CORONAVIRUS UPDATES


We know that many of you have questions and concerns about the SARS-Cov-2 virus and COVID-19. We will be doing our best to keep you informed and guide you through this time safely. Dr. Stone is monitoring the situation as it evolves, investigating proposed treatments, and keeping abreast of guidelines from trusted medical sources and the CDC so that we can provide the best care for you and your family.

In order to protect ourselves and our own families, we are following “social distancing” guidelines and deferring all non-urgent, non-acute visits to a later date (yet to be determined). We will continue to provide care to our patients via telephone, email and video visits.

Below is important information that Dr. Stone would like all patients to view and share

  1. Video: Coronavirus Update 34 (describes how the virus works -and- how we think we can block it)
  2. Video: Coronavirus Update 35 (includes discussion of additional options for treatment and prevention)
  3. Video: Coronavirus Update 37 (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. Paper: Hydroxychloroquine and Azithromycin as a Treatment of COVID-19 (a promising report, but not scientifically rigorous. This combination should only be used with caution for now, with EKG and/or electrolyte monitoring due to the potential for severe heart arrhythmias.)
  5. Website: COVID-19 Food Safety Information (how to keep yourself as safe as possible while procuring or preparing food.)
  6. Update, 4/3/20: I’ve been watching how things have been playing out and have been suspecting for a while now that the drug hydroxychloroquine might be particularly useful to help keep moderately ill people from developing more severe disease. A new report in the New York Times of a small controlled study in China confirms this idea. The upshot? CONTACT ME EARLY IF YOU ARE GETTING SICK! Some of the symptoms to look out for? Fever, cough, diarrhea, feeling tired or lightheaded, getting winded easily, and loss of sense of smell. Don’t wait for more severe symptoms like difficulty breathing to hit – if we start treatment early enough there’s an excellent chance we can keep you out of the hospital.

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 Testing: After a much-too-long delay, we have the ability to test for active COVID-19 infections. In general if you are younger and not having significant concerning symptoms (particularly respiratory symptoms such as shortness of breath) then I would advise you to simply stay home and keep away from other people – as you should be doing anyway. If you are experiencing flu-like symptoms (fever, dry cough, breathing difficulties), Dr. Stone may invite you to come to the office where he will meet you at your car to administer a rapid flu test and collect a sample that will be sent off for SARS-CoV-2 testing.

Antibody Testing: For those who are interested in learning whether or not they have already been exposed to the SARS-CoV-2 virus and are now making antibodies against the infection, we anticipate that we will have antibody (IgM + IgG) test kits available sometime in the middle of April. The test can be performed with a single drop of blood from a fingerstick and will cost $30. Although my first priority will be to have tests available for my patients, I have ordered plenty of kits, so friends and family members wanting to be tested are also welcome to inquire.

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, zinc (found in animal products such as meat, eggs, and oysters) seems to be emerging as a particularly important way help to fight and prevent COVID-19. The effectiveness of many antiviral therapies (including hydroxychloroquine) seem to be dependent on a person having an adequate amount of zinc in their system. (Other antiviral therapies are not zinc dependent). A number of supplements and prescriptions are available through the practice:

Supplement NameSM CostAction(s)Usefulness for COVID-19DoseNotes
Elderberryn/a (don't currently stock)Antiviral? / Immune boosterImmune boosting effects possibly useful to prevent early infection, but may worsen inflammation later on.Suggest discontinuation if developing signs of breathing difficulty.
Zinc$3 / bottle of 30 (50mg)Antiviral (if able to get inside cell, shuts down RNA-dependent RNA polymerase, a critical viral enzyme.)
Very (if deficient in Zinc)15-50mg daily.May not be safe for long-term use without copper. Dr, Chris Masterjohn suggests that forms other than zinc picolinate or zinc oxide *may* work better.
Green Tea Extract with EGCG (epigallocatechin gallate)$5 / bottle of 60Antiviral - Zinc ionophore (allows zinc to penetrate into cells)Potentially veryunclearComes from Green Tea. Works synergistically with quercetin.
Quercetin$6 / bottle of 50Antiviral - Zinc ionophore, may also alleviate cytokine storms.Potentially veryunclear (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.)
NAC (n-Acetyl Cysteine)$5 / bottle of 30Mucolytic, good for liver, quells cytokine stormsPotentially very500-600mg, up to 4 times dailyAlso helps body produce glutathione / good for detoxing.
Serrapeptase
$13 / bottle of 90Mucolytic / proteolytic
Potentially very (for mucus plugging if pneumonia has struck.)1 capsule = 40,000 SPUs
Luteolinn/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
Lysine with Vitamin C and Echinacea$10 / bottle of 180Reputed antiviral (lysine), reputed to help quench inflammation (Vit C)Unclear
Drug NameAvailabilitySM CostAction(s)Usefulness for COVID-19Notes
Hydroxychloroquine (HCQ)Stocked by SM, widely available.$10 / 5-day treatment course.Zinc ionophore; may also act to quell cytokine storms.Initial results were encouraging; subsequent results have been less clear. May be most useful when used early. Builds up slowly but remains in system for many days.
Azithromycin (AZT)Stocked by SM, widely available.$5Antibiotic. Unclear r why it might help with COVID-19.A small French study showed immense benefit when combined with 600mg daily HCQ. Awaiting confirmation.Could potentially lead to heart arrhythmias when used with HCQ. May require EKGs and electrolyte testing for safety.
ChloroquineWidespread outside of the US. Less clear inside the US.n/a (don't stock)Zinc ionophoreEarly results are encouraging.Antimalarial; may be slightly toxic
Oseltamivir (Tamiflu)Stocked by SM, widely available.$26 / pack of 10Neuraminidase inhibitor.Doesn't appear to be helpful.Antiviral commonly used for influenza
Lopinavir / Ritonavir (Kaletra)Widespread but not stocked by SM.n/a (don't stock)Antiviral protease inhibitor combination.Probably not helpful; two studies failed to show benefit.Works on HIV protease; I 'see no evidence that it might work on Coronavirus and a study shows it doesn't seem to help.
RemdesivirInvestigational drug - limited availability.n/a (don't stock)AntiviralUnder study; probably helpful.Investigational drug / compassionate use only by Gilead Health Sciences.
AmantadineStocked by SM, widely available.$22 / 100Antiviral, often used for influenza.Appears to reduce cytokine storm in people with pneumonia.
Thiazide diuretics (chlorthalidone, HCTZ)*** may wish to avoid use for now ***n/a (suggesting avoidance for now)Causes increased urinary loss of zinc. This may hinder ability of body to fight virus.No reason to think would be useful; may cause harm.Haven't seen any papers on this yet.
Angiotensin Receptor Blockers (ARBs) & ACE InhibitorsStocked by SM, widely available.variesBlood 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 Pandemic Update #37

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, please 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. #flattenthecurve

https://www.nytimes.com/2020/03/11/science/coronavirus-curve-mitigation-infection.html  

CDC page for current Coronavirus information: https://www.cdc.gov/coronavirus/2019-nCoV/index.html