Tool Kit for the Second Wave
It is happening worldwide. There is the beginning of freedom once again, a light at the end of this tunnel. Whether it is daylight at the end of the tunnel or an oncoming train will depend, in large part, on what we all do. As we emerge from this first wave of pandemic, the temptation may be to throw off our isolation and think it’s all over and we can finally return and rebuild our previous lives. It is only natural to feel that way! People who lived through this ordeal alone feel an acute need to touch, to hug someone. We live in communities and groups for a reason. We are social creatures!
Pathogens, including COVID-19, exploit our social nature. Our social systems are essential to their survival. Dense populations that are highly mobile feed viruses fresh hosts. That is the nature of a pandemic, a single outbreak can travel across the entire planet hopping from host to host. When it is the common cold, we grit our teeth, buy some tissues, chicken soup, cold remedies and bear it. But COVID-19 is different. It is stealthy, deceptive and often deadly. COVID-19 pathologies extend beyond the respiratory failure as first believed. At this point, avoiding infection is our best option.
Until a vaccine is developed, our only defenses are social behavior and our immune systems. That’s it. If this is our toolbox, it's pretty empty... only two tools. Suffice it to say, we want the social behavior to be the front line of defense and our immune systems to be in the strongest possible condition.
Acknowledging those limitations as the new reality waiting for us on the other side of this first pandemic wave and first lockdown, let's not throw away the hard-won fruits of our diligence. Let us remain cautious and prudent, as a second wave of this virus has the potential to undo our hard work and overtake us with even worse consequences.
Now that we are beginning to know where the new case trend is going (mostly up) after the Memorial Day weekend and the beginning of easing ‘shelter at home,' the numbers in the South and West are increasing. And that is before taking into account the consequences of the mass protests for Mr. Floyd’s tragic death - we haven’t even begun to see those effects on COVID-19 cases.
First Line of Defense: Behavior
Please practice social distancing - we are learning that person-to-person contact is the most efficient way for the virus to jump to another host. This makes contagion much easier in crowds. So, how do we remain prudent as the social distancing is relaxed? There are two aspects to this, social cooperation and personal wellness.
The social aspect requires the same attentiveness and discipline as earlier. Many public venues are restricting to 25-50% capacity. We are also seeing parks, restaurants and other venues marking off 6-foot spacing for lines, outdoor and some indoor dining where people are seated far apart.
More worrisome are other locales where people are dancing and drinking in close proximity. The media coverage of the mass protests show thousands of people without masks and without social distancing. This could be calamitous in propagating a violent second wave of increasing cases and and the renewal of lockdowns.
The good news is that we are gradually moving from lockdown to greater social mingling. It will happen in stages. The rules will be informed by epidemiological data (and government officials). We will need to stay tuned to our local experts at the state, municipal and international level. They will be monitoring the population with heightened awareness. The push is on for better diagnostic testing and contact tracing for any outbreak. Whenever in doubt, the local, state, and federal agencies will be the final arbiters.
Second Line of Defense: Our Immune Systems
But what about our own immune systems? That is the personal wellness aspect of our prudence. Attending to our own wellness means we are all individually accountable. I have put together a basic immune system tool kit:
Your Immune System Action Plan:
Your immune system is at its best when you are at your best. You achieve that with nourishing foods, exercise, rest and mental wellness.
1) If you've been eating comfort foods, get back on good nutrition that includes lots of spring and summer vegetables. Keep your freezer stocked with vegetables as a back-up.
2) Cut out the sugar and alcohol - those weaken immune systems.
3) Find something that brings you pleasure, like stopping to look at a beautiful view or flower. We have had time to slow down (except if you have energetic young children at home!) and appreciate the small things we were moving too fast to notice before. I truly hope that will stay with us.
4) Stay physically active to maintain a healthy level of fitness. This means exercise at a level that challenges you at your current fitness level at least three times a week.
5) Finally, consider adding, if you haven't already, supplements and herbs that show some evidence of antiviral activity. Supplementation should be supervised by an experienced physician or highly trained provider. As an experienced integrative/functional medicine physician, I have had extensive training in nutrition and botanical medicine.
Let’s start with back-to-basics general immune boosting supplementation recommendations:
Vitamins D3 and K2 in combination: Most Americans are low in vitamin D3, especially during and just after winter. Studies show that people with very low Vitamin D levels are more likely to have severe forms of COVID-19. In healthy times, the traditional medical advice is to get sunshine and/or supplement with 400-800 international units (IU) of VitaminD3 daily. A new Harvard study recommends 1000-2000 IUs/day during the pandemic. Personally, I take 5,000 -10,000 IUs of D3 daily depending on whether I have been outside or not. Vitamin K2 is added to lower the possibility of mobilized calcium adhering to arterial walls. This is an instance where a few individuals just supplementing with Vitamin D3 alone can be exposed to some risk. This demonstrates why even supplementation is best done with the guidance of a medical provider. (Dr. JoAnn Manson is a professor of medicine at Harvard Medical School and chief of the Division of Preventive Medicine at Brigham and Women's Hospital, in Boston, Massachusetts. She has written an informative piece on Vitamin D, which can be found here.)
Monolaurin (natural anti-viral (lauric acid) made from coconuts): shortens several flu strain- induced illnesses significantly. I take 1200 mg before and after going out in public. This is in addition to washing my hands thoroughly after returning home.
Elderberry syrup or leaf (specific for other coronaviruses (but not yet tested against COVID-19)): I take a full dose before and after going out in public. If you can, avoid those syrups made with high fructose corn syrup.
Vitamin C (ascorbic acid) contributes to immune defense by supporting several cellular functions of both the innate (what we are born with) and acquired (defenses made when fighting infections) immune systems. Deficiency of Vitamin C results in decreased immunity and infections may decrease levels via increased inflammation and other mechanisms. I take 1000 - 2000 mg/day in addition to eating some fruits high in Vitamin C.
Zinc is an immune supporting mineral. Take 20-30 mg/day or increase intake of good food sources such as pumpkin seeds, sesame seeds, seafood, especially oysters (that are hard to come by during the lockdown) and red meat (lean, and in moderation). There are a variety of zinc-rich foods.
A high quality multivitamin/multimineral to ensure you are getting good nutrition and boosting your immune system each day.
Probiotics to keep your gut’s bacterial (microbiome) immune-boosting functions working. The species Lactobacillus plantarum is contained in a drink found in many grocery stores, called Good Belly, though the fruits in this brand do have natural sugars. Some stores have unsweetened ‘shots’ of this brand (my preference). Five - 10 billion cfus (colony forming units) help build immunity. There are many good sources of probiotics from fermented foods (not to be confused with foods pickled in vinegar) such as raw sauerkraut, kim chi, pickles, etc., to supplements. I prefer multi-strain supplements if you go that route. Stress, nutrient-deficient diets and certain medications (antibiotics, steroids are among them) deplete our natural microbiome. My regimen includes fermented foods (some of which I make at home), a probiotic supplement when feeling stressed (25-50 billion cfus) and prebiotic foods or supplements (prebiotics are the high fiber foods and supplements that provide nutrition for gut bacteria).
While I have summarized some easy-to-implement and inexpensive basics above, here are three of my favorite practitioners with more detailed recommendations, should you be interested. Some overlap each other. All offer evidence-based recommendations:
Dr. Andrew Weil helped establish the field of integrative medicine. His Center of Excellence at the University of Arizona College of Medicine has trained thousands of physicians worldwide and has created curriculum in many US medical residency programs. He is the Lovell-Jones Professor of Integrative Rheumatology, Clinical Professor of Medicine, and Professor of Public Health at the College of Medicine.
You can find Dr. Weil's recommendations, here.
(NOTE: this includes recommendations for astragalus. If you have any autoimmune disorder, please AVOID this herb)
Dr. Mark Hyman is an internationally recognized leader, educator and author in the field of Functional Medicine. He serves as the Head of Strategy and Innovation at the Cleveland Clinic Center for Functional Medicine, Board President for Clinical Affairs for the Institute of Functional Medicine and is a bestselling author of many books on the New York Times list.
Visit Dr. Hyman's website for his recommendations.
(NOTE: again, if you have any autoimmune disorder, please AVOID astragalus)
Stephen Buhner is a master herbalist and is the award-winning author of twenty books on herbal medicine, nature, the environment and indigenous cultures He comes from a long line of healers including Dr. Leroy Burney, Surgeon General of the United States under Presidents Eisenhower and Kennedy.
His white paper offers informed suggestions for interim strategies during the time it will take to develop a vaccine (while a lot of it is technical, the herbal treatment recommendations for coronavirus in general (though not specifically for COVID-19) start on p.12). The first part of the paper explains that COVID-19 is a coronavirus closely related to SARS (severe acute respiratory syndrome) while the rationale for treatment looks at the mechanisms of various herbs and why they might be helpful in blunting some of the ways COVID-19 affects the body, especially the lungs and immune system.
Before starting any supplements, please discuss this approach with your ob/gyn if pregnant or nursing.
As of today, it looks like the light at the end of the tunnel may be another train headed our way. If we can learn from the past 4 months, perhaps we can deflect it away from hitting us head-on. Please, don't let your guard down just yet.
The above are broad recommendations to help boost the immune system for re-entry to society. At Gesundheit Carolina, we do not believe that healthcare should be a one-size-fits-all approach, but we do believe that the recommendations offered in this blog post will be generally helpful.
If you would like a more personalized care plan, please contact us for an appointment. Please visit our Medical Therapies page to learn more about Dr. Herbert's expertise and perspective on wellness. Telemedicine is currently available and the Charleston office will be open shortly.
Disclaimer: This written opinion in no way attempts to diagnose or treat symptoms or ailments. Please consult your healthcare provider before starting any program. If you are interested in becoming a patient of Gesundheit Carolina, please contact us .