COVID-19

Evidence for the Functional Treatment of COVID-19

By Kim Crawford, M.D. Last updated: August 27, 2020
Treatment of COVID-19

Functional Medicine Treatment of COVID-19

At the time of this writing- right after the junction of Passover and Easter, we are all doing our best to “social distance” and the curve is about to flatten any day now-at least in New York. I’ll update this article when something looks to be outdated or even inaccurate. This article is a reflection of what I do as a Functional Medicine Internist with a background in basic research (the Wistar Institute at the University of Pennsylvania) and many years in clinical practice; including over 15 years doing functional or “root-cause” medicine.

The supplements and anti-virals in this article should be discussed with your doctor prior to taking them on your own. The treatment of COVID-19 is evolving week to week and as with all things in medicine-some of the recommendations may not “hold up” under the scrutiny of time. And now, before we discuss the treatment of COVID-19, lets review some of the basics for everyone. (N.B.:publication pre professional editing).

This blog has been updated on 4-24-20. Re-updated 5-8-20. Brief re-update 5-15-20. Update 8-26-20.

Quick Review of Terms

  • COVID-19 is the name of the illness.
  • SARS-CoV-2 is the new or “novel” coronavirus causing the disease COVID-19.
Topics:
  • Routes of transmission
  • Risk factors
  • Symptoms
  • Prevention basics
  • Lifestyle strategies for optimal immune health
  • Supplements for immune support
  • Anti-viral products
  • Pharmaceutical treatment
  • Specifics of my prophylaxis and treatment protocols
Routes of Transmission

COVID-19 is transmitted via what are called respiratory droplets which (as of 4-9-20) may or may not (but probably does) include aerosolization through talking or exhalation. 5-8-20 update: Data from Chinese hospitals indicate that virus is found in aerosols.5-15-20 update: Well-done study finds that the virus is detected in aerosols from speaking after as long as 14 minutes. We also know that it’s transmitted via hand-to-face touching and via contact with contaminated surfaces like furniture, cardboard boxes and clothing.  Fecal shedding also has been demonstrated from some patients.

The CDC website has many details about which surfaces harbor the virus for longer periods of time than others and has a list of acceptable cleaning solutions and much more. We’ll touch on all of that, but the focus of this article is the functional treatment of COVID-19 after exposure or appearance of symptoms. Effective prophylaxis will be included in these recommendations as well. Let’s start with the risk factors.

Risk Factors for the Coronavirus

No one is immune. It appears that children are more apt to have asymptomatic or minor-symptom cases of this virus. However, there have been reported deaths in all age groups. It is well know that being over 65, having underlying medical conditions such as diabetes, pulmonary disease or being a smoker puts you in a higher risk group. Vaping appears to be a risk factor for illness and pulmonary complications, too. Being male seems to portend a worse outcome but we don’t yet know if that is simply due to smoking statistics or to something else. 5-8-20 update: The presence of testosterone and/or absence of “high enough” levels of estrogen and progesterone are being studied.

4-24-20 update: Data shows that by the time we recorded our first U.S. case, there may have been 10,000 cases! It may have been circulating in NYC and on the west coast as early as January. The good news is that brings down  the “death  toll” from this virus. 5-8-20 update: Epidemiological studies are looking into whether or not the virus was circulating as early as mid to late November, 2019.

The random antibody testing done in NYC also supports an increased  incidence/prevalence and a lower death toll; down to .5%, making this highly infectious disease “only” five times more lethal than the HINI flu. Please don’t be complacent about this lowering of the chance of fatalities, even in light of new NYC data showing  that 95% of those who died had pre-existing conditions. Remember that obesity is now considered a pre-existing condition and  no one needs to be reminded about how prevalent that condition  is.

It is therefore time to take “healthy eating” very very seriously. This is also the time to switch to nicotine gum or “the patch” if there ever was. I suspect that we’ll find “hidden” risk factors which are generally not taken into account by “non-functional doctors” such as leaky gut (inflammation), but we don’t have any data on that sort of thing yet. Suffice it to say that the more you clean up your lifestyle to support your immune system, the better off you’ll be. We’ll dive right into that in the lifestyle section coming up soon. First, let’s review the symptoms.

Symptoms

When first symptomatic, COVID-19 mimics the “regular” flu, with a headache, cough, fatigue, and muscle aches and a generally higher fever than a typical flu. Reports show that it sometimes starts or is accompanied by chest pain which is heart inflammation or myocarditis. Sometimes gastrointestinal symptoms such as abdominal pain and diarrhea are the primary or accompanying symptoms. Now- we are seeing some cases of brain involvement called encephalitis. The more severe pulmonary symptoms with onset of lung congestion tends to happen during week two-and I’ll have more to say about that in the “treatment” section.  But –please do remember that this disease can occur with no symptoms (at least 25% and up to 50%)  and most importantly, these asymptomatic patients can easily spread the disease. This is why it is imperative that we test, test, test- a lot more than we are doing right now.

5-8-20 update: The CDC has added chills, shaking chills, muscle pain, headache, sore throat, and new loss of taste or smell to the official list of original symptoms. The newly reported phenomenon of “COVID toes” has not been added, but is thought to be due to coagulation issues either during or just after infection. Thus far, this has not been a serious complication.

Basic Prevention Strategies

Wash your hands for at least 20 seconds with soap and water after leaving your home, using the bathroom, having any social interactions or touching common surface areas. This now includes touching cardboard boxes which are delivered and not sprayed down thoroughly with an accepted spray (to be discussed) or simply left outside for 24 hours. Some hand sanitizers are 70% alcohol and can substitute for soap, but hands need to be cleaned (meaning no visible dirt) first and then sanitizer contact needs to be maintained for 30 seconds.

Note that the soap you use doesn’t need to be anti-bacterial or in any way “special” other than having an ability to make a visible foam. Why? This coronavirus is very fragile; being protected only by a thin layer of fat.  The foam you create while “soaping up” is what cuts through the fat and kills the virus. Hot water allows for a “heat killing” effect while creating more foam; so use hot water for best viral-killing results. The fat layer is dissolved with 65% or greater alcohol solutions as well.

You know the rules about social distancing; but here are the basics. No crowds, no shaking hands and 6 feet of space between you and others when walking outside or grocery shopping. Avoid touching your eyes, nose, and mouth with unwashed hands, because contaminated hands can transfer virus to these areas and make you sick. This coronavirus does not penetrate the skin. It is prudent to wear some sort of face covering which yes, mostly protects others but also protects you to a small extent.

Clean counter-tops when you bring in items from shipments or the grocery store. Use one large counter-top where you put a masking tape dividing line for clean versus possibly contaminated products.

The following cleansers will kill most viruses, including corona viruses, with 30 seconds of contact: 70% alcohol, 0.5 % hydrogen peroxide and 0.1 % bleach (hypochloric acid).

Basic Lifestyle Strategies for Immune Health

Diet: Now more than ever, you want to eat an anti-inflammatory diet. I’ll email you what I give to patients if you contact me. You want to eliminate things that cause inflammation or leaky gut. To keep it simple-mainly watch sugar, starchy carbs and lectins. The more microbiome-damaging lectins are gluten, high-lectin grains, beans and low-fat dairy.  Immune-boosting foods include garlic and hot peppers, horseradish and wasabi. Garlic is actually a bit anti-viral.  A very important component to your diet is what you eat to support the health of your microbiome. Microbiome health=immune health; we’ll cover that next.

Microbiome Health
The human microbiome is made up of 10–100 trillion symbiotic microbial cells with unique genes, principally from bacteria (and some yeast) in the gut. Our “bad” or unhealthy gut bacteria, of which we have up to ten times more than human cells, thrive on the things that create inflammation in our body, including sugar, refined carbs, unhealthy fats, and processed foods (to name the biggest offenders.) We want to eat good prebiotic food as “fertilizer” for probiotics.

Prebiotic fiber:   Prebiotic fiber is comprised of non-digestible carbohydrate compounds found in fibrous foods that assist in the growth of healthy bacteria in the gut. Foods, spices, and supplements high in polyphenols appear to promote gut diversity. Hazelnuts, berries, dark chocolate, and cloves, along with red onions and artichokes, are good sources of polyphenols. White and even better-red onion as well as chicory, garlic, asparagus, unripe banana and artichoke-especially jerusalem artichoke are great “gut food.” They are all thought to assist gut health by producing healthy-gut-bug-food such as butyrate.

Speaking of butyrate production, cook with either ghee or MCT oil to “max this out.” Eat lots of mushrooms which play a role in supporting your GI tract lining and boosting your immune system. More about mushrooms to come. Here’s a cooking tip from someone who is not a “cook”: we stir up the following as a veggie-topper- MCT oil-add a clove of crushed garlic, sliced red onions, and some portobello mushrooms.

Probiotics: Good quality yoghurt, kefir (preferably home-made) and fermented foods supply a fair amount, but I generally supplement everyone. We are just starting to see evidence that sporulating probiotics appear to be a bit more immune-supporting. Let’s keep an eye on this data. Meanwhile, I’m taking them, in case you want to know.

Stress Management

Stress depresses the immune system. It does this via several mechanisms. First; sustained high cortisol levels cause gut hyper-permeability AKA “; leaky gut” which causes inflammation and “more.” Cortisol also interferes with T-cell (a type of white cell) production and function, making your body more susceptible to pathogens like viruses. This is why you might notice that you get more colds when you are under stress. It is indeed a stressful time. Easy things to make sure you are managing your stress include regular “safe distancing” outdoor exercise, deep breathing (good for stress and your lungs) and-don’t forget- it’s easy to activate the vagal (relaxation) nerve by singing and even gargling. Some people also benefit from liposomal GABA supplements. And of course, part of all of this is getting adequate, restful sleep.

Supplements to support the immune system

Multivitamin supplements

You want to make sure you are either “juicing veggies” which would be difficult; given our circumstances, or taking good oral vitamin supplements, high in antioxidants; especially vitamin A. Most good supplements also contain iodine which is also needed for proper immune system function. Vitamin C is another story-you need more of that then you get in a multi-vitamin. We’ll discuss that in the “anti-virals” section.

Reishi mushroom extract

All types of mushrooms contain natural polysaccharides called beta-glucans in their cell walls. Beta-glucans ramp up the immune system via several mechanisms, such as enhancing macrophages (a protective white blood cell that kills certain foreign invaders), activating  what is called the “complement” component of the immune system, and boosting natural killer (NK) cell function. This is why I’m recommending that they are an integral part of your diet; especially now. And there is an especially “active” species of mushrooms called ganoderma lucidum or reishi mushrooms. They are not especially tasty, but are used to formulate potent immune enhancing supplements.

Reishi mushrooms possess numerous immune stimulating properties and are also quite anti-inflammatory. Reishi has a demonstrably positive effect on NK cell activity. It stimulates the aforementioned macrophage activity, increases T cell activity and is markedly superior to other mushrooms in terms of it’s immune-enhancing properties.

DHEA

The intermediary hormone, DHEA is well known to positively impact adrenal function and therefore cortisol levels. It has demonstrable anti-inflammatory properties and is most likely immune-supporting and even enhancing via several complex hormonal pathways.

Vitamin D

Vitamin D is well-known for its role in calcium homeostasis and bone growth, but is also well-studied for its anti-inflammatory properties. Vitamin D is also noted to be anti-cancer, anti-autoimmune disease and anti-heart disease. What you might not know is that vitamin D is needed for a properly functioning immune system.

Within the immune system, vitamin D inhibits negative immune pathways and promotes positive ones. It also positively impacts the composition of the microbiome and the gut barrier. As one small example, a study in Japan showed that children taking 1,200 units of vitamin D per day during the winter time reduced their risk of getting influenza-A-infection by approximately 40 percent. 8-26-20: Clinical studies show low vitamin D levels are a risk factor for coronavirus infection.

Melatonin

Melatonin is a powerful  anti-oxidant and an anti-inflammatory; not just something you take to help you sleep.  It has been studied and found to block what are called inflammasomes; which are part of our innate immune system. Once the coronavirus enters our cells, we can measure inflammasomes in the blood. These inflammasomes end up facilitating the release of all sorts of inflammatory cytokines which I’ll discuss in more detail at the end of this article. Suffice it to say that blocking the level of inflammasomes would (theoretically) be a good thing. And yes, there’s evidence of this in animal studies.

In one study, referenced below; an animal model of acute lung injury, melatonin markedly reduced lung damage by inhibiting the inflammasome response. When melatonin is given to experimental mice with severe heart infection issues, it transforms the life-threatening condition into a milder one and improves the chances of survival of the mice.

In rodent models of acute respiratory distress syndrome similar to the ARDS (acute respiratory distress syndrome)  caused by coronaviruses, melatonin significantly slowed down the progression of lung damage. Finally, a study, done in 2020 demonstrates melatonin’s benefit in sepsis (severe, life-threatening infection).

When we’re discussing the use of potentially dangerous drugs, it seems like a no-brainer to me to add some harmless melatonin into the mix. There’s a good reason that the “expanded” use of melatonin won it’s scientists the 2017 Nobel Prize in “physiology or medicine.” And yes, I’ll discuss all  dosing issues in the dosing section. Now let’s discuss supplements which are clearly anti-viral.

Specifically Anti-viral supplements and products

Zinc

Zinc is a well known potent anti-viral mineral which helps our bodies slow the replication of invading viruses. Zinc has been tested and shown to have anti-viral activity against many viruses; even some coronaviruses; although it is not yet tested on the novel coronavirus. 8-26-20:RNA-dependent RNA polymerase — the enzyme critical for the reproduction of RNA viruses such as SARS-CoV-2 has been found to be blocked by zinc.

Zinc has been shown to help shorten the duration of the common cold (typically a rhinovirus but sometimes a coronavirus) if it is taken early on, in a sufficient dose.  When taking long term zinc supplementation, check to make sure you have enough dietary or supplemental copper “on board.”

It is well know that zinc deficiency causes  a decreased sense of smell. Recent reports list “loss of sense of smell” as a new and definite symptom to add to our list of COVID-19 symptoms.

Quercetin

This entry is made on 8-26-20, with data on quercetin and the addition of this product to my protocol. Zinc is transported into cells by the ionophore-quercetin, found in large amounts in capers and lesser amounts in red onions. A randomized controlled trial involving over 1,000 people indicated that supplementation with 1,000 milligrams of quercetin per day for 12 weeks was associated with a reduction in the rate and severity of upper respiratory tract infections in individuals over 40.

Vitamin C

For some reason what the Chinese doctors in Wuhan used to combat the coronavirus is not well publicized. When innundated with sick patients at their hospitals, Chinese doctors were quick to use intravenous Vitamin C. When their patients tested positive for COVID-19, some of the doctors then added the anti-malarial drug hydroxychloroquine and  the antibiotic-zithromax to the IV. Those two drugs will be discussed in another section of this article. The Chinese doctors also gave patients oral doses of the supplements zinc and melatonin. Yes, really.

The link to the Shanghai consensus on comprehensive care for COVID-19 patients is in the reference section. Upon analysis; of the first 50 patients treated with this “cocktail”, no-one died! It was then apparently hard to get patients to commit to a clinical trial with  IV vitamin C until just recently.

Just recently registered on clinicaltrials.gov (Identifier: NCT04264533), a new clinical trial to investigate vitamin C infusion for the treatment of severe 2019-nCoV infected pneumonia has commenced in Wuhan, China. Investigators will treat 140 patients with a placebo control or intravenous vitamin C at a dose of 24 g/day for 7 days. They will assess requirements for mechanical ventilation and vasopressor (blood pressure supportive) drugs, organ failure scores, duration of ICU stay and 28-day mortality.

Three other studies in the U.S.; using lower doses of the vitamin C have been approved to treat SARS-CoV-2.  A randomized clinical trial; published in JAMA in the fall of 2019 was conducted in 167 patients with sepsis-related ARDS indicated that administration of approximately 15 grams per day of IV vitamin C for 4 days may decrease mortality in these patients. It appeared to decrease the time spent on ventilators.  Encouraging studies with IV vitamin C started with reports by Dr. Paul Marik.

When coronavirus cases hit Virginia, Dr. Paul Marik used his full “HAT” protocol (IV hydrocortisone, ascorbic acid, thiamine) proven to reduce mortality on ARDS patients in the ICU (Chest:2017), while also adding the supplements and drugs used by the Chinese.  He recently used his protocol to save the lives of several COVID-19 patients, including an 86-year old man with heart disease who had been admitted to the hospital on 100% oxygen.

Other ICU Physicians are using IV vitamin C and various supplements with preliminary reports revealing an average of as low as 48 hours on a ventilator versus the national average of 10-21 days. To these front line ”docs” I say bravo!  Please note that oral and (better yet-if you’re at home) liposomal vitamin C has anti-viral activity as well.

Nitric Oxide

Nitric oxide (NO) is well known to be bactericidal; able to act directly as an anti-microbial compound that can disrupt and destroy bacterial structural fats, proteins, and nucleic acids.  Certain families of immune cells called “DC’s” have been reported to produce NO which has contributed to the resolution of both bacterial and influenza infections. The non-proven clinical inference is that higher NO levels contribute to a more rapid clearing of both bacterial and viral host invaders.

Something I’m not supposed to discuss: Colloidal silver throat spray

We know that colloidal silver spray dissolves the thick calcium-containing biofilms made by multiply-antibiotic-resistant staphylococcal bacteria. Does it dissolve a weaker membrane like the thin, fatty novel coronavirus capsule?  We just don’t know. What about squirting it up our noses? Don’t know. We do know that it works as a fungicide and larvacide, though. We also know that it’s harmless, when made and used correctly.

The FDA is cracking down on clinics and websites that promote the use of these products, so as Forrest Gump would say “and that’s all I have to say about  that” other than to tell you I personally use this for “outings” as a spray for my mask.

Anti-viral Rx peptide: Alpha-thymosin-1 

The mechanism of action of alpha-thymosin-1 (chemically “tweaked” and approved as the hepatitis treatment drug zadaxin) is not completely understood but is thought to be related to its ability to augment T-cell function. It has been shown to increase natural killer cell (NK cell) activity, T “helper cell” activity, cytotoxic T cell activity and to increase antibody responses to T-cell dependent (e.g.:viruses) antigens.

The drug is approved for primary treatment for patients with acute infections, such as seen in severe sepsis, and for chronic infections including chronic hepatitis B (CHB), chronic hepatitis C (CHC), and HIV; as an adjunct treatment for cancers, including melanoma, hepatocellular carcinoma (HCC), and as an enhancement to both hepatitis B and influenza vaccines in immune-depressed individuals.

Alpha-thymosin-1 has undergone around 80 clinical studies, with demonstrable activity against a number of viruses, with minimal to no side effects; even in the elderly and infirm. It is currently (and notably) used as a vaccine adjuvant for HINI; resulting in higher antibody (and immunity) post-vaccination in (mostly) immuno-compromised patients. But the reason it is being used widely by Functional Medicine M.D.’s such as myself is based on the experience we have with the SARS coronavirus, as well as with other respiratory coronaviruses regarding both prophylaxis and treatment.

Severe Acute Respiratory Syndrome (SARS) was first identified in Asia in 2003 and then rapidly spread to many countries in Europe, North America and South America before it was contained. After a near pandemic of the virus between November 2003 and July 2003, about 8000 cases were reported with 77 deaths worldwide .

At that time, an animal model demonstrated efficacy of Alpha-thymosin 1 (aT1) against the virus. Many persons were given aT1 prophylactically during that outbreak, due to the animal studies, as well as several interesting published reports in China suggesting that aT1 treatment may have contributed to controlling spread of the disease. 5-8-20 update: Data regarding ACE receptor inhibition and antioxidant capacity of aT1 suggests possible mechanism of action.

aT1 has also shown been used in the successful treatment of  patients infected with the highly pathogenic avian influenza H5N1 strain. I don’t leave my house without some of this “on board.”

IV Ozone

Ozone whole blood irradiation is a powerful tool against viruses (and everything else). We use this routinely for chronic lyme disease; it hasn’t been studied for use in COVID-19; so I’m just “putting this out there” as another modality we should study.

Pharmaceuticals under Investigation

Chloroquine, hydroxychloroquine and azithromycin

A study led by Didier Raoult, MD, PhD, on the combination of hydroxychloroquine and azithromycin in patients with COVID-19 was published on March 20, 2020. The latest results from the team in Marseille (France), which involves 80 patients (and no control group), were reported on March 27, 2020.

The investigators report a significant reduction in the viral load (83% patients had negative results on quantitative polymerase chain reaction testing at day 7, and 93% had negative results on day 8). There was a “clinical improvement compared to the natural progression.” One death occurred, and three patients were transferred to intensive care units.

If the data seem encouraging, the lack of a control arm in the study leaves clinicians confused, especially in light of the fact that chloroquine is an immune suppressant, can cause retinal damage, and can trigger cardiac arrhythmias; something potentially highly problematic in a patient population prone to myocardial inflammation. I’m not ruling out the use of any of these drugs; I’m just saying; due to a significant side effect profile; most doctors require more studies before using them.

4-24-20 update: Hydroxychloroquine  with or without azithromycin  is not associated with a lower risk of requiring mechanical ventilation, according to a retrospective study of 365 male Veterans Affairs patients hospitalized with COVID-19.

The study, which was posted online (pre-publication) April 21 and  has not yet been  peer reviewed, also showed an increased risk of death associated with COVID-19 patients treated with hydroxychloroquine alone. These deaths were primarily related  to cardiac arrhythmias.

The Infectious Diseases Society of America and a guideline panel convened by the National Institutes of Health each concluded recently that because of insufficient data, they could not recommend any specific treatments for patients with COVID-19.

Anti-viral drugs:

New data on the investigational antiviral drug remdesivir suggests clinical improvement in 36 out of 53 patients (68%) who are hospitalized for severe COVID-19, according to a study published online (April 10, 2020 in the New England Journal of Medicine. But as with the use of chloroquine and azithromycin, these data are derived without benefit of randomization or a control group, due to “compassionate use” prescribing.

4-24-20 update: 2 more (as yet un-published) clinical trials with remdesivir appear to be quite promising. This is definitely something to watch closely. 5-8-20 update: Time on a ventilator was shortened by 25% for very ill patients; making this drug a “tool in the toolbox” for this population of patients.

ACE and ARB Medications

This class of blood pressure-lowering medications binds to the same receptors as the novel coronavirus uses to enter the cells. Logic would have it that these medications then act as inhibitors, meaning they stop the virus from binding with the ACE2 receptors and entering the cells. The theory goes-those who are already taking these types of blood pressure meds are potentially likely to be somewhat protected from the virus. Or- according to other studies, they are actually more susceptible to the virus. The data is split 50/50 so at this time we do not recommend stopping or starting these medications vis-à-vis coronavirus protection or harm.

As of 4-24-20 the data appears to be more considerably more positive than negative regarding these drugs. This includes quite a bit of data from China, looking at hospitalized, hypertensive COVID-19 patients who were taking these drugs. 5-8-20 update: Even more favorable data on ACE inhibition has been revealed.

Anti-inflammatory drugs

As of 8-26-20 the steroid dexamethasone is being used for patients with a heightened immune response, but the data on morbidity and mortality remains mixed.

Treating the fever and Muscle Aches

Preliminary evidence that those who took non-steroidal anti-inflammatory medication such as aleve and ibuprofen seems to have been contradicted; but I haven’t seen enough evidence either way, so “here’s my take” in general. NSAIDS are notorious for causing leaky gut; far more than acetaminophen; Tylenol.

Leaky gut causes inflammation as you now know. In studies involving everything from healing from muscular injuries to getting over a viral illness, previous studies hint at the fact that NSAIDS may impair normal healing.

Therefore, it is prudent to recommend Tylenol for fever and muscular pain. As you’ll see in the final “musings” section of this article, my thoughts are that curcumin is the best choice for muscle aches and pains. I have (successfully) treated a number of patients at home with active disease; and they all found relief from a combination of curcumin (they found that this was the best for muscular pain) and Tylenol (for fever). This, however, is “anecdotal”-meaning a non-scientific sampling, and should be regarded as such.

Timing and dosing

As promised, here is a brief discussion of dosing and timing of the things you have been reading about; with the notable exception of omission of discussion of colloidal silver. The COVID-19 disease appears to occur in two distinct stages as follows. (And prophylaxis will be discussed separately). Remember to take your temperature twice daily and keep a record of your symptoms. Due to the ARDS data my 4-24-20 update recommendations would  be to obtain a pulse oximeter to measure your blood oxygen saturation  levels; should you become symptomatic.

  • The first stage of this disease is approximately the first week when your immune system is gearing up for the fight. This is when “immune boosters” as well as immune support and anti-virals seem like the sensible choice. Take your multi-vitamin, vitamin D, your melatonin, zinc, the reishi and the anti-virals. During this stage you might not even have a fever; but you’ll have fatigue, muscle aches, maybe an early cough and possibly some diarrhea. If you have chest pressure: seek medical help. If you have shortness of breath (unlikely but possible) during this time:ditto.

Vitamin D: You want a level of 75 ng/dL which takes most Americans 2-3 weeks of 5000-6000 IU/day; so if this is a new supplement for you; double up for the first few days.

Zinc: Ideal dosing is about 25 mg per day:so again, just double up for the first few days and again for outings.

Quercetin: 500 mg per day and 1000 mg per day for “outings.” (added 8/2020)

Vitamin C: Liposomal preparations can be taken in dosing up to 3 grams per dose without GI distress (in general); and I suggest you try half of that; four times daily to give you the dosing being used in some U.S. clinical studies. Regular buffered vitamin C can be taken as a 500 mg dose so just space that out accordingly.

Reishi: Find a good brand; and follow the labeling directions.

Melatonin: Studies have the maximal efficacy at 10-20 mg per night.

DHEA: Important note: Men with a history of prostate cancer and women with PCOS or a history of breast cancer must take the keto form of this hormone; if at all, since the keto form has not been studied for immune enhancement.  Otherwise, men should take a daily dose of 50 mg; women-25 mg.

NO: A well known and popular brand is a typical twice daily dose. (Neo40).

Alpha-thymosin-1: There is no “accepted” dosing for COVID-19 treatment: and since there is such a benign window of “no side effects” compared to upper level dosing, many practitioners are giving the maximal dose of 1.5 mg up to 2x/day for active cases. This is the dose I have used in the active cases I’ve treated, with everyone having no symptoms after exposure, or active disease with symptoms which resolve within 3-4 days, when this is added to the other modalities in this article.

  • The second stage comes around week two which is often an exaggerated inflammatory response, or “cytokine storm.” This is when you want to continue “support” and anti-virals, but do back off on immune boosters such as the reishi, probiotics, colostrum (if you’re taking it), and DHEA. For severe muscle aches and high fevers (indicative of this cytokine storm); see the suggestions and ideas below in the final section of this article.
  • 4-24-20 update: Those who become “seriously ill” seem to have positive blood clotting studies; but these reports are for those already hospitalized. It seems prudent to closely monitor your oxygen saturation and please remember to stay in touch with your doctor during not just week 2 but during the entire duration of  your illness.

Notes on prophylaxis and exposure with no symptoms: For everyday immune support, it seems prudent to take a good MVI, vitamin D, zinc, reishi, DHEA, melatonin, and a NO supplement. For “outings” where you maintain social distancing and wear a mask, it also seems prudent for both you and household members to take some vitamin C and a prophylactic (450 MCG) dose of the alpha-thymosin-1.

Final Musings

I’d like to continue the discussion about “phase two” of this virus which, of course includes those who need hospitalization, ICU care, and ventilator support. These patients are being confirmed as having super-activated inflammatory responses.

Inflammatory pathways which are documented to be hyper-triggered are the IL-6 pathway and the TNF-alpha pathway; to name the main two.  Clinical studies are commencing to look at the effects of pharmaceutical IL-6 and TNF-alpha blockers; typically used for autoimmune disease.

For those who are familiar with these two pathways; they will recall that it is well known that intermittent fasting and “cold therapy” will block them down. I have contacted several doctors to suggest that these methods be tried in the ICU; so we’ll just have to see if anyone follows my lead on this. Yes, I’m advising “week 2 sick patients” to do intermittent fasting and comfortable cold packing.

Meanwhile, for those suffering with “second stage” hyper-inflammatory symptoms at home: we are certainly aware of non-drug therapies which are helpful to block these pathways as well. They include: curcumin, PQQ, ECGC, zinc, magnesium, vitamin D, resveratrol and quercetin. I routinely place my auto-immune patients who need IL-6 and TNF-alpha blockade on a combination of curcumin, resveratrol and ECGC. As of 4-24-20 a number of Functional and “regular” doctors are recommending curcumin-anecdotal reports as of yet. 5-8-20 update: Due to “clotting issues” seen due to the “cytokine storm” in seriously ill patients, anti-coagulant use is now routine. In addition, unless contraindicated, all  of my “week two” patients take fish oil supplements.

As I write this article, grapefruit seed extract is being studied as a surface viral disinfectant, and cedar leaf oil vapor is being studied as an essential oil to inhale. Neither have been proven to have activity against this coronavirus as of yet. Several other essential oils are being “looked at” as well; again; nothing has been shown to be active enough to mention other than these two.

Antivirals are being studied, and would certainly make a lot of sense, were we to find an effective drug. More likely- a “drug cocktail.”

The FDA just approved testing for convalescent antibodies; and as of 8/2020: approved use of them—-which MIGHT makes sense for not just plasma-exchange treatment of the critically ill, but for monitoring of who we hope are recovered and immune patients. Testing needs to be expanded to include everyone, and I believe that goes without having to mention it; although I know I just did. It would be great if someone looked boosting antibody levels with the alpha-thymosin1.

Many companies are racing to make an effective vaccine, but this will take clinical trials which means “time.” Only then will we be “back to normal” as a society and as a world. And what will we do about possible “irreversible” lung damage? My educated guess is that we’ll be turning to nebulized stem cell nano-pods called exosomes. Stay tuned for more on this to come. May we be better prepared “next time” and may you have no illness; or at worst; mild illness. Again, other than the broad prevention guidelines, this article is not meant to diagnose or treat anyone with COVID-19. Please be in touch with your own doctor if you want to follow any recommendations I’m using in my clinical practice.

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2 Comments

  1. Hi Dr. Kim – Nice article – I think I had the intestinal version of Covid-19. I could not get to see my doctor so I drank a stevia sweetened tonic water (quinine) 3 times a day – 1500 mg of berberine and serraptase for sinus congestion. I did get to finally get tested (negative result ) so I can go back to work.

    • Hi Sean,
      Thanks for the comment. Since 15% and up to 25% of testing (including fecal testing) has been reportedly false negative, we just don’t know if you had this or not. Antibody testing is still not accurate but hopefully, serum antibody testing will indeed be decently accurate soon; so at least you might know. Until then, we all need to keep up the social distancing and so on. I hope your workplace has made things safe for you and others. Take care, Dr.Kim

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