://www.cdc.gov/flu/about/burden/2016-2017.html
  48. https://www.cdc.gov/features/rhinoviruses/index.html
  49. https://www.medicalnewstoday.com/articles/166606.php
  50. https://www.cdc.gov/flu/keyfacts.htm
  51. https://www.eurekalert.org/pub_releases/2020-02/miot-sts021020.php
  52. https://www.ncbi.nlm.nih.gov/pubmed/25386977
  53. https://www.fasebj.org/doi/abs/10.1096/fj.00-0721fje
  54. https://www.ncbi.nlm.nih.gov/pubmed/25593145
  55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243048/
  56. https://www.ncbi.nlm.nih.gov/pubmed/19273783
  57. https://www.ncbi.nlm.nih.gov/pubmed/10975787
  58. https://www.ncbi.nlm.nih.gov/pubmed/11981342
  59. https://jamanetwork.com/journals/jama/fullarticle/2749214
  60. https://www.ncbi.nlm.nih.gov/pubmed/21036571
  61. https://www.ncbi.nlm.nih.gov/pubmed/12807338
  62. https://www.ncbi.nlm.nih.gov/pubmed/10933257
  63. https://www.ncbi.nlm.nih.gov/pubmed/19262509
  64. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13615-X/fulltext
  65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629407/
  66. https://www.ncbi.nlm.nih.gov/pubmed/15080016
  67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848651/
  68. https://pubmed.ncbi.nlm.nih.gov/11399518/
  69. https://www.ncbi.nlm.nih.gov/pubmed/26265958/
  70. https://www.sciencedirect.com/science/article/pii/S0166354217306101
  71. https://www.nature.com/articles/s41422-020-0282-0
  72. https://www.evolutamente.it/covid-19-pneumonia-inflammasomes-the-melatonin-connection/
  73. https://www.theguardian.com/world/2020/mar/13/coronavirus-pandemic-visualising-the-global-crisis
  74. https://healthmetrics.heart.org/wp-content/uploads/2019/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-%E2%80%93-2019.pdf
  75. https://www.cancer.gov/about-cancer/understanding/statistics
  76. https://www.cdc.gov/nchs/fastats/accidental-injury.htm
  77. https://jaoa.org/article.aspx?articleid=2093631
  78. https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf
  79. https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html
  80. https://jaoa.org/article.aspx?articleid=2092511
  81. https://www.ncbi.nlm.nih.gov/pubmed/1291818/
  82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/
  83. https://www.bmj.com/content/bmj/356/bmj.i6583.full.pdf
  84. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124957/
  85. https://www.ncbi.nlm.nih.gov/pubmed/23440782
  86. https://www.tandfonline.com/doi/full/10.1080/07315724.2012.10720441
  87. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3686844/#!po=32.5000
  88. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537893/
  89. https://www.ncbi.nlm.nih.gov/pubmed/23340963
  90. https://www.ncbi.nlm.nih.gov/pubmed/24563519
  91. https://www.ncbi.nlm.nih.gov/pubmed/19145994
  92. https://www.ecampnd.com/homeopathy/A_Chorus_of_Fifty_in_Harmony.pdf
  93. https://www.acupuncturetoday.com/mpacms/at/
  94. https://www.gilead.com/news-and-press/company-statements/gilead-sciences-statement-on-the-company-ongoing-response-to-the-2019-new-coronavirus
  95. https://www.ncbi.nlm.nih.gov/pubmed/28659436
  96. https://www.ncbi.nlm.nih.gov/pubmed/32020029
  97. https://www.sciencedirect.com/science/article/pii/S2095809920300631
  98. https://www.ncbi.nlm.nih.gov/pubmed/19667296
  99. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414701
  100. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560336/
  101. https://pediatrics.aappublications.org/content/124/2/e172
  102. https://apnews.com/ACCESSWIRE/b95a50ede1b77fa90388b870803d8872
  103. https://www.preprints.org/manuscript/202003.0226/v1
  104. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
  105. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ending-isolation.html
  106. https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
  107. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html
  108. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html
  109. http://www.chinaxiv.org/abs/202002.00084
  110. http://www.aginganddisease.org/article/0000/2152-5250/ad-0-0-216.shtml
  111. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056079/

Privacy Policy