• 8/19/21 Update:  After a brief respite this past spring when we saw plummeting COVID cases and fatalities in the U.S. (coinciding with a partially successful vaccination campaign), the emergence and rapid spread of the super-contagious Delta Variant has demonstrated the need for ongoing caution.  This column by Dr. J. Stacey Klutts explains how our current vaccines do (and don’t) work to protect us.  (TL;DR: Our current vaccines teach our bodies to recognize COVID and create IgG-type antibodies – the ones that allow our immune systems to gain the upper hand and clear COVID infections from our blood. Unfortunately they don’t really help us to make the IgA-type antibodies that we need to coat our mucous membrane and keep the virus from infecting us in the first place. The good news is that the vaccines continue to do an excellent job of preventing serious illness and death.)

• 8/13/21 Update:  This CDC update describes current clinical considerations regarding the COVID-19 vaccine, including new recommendations for booster shots for immunocompromised people.

Below are important resources that can help you understand COVID-19 … and maybe help someone you know survive it.

1. Coronavirus Update 34 video – describes how the virus works — and how we think we can block it.
2. Coronavirus Update 35 video – includes discussion of additional options for treatment and prevention.
3. Coronavirus Update 37 video – discusses the ACE2 receptor and concerns regarding certain blood pressure medications — executive summary: based on our best current understanding you should probably stay on your ACE inhibitor or ARB medications.
4. Website: COVID-19 Food Safety Information – how to keep yourself as safe as possible while procuring or preparing food.
5. Update, 4/16/20: Many of you may know that one of my favorite geeky bioscience podcasts is “Found my Fitness”, by Dr. Rhonda Patrick (PhD). She put out a tour de force Q&A podcast / video on COVID-19 (including treatments and supplements) a couple of days ago. Some of this may be redundant to other things I’ve posted here, but much was new. (Warning: long and detailed.)
6. Coronavirus Update 59 video – describes Dr. Seheult’s daily regimen; no new news to speak of with this, but a useful summary of previously mentioned supplements that are likely to be useful to some degree.
7. This New York Times article – discusses some signs and symptoms that differentiate mild COVID-19 from more severe cases — and how we can figure out if you or a loved one is sick enough to go to the hospital.
8. Coronavirus Update 61 video – explains how severe oxidative stress from COVID-19 can cause blood clots (including heart attacks and strokes.

Diagnosis: Check out this handy screening tool, courtesy of Apple (in conjunction with the CDC). Transmissibility: First, the bad news. This disease is EXTREMELY contagious, and there may be a long incubation period during which many people will be infectious before developing any symptoms. Some people may become infectious and never become ill — whereas others may become extremely sick and require hospitalization to remain alive. There is reason to believe that even people who have fully recovered from it and who feel completely well may still remain infectious for many days or even weeks afterwards. The better news: The virus is also relatively easy to eradicate. Washing hands frequently with soap and water and using disinfectants on surfaces can potentially go a long way towards preventing the spread of this disease. Most people will be safe if they are able to stay home and avoid contact with other people who might have been exposed. PCR and Rapid Antigen Testing: Testing for active COVID-19 infections is now readily available. The best time for testing (least likelihood of having a false negative test) appears to be about 3-4 days after symptom onset (roughly 8 days after an exposure). If you are having symptoms and you have reason to believe you may have been exposed, Walgreens is offering drive-thru testing for qualifying people. See https://www.walgreens.com/findcare/covid19/testing for more details. Antibody Testing: For those who believe they may have been exposed to the SARS-CoV-2 coronavirus and are interested in possibly confirming that with a test to see if they are now making antibodies against the infection, we now have test kits (IgM + IgG) available.The test can be performed with a single drop of blood from a fingerstick and costs $30 (I am also making these tests available to your friends and family members). Be aware that these tests (like all lab tests) are not perfect; there is a definite possibility of false positive or false negative results. They should be used only when there is already strong suspicion of a previous SARS-CoV-2 infection and greater confidence in that belief is desired. Treatment: No medications or supplements have yet been officially approved for the treatment of SARS-CoV-2 although many are under investigation. We have stockpiled several medications and supplements for our patients that we expect to be helpful. In terms of what people can do for themselves right now, Vitamin D supplementation may be particularly helpful. The use of metformin (a diabetes drug) is strongly associated with decreased disease severity.  Zinc (perhaps in conjunction with zinc ionophores such as quercetin and EGCG) may have an important role in slowing replication of the virus, particularly during the first week of the infection. A number of supplements and prescriptions are available through the practice:

Supplement Name	SM Cost	Action(s)	Importance / usefulness for COVID-19	Dose	Notes
Vitamin D	$10 / bottle of 100 (5000 IU)	Multifactorial - immune boosting / helps prevent lung damage	Probably crucial. (Mortality has been observed to be highest in groups with widespread Vitamin D deficiency - elderly, obese people, and people with darker skin.)	5,000 IU daily if low / not already supplementing (more if obese).	Listen to Dr. Patrick's podcast for more information.
Zinc / copper	$6 / bottle of 30 (15mg / 1mg)	Antiviral when used with zinc ionophores (zinc inside cells can shut down viral replication)	Particularly important if zinc deficient; COVID-19 may also deplete zinc.	Suggest 1 capsule daily for 1 week, then 1 capsule every other day.	Zinc should be balanced with copper to prevent zinc-induced copper deficiency.
NAC (n-Acetyl Cysteine)	$5 / bottle of 30	Mucolytic, good for liver, quells cytokine storms, helps with glutathione (essential for Th1 / antiviral responses).	Very.	500-600mg, up to 4 times daily
Quercetin	$6 / bottle of 50	Antiviral - Zinc ionophore, helps alleviate cytokine storms. Helps shift immune CD4+ polarization from Th2 dominant to Th1.	Very.	Unclear (typical dose for allergies is 500-1000mg, which seems reasonable for prevention. Dose for treatment of active infection might be 7-8 grams or more.)	Found in many foods, but unclear if high doses in supplements are safe during pregnancy.
EGCG (epigallocatechin gallate)	$5 / bottle of 60	Antiviral - Zinc ionophore (allows zinc to penetrate into cells)	Potentially very	Suggest 1 capsule daily	Derived from green tea (has caffeine). Excess may cause nausea, gastric upset. Not recommended for pregnant women. Works synergistically with quercetin.
Nattokinase	$13 / bottle of 90	Degrades fibrin, acts as an ACE inhibitor (mitigating lung damage.)	May be lifesaving in advanced disease; can break up blood clots as they form.	1 capsule = 2,000 FUs	Not antiviral but can mitigate damage
Serrapeptase	$13 / bottle of 90, $6 / bottle of 30.	Degrades fibrin, mucus and other proteins	May be lifesaving in advanced disease; can break up clots as they form.	1 capsule = 40,000 SPUs	Not antiviral but can mitigate damage
Natto-Serra (combination pill)	$19 / bottle of 90	As above	As above	1 capsule = 40,000 SPUs Serrapeptase and 2,000 FUs of Nattokinase	As above
Lysine with Vitamin C and Echinacea	$10 / bottle of 180	Lysine is a reputed antiviral, Vitamin C boosts immune function (makes neutrophils more potent) while limiting damage to other tissues. Echinacea reputed to have antiviral properties.	Likely useful for antiviral support.
Luteolin	N/A (don't currently stock)	Inhibits furins, which are enzymes that allow the virus to bind to cellular receptors.	Unclear, but good theoretical support.	Unclear
Omega-3	(Being researched)	May help prevent blood clots.	?	(Being researched)	See article: Dietary intake of marine n‐3 polyunsaturated fatty acids and future risk of venous thromboembolism
Vitamin C (high dose, intravenous), possibly also with thiamine.	N/A (don't currently stock)	May improve survival in sepsis / severe disease.	May be particularly important in advanced disease.	Multiple grams daily (above what can be tolerated / absorbed with oral dosing).	Suggest listening to Dr. Patrick's podcast for more information. See also Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic Acid
Myo-Inositol	N/A (don't currently stock)	Can decrease IL-6, potentially mitigating severe lung disease	Potentially useful in advanced disease (hospitalized patients) to prevent or mitigate SARS.	Unclear	See research paper: Inositol and pulmonary function. Could myo-inositol treatment downregulate inflammation and cytokine release syndrome in SARS-CoV-2?
Elderberry	N/A (don't currently stock)	Antiviral? / Immune booster	Immune boosting effects possibly useful to prevent early infection, but may worsen inflammation later on.	?	Avoid using for more than a week. Discontinue if developing signs of breathing difficulty.

Drug Name	Availability	SM Cost	Action(s)	Usefulness for COVID-19	Notes
Ivermectin	Widespread in pharmacies.	N/A (don't stock)	Slows viral entry into cells by binding to viral spike proteins, inhibiting viral binding to ACE-2 receptors.	Authoritative guidelines are lacking, but the the FLCCC makes a reasonable case for it. A few patients have told me it noticeably helped alleviate their COVID symptoms.
Remdesivir	Investigational drug - limited availability.	N/A (don't stock)	Antiviral	Under study; probably helpful.	Investigational drug / compassionate use only by Gilead Health Sciences.
Amantadine	Stocked by SM, widely available.	$22 / 100	Antiviral, often used for influenza.	Appears to reduce cytokine storms in people with pneumonia.
Angiotensin Receptor Blockers (ARBs) & ACE Inhibitors	Stocked by SM, widely available.	Varies	Blood pressure medicine - might stabilize ACE2 receptors in a way that prevents viral binding and entry into cells.	Controversial / unclear - No antiviral activity, but may slow disease progression.	See YouTube video: Coronavirus Update 37
Fluvoxamine	Widely available, not stocked by SM	N/A (don't stock)	Strong antidepressant / anti-anxiety drug	Under study	Depersonalizing effects of fluvoxamine blamed by some for possibly playing a role in the Columbine massacre.
Metformin	One of the most available drugs in the world. Stocked by SM.	$7.50 / 200 pills	Anti-diabetic drug; likely improves immune system metabolism.	Noticeable effect size, at least as good as ivermectin for people with metabolic syndrome.

If you are sick, please notify Dr. Stone right away. If you are having more urgent symptoms that include shortness of breath, please don’t rely on an email being seen and answered in a timely manner; it might be best to call the office at 984-999-1010. As always, feel free to reach out to us with any concerns or questions you may have. Fevers: There is emerging evidence to suggest that one should generally NOT use fever-reducing medications such as acetaminophen, aspirin, ibuprofen, or naproxen in someone suspected of having COVID-19. Why not? Fever is an extremely important natural response of the body to infection. Elevated temperatures (within reason) not only help to activate important parts of our immune systems to do a better job of fighting off viruses, they also help to dampen cytokine production once macrophages have been activated and thus help prevent out-of-control “cytokine storms.” Please help us all out by practicing social distancing during this critical time. If we can #flattenthecurve we will save lives, maybe a life that is near and dear to you. Here’s an NYT article on the subject: Flattening The Coronavirus Curve.

Here is the CDC page for current Coronavirus information.