The coronavirus has reached us in California. Given how rapidly the epidemic is evolving, by the time you read this, some details—how many people have tested positive and the degree to which it is spreading—will have changed. The federal, state and local public health response will be more coordinated and testing will be more readily available. But in this critical window, on the precipice of a pandemic, we can prepare ourselves. I’d like to highlight the essential public health practices in which we can all engage, informed by an understanding of the way the virus affects the body. These practices may help each of us be as resilient as possible.
The coronavirus, like other viruses, has a fascinating ability to enter the body, hijack our cellular machinery to produce more copies of itself, and cause symptoms that make us agents of transmission—its life purpose. When an infected person coughs or sneezes, droplets containing the virus can be breathed in by someone else, or land on their mouth or nose. This is the main mode of transmission. The virus is thought to be much less likely to be transmitted through the droplets landing on a doorknob or counter, although it can live for up to nine days on surfaces.
Once the virus has made contact with the mucous membranes of the mouth and nose and possibly the eyes, it can enter the system and begin replicating itself. For an incubation period of two to 14 days, the infected person shows no symptoms. When they arrive, initial symptoms include achiness and fever, signs the immune system is mounting its response to the invader. The virus travels to the cells in the lungs, triggering a cough. The infected person coughs and sneezes, spraying the air and bystanders with the virus. Voilà.
In most cases (81 percent in China), the illness is relatively mild, yet more severe and sometimes fatal illness can result.
The virus attacks respiratory cells with cilia, the little hairs that sweep things like mucous and viruses out of the lungs. The cilia then slough off, sometimes leading to pneumonia as mucous and cellular debris collects in the lungs. Pneumonia is life-threatening in and of itself, especially to older people with health problems.
The most severe manifestations of the coronavirus infection appear to be caused by an overwhelming inflammatory immune response that sometimes occurs. Known as a “cytokine storm” or cytokine release syndrome, a dysregulated amount of immune system mediators floods the body, leading to all sorts of life-threatening problems, including fluid in the lungs, destruction of lung tissue and systemic shock causing organ failure.
We do not completely understand who is at greatest risk for this dangerous response. It may be that some people have a genetic susceptibility, it may reflect underlying inflammatory factors in a patient’s system. It is thought to be this cytokine storm that caused so many young, healthy people to die in the 1918 influenza pandemic.
In the case of COVID-19, the mortality rate in China has been highest for those over 80 years old, at 14.8 percent, followed by those in their 70s, at 8 percent. None of the 416 infected children younger than age 9 have died, and for those aged 10 to 19, one child died, a rate of 0.2 percent. Overall, the mortality rate has been 2.3 percent. This is expected to fall as testing is expanded beyond the sickest of patients.
What can we do to slow the spread of this highly contagious virus? Is it possible to prevent a profound inflammatory response? What is the role of supplementation, if any?
The transmission of the virus depends on infected people coming in contact with non-infected people. So stay clear of ill people and, if you are sick, stay home until your symptoms resolve. Cover your cough or sneeze, throw your tissues away, avoid touching your face and wash your hands frequently for at least 20 seconds. Soap and water is best, and a hand sanitizer with at least 60 percent alcohol is effective. Anti-bacterial hand-sanitizers without alcohol are ineffective.
At the community level, depending on how this evolves, our public health department may recommend further social distancing strategies. If our community becomes directly affected, it would make sense to postpone mass gatherings, replace in-person work meetings with conference calls and close schools. None of these strategies are recommended at this time; however, it is wise to have supplies on hand at home in case you should need to stay there—plenty of non-perishable food, tissues and sanitizing materials.
Beyond these prudent measures, we should support our own immune system. Eight hours of sleep each night, hydration, regular exercise and a diet rich in immune-supporting fresh veggies strengthens it. Minimizing immune-system-depleting factors like stress, sleep deprivation, consumption of processed food and refined sugar and smoking helps. The mortality rate in China for coronavirus is higher in males, perhaps because smoking is much more common in men than women.
Given the role that an exaggerated, dysregulated inflammatory response plays in critical COVID-19 illness, it makes sense to attend to whatever sources of inflammation you can identify in your lifestyle or body. If you suspect you have sleep apnea or have out of control blood pressure or blood sugar, address it with your primary care provider. Address dental issues too. Taking an anti-inflammatory type supplement like omega-3 fatty acids or curcumin won’t hurt and may help. Nature immersion and feeling love and connection decreases inflammation.
There is also promise in the use of herbal medicine. During the SARS epidemic in 2003, traditional Chinese medicinal herbal preparations were used to prevent the spread of the virus. Studies comparing groups of people taking the herbs to control groups not given the herbs found that those taking herbal medicine contracted the virus at a lower rate. Unfortunately, the studies were not well-designed and so we lack good science guiding this strategy. Yet we know that many plants contain potent antiviral and immune-supporting phytochemicals that inhibit viral invasion and replication. Plants contain a complex array of active chemicals that target viral processes, often while offering synergistic support of the host’s immune system. In this epidemic, traditional Chinese medicine is being widely used, to reported good effect; well-designed studies of ongoing efforts will be important. The use of herbal medicine warrants as much intense research and development as the creation of a vaccine, which will likely not be ready for 18 months, after the situation has subsided. There is much resilience that could come out of having community medicine gardens full of effective herbal medicine.
Given the circumstances of modern human existence, we can predict that there will be pandemic illness with some regularity. For now, take good care of yourself and each other, wash your hands a lot, master the art of effectively covering your sneeze and cough and don’t hesitate to stay home.
Anna O’Malley, M.D., is an integrative family and community medicine physician with the Coastal Health Alliance. She also directs Natura Institute for Ecology and Medicine in the Commonweal Garden, where she just made a big pot of nourishing soup loaded with herbs.