Navigating COVID-19 (and the next rogue virus that comes to the United States)
COVID-19 isn’t the first deadly virus to come to the United States in the last 15-20 years. Starting with SARS (2003) , we have had H1N1 (2009) MERS (2012), Ebola (2016) and now COVID-19 (2020). Fortunately, we didn’t see community spread with the others, so they didn’t have the devastating impact to our economy and to the families who lost loved ones. And it is likely that COVID-19 is not the last of the “new” highly contagious viruses to hit our shores that threaten our health and the very foundation of our society. The question is what can we do about it? What can we do to help ensure that any one of us is in the 86% of the population that gets infected with COVID-19 but are asymptomatic or mildly symptomatic? The answer is we have to focus on our immune health.
Understanding Immune Health – macro level
To keep this blog short and readable, let’s work with an oversimplified view of the immune system. The immune system is basically comprised of groups of cells called Th1 cells, Th2 cells, Th17 cells and Treg cells. A properly functioning immune system keeps all of these in proper balance. Th1 cells focus on viral and bacterial infections, Th2 cells produce antibodies, Th17 cells are a subset of pro-inflammatory T Helper cells that play an important role in maintaining mucosal barriers and contributing to pathogen clearance. Treg cells promote immune harmony and prevent the body from attacking itself with immune response.
Immunoglobulins play a key role in the body’s immune system. They are proteins produced by specific immune cells called plasma cells in response to bacteria, viruses, and other microorganisms as well as exposures to other substances that are recognized by the body as “non-self” harmful antigens.
Immunoglobulin G (IgG), the most abundant type of antibody, is found in all body fluids and protects against bacterial and viral infections. Immunoglobulin M (IgM), which is found mainly in the blood and lymph fluid, is the first antibody to be made by the body to fight a new infection. So, think of IgG as the “memory” of the immune system and think of IgM as being on the front line of any new infection that you haven’t had before. And Immunoglobulin A is mainly present in body secretions and is the chief antibody in the mucous membranes of the gastrointestinal and respiratory tract and in saliva and tears.
Measuring your levels
If you have been following Chris Cuomo (brother of New York Gov. Andrew Cuomo), you aware that he has been battling a case of COVID-19 that has dealt him more than minor symptoms, but he remains at home and not in a hospital. He has admitted to having an IgM deficiency and that deficiency has likely contributed to his illness being more severe than most. I feel that everyone needs to know the status of their immune health just as we know our glucose levels, blood pressure, lipid panel and numerous other primary health measures.
There are two tests that will help to understand the state of your immune system. The first one is Immunoglobulin G, Subclasses (1-4). The second test that we use to assess immune health is the Immunoglobulins, Quantitative, IgA, IgG, IgM test. This test tells us the levels of IgA, IgG and IgM in the body. Again, a healthy immune system will have the optimal levels of all three of these immunoglobulins. Higher levels can be problematic as well as low levels, but most people are concerned with low levels for basic immune health. In Chris’ case, he apparently has a historically low level of IgM, which is the immunoglobulin on the front line of combating a viral infection.
Why it matters – understanding the viral disease process
Again, this section will be an oversimplification. First, let’s understand that with respect to the present coronavirus (COVID-19), 86% of the population that gets the disease is either asymptomatic or mildly symptomatic. It is the 14% that need hospitalization that are the issue. Even a large portion of the hospitalized only need supportive therapies and they are discharged without the need for intensive care. The reported death rate at this point is somewhere in the range of 3-4% but this is inflated due to the lack of testing. Once we have a significant portion of the population tested, I suspect the death rate will be well less than 1%, a bit higher than the yearly standard flu virus.
What basically happens is this. You come in contact with the virus on your hands or by direct contact with an orifice like your eyes, nose or mouth. The virus cannot get through your skin, so this is why handwashing is so important. If the virus gets on your hands and you wash and/or sanitize them properly, then the virus will not get to make the move into your eyes, nose or mouth. Presuming that the virus does find its way to your eyes, nose or mouth, then the infection process begins.
Infections are dealt with both by our smart “adaptive immune system” and by our innate (not so smart) immune system. The adaptive immune system uses very targeted actions to rid the body of foreign antigens but the innate immune system in many cases does as much harm as it does good as it uses far less precise measures. Think of the adaptive immune system as a highly trained sniper that can take out a target at 500 yards with no collateral damage. Then think of the innate immune system as a blind-folded person with a gun wildly shooting at a presumed target.
At the start of an infiltration by a foreign antigen (COVID-19 in this case), there is a component of the adaptive immune system that does “antigen presentation”. This is where the body recognizes that there is a foreign antigen present and from there, the remainder of the body’s adaptive immune system has its attention directed to defeat the foreign antigen. The process of identifying and defeating may take from hours to days to short weeks depending on the particular virus and the health of your immune system. In the meantime, the virus attempts to replicate and infect more and more cells. A healthy immune system will act to slow or even prevent the replication so that you are infected yes, but you don’t have enough infected cells to get really sick. You may have some mild symptoms, but heavy symptoms come with significant replication of the virus in your body, perhaps supported by some medications as was discussed in our earlier message about ACE inhibitors and Angiotensin Receptor Blockers. The other thing that happens is that the primary or innate immune system gets involved using its preferred method of intervention being the use of pro-inflammatory cytokines which produce inflammation. In many cases, the inflammatory response causes the more severe respiratory symptoms than the disease itself.
Now, returning to the hours to days to weeks that it may take the adaptive immune system to develop a targeted plan to destroy the foreign antigen. A strong immune system will do this faster and more accurately and while doing it will keep replication of the virus to a minimum. Accordingly, this patient doesn’t get sick and becomes part of what is now being called “herd immunity”. The patient with the weak immune system gets sick because the virus replicates quickly and the innate immune system inflammatory response actually increases the issues that have to be managed in a hospitalized setting.
Optimizing your immune system
From the start of the present outbreak, I have been advocating several strategies to help increase immune health. Here, I will outline a number of lifestyle modifications as well as nutritional supplements and medications that all work to enhance the immune system. Some may help specifically with COVID-19 but know that COVID-19 is too new for studies to be published that are directly on point.
• Growth Hormone Releasing Hormone (Sermorelin, CJC1295, Ipamorelin). The role of growth hormone in immune function is well documented in medical science. See (3) in the definitions section below for more details. The mentioned peptides, Sermorelin, CJC1295 and Ipamorelin all help your body to make more GH. Typically we have used these medications to help with weight loss and for patients with very low IGF-1 (a measure of GH) levels.
• Thymosin Alpha I (TA1). Thymosin Alpha 1 (Ta1) is a therapeutic peptide that has been shown, in over 70 clinical studies to improve the human immune response to multiple strains of viruses, including SARS, HIV, hepatitis B and C. Ta1 supports both the adaptive and innate immune systems by:
o Modulating anti-viral cytokine production
o Promoting T-cell maturation and differentiation
o Upregulating MHC Class 1 expression
o Inhibiting viral replication
• Vitamin C, both oral and periodic High Dose C IV (HDC). The case for vitamin C gets stronger and stronger. Recently, it was reported that three U.S. hospitals have adopted the use of HDC for COVID-19 patients and it has proven to lessen severity of the disease. The Chinese has adopted the use of HDC as “standard of care” for COVID-19 patients so there is an increasing body of evidence showing the effectiveness of HDC and even oral C. We recommend that patients consider quarterly HDC in addition to taking daily oral C to bowel tolerance (typically 2000-3000 mg daily).
• Phosphatidylcholine IV (PC). Studies have shown that PC works to inhibit pro-inflammatory signaling. Recall that a large part of what causes patients to become sick from COVID-19 is the excess pro-inflammatory signaling from the innate immune system. PC inhibits this proi-nflammatory signaling and accordingly may help to make COVID-19 infections less severe. Besides, PC has numerous other benefits for CIRS, Lyme and other chronically ill patients, especially patients with neurological impact (foggy brain). We recommend that chronically ill patients consider periodic PC IV’s to gain the benefits and the possible reduction of impact from any infection.
• Glutathione, by IV push and oral for continued support (oral should be liposomal formulation). Glutathione is a master antioxidant and helps to strengthen immune function in general. Get it by IV push with any of our IV’s or by taking liposomal glutathione.
• N-Acetyl Cysteine (NAC). It is an amino acid that is a precursor to glutathione, meaning that you need NAC to make glutathione. NAC is a well-documented immune booster.
• Zinc. Zinc is well-documented as a mineral that prevents replication of many viruses including coronaviruses.
• Quercetin. Quercetin is a nutraceutical product with anti-inflammatory and anti-histamine properties so it is clinically useful in treating allergies, mast cell activation disorder and a host of other illnesses. But studies also show that Quercetin inhibits replication and reduces viral load of coronaviruses specifically. Here are references to a study.
• Transfer Factors specifically Researched Nutritionals Multi-Immune. Transfer factors leverage the robust immune systems of chickens to create a way to boost the immune system of humans. Specifically Transfer Factors increase natural killer cells and promote a stronger Th1 immune response. In clinical studies, Transfer factors increased natural killer cells from 235% to over 600% depending on dosing. Recommended for all but especially for patients at high-risk (CIRS/Lyme, patients with low IgG immune test results, etc.)
• Exercise. Exercise is also well-documented as an immune booster. It doesn’t take a lot but 15-20 minutes of resistance-based exercise will go a long way to boost anyone’s immune system. This is recommended for all patients.
• Reduce stress. Nothing new here as most of us know that stress reduces immune function. Now, more than ever, find a way through reading, medication, yoga, etc. to reduce stress in your life.
• Quality sleep. This is another one that goes without saying. 7-8 hours of quality sleep improves immune function in many ways. With less stress, working from home, which saves time, we should be able to find a way to get in more quality sleep.
• Infrared sauna. By supporting detoxification, many patients benefit from infrared sauna therapy. If you have access to one, use it. If you are considering purchasing one, we can provide some guidance. Many of our Bredesen patients have seen major improvement when infrared sauna therapy was added.
What do you need to do?
Depending on your risk level, that should determine your urgency. If you are a high-risk patient as defined below, or you travel for work, or you work with the public, then you need to urgently implement strategies to strengthen your immune system. The CDC defines high-risk patients as below:
(1) Over 65
(2) Chronic lung disease
(4) Severe heart disease
(5) Immunocompromised (CIRS/Lyme, others with chronic illness or low immune function from testing)
(8) Kidney or liver disease
I hope that you find this message to be informative and useful as we navigate the next chapter of COVID-19. Please feel free to contact us at (703) 822-5003 if you are ready to have your immune system evaluated or want to optimize your immune heath.