There is so much information spreading about COVID-19, that I thought it important to share what I know with my readers.

Likely everyone has heard about the new coronavirus infection, COVID-19.

Unfortunately, misinformation is being shared by both on-line sources and our country’s top administration.

As nearly everyone knows, COVID-19 has spread worldwide and has reached pandemic proportions. COVID-19 is highly contagious and projected to be several times more deadly than influenza (the flu), and the flu kills 500,000 people worldwide annually.

One of the reasons the COVID-19 virus is thought to be far more deadly than the influenza virus is that most people have at some point been exposed to influenza, giving them some immunity and internal ability to fight it. Nobody has been previously exposed to COVID-19, so we have no internal immunity to this virus.

There are hundreds of coronaviruses, including the common cold and more serious forms, in particular, SARS (which emerged in 2002) and MERS (which emerged in 2012). The trend appears that a new and dangerous coronavirus appears about every decade. What makes COVID-19 unique is that with SARS and MERS, people became very sick almost immediately, which limited the spread of the disease, often either incapacitating or killing their victims before they could spread it in the community.

In contrast with COVID-19, many people who are infected have few or no symptoms during the first 5 days of the infection while they are highly infectious, allowing the virus to be spread before you know that you have it.  People can be infectious for up to 14 days.

This is why people who have been exposed to someone with the virus are being put in quarantine for 14 days to see if they develop the illness, and people who test positive are being isolated for a minimum of 14 days.

According to the World Health Organization (WHO), about 80% of cases are mild. Symptoms include a fever, cough, and fatigue and can be strong to almost none.  At least 15% of infections progress to pneumonia, causing major shortness of breath, fatigue, fever, and low levels of blood oxygen saturation, which may require hospitalization. Currently, about 3.5% of cases result in death.

Fortunately, unlike influenza, most children seem to have a mild form of this infection. Like influenza, the elderly and those with heart, lung, and immune deficiencies are the ones who develop severe infections. Although, there are several reports of healthy 40- to 50- year olds who have died from this disease, so clearly none of us should ignore that rare possibility and ignore the seriousness of this illness.

As this is a new virus, we currently have no proven vaccines to prevent it, or therapies to treat it. It will likely take at least 1-2 years to develop vaccines and therapies, although every effort will be taken to shorten their release. An example of a promising new therapy is Remdesivir, an investigational antiviral drug being developed and tested in patients with COVID-19.  Unfortunately, vaccines and therapies that are released early in a rush will lack traditional safety testing and may be less effective and cause more adverse events.

For serious cases, the only proven treatments that we have are supportive, meaning: hydration, oxygen, and sometimes intensive hospital care, in the most serious cases including intubation and mechanical breathing.

The big concern is that if too many people become sick at once and health care providers also become ill, we will overwhelm our ability to provide supportive care and people who would have normally survived will die.

This means health officials want the number of cases to occur gradually over time, not spike all at once as has happened in Wuhan, China, South Korea, and northern Italy, overwhelming the hospital and medical care systems.

This is why you are seeing public events being canceled and schools being closed. Health officials are trying to slow the spread of the rapidly proliferating disease.

Even though children usually have milder cases, they remain an important vector (carriers) of this infection.  Closing schools and preventing them from getting infected in mass is a very effective strategy to stop the spread of the infection in a community. Again, the goal is to slow the spread of the disease so that our hospital and medical providers are not overwhelmed.

COVID-19 is tested by using nasal swabs and throat swabs. It takes about 2-3 days to get a result after testing.

What has made the spread of this infection far worse in the US than it should be has been the lack of testing. Other countries have been testing thousands of people daily, while our ability to do testing has been extremely limited.

I have spoken to many physicians this week who have tried to test patients for COVID-19 but were told that testing kits were not available. Even today in Florida, my neighbor who has had a fever, cough, shortness of breath and fatigue for one week and feels worse was denied testing when she went to her clinic.

The disease is now spreading through the US community rapidly, making planning and tracking very difficult. Hopefully, we will catch up soon, but the initial delay in this country has hampered our ability to control the proliferation greatly.

This virus is spread in large droplets by infected people who are coughing and sneezing. These droplets fall to the ground and other surfaces fairly quickly, within a 3-6 foot distance. It is also spread by infected people touching surfaces with hands that have been coughed on. This means that the air will not infect you, but all the surfaces where these droplets land are infectious for about 7 days – every surface that is associated with infected people will be contaminated and potentially infectious.

The most likely way to get infected in public is to touch a contaminated surface and then touch your nose or mouth. Thus, public spread occurs mainly through surface contact, and being coughed on most likely occurs while in close contact with family or friends.

This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

To compensate for the initial rapid spread and the highly contagious potential of this infection, for the short term all of us need to take steps to help prevent this life-threatening disease, especially as you could be infected, spreading it, and not know for several days.

HOW TO LIMIT THE SPREAD OF COVID-19:

1. NO HANDSHAKING OR HUGS! Use an elbow bump or foot tap instead.
2. Avoid touching your face with your hands, especially when in public.
3. In public places, open doors with your elbow, closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door.
4. Do not allow yourself to be nutritionally deficient. People with low levels of vitamin D and zinc have depressed immune function and are more likely to get ill and will have more severe infection than people without a deficiency.
   • Be sure to get at least 2000 IU of vitamin D every day with your supplement routine.
   • Take a good quality multivitamin with at least 250 mg of vitamin C and 15 mg of zinc daily.
   • Eat cold-water seafood 3 times per week or take a good quality fish oil supplement daily.
5. Use disinfectant wipes when they are available, including wiping the handle and child seat in grocery carts.
6. Before you eat or touch your face after having been in public, wash your hands with soap for 20 seconds and/or use a greater than 60% alcohol-based hand sanitizer
   • Similarly, wash your hands whenever you make contact with a door or handrail in public.
   • When you return home from ANY public outing, wash your hands and/or use an alcohol-based hand sanitizer before touching surfaces in your home.
7. Keep a bottle of sanitizer available at each of your home’s entrances and in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
8. If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you do not have a tissue; the clothing on your elbow will contain an infectious virus that can be passed on for up to seven days. By all means do not cough or sneeze without covering your mouth to limit the spread.
9. Avoid large gatherings: sporting or public events where people are close together. When you are in public places, avoid crowding together try to maintain some social distance (at least 3 feet and preferably 6 feet) when feasible. Likewise, for the near future, minimize inviting friends or family over for parties and other large events.
10. As the elderly are especially prone to severe, life-threatening infections, people over 70 years of age and/or those with lung, heart, or immune-deficiency health issues should isolate themselves as much as possible for the near future.
11. If you are going to have contact with public surfaces, consider wearing latex gloves.
12. If you have the option to work from home, do so.
13. What about wearing a mask to prevent an infection?
    • If someone coughs on you, wearing a typical surgical mask will not prevent the virus from passing through the mask into the air you breathe. (There are N-95 masks that limit small particles and exclude a virus, but these are in very short supply even for medical providers caring for severely infected patients.)
    • Wearing a surgical mask will help to prevent you from touching your nose and/or mouth (We touch our nose/mouth 50-100 times per day without knowing it!). This is the only way this virus can infect you – it is lung-specific. Since the mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep you from touching your nose or mouth.
    • Wearing a surgical mask will also help prevent the spread of the virus in case you become infected, especially if you do not yet know that you are infected and are spreading the disease.

WHAT TO DO IF YOU GET SICK WITH COLD SYMPTOMS:

Many of us are going to get sick with cold-like symptoms over the next few months as the common cold and influenza are also spreading through the community. Without testing, you will not know if you have a minor cold, the flu, or a COVID-19 infection.

1. Stay home, avoid contact with others, and disinfect the area around you (doorknobs, counters, anything that you and others might touch).
2. As feasible, stay at least 6 feet away from other people as when you cough or sneeze the virus becomes airborne. Cover your mouth with a Kleenex as able with coughing or sneezing.
3. Call your medical provider’s office to see if testing is available in your area and to clarify your symptoms. (Hard-hit areas like Western Washington are getting testing kits first.) Testing options will vary by region.
   • Especially if your symptoms are more than mild, or if you are getting worse over time, ask your doctor what testing is available, and I suggest that you ask for testing for influenza and COVID-19. Many people are also getting the flu, which can have similar symptoms, and rarely you could have both, which likely would make you at higher risk for a severe infection.
   • The worse your symptoms, the more important that you get tested, just in case your symptoms continue to worsen over time.
   • Do not just show up at the doctor’s office or the emergency room unless you have serious symptoms as you put yourself at risk to infect yourself from COVID-19 infected people at medical facilities.
   • Again, 80% of infections will be mild and do not require medical therapy, so until testing is available, if you think you might have COVID-19, take preventative measures to avoid infecting other people.
4. Irrigate your nose with nasal saline. It is very soothing to your tissues and helps reduce congestion.
5. Get adequate sleep and rest, hydrate, and avoid using excess alcohol which can depress your immune function. If you smoke, stop smoking as it decreases your lung function and puts you at much higher risk for pneumonia.

WHAT IF YOU TEST POSITIVE FOR COVID-19?

1. Follow your medical provider and public health department advice regarding treatment and recommendations.
2. Stay at home and avoid exposing others to the disease for at least 14 days.
3. Wear a mask to decrease the spread of the infection. Masks block you from spreading the large droplets into the air that carry the virus. Ideally, everyone would have masks at home, yet the problem is that masks are in very short supply and are being rationed for medical care settings.
4. Use hand sanitizers to keep your hands from spreading the infection to others.
5. Regarding natural products, ask your doctor about using zinc gluconate lozenges.
   • In updates shared by molecular biologists that have studied the coronavirus for decades, zinc lozenges have been proven to be effective in blocking coronavirus (and several other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx.
   • There are many brands available, and compounds made with zinc gluconate appear to be the most effective. However, we do not know if any of these are effective for COVID-19.
   • In excess, zinc lozenges can cause nausea.
6. Similarly, ask your doctor about taking vitamin C at 3 to 5 grams daily during an acute infection. It is unclear if this treatment will help shorten the duration and severity of COVID-19 infections, but it appears to have some benefit in limiting the severity of other coronavirus infections. Taking vitamin C in high doses has not been shown to prevent corona infections.
7. Elderberry extract and anti-inflammatory compounds are being considered to limit the severity of the COVID-19 symptoms. In the future, natural anti-inflammatory compounds, such as curcumin, boswellia, and quercetin may be found to help with severity, but for now are unproven remedies.

FINAL NOTE:

I pray that this pandemic will be reasonably contained without overwhelming our health care systems. I sincerely hope that you will be able to say that my recommendations were excessive, but personally I do not think this will be the case, as of right now the numbers of infections are increasing rapidly nationwide and will very likely continue over the next several months.

Later, all of us will be glad that we did our best to help prevent the spread of this infection that currently lacks a vaccine or curative treatment.

I wish that you, your family, and your friends remain well over the next few months.

Steven Masley, MD, FAHA, FACN, CNS