Protection Protocol For COVID-19
April 5, 2020
From Ahvie Herskowitz, MD and Devin Wilson, ND
I wanted to present protection strategies that include specific anti-viral approaches, as well as approaches to help one’s immune system to stay in a modulated and anti-inflammatory state during this pandemic.
As you will see below, the strategies include rationale for various natural agents such as vitamin D, vitamin C, vitamin A, zinc, colloidal sliver, melatonin, probiotics, and elderberry as well as drugs such as hydroxychloroquine and Zithromax. The role for stem cells and exosomes as regulators of immune responses to any virus or pathogen, or post-viral autoimmune states is also included.
SCIENCE: Biology of the Coronavirus (SARS-CoV-2) — A Quick Review
ACE2 is not just a doorway for viruses to enter cells.
Similar to its relative, SARS-CoV, which caused the 2003 SARS outbreak, the SARS-CoV-2 virus, enters human cells using an enzyme called angiotensin-converting enzyme 2 (ACE2) as a doorway. ACE2 is found in many tissues but especially high levels in the lung.
Considering the virus uses ACE2 to enter cells there is concern that increasing it may lead to increased risk of infection and severity of COVID-19. However, this is speculation and there is no clinical evidence supporting it. On the contrary, restoring ACE2 levels may be protective.
ACE2 has powerful anti-inflammatory and immune modulating effects but when levels are reduced these beneficial effects are lost. As COVID-19 progresses it causes a state of “ACE2 exhaustion” where ACE2 levels are significantly diminished due to viral particles binding them. Low levels of ACE2 are believed to be responsible for the severe cases of COVID-19 with acute respiratory distress syndrome (ARDS), pneumonia and lung damage. Studies have shown the importance of ACE2 in regards to lung health and underlying conditions that increase the risk of severe COVID-19.
Low ACE2 may also exacerbate underlying cardiovascular conditions including high blood pressure, atherosclerosis, heart failure, kidney disease, serious lung injury, and others. Disease models have demonstrated that the loss of ACE2 function can lead to increased neutrophils (a type of white blood cell) in the lung, exaggerated inflammation and lung injury.
Despite the speculative concern that restoring ACE2 may exacerbate COVID-19, there is ample evidence drawn from previous studies to support its beneficial role. Many natural agents can improve ACE2 and are presented below.
Once inside human cells the process of cellular take over begins and the virus starts to replicate. The virus also begins damaging cells by producing an enzyme called 3CL Protease. This enzyme not only damages cells and causes inflammation; it allows the virus to spread to other nearby cells. Inhibiting this viral enzyme may be beneficial in reducing tissue damage and spread of the virus. Many natural agents can inhibit 3CL Protease and are presented below.
Evading the innate immune system
Even after the virus enters cells and begins replication it still needs to evade our innate immune system, a specialized subset of immune cells and proteins that kill viruses.
Viruses have many mechanisms to evade the immune system thus supporting the innate immune response will likely be helpful to prevent infection and reduce risk of progressing to severe COVID-19. Furthermore, those with a weakened immune system are at risk and may greatly benefit from such preventative immune support.
COVID-19 Prevention With Natural Substances, Drugs and Advanced Therapies
There are a number of things you can do to prime your body in case of infection. These are not necessarily treatments but are preventative strategies that may help you reduce risk of infection and support you being part of the 80% with minimal to mild symptoms and a quick recovery. These strategies have the greatest chance of success if they are started before you are exposed.
In addition to regular exercise and a plant-based whole foods diet many natural agents have shown to improve ACE2. This includes curcumin, resveratrol, rosmarinic acid, and alpha lipoic acid. In addition to its effect on ACE2, resveratrol has been shown to inhibit the growth of the MERS corona virus and reduce corona virus induced inflammation.
Inhibiting 3CL Protease
Many natural substances can be used to inhibit the 3CL protease enzyme that the virus produces to damage cells and spread infection. Elderberry fruit inhibits this enzyme and has also been shown to reduce corona virus activity in cells. It seems to be most effective when taken prior to infection and during the initial infection period. Ground flax seed has also been suggested due to its content of herbacetin, a potent inhibitor of 3CL protease.
Anti-Viral Effects: Hydroxychloroquine and Zithromax
Chloroquine and its cousin hydroxychloroquine, are medications that have been used for decades to treat malaria all over the world. Previous studies done in the early 2000s, demonstrated that chloroquine active against the SARS-CoV virus that caused the SARS outbreak in 2003.
Just recently two studies (3, 4) have confirmed that both chloroquine and hydroxychloroquine effectively inhibit the SARS-CoV-2 virus responsible for current COVID-19 pandemic.
These anti-malarial medications are now being highly considered for treating COVID-19 patients. Although data from human studies is currently limited at this time a number of clinical trials investigating these antimalarial medications are underway. Click here to read more.
A recent study from France investigated the impact of hydroxychloroquine alone and in combination with azithromycin, a common antibiotic on viral clearance in patients with COVID-19.
Twenty two COVID-19 positive patients received 200 mg of hydroxychloroquine three times per day for ten days. Among these, six patients were treated with azithromycin (500 mg on day one and 250 mg daily for four days) to prevent bacteria super infections. Sixteen COVID-19 patients did not receive therapy and served as a control group. PCR based tests to detect viral loads were performed throughout the study period.
Significant reduction in viral loads of COVID-19 patients after being treated with hydroxychloroquine alone and when combined with azithromycin.
Although the trial has not ended their results show significant reduction in viral loads of COVID-19 patients after being treated with hydroxychloroquine alone and when combined with azithromycin.
70% of patients who only received hydroxychloroquine tested negative for SARS-CoV-2 at day 6 of treatment compared to 12.5% in the control group. At day 6 of treatment, 100% of patients treated with both hydroxychloroquine and azithromycin tested negative for SARS-CoV-2.
Anti-Viral Effects: Colloidal Silver
Prior to the advent of antibiotics, silver was known for its therapeutic properties and commonly used to treat infections. While there is no clinical evidence showing that silver is effective against viruses in humans the antimicrobial properties of silver have been confirmed.
Experimental studies have shown silver to be effective against several types of bacteria, and viruses including corona virus. A 2009 study revealed that silver reduced viral activity of a coronavirus strain commonly used as a model for the 2003 SARS virus by 90% within 60 minutes of exposure and by 99.99% after 24 hours of exposure. Silver has also been shown to be active against other viruses including human imunodeficiency virus (HIV), hepatitis B virus, herpes simplex virus (HSV), and respiratory syncytial virus (RSV).
Despite the lack of human evidence regarding the anti-viral effects of ingesting silver we use colloidal silver extensively in our practice without any safety issues. Proper formulations of very low parts-per-million (PPM) nanoparticles, silver colloid such as Sovereign Silver, will not accumulate in body tissue and is extremely safe. Gargling and use of nasal spray preparations MAY reduce viral loads, if used several times a day.
Anti-Viral Effects: Vitamin C
Studies from China have described positive effects of IV Vit C at relatively low doses of 10 grams and the Chinese government has recommended daily oral doses of 2-3 grams as an anti-oxidant dose. Those of us that use IV Vit C extensively believe that an adequate anti-oxidant dose (for immune modulation and as a “prevention strategy”) is in the range of 20-25 grams. An anti-viral dose would likely be at 50 grams (the maximum dose we use) and upward. A few studies on the use of IV Vit C are underway in a few US hospitals at this time. There are no published clinical trials on the use of oral or IV Vit C specifically on COVID-19, but if such studies show safety and efficacy, we can finally see more extensive use in the USA for a variety of serious infections, sepsis, and all sorts of inflammatory states.
Supporting the innate immune system
The innate immune system is present at birth and is your biggest ally against most infections. Its function is supported by many things including ample sleep, exercise and a healthy diet. Protein is the most important dietary component as protein deficiency impairs innate immunity.
Beyond sleep, exercise and diet, many natural substances can be used to support the immune system. Some of the most important substances include vitamin D, vitamin A, vitamin C and Zinc.
Melatonin and mushroom extracts can also have beneficial effects as they both support the immune system to fight viruses. Melatonin also reduces inflammation caused by corona virus infection.
Probiotics may also be beneficial in COVID-19 as they support the innate immune system by balancing the gut microbiome. Probiotics with the best evidence for immune stimulation are Lactobacillus species commonly found in fermented foods and Bacillus species.
In addition to natural supplements more advanced therapies such as stem cell therapy and exosome therapy may be beneficial for prevention COVID-19. Two trials have already demonstrated promising results and a number of other trials are currently underway.
Protection against COVID-19 with stem cells and exosomes
Stem cells have long been used in studies as an emerging therapy for lung disease such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and pneumonia.
Recently, they have been identified as a potentially effective treatment option for COVID-19 due to their anti-inflammatory, immune modulatory and tissue repair properties. In fact, two clinical trials (1, 2 ) from China have already demonstrated promising results of intravenous stem cells in moderate and severe COVID-19 cases.
Stem cells along with exosomes may also be useful for COVID-19 prevention. Stem cells have been shown to support the immune system by improving the function of specific anti-viral immune cells as well as reducing an overactive immune response.
Stem cell therapy is also beneficial for many of the underlying health conditions such as heart, lung and kidney disease and may reduce the risk of severe COVID-19 cases and death.
Exosomes, which share many of the therapeutic properties of stem cells, may also be beneficial. In animal studies, exosomes have been shown to inhibit viral replication of the influenza virus, significantly reduce viral shedding and reduce lung damage.
Although there are no clinical trials showing its efficacy in COVID-19, a trial for inhaled exosomes is underway in China and a New Jersey doctor recently reported significant improvement in a COVID-19 patient with acute respiratory distress syndrome (ARDS) after being treated with exosomes.
Considering SARS-CoV-2 has a number of mechanisms to evade the immune system priming it with natural agents and advanced therapies may be a promising strategy for prevention of COVID-19.
In addition to the commonly recommended strategies to prevent COVID-19 infection additional measures to support the immune system should be taken, considering that most people in the US are likely to be exposed to SARS-CoV-2 over the next 12 months. Vitamins and minerals including vitamin D, vitamin C, vitamin A, and zinc, along with other natural agents such as curcumin, resveratrol, alpha lipoic acid, melatonin, mushrooms and probiotics may be useful. In addition, stem cells and exosomes may exert added benefit for the prevention of COVID-19.
Over 500 years ago a Dutch philosopher once said “prevention is better than cure”.
About Ahvie Herskowitz, MD
Dr. Herskowitz’s extensive training includes a medical degree from The Albert Einstein College of Medicine, residencies in Anatomic Pathology and Internal Medicine, and Fellowship training in Cardiology at The Johns Hopkins Medical Center. During his 12 years at Johns Hopkins, he became Associate Professor of Medicine and Immunology and Molecular Microbiology and led a research team in the study of molecular and immunological mechanisms of inflammation, autoimmunity, ischemia, heart transplantation rejection and congestive heart failure.
Dr. Herskowitz’s latest academic appointment was as Clinical Professor of Medicine at UC San Francisco. To learn more about Dr. Herskowitz, you can read it bio here.
About Devin Wilson, ND
Dr. Devin Wilson is a licensed Naturopathic Doctor in the state of California. He treats an array of acute and chronic diseases using a holistic and integrative approach to health. Dr. Wilson is also a health consultant, researcher and writer focusing on anti-aging and longevity medicine including stem cell therapy and exosome therapy.
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