Coronavirus Updates

Understandably, many of you have questions and concerns about the SARS-Cov-2 virus and COVID-19. Slower Medicine 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 as well as 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 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, 4/3/20: 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.
  6. 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, detailed.)
  7. 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.)
  8. Coronavirus Update 60 video (discusses why the large VA retrospective study of hydroxychloroquine wasn’t useful; overview of some scary / bad data from NYC hospitals)
  9. 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.
  10. 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 Testing: After a much-too-long delay, testing for active COVID-19 infections is now available (subject to occasional limitations in the availability of testing swabs). 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 for more details. If you are experiencing flu-like symptoms (fever, dry cough, diarrhea, muscle aches, headaches, breathing difficulties, etc.) but the Walgreens testing program doesn’t work for you for some reason, Dr. Stone may invite you to come to the office where he will meet you at your car to collect a sample to be sent off for SARS-CoV-2 testing.

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. Zinc (especially in conjunction with zinc ionophores such as hydroxychloroquine, quercetin, and EGCG) has emerged as a particularly important way help to fight COVID-19 during the first week of the infection when viral replication is peaking. A number of supplements and prescriptions are available through the practice:

Supplement NameSM CostAction(s)Importance / usefulness for COVID-19DoseNotes
Vitamin D$10 / bottle of 100 (5000 IU)Multifactorial - immune boosting / helps prevent lung damageProbably 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 30Mucolytic, 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 50Antiviral - 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 60Antiviral - Zinc ionophore (allows zinc to penetrate into cells)Potentially verySuggest 1 capsule dailyDerived from green tea (has caffeine). Excess may cause nausea, gastric upset. Not recommended for pregnant women. Works synergistically with quercetin.
Nattokinase$13 / bottle of 90Degrades 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 FUsNot antiviral but can mitigate damage
$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 SPUsNot antiviral but can mitigate damage
Natto-Serra (combination pill)$19 / bottle of 90As aboveAs above1 capsule = 40,000 SPUs Serrapeptase and 2,000 FUs of NattokinaseAs above
Lysine with Vitamin C and Echinacea$10 / bottle of 180Lysine 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.
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
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-InositolN/A (don't currently stock)Can decrease IL-6, potentially mitigating severe lung diseasePotentially useful in advanced disease (hospitalized patients) to prevent or mitigate SARS.UnclearSee research paper: Inositol and pulmonary function. Could myo-inositol treatment downregulate inflammation and cytokine release syndrome in SARS-CoV-2?
ElderberryN/A (don't currently stock)Antiviral? / Immune boosterImmune 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 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 why it might help with COVID-19.?? - One isolated group in France continues to report immense benefit from use of the combination of azithromycin and hydroxychloroquine, but their results have not been replicated. As of 4/21/20, the NIH is recommending against use of this combination.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 storms 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 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, 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

Here’s an NYT article on the subject: Flattening The Coronavirus Curve

CDC page for current Coronavirus information.