COVID-19 Update (Sept. 25, 2020)

The COVID-19 pandemic has become so politicized that misinformation is rampant. To cut through the clutter, I recommend ignoring much of what you hear in the media and instead focus on what the research shows — that and have a good dollop of common sense.

(Note: I've included more footnotes with references to studies in this article than I normally do. I've done this to give you the opportunity to read the research first hand and judge for yourself if my views are supported.)

Simple Ways to Optimize Immunity

There is a reason why less than 1% of the population has had any symptoms at all from this virus. This virus simply isn't that contagious. For example, in people who have a family member with the illness (e.g. living in the same home), only 12% have also tested positive for the virus. In general, only 2% of people who come into contact with somebody who has the virus will test positive.[1]

Research suggests that nutritional status plays a big role. Dr. Fauci has noted that he himself takes vitamin D and considers vitamin C to also be helpful protection from the virus.[2] Optimized vitamin D levels are associated with a 77% lower risk of developing COVID-19.[3] Numerous studies have confirmed the critical role of vitamin D in protecting from the virus.[4] You can read a short review by a Harvard professor giving some of the rationale for this in a footnote at the end of this piece.[5] Since having written this, numerous other studies have been published supporting the importance of vitamin D. This raises concerns about vitamin D deficiency from the shelter-in-place recommendations keeping people indoors, as vitamin D is the "sunshine vitamin."

A number of studies have shown that low levels of vitamin K is associated with more severe cases of the disease.[6] (I recommend 100 µg of vitamin K daily.)

The research also suggests that zinc is poison to coronavirus and decreases its reproduction. I recommend initially taking about 50 mg of zinc a day for the first month to optimize zinc stores, and then 15 mg a day thereafter. If you begin to experience COVID-19 symptoms, I recommend increasing to 50 mg a day for another month. The rationale for this is given in several footnoted reviews.[7,8]  

Dr. Fauci also notes that 40-45% of people who get the virus will have no symptoms at all.[9]

It is obvious that there is a remarkable amount that you can do as an individual to stay safe. Unfortunately, in contrast to expensive medications being proposed, there are no financial or political incentives for lobbyists to argue for these low-cost tools in the media or medical establishment.

Also note that having cancer and being treated with chemotherapy[10], or having asthma[11] are not associated with increased COVID-19 risks in adults.

As I've discussed in previous articles, also be sure to do what you can to optimize sleep and stay hydrated.

Effect of Age on Risk of Death From COVID-19

This is important to know as it can help you decide how much risk is reasonable for you to take. Of course, this decision needs to also consider the risk you might be adding to those living in the same household.

The overall mortality rate of people who contract COVID-19 is currently suspected to be 0.6%. So only about 1 in 180 people who get the disease dies. For those who are 40 years old, this drops to 1 in 1,600.

In crunching the numbers, Meyerowitz-Katz found that children have a very low risk of death — about 5 in 100,000 children who've been infected have died. But this rises to 60 in 100,000 by age 40; 680 in 100,000 by age 60; and 8,000 in 100,000 by age 80. So although every life is of course important, the risk for those under 60 is modest compared to other causes of death in that age group.[12]

No Increased Risk of Death Seen in CFS/FMS

There appears to be no additional risk of death from COVID-19 for those with CFS and fibromyalgia. This is not surprising, as research I referenced earlier shows that even people on chemotherapy aren't seeing increased risk.[10]

I have been keeping a close watch on the impact of this illness in CFS and fibromyalgia. What am I seeing? About 55% of people who do not have CFS or fibromyalgia continue to experience severe fatigue and other symptoms similar to CFS/FMS even 10 weeks after they've otherwise recovered from COVID-19. And the likelihood of being affected this way is not dependent on how severe the illness was.

My suspicion is that about 15% of people who get the virus will develop long-term postviral CFS and fibromyalgia. I expect these people would respond well to the S.H.I.N.E.® protocol, just as those with other forms of postviral fatigue do. The silver lining to this? We are seeing more research funding and media attention for CFS and fibromyalgia than ever before. For example, see this referenced excellent article by U.S. News & World Report where I was quoted.[13]

Common Sense Social Policy

What are some common sense precautions you can take to improve your chances of being among the 98% of people who experience no problems with COVID-19, even if you come into close contact with the virus?

1. Masks

It appears that the main way people contract coronavirus is if they spend 20 minutes or more in a small area where viral particles have built up to a high concentration. Sadly, a key example for this is inside restaurants. Going into a restaurant to pick up carry-out doesn't present much risk. But I recommend being seated outdoors if you plan to eat at the restaurant.

Meanwhile, regardless of risk, it is both reasonable and considerate to wear masks when you are indoors in any enclosed public space. For example, a store or supermarket. This decreases the accumulation of viral particles in the air. The risk of catching the virus in a large space such as a Costco or supermarket is low, because the air volume of the building is so high. So I personally have little concern of risk in those settings. But even still, I always wear a mask while there as a social courtesy and to add protection to others in the building by preventing my viral particles from contributing to the concentration already accumulated there.

On the other hand, I generally consider wearing a mask when I'm outside to be unnecessary, especially when I'm just walking or exercising (though I keep one in my pocket in case needed in unexpected encounters). The exception, of course, is if I'm outside but in close quarters with a lot of people. Even Dr. Fauci takes his mask off when going for a walk if there are no other people nearby.[2] Given the size of the atmosphere and the effect of breezes blowing away the virus, the odds of viral buildup to dangerous levels when outdoors is quite low. And when was the last time somebody walked by you and sneezed in your face?

Meanwhile, though not zero, the risk of getting the virus by touching objects that people with the virus have touched has been found to be low.[2]

2. Schools

The health risk to children themselves from contracting coronavirus is low, unless they have some other severe illness. However, if they live in a home with somebody over 60 years of age, or with a high-risk person (e.g., over 65 or has an underlying condition such as diabetes, severe obesity, or uncontrolled hypertension), then it makes sense to homeschool. Absent that situation, whether to send children to school or use distance learning instead is largely a personal choice.

3. Social Distancing

I think we will find that coronavirus particles are spread more by aerosols than droplets, which means the contagion presents itself to you around you more like how you smell a nearby fire than from someone sneezing next to you.[14] This makes strict social distancing of 6 feet (which protects against droplets) less likely to be as critically helpful as the medical community currently thinks — though it's still an appropriate social courtesy for now.

4. Sheltering at Home

Provided you follow the precautions listed above, there is a strong possibility that sheltering at home is causing more harm than good. As noted earlier, optimizing vitamin D is likely to have a dramatically larger benefit than sheltering at home, and not being out in the sunshine is contributing dramatically to vitamin D deficiencies. Meanwhile, the emotional damage caused by extended self-isolation must be weighed.

A recent survey by the Centers for Disease Control sheds light on what is occurring. For example, pandemic stress is contributing to a doubling of suicidal ideation. This would translate to 24,000 excess deaths yearly. 31% reported symptoms of anxiety or depressive disorder; and 26% reported symptoms of a trauma- and stressor-related disorder related to the pandemic. The prevalence of symptoms of anxiety disorder alone was roughly three times that reported in the second quarter of 2019. In addition, roughly 13% of respondents said that they started using substances or increased substance use (and abuse) to cope with stress or emotions related to COVID-19.[15]

This is the tip of the iceberg and will likely increase dramatically as the economic repercussions of the virus begin to be felt. And these are dramatically worsened by prolonged sheltering at home policies. A far more effective approach is the next one in this list...

5. Contact Tracing and Increased Testing Availability

This could provide dramatic benefits with far less individual and social cost.

Most Helpful Treatments

Although the research is not yet conclusive, I think if you are hospitalized for COVID-19 you should consider dexamethasone and, in more severe cases, Remdesivir. This latter treatment will get the lion's share of positive media attention because the company that makes it is a major media advertiser. But if you're hospitalized, physicians will guide you correctly.

There are things you can do on your own if you begin to feel symptoms of coronavirus. Numerous studies suggest that a number of simple, cheap, and readily available over-the-counter treatments can help you even before being prescribed for expensive medications. Below are a few examples. I would not start these unless I came down with symptoms of the virus, but would begin them as soon as I did and while waiting for the test results.

Pepcid or cimetidine. We have been discussing the immune benefits of this family of medications for decades. So it is not surprising to see as much as a 58-73% lower death rate in people hospitalized with COVID-19 who are given these.[16] That rate would suggest they are more effective than expensive options such as Remdesivir. This benefit has been shown in multiple studies.[17] However, because they are very low cost and therefore much less profitable, they receive much less attention.

It appears that the benefits may also be augmented by combining with other antihistamines such as Zyrtec. Doing so was associated with a greater than 50% decrease in intubation, as well as a marked decrease in death rates.[18]

What would I personally do if I came down with symptoms of COVID while waiting for the test?

1. Take Pepcid (famotidine) 40 mg twice a day.
2. Take Zyrtec 10 mg twice daily.
3. Take melatonin 5 mg four times a day.
4. Do NOT use acid blockers such as Nexium or Prilosec. These are associated with a 2-3 fold increased risk of getting the virus.[19] 
5. Consider Plaquenil 400 mg twice a day for one day and then 200 mg twice a day for five days. Yes, the research is still suggesting that this is safe and effective. But because this medication became politicized, different media began reporting on different aspects of it. Basically, a few studies were designed where people were given insanely high doses known to be toxic, instead of the safe dosing I and most other experts are recommending. And then, unsurprisingly, these toxic doses were toxic, and the media focused on them.

   Most studies have shown a marked decrease in the risk of catching and severity of the virus with Plaquenil treatment. However, the studies did not have enough people in them to demonstrate statistical significance. So they were characterized as being negative. Because there are so many study references showing the benefits of this treatment, I am including a footnote at the end of this piece to a Newsweek article by a Yale professor discussing this issue.[20]

6. Optimize nutritional and natural support as discussed elsewhere, along with sleep and hydration.

My opinion? It's an acceptable time for people, especially those at low risk, to consider getting on with their lives as long as they adhere to the common-sense precautions discussed above — of course when you feel safe in doing so. Our understanding of this virus continues to evolve. So stay informed. It'll not only help you to feel safe, but to be safe as well.

COVID-19 requires common sense, not fear. Turn the media off. And look to the science!

Footnotes

1. Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020
2. Dr. Fauci with Jennifer Garner on Instagram  (at the 32-33 minute mark)
3. Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results
4. Vitamin D Levels Associated with Covid-19 Infection Risk
5. Does Vitamin D Protect Against COVID-19? .
6. Reduced vitamin K status as a potentially modifiable risk factor of severe COVID-19
7. Potential role of zinc supplementation in prophylaxis and treatment of COVID-19  
8. Can Zn Be a Critical Element in COVID-19 Treatment?
9. Fauci: 'About 40%-45% of Infections Are Asymptomatic'2
10. The Potential Role of Immune Alteration in the Cancer–COVID19 Equation—A Prospective Longitudinal Study
11. Asthma may not be a significant risk factor for severe COVID-19 
12. What Changing Death Rates Tell Us About COVID-19
13. What Are the Long-Term Effects of COVID-19?
14. COVID-19 Data Dives: Why Arguments Against SARS-CoV-2 Aerosol Transmission Don't Hold Water
15. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020
16. Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study (PDF Download)
17. More Evidence Heartburn Drug May Help COVID-19 Patients
18. Dual-histamine receptor blockade with cetirizine - famotidine reduces pulmonary symptoms in COVID-19 patients
19. PPIs and COVID-19 Risk: A Closer Look at the Data
20. The Key to Defeating COVID-19 Already Exists. We Need to Start Using It | Opinion