Covid-19 is a novel virus that likely came from animal origins starting in Wuhan, China. There have been multiple waves of this disease as it has spread across the globe, first in China, then in Iran and Italy and now it has made its way to the United States. We have had time to learn from experiences in other countries about who is effected, how the disease is transmitted and mechanisms for reducing the rate of transmission and spread in our communities.
We have also learned that if we do not do this effectively that our healthcare system could become overwhelmed and this could make this disease more fatal than it should be.

The approach to reducing the transmission has evolved from an attempt at Containment, where patients would be placed in quarantine and all of their contacts would be traced, tested and quarantined if they tested positive, to where we are headed next and some communities have already begun to head, which is Mitigation. Containment is the best approach but when it is not possible, mitigation is a more effective use of resources and that is where the world is at currently given that containment has not been possible.

Mitigation involves Social Distancing such as cancelling public events, working from home, avoiding crowded areas and recently recommendations have been made to avoid even small gatherings. Hygiene precautions are also an important means of reducing the likelihood and rate of transmission. This means washing your hands for 20 seconds with soap and water and using hand sanitizer on your phone after touching objects, using alcohol or chlorhexadine wipes over metal surfaces, which can allow the virus to live for 12 hours or more and softer surfaces, which can allow the virus to live for roughly 3 hours. This also means avoiding self contamination by touching the face where the virus can enter the blood stream via mucous membranes in the eyes, mouth or nose. The virus dies in high heats so running dishes through a dishwasher or cooking foods well can effectively kill the virus.

If you are sick, this means wearing a surgical mask to reduce transmission to others, which occurs by respiratory droplets that are spread by cough or sneezes. For health care practitioners, using N95 masks and eye protection has been shown to reduce transmission while treating patients acutely ill with Covid-19, where the likelihood of transmission is much greater and the proximity needed to assess, obtain an oral swab or intubate means that keeping a safe distance is not possible.

Covid-19 can have a 2-14 day incubation period, on average of 4 days, when you may not have any symptoms. You can still spread the disease at this point, which is why this has been especially difficult to contain. The first symptoms will likely be fatigue and a sore throat and may mimic typical symptoms of a seasonal cold such as sinus congestion. People describe this type of sinus congestion as a suffocating feeling in the sinuses. Shortness of breath may soon follow as well as fever and a cough. 3 factors contribute to death in this disease, the virus causing destruction in the lungs, the body’s response to the infection, called cytokine storm, and bacterial superinfections that occur as the lung’s immunity becomes impaired from the destruction caused by the first two. Subsequently patients with heart disease may have increased demand on the heart and this can be another cause of death.

Prior to developing a cough, some patients in Asia have reported testing whether they have lung involvement that may be more indicative of the Coronavirus by taking a deep breath and holding it for 10 seconds. If that doesn’t cause a cough then it is less likely that they have any lung involvement and may be less likely to be the Coronavirus but it may also be too early to diagnose by this method.

Children have been mostly spared and are the least likely to suffer serious complications from this disease. Patients up to the age of 40 have about a 0.2% chance of these types of complications and 80% of all patients have a mild to moderate upper respiratory infection. Patients with other pre-existing cardiac or respiratory conditions are at the greatest risk as are patients over the age of 80.

We do not know yet know if there is any lasting immunity after infections but preliminary anecdotal evidence has shown that some patients in China have acquired this infection more than once and have not shown lasting immunity, much like the other Coronaviruses that we typically refer to as the common cold viruses in the U.S. Though some of these viruses do have a seasonal peak, there is no reason to believe that the temperatures changing would reduce the spread of this virus, i.e. it has spread rampantly in Iran. When a vaccine is developed, we do not know how long it will provide immunity or if the virus will mutate yearly requiring a yearly vaccine like the Influenza vaccine.

We know that the rate of infection increases exponentially around 14 days after case numbers begin to rise and as of the day I am writing this, 3/13/20, that means that we, in the Bay Area, are only 7-10 days away from this surge in the amount of people infected given the number of cases we have already seen.

Though all of the above is useful information, it is incomplete without a plan for what to do should you contract Covid-19. Clearly we know that you should quarantine yourself to prevent further transmission but what else could you do to help support your immune system so that you fall into the 80% category that has a mild and uncomplicated infection.

The training in conventional Family Medicine for treating viral upper respiratory infections typically involves recommending rest and hydration as well as symptomatic support such as mucolytics (i.e., mucinex), codeine for suppressing night time coughs, albuterol inhalers for helping to maintain open airways and sometimes steroid inhalers for reducing inflammation in the lungs that can cause the infection to be persistent or cause further complications. If bacterial superinfections occur, then antibiotics may have a place in the care of infections that start out as viral. In the case of the Flu, Tamiflu has been shown to reduce the symptoms by up to 48 hours but has not been shown to reduce any risk of serious complications or death from the flu. The Influenza virus mutates each year and vaccines have had variable success at providing immunity but they are one of the few direct preventative strategies that we have other than hygiene and health maintenance. In some cases, heroic measures are required to save lives in the Intensive Care Unit, such intubation and respirators. These clearly have a role at saving lives and are used when nothing else is working.

As an Integrative Family Medicine physician, I have learned and practiced using nutraceutical approaches to treating viral upper respiratory infections that have consistently proved to be synergistic to the conventional approach. There is no Cure for the common cold or the Coronavirus, to date, but the following nutraceutical approaches have consistently shortened or eliminated viral syndromes within days as opposed to weeks in my practice. Some of these therapies have statistically significant evidence to support their use in viral upper respiratory tract infections and others do not but they all have a long history of clinical use and have been shown to be safe in common viral upper respiratory infections. Though we cannot know for sure that the Coronavirus will be similar, it is in all likelihood very similar in how it will respond to these therapies. That being said, the following cannot be construed as specific medical advice and should not be considered a substitute for seeing a doctor who can evaluate your specific condition. There may be interactions with other medications that you are taking or specific conditions that you may have that would make following these recommendations contraindicated. You should consult with your doctor if you feel you have the Coronavirus and determine with their guidance whether it is safe for you to use any of these therapies.

The simplest approach that has worked the most often in my practice for shortening viral upper respiratory infections has been the following:

Vitamin D3 100,000 IU daily for 3 days only. You can find a liquid Vitamin D 1000 IU and take 100 drops or high potency capsules with 50,000 IU and take 2 daily. Vitamin D does build up in your system and taking high doses for prolonged times can cause liver failure. This can be additive with other medications that effect the liver so it is important to take this into consideration.

Viracid by Orthomolecular
2 tab every hour for 6 hours, repeat daily until symptoms are gone (usually 1-3 days).

Viracid contains the following nutraceuticals which, if this were on back order, I would recommend purchasing separately:

Black Elderberry (Sambucol brand is one that I have used in the past)- 2 teaspoons 4 times a day.
This both boosts your immune system and is directly anti viral.

L-Lysine 6 grams per day
This is an amino acid that inhibits viral replication.

Andriographis, which is anti viral and boosts your immune system.
Take this at the recommended dosage on the brand that you get.

Echinacea Purpura, which works by boosting your immune system.
Take this at the recommended dosage on the brand that you get.

Usually the combination of Viracid and high doses of Vitamin D3 does the trick for upper respiratory infections. Covid-19 is more lethal than the flu and I would not expect it to be as easy to treat as the usual common cold however. The next most important therapies are:

Vitamin C (Ascorbate rather than Ascorbic acid is preferred)
I like the Perque Potent C Guard best.
3 grams 3 times a day if you are sick and 3 grams 1-2 times per day as a preventative. Vitamin C can help diminish the Cytokine storm that is from your body’s immune response to the virus and which causes much of the destruction in the lungs.
Another more potent therapy using primarily Vitamin C is an Intravenous drip. In Shanghai, they have been effectively treating Covid-19 using high dose

IV Vitamin C (15-30 grams 1-2 times/day for only a few days in row). If oral supplements were not working then this would be my next step up. This is not safe for patients with Sickle Cell or a G6PD deficiency.

Astragalus (Gaia makes a good Astragalus product)
This can help reduce binding of the virus to the lung tissue and it also helps to support the immune system.

Beta-Glucans from medicinal mushrooms such as Chaga, Turkey tail, Reishi and Shitake mushrooms. Orthomolecular Products makes a good extract version called Wholeimmune and Host Defense is another brand that makes a great blend called My Community. Beta Glucans increase Natural Killer cells that are a key part of the immune system that helps fight viruses. This would be a good preventative herbal medicine as well as a good inclusion in treatment. Some brands of medicinal mushrooms can have fungal contaminants or be contaminated with the fungicides that are used to prevent this. That is why for these products I would only stick with the two recommended brands listed above.

Zinc- I like Reacted Zinc by Orthomolecular products 1 tab /day Zinc is essential for your body to mount an immune response. I often find patients who have recurrent or chronic infections to be deficient in zinc and adding this can make all the difference at preventing the next infection or effectively treating the current one.

Vitamin A- 100,000 IU per day for 3 days. This is not safe for pregnant women and is not safe to continue for longer periods of time because it is a fat soluble vitamin that will build up in your body. Incorporating orange vegetables such as sweet potato or carrots can help increase your Vitamin A (1 sweet potato may contain about 20,000 IU of Vitamin A).

Oregano Oil and Thyme Oil – These have anti viral properties and one preparation that I have used in the past is called Candibactin AR by metagenics or Candicid Forte.

Berberine or Goldenseal- Candibactin BR by Metagenics contains berberine, which has anti viral properties and helps to reduce inflammation and improves detoxification pathways.

Silver Hydrosol- Silver has anti viral properties because it carries oxygen free radicals that work much like hydrogen peroxide or bleach but it is safe for human consumption. Argentyn 23 or the less potent Sovereign Silver are the only types of Silver Hydrosol that I would recommend as other forms of colloidal silver can contain contaminants that can permanently stain skin blue.
Follow the instructions on the bottle for how to take this.

Sinus Rinses can be very effective at reducing the viral load in your sinuses, which reduces the amount that drips down into your lungs. The Xlear nasal spray or rinse has xyllitol and some preparations have grapefuit seed extract or rosemary and thyme oil. These are directly anti-viral and can be used 2-3 spray/ nostril 3-4 times per day.

Yes you can actually take all of these supplements safely at the same time but you may not need to. Given that there can be significant back orders I wanted to list a variety of natural anti viral supplements and these can work by different mechanisms to have an overall synergistic effect.

Water is a natural anti-histamine and drinking water regularly throughout the day reduces the contamination from the sinuses into the lungs by washing the virus into the stomach where the stomach acid will kill it. Try to drink 3 liters of water a day if you are sick and at least 2 liters a day if you are not.

When patients are sick, I recommend following an Alkaline Way diet. There is a free e-book, called the Alkaline Way that you can find by googling that + “ Pdf “ and it has an easy to follow chart that shows which foods should be avoided and which foods will help with supporting your immune system. In general, avoiding alcohol, coffee, grains and breads, dairy and red meat during an active
cold can help reduce the amount of mucous and phlegm and maintaining are more alkaline state can help to boost immunity. Green Tea is a great substitute for coffee if you are sick. The number one thing to avoid if you are hoping to avoid getting sick or are already sick is Sugar. It is a potent immunosuppressant. Alcohol is also an immunosuppressant so be sure to avoid this as well.

Be sure to get to sleep before midnight. There are a number of reasons why sleep may not be restorative or other issues with sleep. This is beyond the scope of this article but addressing sleep is important and sometimes you have to fake it until you can make it because no matter what, if you do not sleep, your immune system will be compromised. This can mean using Benadryl to knock
you out, which may also help reduce some symptoms of a cold such as sinus congestion. I have also found Magnolia bark extract (a product called Sedalin by Xymogen, you can order from their website using my practitioner code: SFIIRM1341 ) to be very effective for inducing sleep because it works by lowering cortisol, which is usually responsible for an over active mind in bed. CBD can also be effective at inducing sleep and there are tinctures that blend that with passionflower, lemon balm and other mild herbal sedatives that can be a good approach to inducing a restorative sleep.

Stress Reduction!
These are stressful times. The Coronavirus is stressful. The economy is now becoming more stressful. Politics have become more stressful and are likely to become increasingly more stressful as elections draw near. This is on top of whatever else is going on in your life. Though thinking about these things can be important in order to make a plan, which in the end is the best way to feel more
relaxed about any stress, I find it can be extremely therapeutic to do the following exercise:
Imagine that whatever is stressing you out, work, politics, money, the environment, the coronavirus, Imagine that it has been solved. That the virus has passed and is gone. That the political turmoil has been resolved. The economy is booming and money is no longer an issue for you. Just take a moment to imagine what that would feel like. Shake your hands out and just experience that relaxed state for a moment. It is important to let go of these worries every once in a while because the constant burden of unresolved stress can significantly impair your immune system.
One mentor of mine would ask his patients to say to themselves, “I’m not in imminent danger” three times. Some times you have to Fake it until you Make it. These types of exercise can get you to the goal immediately and we all need a break from the struggle sometimes.
Unplugging from your phone and the news can be necessary. Maybe check once a day when it is important but don’t spend all day obsessing about it.
Another exercise can be to just lay on the earth in the grass or on a rock or going for a walk in nature. These can all help to get our minds and bodies back into a more natural state and out of the buzz and hum of the modern era that can be more stress inducing than our ancient mind and bodies were made to endure for extended periods of time.

If you are actively sick, exercise is not likely to be indicated. As a preventative, high intensity interval training is a great way of improving your blood flow, lymphatic drainage, anabolic hormone production, autonomic nervous system tone and due to all of these factors, improve your immune system.

It is important to know when home care is not working and when it is time to head in to an urgent care for a chest x-ray and evaluation or when to head to the Emergency Room. Waiting too long to do this in hopes that any home remedies will help you turn the corner can be hazardous to your health. If your condition is worsening, you are having trouble breathing, high fevers, extreme fatigue and
you are concerned for your health, then you should contact your doctor’s office and if nothing else put on your surgical mask and head into the the urgent care or ER to be evaluated. While quarantine and minimizing public exposure is important, there is a time when it is right to be evaluated for other interventions, such as treating a bacterial superinfection in the lungs or when a patient might
need to be intubated. Please use your best judgement and if your are uncertain contact you doctor for guidance on when this is right in your case.

My hope in providing this information to you is that it will help give you a further sense of control and thus reduce your stress. It is very likely that new therapies will emerge for treatment, such as anti viral medicines and prevention, such as a vaccine, that will help make the Coronavirus much like the measles or at worst like the Influenza virus. Until then, following the guidelines that the WHO and the CDC have recommended, which are largely mitigation practices of hygiene and social distancing and adding the therapies listed above when indicated can help to keep our hospitals available to the patients who will need it the most.