COVID-19 has arrived in all 50 states and many cities, including my current home in Austin, TX. There is no denying that adapting to a "new normal" every few days has been tiring and stressful. My first post on this topic was focused on calming the anxiety and panic that I was observing, as well as encouraging people to be prepared while staying grounded and focused on the wellness of the whole community and not just themselves. A short four weeks later and we are in a whole new reality with shelter-at-home orders and concerning news on every outlet.
Based on observing the virus as it moves around the world, and through our communities, my basic advice remains:
Don’t panic. Don’t hoard. Look out for friends, family, neighbors and strangers. Try not to disseminate unconfirmed misinformation. Try to help others stay calm.
BASIC health support activities (sleep, exercise, getting fresh air and sunlight, hand washing, healthy diet, low sugar, and anything you can do to keep anxiety low) are still the most important, and most powerful things you can do to protect your health.
Avoid taking high dose anti-inflammatory supplements or OTC medicines (like Ibuprofen or steroid creams/nose sprays, even fish oil). Normal dose of these things should be fine.
Avoid taking anti-viral* supplements or herbal formulas before you are actually ill, unless recommended by a qualified practitioner.
Vitamin C, Zinc, Astragalus and Mushrooms (in moderate, standard doses) are really the only supplements healthy individuals need beyond the basic health support activities listed above.
If you ended up with a lifetime supply of toilet paper (ahem), hand sanitizer, face masks, or anti-viral* herbs, be willing to share with others.
I still recommend the immune boosting and balancing supplements listed in my previous post Coronavirus Dos and Don'ts, though I do highly recommend that you consult with a practitioner when selecting from those lists.
*anti-viral supplements are herbs and nutrients that support the part of our immune system that fights viruses. These supplements do not kill viruses directly, nor do they prevent you from getting viruses.Additional Recommendations
Now that the virus is active in most areas of the US, I also recommend the following:
Stay home as much as possible, even if your city has not issued "stay at home" orders.
Without access to population-wide testing and tracking, the only way to slow the spread is to limit the potential for spreading the disease to others. Sadly, the time for dancing and laughing with your friends in person is not now. However, you can still dance and laugh virtually with your friends (or you can have an 80's flashback and dance with yourself!)
Wear a face mask when going out in public.
The most effective masks are the N95 medical masks. Right now we are facing a worldwide, severe shortage of these masks. The ones that we do have need to be reserved for healthcare workers on the front lines in hospitals, working with seriously ill, infected patients. We need to protect our doctors, so that they can continue to care for us. We are still facing shortages of other types of manufactured masks as well. It has been suggested that people begin wearing homemade masks. While a homemade mask of cotton, flannel or other material is not nearly as effective as the N95, it will still help.
In general, masks are more helpful in catching respiratory droplets you may exhale and keeping any infections you may have from spreading to others. Masks also reduce the particulates that you inhale. While homemade masks are not ideal, and do not offer you full protection, they are better than no mask at all.
Here is a link to a website with several face mask patterns. Most mask patterns recommend cotton or flannel. I like the patterns that include a pocket where you could add an additional layer such as a strip of coffee filter, or paper towel. I also recommend the patterns that include a sleeve for pipe cleaners so that you can mold the top of the mask over your nose. Some are suggesting making masks out of HEPA filter vacuum cleaner bags. These may contain fiberglass, so I would not recommend vacuum bag masks at this time.
Consult with a trained Naturopathic doctor, Functional Medicine doctor, Integrative or Chinese medicine practitioner.
If you are in a high-risk group, feel that you may be getting ill, or just need some peace of mind, please consider having a consultation with a trained naturopathic doctor or acupuncturist so that they can help create a customized care plan for you and your family. Myself and my colleagues have years of training in not only the physiology and chemistry of the immune system, but also in the precise application of nutrients, herbs and other natural remedies to optimize and enhance the immune response. I am able to offer tele-health consultations for both local and remote clients and can set up home delivery of many herbs and supplements.
Limit the amount of time you spend reading, watching or listening to stories about coronavirus. Twitter feeds and Facebook posts are not always the best way to get factual information (though there are lots of health care providers and health organizations using social media to put out good information). Without a fair amount of training in health and science it can be tough to sort out the good information from the hype. It is PROVEN that going down the Facebook rabbit hole increases anxiety and stress hormones (not to mention the EMF radiation you are getting from your phone). Put the phone down, turn off the TV and radio. Go for a walk in this beautiful spring weather.
Get your information from trusted sources. Try to limit most of your coronavirus information updates (or at least where you get your facts) to these reliable sources:
Texas Health and Human Services
Austin Local
If you feel sick
The symptoms for COVID-19 are:
Fever
Cough
Difficulty breathing / sense of constriction or tightness in chest
Some people also have GI symptoms such as loose stools
If you have symptoms and have reason to suspect you could have been exposed, the fist step is to:
CALL
Your primary care doctor if you have one
If you do not have a doctor or insurance you can CALL an urgent care clinic, walk in clinic or emergency room, and inquire about testing/ screening
In Austin
CALL 2-1-1 and they can direct you to low-cost or no-cost providers.
CALL CommUnityCare at 512-978-9015, they can provide over the phone triage and help point you in the right direction.
STAY HOME
Have food and medicine delivered to your door.
Take antiviral* cold / flu supplements (considering the nature of this particular virus, I do recommend consulting with a practitioner who can make recommendations specific to you, there are some traditional flu remedies that are not recommended in some circumstances).
If you indeed have the flu, pneumonia or COVID-19 strongly consider taking N-Acetyl Cystiene and / or Mucinex to help keep phlegm thin.
Update on the Statistics
The "less bad" news
The percent of the total population that is affected is still very small (less than 1%).
80% or more of the <1% that get the virus only experience mild cold / flu like symptoms.
10-20% of the <1% that get the virus might get sick enough to require medical care or hospitalization.
The average lethality of this virus is holding at around 4% globally (4% of the <1% that get the virus do not survive). This percent is much higher in in older adults and much lower in younger people. This percent also varies quite a bit from country to country (with higher numbers in countries that did not slow the spread effectively). As with any other infectious disease, baseline health and access to care are the main issues. If the healthcare system becomes overwhelmed, this number will, unfortunately, increase.
More than 80% of the <1% who contract this virus, recover on their own within a few weeks. Some people only become mildly ill, and others never develop symptoms.
Based on observation of the countries who have done better at controlling the spread of the virus, the key elements appear to be: early and strict social distancing (shelter-at-home and limiting travel), aggressive large scale testing (allowing tracking and quarantine of exposed individuals), and the use of face masks when going out in public. Getting this virus under control is possible, but everyone will have to be on board and participate.
The bad news
While the statistics above seem potentially comforting, those percentages, projected over a population of millions or billions, means the possibility of overwhelming the healthcare system. We are, unfortunately, approaching that point very quickly. This is why slowing the spread is so important.
Globally the numbers affected are steadily and rapidly growing. The spread rate is quite different from country to country and from city to city. Right now we are looking at viral spread doubling every 2-4 days in some places. This is worse than we had hoped.
This virus has a long incubation period (up to 14 days), and can be asymptomatic or mild. People are still contagious during this incubation period as well as when they are asymptomatic or have only mild symptoms that are mistaken for allergies or a common cold. Based on the incredible surge we have seen in the past 2 weeks, it is clear that many people were infected and spreading the virus before social distancing measures were put in place. Because we are unable at this time to do aggressive population wide testing and tracking, it has made targeted isolation all but impossible.
US numbers: unfortunately, the US did not do what it needed to prepare for this. Social distancing measures are not being put in place early enough, we do not have enough testing supplies, hospital beds, respirators for critically ill patients, or protective equipment for our healthcare workers. This does not bode well for success with "flattening the curve" here in the US. In the month since I wrote my earlier article we have gone from an almost negligible number of infections to hundreds of thousands of cases that we know of. Because testing is still so limited (and incubation time so long), the actual numbers are likely much higher than currently reported.
It remains true that older adults and people with underlying health conditions are at much higher risk for more serious illness. However, in the US, young people are falling seriously ill and needing hospitalization at a higher rate than in other countries. The US has some of the only COVID-19 infant fatalities reported world wide (there are only a few, but any is distressing).
40-60% of the US population is in the "at risk" category. Not only do we have a large population of older adults, but we have exceptionally high rates of chronic diseases such as diabetes, autoimmune and cardiovascular disease.
The virus can spread from person to person by respiratory droplets, but can also travel through the air for longer distances. It is also showing up in the GI tract of infected individuals, so could potentially be passed via fecal-oral transmission (similar to Hepatitis A), making hand washing even more important. This gives the virus more ways to spread than the flu.
Exact statistics are not possible to generate, but at this point, COVID-19 is many times more contagious and more deadly than the common flu. **The assessment I made in my first post, while based on the current statistics, has turned out to be quite wrong. **
Because this is a new virus, we do not have specific drugs known to treat it, and it will be some time (a year or more) before vaccine development and testing will be complete. A large array of antiviral and antimicrobial medications have been tried in different countries and hospitals, with inconsistent results. Supplies of these medications are also limited.
A glimmer of hope
To the extent they are able, medical systems around the globe are sharing information.
While there are currently no prescription medications available to cure this infection, there is a lot of data to support the use of nutrients and herbs to enhance and modulate the immune system response to viral and respiratory infections in general. (Why is NO ONE in the western health care system talking about this?)
During the 2003 SARS epidemic, the hospital system in Hong Kong did a study with several thousand health care workers (who would be highly exposed to the SARS Covid virus). In this study the hospital staff volunteers took an herbal formula as a preventative measure during the SARS epidemic. None of the subjects that took the herb formula contracted the virus (0.4% of the non-herb taking staff did contract the virus). Some of the herb taking staff also had lab tests done that showed significantly improved immune markers. ("Using Herbal Medicine as a Means of Prevention Experience During the SARS Crisis". The American Journal of Chinese Medicine, Vol. 33, No. 3, 345–356)
At “ground zero” in Wuhan, China the hospitals found that the most powerful and reliable treatment for those that had become gravely ill with COVID-19 was the combined use of western medicine and herbal medicines (which were prepared and dispensed in the hospitals). Patients who received herbal treatment along with antiviral medications and respiratory support were more likely to recover and recovered more quickly than those that were given only the support of “western-style” medicine. The difference in survival rate was statistically significant enough that they mandated the inclusion of these herbal formulas in many hospitals in China.
In a tremendous act of collaboration, several hospitals in China created reports outlining the stages and common presentations of this illness, along with a detailed list of herbal formulas that were found to help during different phases of the illness. The reports have been translated and sent out to the international Acupuncture / Chinese Medicine community. (article 1, article 2)
The information shared by the hospitals in China and Hong Kong has given us a HUGE advantage in both prevention and supporting those that might become ill. There are not standard “products” to buy, but trained practitioners can leverage this gift of knowledge in creating custom protocols for clients.
I want to stress the importance of engaging with the medical system should you be sick or exposed. This is not an either holistic or conventional scenario. Based on this preliminary reporting from China, integrative approaches (combining conventional and complimentary / natural medicine) seem to have an important place in our response to this new virus.
Testing Update
The US in general, and Texas in particular are still lagging behind in the availability of test kits and streamlined testing procedures. There still are not enough testing supplies available for everyone to be tested. This situation is improving daily. Many private labs have come out with testing options this past week. Currently (end of March, 2020), testing must still be done and ordered by a physician. In some locations the test itself is FREE, though the doctor’s visit to be evaluated and tested may not be. There are a few companies trying to develop direct-to-consumer options (where you can test yourself), but it is too early to say if these will be accurate enough to be helpful.
Testing for Austin, Texas
The news outlets have reported several “drive through” testing centers that opened in mid March. These do actually exist. They are NOT “self-order” or “on demand” sites. They are test sites for pre-screened patients to receive testing without entering the facility where they could potentially spread the virus.
In order to be tested at one of these sites you must:
Open a patient portal account with the facility running the test site
Take the free, online questionnaire to see if you might qualify for testing
Then you must pay for a tele-health screening visit with one of the staff clinicians
While no appointment is technically needed for these tele-health visits, there can be a backlog of people waiting.
Testing Criteria
You must meet certain screening criteria to be tested. The screening criteria are slightly different depending on the lab running the test. It is possible that respiratory illness symptoms are due to other infectious agents. Most guidelines require that you are tested for other things (like the flu, pneumonia, and other common illnesses) before you are tested for COVID-19.
Most hospitals and clinics will be following these CDC recommendations for who to test.
Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.
Other symptomatic individuals, such as older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
Any persons, including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of their symptom onset. (since this is now everywhere, we are expecting a change to this criteria soon).
These testing guidelines / restrictions are being re-evaluated, and we expect them to evolve (and hopefully expand dramatically) over time.
Ok, this post has gotten REALLY long. I will post more as I can. Hang in there everyone!
In Health -
Dr. Becky