, an independent data source maintained by Chinese physicians.<\/span>\u00a0<\/span><\/p>\n<\/span>As of March 12, 2020, there have been at least 127,863 global confirmed cases, 80,932 of which are in mainland China. The rate of new daily cases in China is slowing down while the rate in other countries has been increasing. Italy, Iran, and South Korea have the next highest number of COVID-19 cases, at 12462, 10075, 7869 cases respectively.\u00a0<\/span>As of March 12, 2020, there are 1,323 cases of confirmed COVID-19 in the US.\u00a0<\/span><\/p>\n<\/span>Infection from exposure to COVID-19 from <\/span>within <\/i><\/b>the reporting country is far surpassing infection from exposure due to travel from another country, with an increasing number of infected persons with no history of international travel or close contact with a patient with known infection. Domestic community spread is becoming an increasing concern in the US and in other countries, and we need to have more strategies for early detection, containment and treatment than just closing our borders.\u00a0<\/span><\/p>\nHow is COVID-19 transmitted?<\/strong><\/h3>\n<\/span>It is now clear that human-to-human transmission of COVID-19 is possible and is occurring. Transmission is mainly through respiratory droplets and close contact – similar to how influenza is spread. <\/span>The CDC defines close contact as being within 6 feet or within a room or care area for a prolonged period without personal protective equipment OR having direct contact with secretions of a person with COVID-19 infection. <\/span><\/span>There is some evidence that fecal-oral or blood transmission may be possible, even when COVID-19 is not detected in oral swabs (3). <\/span><\/p>\nSARS-CoV-2 is now known to survive on various surfaces and possibly be transmitted through \u201cfomites\u201d (a fancy word for objects or materials that can carry infection, such as tabletops, keyboards, clothes and utensils), and may also possibly have airborne transmission. This study (37) found the following survival rates on various surfaces:<\/span><\/p>\n\n- Aerosol (in the air) – at least 3 hours<\/li>\n
- Copper – 8 hours<\/li>\n
- Cardboard – 8 hours<\/li>\n
- Stainless steel – 48 hours<\/li>\n
- Plastic – 72 hours<\/li>\n<\/ul>\n
<\/span>The incubation period is thought to be 2-14 days, with a median incubation period of 4 days. Patients are thought to be most contagious when they are symptomatic. However, one report (4) found that an asymptomatic woman who transmitted COVID-19 to 5 other people may have had an incubation time of 19 days.\u00a0<\/span><\/p>\nWhat are the symptoms of COVID-19?<\/b><\/h3>\n
What is important to remember is that the vast majority, likely over 80%, of infected people appear to have <\/span>mild <\/i><\/b><\/span>infections – with mild cold-like symptoms and fever, and likely many who have no symptoms. As noted above, there are case reports of asymptomatic carriers. However, most people who contract COVID-19 do seem to develop symptoms of some sort.\u00a0<\/span><\/p>\nReported symptoms include:<\/span><\/p>\n\n- Fever (which may not be present in the very young or very old, or immunocompromised)<\/span><\/li>\n
- Uncomplicated upper respiratory symptoms (<\/span>Cough, sore throat, nasal congestion, malaise, headache, muscle aches)<\/span><\/li>\n
- Difficulty breathing<\/span><\/li>\n
- Mild pneumonia<\/span><\/li>\n
- Severe pneumonia (the severe <\/span><\/span>pneumonia caused by COVID-19 is now named severe acute respiratory infection (SARI))<\/span><\/li>\n
- Diarrhea and other GI symptoms (nausea, anorexia)<\/li>\n
- Loss of smell (anosmia) and taste (ageusia)<\/li>\n
- <\/span>Acute Respiratory Distress Syndrome (ARDS)<\/span><\/li>\n
- Sepsis and Septic shock<\/span><\/li>\n
- Death<\/span><\/li>\n<\/ul>\n
Death is of course what we are all worried about. So let\u2019s look at that a little more closely in the next section.\u00a0<\/span><\/p>\n<\/span>What is interesting to note is that children seem less vulnerable to infection and appear to have milder symptoms than adults. There have been NO reported deaths in children 0-9 years of age. One very small study of 9 infants under 1 year of age infected with COVID-19 found that none of the infants had severe illness or complications. In fact, 1 had no symptoms, 2 had mild upper respiratory tract symptoms, and 4 had fever. (5) Another larger study (38) of 2143 pediatric patients (731 lab-confirmed and 1412 suspected), 94.1% had no to moderate symptoms. There was one death in a 14-year old child, and to date there have been no reported deaths in any child under 10 years of age.<\/span><\/i><\/p>\n<\/span>Pregnant women also do not appear to be at greater risk for complications. In a small study of 9 women in Wuhan in their 3rd trimester of pregnancy with confirmed and symptomatic COVID-19 infection, none developed severe pneumonia or died. All gave birth via c-section to healthy-appearing babies with normal Apgar scores. No virus was found in amniotic fluid, cord blood, breastmilk or neonatal throat swab.\u00a0(6) Two additional studies also confirmed that intrauterine infection does not occur, and reported no deaths in mothers or newborns. (39, 40)<\/span><\/i><\/p>\n<\/span>What is the COVID-19\u00a0 mortality rate?<\/b><\/h3>\nUnfortunately, we don\u2019t really know. As stated above, we need real<\/strong><\/em>\u00a0<\/strong>case numbers to know\u00a0real<\/strong><\/em> death rates.\u00a0The high number of deaths in China is devastating, but may not be reflective of mortality rates in other parts of the world given the tragic lack of hospital staff, medical supplies, ICU beds, and test kits that China is facing. And this may similarly be the case in other countries like Iran. <\/span><\/p>\nIf we just look at our current numbers, the death rate appears to be quite high. The reported mortality rate is highest in Italy at 10%, in China it is 4%.\u00a0BUT<\/strong> – let’s take a look at South Korea. In South Korea, after testing 100s of thousands or people, the mortality rate is closer to\u00a01.4% mortality rate <\/span><\/strong>– much lower than the 2-3.5% mortality rate that is currently being reported in the news.<\/span>\u00a0In an editorial written by Dr. Anthony Fauci, MD director of the National Institute of Allergy and Infectious Disease, he writes:<\/p>\n“If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%.” (33)<\/span><\/em><\/p>\nNote that even 1.4% is still significantly higher than the estimated 0.1% mortality rate from influenza.\u00a0No death is to be taken lightly, and my heart goes out to those who are suffering tragic losses. But b<\/span>efore we accept the high reported mortality rate and succumb to the rapidly worsening hysteria and potential worldwide economic collapse, we need REAL NUMBERS<\/strong>. I urge policymakers to quickly develop more widespread and rapidly available testing capabilities, not simply to quarantine those who are infected, but to shed real light on the gravity of the situation and help the public, clinicians, public health departments, and businesses be calmly and rationally prepared.<\/p>\nThat being said, we certainly do not want to take any deaths lightly. Certain populations do seem to be more at risk for serious infection and for death. Increasing age seems to be the most important factor, and as mentioned above, children appear relatively spared. In a report released by the Chinese CCDC on February 17, 2020 in the Chinese Journal of Epidemiology, the risk of death increases with age, with being over 80 the highest risk factor. The fatality rate of patients over 80 years old was estimated to be 14.8%. Death in those under 50 appears to be unlikely, with the mortality rate of 40-49 year olds estimated to be 0.4% and 0.2% for patients 10-39 years of age. As noted above, there have been NO deaths in children 0-9 years old.\u00a0Having a chronic, pre-existing medical condition also significantly increased the risk of death. Without any pre-existing condition, the mortality rate was 0.9%. A history of cardiovascular disease increased the risk to 10.5%. (7)<\/span><\/p>\n<\/span>So like the influenza virus, the elderly and those with underlying chronic medical conditions appear to be most at risk for serious complications and death from COVID-19. However, unlike influenza, children so far appear to be relatively protected.<\/span><\/p>\n<\/span>How and who do you test for COVID-19?<\/b><\/h3>\n<\/span>COVID-19 is detected by testing nasopharyngeal swabs (basically a q-tip up the nose), oropharyngeal swabs (a throat swab), and sputum for genetic material of COVID-19 by polymerase chain testing (PCR). The test kit is called <\/span><\/span>the \u201cCenters for Disease Control and Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel.\u201d In the US, these test kits are NOT widely available currently through doctor\u2019s offices, community clinics, or hospitals\u00a0 (i.e. <\/span>I do NOT have test kits<\/b><\/span>). The CDC has begun rolling out test kits to certain state public health departments, including California and hospital labs and commercial labs like Quest and Labcorp have already rolled out their testing. BUT, there are still not enough testkits to test every patient with fever and upper respiratory symptoms.\u00a0 There are not enough nasal swabs and “V-C-M” media for community clinicians like me to test possible cases, and sending nasal swabs to Quest or Labcorp have the further difficulty of needing to be sent on ice.<\/span><\/p>\n<\/span>Currently, the recommendations are to test patients with fever and lower respiratory symptoms (cough or shortness of breath) who have had close contact with: 1) a person with confirmed COVID-19; or 2) history of travel from affected geographic areas with 4 days of symptoms; OR anyone with severe acute lower respiratory illness that requires hospitalization and does not have another diagnosis like influenza, even without any known source of exposure. Remember, the CDC defines close contact as being within 6 feet or within a room or care area for a prolonged period without personal protective equipment OR having direct contact with secretions of a person with COVID-19 infection.<\/span><\/p>\nThis is the protocol that was emailed to me by my local health department (8):<\/span><\/p>\n![\"\"](\"https:\/\/healthykidshappykids.com\/wp-content\/uploads\/2020\/02\/pui-guidelines_2.26.2020.jpg\")
<\/p>\n
The CDC also recommends that providers test for other respiratory pathogens, like they would as part of their usual workup for anyone who comes in with fever, runny nose, and cough – like the flu! Because let\u2019s face it, we\u2019re still in the middle of flu season, and\u00a0…<\/span><\/p>\nIf you or your child have cold or flu symptoms,
\nthere is a good chance that your child has a cold or the flu!<\/span><\/h4>\n<\/span>As we begin to see more domestic spread of COVID-19 in the United States, please …<\/span><\/p>\nDo NOT<\/i><\/b> rush to your doctor\u2019s office or hospital to get tested at the first sign of fever or cough unless your health is declining and you need urgent medical attention.<\/h4>\n
Your doctor or emergency department likely has very limited\u00a0<\/span>capability to test for COVID-19, and going unnecessarily to the doctor\u2019s office or emergency department may inadvertently expose you or your child to\u00a0COVID-19 or other infections and likewise expose other people to whatever illness you may have. Many cases of COVID-19 in China are likely due to uninfected people becoming infected after exposure while waiting in long hospital and clinic lines to be tested. The California Department of Public Health urges that:<\/span><\/p>\nIf a person develops symptoms in COVID-19 including fever, cough or shortness of breath, and has reason to believe they may have been exposed, they should<\/span>\u00a0call<\/span><\/em>\u00a0their health care provider or local health department\u00a0<\/span>before<\/span><\/em>\u00a0seeking care. Contacting them in advance will make sure that people can get the care they need without putting others at risk.<\/span><\/h4>\n<\/span>How do you treat COVID-19?<\/b><\/h3>\n<\/span>There are currently NO<\/strong>\u00a0specific antiviral medications known to treat COVID-19, Treatment is supportive with rest, fluids, oxygen, and more intensive care if needed. Scientists are actively researching possible existing or new antiviral medications that may have activity against COVID-19, and vaccines that may help to prevent COVID-19. Tamiflu will not work. While these efforts are critically needed, the manufacture and testing of a new pharmaceutical agents or vaccines is likely several months to over a year in coming.<\/span><\/p>\nThere are currently over 80 clinical trials across the world looking at pharmaceutical and even natural treatment options for COVID-19, including high-dose Vitamin C. Hydroxychloroquine, a safer version of chloroquine, appears to hold the most promise. A study in Marseille (41) found that a combination of hydroxychloroquine of 300mg TID x 10 days + azithromycin 500mg on Day #1 then 250mg QD on Days #2-5 significantly reduced viral load and percentage of patients still carrying SARS-CoV-2 at 6 days.<\/p>\n
Other potentially promising medications under investigation are Remdesivir, Sarilumab (a human IL-6 receptor blocking monoclonal antibody), and anti-SARS-CoV-2 IgG antibodies from infected patients.<\/p>\n
<\/span>In the meantime, while there are no pharmaceutical options approved for COVID-19, are there any existing natural treatments that might work? We just don\u2019t know. A huge amount of funding has been committed to clinical treatment trials. While we wait anxiously for results, <\/span><\/span>I urge scientists and researchers to consider some of the evidence we currently have about natural treatments for prior coronavirus outbreaks (SARS, MERS) and sepsis that may theoretically hold promise for successfully treating COVID-19, and would be more readily available and much less costly than any newly-engineered drug.<\/i><\/b>\u00a0<\/span><\/p>\n<\/span>I am here to educate and inform, NOT to recommend any particular treatments because we simply do not yet know what will be effective against COVID-19. I did this research out of an effort to educate myself on all possible therapeutic options if\/when COVID-19 arrives. Here is what I found. <\/span>These are theoretical possibilities only<\/i><\/b><\/span>. Please do not stockpile these natural medicines. If you suspect you or your child has COVID-19, please consult with your physician on your best treatment options.<\/span><\/p>\nZinc\u00a0<\/b>has been found to inhibit Coronavirus RNA <\/span><\/span>polymerase activity in vitro and zinc ionophores CAN block the replication of these viruses in cell culture. (42) Z<\/span>inc + zinc ionophores (compounds that affect the cellular transporters for zinc) have been shown to block SARS-CoV multiplication, which means that they may be able to stop the current circulating SARS-CoV-2 from replication and wreaking havoc in our immune systems. (43) What’s fascinating is that chloroquine is a zinc ionophore, and this (44), and this maybe why it has been found to be helpful in Coronavirus infection.<\/p>\nQuercetin and Epigallocatechin-gallate (EGCG found in green tea)\u00a0<\/span><\/b><\/span>have also been found to have zinc ionophore activity (45), and should therefore be considered for research in all potential treatment options for COVID-19.<\/span><\/p>\n<\/span>Sambucus Formosana Nakai<\/span> <\/b><\/span>(a species of elderberry similar to Sambucus nigra or black elderberry that has been found to have anti-influenza activity) was found to have strong activity against <\/span><\/span>Human coronavirus NL63 (HCoV-NL63). (9)\u00a0 <\/span>NOTE: <\/b><\/span>This is NOT the same as the elderberry syrup you\u2019ll find on shelves, and I am not recommending that you go out and stockpile Sambucus Nigra). The caffeic acid component of Sambucus <\/span><\/span>Formosana Nakai seemed to be responsible for most of the anti-<\/span><\/span>HCoV-NL63 activity, and significantly inhibited replication and blocked attachment of HCoV-NL63. Caffeic acid is actually NOT related to caffeine, but is found in many foods such as <\/span><\/span>coffee, wine, turmeric, basil, thyme, oregano, sage, cabbage, apples, strawberries, cauliflower, radishes, mushrooms, kale, pears, and olive oil. It definitely couldn\u2019t hurt to load up on caffeic acid-rich foods (minus the coffee and wine, perhaps\u2026). [PLEASE NOTE: I have been asked where people can find Sambucus Formosana Nakai, and unfortunately, as far as I can tell it is not available commercially. I included this information for research purposes, and do not know if Sambucus nigra would have similar effects.]<\/span><\/p>\nTraditional Chinese Medicines<\/b><\/span><\/span> have been met with significant controversy and panic stockpiling when Chinese researchers claimed that a traditional herbal formula (shuanghuanglian made with honeysuckle, Chinese skullcap and forsythia) could inhibit 2019-nCoV in vitro. This was a premature announcement and clinical trials need to be performed. However, if we look to prior research on other coronaviruses, there are studies showing the efficacy of various Chinese herbal agents against other coronaviruses, including SARS-CoV and CHOV-22E9. (10) These herbal medicines include: Bupleurum, Heteromorpha, and Scrophularia scorodonia (11); Lycoris radiata, Artemisia annua, Pyrrosia lingua, and Lindera aggregata (12); Isatis indigotica and Torreya mucifera (13,14,15); and Houttuynia cordata (16)\u00a0 My hope is that researchers take interest in these initial in-vitro results and consider clinical trials that could potentially find a cure in these natural agents.<\/span><\/p>\n<\/span>COVID-19, sepsis & cytokine storm<\/b><\/h3>\n<\/span>When patients with COVID-19 die, it is often due to sepsis, in which the immune system goes haywire and overreacts in what is called a <\/span>\u201ccytokine storm.\u201d <\/i><\/b><\/span> Natural agents that are immunomodulatory and immunoregulatory, and bring BALANCE to an overactive immune system, may be one of the best options to support patients with sepsis. Here\u2019s what the literature shows for what may be helpful for critically ill patients with sepsis. In life-or-death critical situations like sepsis where conventional medicine does not offer significant success, I would urge researchers to consider all potential treatment options for further investigation.\u00a0<\/span><\/p>\nVitamin C,<\/span><\/b>\u00a0<\/b><\/span>1.5 grams IV every 6 hours (6 grams total daily), given with hydrocortisone and thiamine was found to significantly decrease mortality and prevent progressive organ failure in patients with sepsis. In fact, patients treated with the vitamin C protocol had an 8.5% death rate compared with 40.4% in the control group! (17) Thankfully, there is currently a research trial underway to investigate vitamin C infusions for the treatment of severe 2019-nCoV infected pneumonia (18) where patients in the treatment group will receive 24 grams of Vitamin C daily for 7 days.\u00a0<\/span><\/p>\nVitamin D<\/b><\/span>\u00a0has been called a \u201cpro-survival molecule.\u201d In this review of the literature on Vitamin D and immunity (19), the authors conclude that:\u00a0<\/span><\/p>\n\u201c… vitamin D not only helps the immune system to be dampened during an excessive or chronic reaction (anti-inflammatory potential) but also to rapidly reach its completion or exhaustion, helping innate cells to kill bacteria or viruses. In this sense, vitamin D maintains its pivotal role as a pro-survival molecule.\u201d<\/span><\/p>\n<\/span>Cathelicidin produced by Vitamin D can neutralize LPS (lipopolysaccharides) that are responsible for so much of the damage that we see in sepsis, and also has antimicrobial and immunomodulatory effects. (20) Vitamin D deficiency may actually be considered a risk factor for sepsis and inflammatory disorders, so please ensure that your and your child\u2019s vitamin D levels are optimized as I discuss below in how to protect your child.<\/span><\/p>\nOther Natural Agents: <\/b><\/span>
![\"\"](\"https:\/\/healthykidshappykids.com\/wp-content\/uploads\/2020\/02\/Coronavirus-Blog_jpg.jpg\")
<\/p>\n[Updated March 24, 2020 to include the latest potential therapeutic options.]\n