How to Protect Yourself Against COVID-19

COVID-19: Mechanisms of Infection and How We Can Prevent and Protect Ourselves

Rapidly changing guidelines, doubling infection rates every 3-5 days, and massive business, school, and economic impacts worldwide. What is this virus and why is it stopping us in our tracks?

I would like to describe for you, based on a combination of understanding from recent scientific publications and prior understanding about SARS (severe acute respiratory syndrome), what is COVID-19 and what we can and should consider to combat it.

COVID-19 is a coronavirus with many shared attributes to SARS (severe acute respiratory syndrome), another human respiratory coronavirus. We have learned a lot about SARS since its outbreak in China in 2002 and presents with similar symptoms as COVID-19 including fever, cough, headache, muscle aches, and difficulty breathing. The way COVID-19 impacts younger and older individuals disproportionately in SARS is similar to our present understanding in COVID-19 with younger individuals the least affected and those over sixty-five years old being most severely impacted. The mechanism behind this has been explained due to the way in which the virus infects cells, and namely, the particular protein it binds to get into the cell to reproduce itself.

Basic Virology Review

COVID-19 and SARS, both bind to a particular protein called Angiotensin Converting Enzyme II (ACE2). This protein is like the door to the cell and, unfortunately, COVID-19 and SARS, are attracted to this doorway and can sometimes push their way through if they are not identified by immune system first. A recent study published states “the cells with ACE2 expression may act as target cells and thus are susceptible to 2019-nCoV infection; such cells include type II alveolar cells (AT2) of the lungs” (Zou et al., 2020).

One of the purposes of ACE2 is vascular constriction, defined as tightening of blood vessels. As more and more cells become infected, the ACE2 function is destroyed and increased fluid accumulation occurs in the lung tissue along with the influx of a specific type of immune cell called neutrophils. Neutrophils are an important component of a robust immune system, however, if their recruitment is overdone, the inflammation they attract can lead to a downward spiral of the recovery efforts and ultimately destruction of lung tissue (Lai et al., 2020).

The specific type of lung cells that have ACE2 present are alveolar type II cells and are particularly important for maintenance of oxygen exchange in the body. Without these cells, the lungs are unable to exchange carbon dioxide (our natural waste product) for fresh oxygen. If enough of alveolar type II cells are damaged, the person may develop acute respiratory distress and ultimately can lead to death.

Why is Youth a Protective Factor Against COVID-19 and What Can We Learn From This to Help Our Most Vulnerable?

It is also under investigation whether the medications known as ACE-Inhibitors (e.g. lisinopril) and ARBs (e.g. losartan) may play a protective role or may increase disease severity and course. The reason being is these medications increase ACE2 protein presentation three and five-fold which may increase susceptibility of these cellular targets (Watkins et al., 2020). It is currently unknown whether these drugs may help or hinder those with COVID-19 and current guidance is not to change medications or dosing for those being treated for high blood pressure. There are botanicals that are known as ACE-Inhibitors such as Hawthorne, however, they are not recommended for empiric experimentation at this time until more data is known about their specific effects in relation to this virus.

Using the understanding of how ACE2 may play a role in entry for the virus, a current clinical trial is underway to assess whether giving a pharmaceutical agent of ACE2 may prove supportive against severe presentations of COVID-19 (National Clinical Trials (https://clinicaltrials.gov/ct2/show/NCT04287686).

How to Prevent COVID-19: Beyond Basic Handwashing

Handwashing frequently, using hand sanitizer when soap and water are unavailable, and wiping down surfaces including your phone, computer, and any other commonly touched items are the absolute foundation of prevention. Avoid touching face and eyes etc.

Stress Management

The other critical piece of prevention is around managing stress effectively. During these very uncertain and downright fearful times, high stress can actually hinder our immune system, ultimately leaving us more vulnerable that we would normally be.

Here are some stress management strategies that also may build a strong respiratory system. 

• Consider picking up the practice of pranayama deep breathing. This is a specific yoga type of breathing that enhances lung volume and capacity and helps to reduce stress (Peterson et al., 2017)
• Exercise and spend time with your loved ones doing outdoor activities. Many of us are feeling a little stir crazy already. Getting outdoors and breathing fresh air, ideally in a park or non-urban environment can help calm the nervous system and allow us to appreciate all the good things that nature has provided.
• Start a meditation practice. If you are someone who has never tried this before, this might be a perfect time to start. If you already practice meditation, be diligent about your commitment to your practice. Your stress and immune systems will thank you. There are thousands of free online programs and phone applications. A few of my favorites include meditation oasis, synctuition, and calm.
• Read something other than the news. Has there been a book you’ve been wanting to read? What about something online you’ve been wanting to learn? With the digital information age we live in, consider focusing some of your mental energy on something besides consumption of negative news media. The world will still turn, it’s your choice how you want to live.

Home Immune Support Strategies

• Ensure adequate hydration, eat nourishing, healthy foods including fruits and vegetables. Eating low-nutrient high calorie foods right now is not what your body needs to support itself and create a robust immune response.
• Get plenty of sleep every night. Sleep is how the body filters itself and cleans out the waste products from the day. Inadequate sleep is highly correlated to a depressed immune response.
• Consider sweat therapy at home. If you are so lucky to have an infrared sauna, lucky you. For the rest of us, access to a hot bath and then wrapping warmly in warm clothes and inducing a 20-30 minute sweat session under the covers can also help to challenge our immune system, detox, and build cellular resiliency.
• On the flip side, consider a cold shower for 30 seconds to 1 minute after you heat up the body in a hot shower. This cold shock helps to support immune system stimulation and build a healthy adaptive immune response (Lindsay et al., 2016).

Nutraceutical Interventions

Vitamin D

Vitamin D has been called the survival molecule and is associated with a better educated immune system and response. In regards to a respiratory infection, lower blood levels of Vitamin D are associated with acute lung injury and acute respiratory distress syndrome. Adequate Vitamin D levels are associated with preserved lung barrier function and should be considered a strong recommendation for a healthy immune response (Shi et al., 2016).

Dosing for Vitamin D

Ensure adequate Vitamin D levels by taking between 2000-5000 IU daily or ask your doctor about getting your Vitamin D levels tested to get a personalized recommendation.

Vitamin C

There is a lot of discussion whether Vitamin C is directly antiviral or not and the currently clinical trial that is ongoing in China is evaluating whether once infected with COVID-19, whether Vitamin C reduces the severity of pneumonia cases (National Clinical Trials https://clinicaltrials.gov/ct2/show/NCT04264533). The mechanism behind this is suggested to be a reduction of neutrophils (immune cells) that accumulate in the lungs, thus destroying gas exchange capability. Vitamin C as an antioxidant also reduces the severity of damage accumulated by the inflammatory response of an infection as described by Biancatelli C., 2019 “Vitamin C is a potent antioxidant, which directly scavenges oxygen free radicals as well as restoring other cellular antioxidants. Vitamin C may therefore ameliorate viral induced oxidative injury”.

Dosing for Vitamin C

Orally 1000mg-2000mg per day or more depending on bowel tolerance. If you have access to an infusion of Vitamin C, you can do higher doses between five and twenty-five grams, depending on what your physician recommends.

Licorice

Licorice root has many different compounds present in the plant. One of the most potent antiviral compounds present in licorice is glycyrrhizic acid which has been studied against the SARS-coronavirus in a laboratory (in-vitro) study (Hoever G et al., 2005) as increasing antiviral activity. The mechanism behind the efficacy of licorice may be its affinity to bind to the ACE2 receptor, thus essentially blocking the ability for the virus to gain entry into the cell itself (Buhner, Stephen 2013). While there is no data demonstrating efficacy of licorice root against SARS or COVID-19 in human trials, it is a widely used botanical for immune function, anti-inflammatory activity, and even helps to manage stress. It is, in my humble opinion, a strong choice for immune support and protection. However, until we have human data it is unknown it’s actual efficacy against reducing COVID-19 viral load. It is important to note, licorice is NOT an appropriate intervention for those with high blood pressure.

Dosing for Licorice

1/8 -1/4 tsp licorice extract twice daily or 1000mg twice daily in capsule form.

Chinese Skullcap (Scutellaria baicalensis)

Similar to licorice, however less published data, skullcap is widely used in Chinese medicine in combination with other botanicals. It is also used to reduce stress and has a proposed mechanism to also bind to the ACE2 receptor reducing the ability of the virus to gain entry into the target cell (Buhner, Stephen 2013). A 2019 study on the antiviral effects of skullcap and influenza A virus demonstrated multiple benefits including lowering viral load, anti-inflammatory, and preservation of lung tissue (Zhi et al., 2019).

Skullcap is typically found in Chinese medicine or other botanical blends including Nazanol (Metagenics) or ViraCon (Vital Nutrients)

Cordyceps mushrooms

Medicinal mushrooms have long been used as immune modulatory molecules which can help support the immune response while concurrently balancing the inflammation response that may ensue. This is particularly important for an infection like SARS or COVID-19 that may have an explosive inflammatory response which requires modulation of the immune response after infection. An article published in 2019 demonstrated an increase in immune activity and modulation response after 8 weeks of use (Jung et al., 2019).

Dosing for Cordyceps

1 gram twice daily

Curcumin

This potent, non-specific anti-inflammatory that is derived from turmeric, however is hundreds of times more potent, helps to modulate the inflammation response, particularly in regards to an overly aggressive response that has been described in multiple viral infections. An article published in 2015 described the mechanism of curcumin supporting the “cytokine storm” reaction being a worthy consideration in viral infections (Sordillo P., Helson L., 2015).

Dosing for Curcumin

1000mg twice daily.

**In the medical literature there are different grades of evidence. One of the most basic forms of evidence is considered in-vitro studies. This means looking at how cells behave in a laboratory environment and making hypotheses to how this may function in a living organism like a human. Unfortunately, much of the literature we have on botanicals in-regards to coronaviruses like COVID-19 and SARS is based on these basic research methodologies. However, these mechanisms are plausible and should be considered when consulting with your healthcare provider.

References

Biancatelli RMLC, Berrill M, Marik PE. The antiviral properties of vitamin C. Expert Review of Anti-infective Therapy. 2019;18(2):99-101. doi:10.1080/14787210.2020.1706483

Buhner, Stephen Harrod. Herbal Antivirals: Natural Remedies for Emerging & Resistant Viral Infections . Storey Publishing, LLC. (2013) Kindle Edition.

Cao, Q., Chen, Y.-C., Chen, C.-L., & Chiu, C.-H. (2020). SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. Journal of the Formosan Medical Association. doi:10.1016/j.jfma.2020.02.009

Caselli D, Aricò M. 2019-nCoV: Polite with children! Pediatric Reports. 2020;12(1). doi:10.4081/pr.2020.8495

Clercq ED. Potential antivirals and antiviral strategies against SARS coronavirus infections. Expert Review of Anti-infective Therapy. 2006;4(2):291-302.

Davis R, Taylor A, Nally R, Benson KF, Stamets P, Jensen GS. Differential Immune Activating, Anti-Inflammatory, and Regenerative Properties of the Aqueous, Ethanol, and Solid Fractions of a Medicinal Mushroom Blend. Journal of Inflammation Research. 2020;Volume 13:117-131.

Hemila H. Vitamin C and SARS coronavirus. Journal of Antimicrobial Chemotherapy. 2003;52(6):1049-1050. doi:10.1093/jac/dkh002

Hoever G, Baltina L, Michaelis M, et al. Antiviral Activity of Glycyrrhizic Acid Derivatives against SARS−Coronavirus. Journal of Medicinal Chemistry. 2005;48(4):1256-1259.

Jung S-J, Jung E-S, Choi E-K, Sin H-S, Ha K-C, Chae S-W. Immunomodulatory effects of a mycelium extract of Cordyceps (Paecilomyces hepiali; CBG-CS-2): a randomized and double-blind clinical trial. BMC Complementary and Alternative Medicine. 2019;19(1).

Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents 2020 Feb 17.

Lee, P.-I., Hu, Y.-L., Chen, P.-Y., Huang, Y.-C., & Hsueh, P.-R. (2020). Are children less susceptible to COVID-19? Journal of Microbiology, Immunology and Infection.

Lindsay A, Othman MI, Prebble H, Davies S, Gieseg SP. Repetitive cryotherapy attenuates the in vitro and in vivo mononuclear cell activation response. Experimental Physiology. 2016;101(7):851-865.

Peterson CT, Bauer SM, Chopra D, Mills PJ, Maturi RK. Effects of Shambhavi Mahamudra Kriya, a Multicomponent Breath-Based Yogic Practice (Pranayama), on Perceived Stress and General Well-Being. Journal of Evidence-Based Complementary & Alternative Medicine. 2017;22(4):788-797.

Watkins J. Preventing a covid-19 pandemic. Bmj. 2020:m810.

Shi Y-Y, Liu T-J, Fu J-H, et al. Vitamin D/VDR signaling attenuates lipopolysaccharide-induced acute lung injury by maintaining the integrity of the pulmonary epithelial barrier. Molecular Medicine Reports. 2015;13(2):1186-1194.

Sordillo PP, Helson L. Curcumin suppression of cytokine release and cytokine storm. A potential therapy for patients with Ebola and other severe viral infections. In vivo (Athens, Greece). 2015;29(1):1-4.

Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine. December 2020. doi:10.1007/s11684-020-0754-0

Zhang, H., Penninger, J. M., Li, Y., Zhong, N., & Slutsky, A. S. (2020). Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Medicine. doi:10.1007/s00134-020-05985-9

Zhi H-J, Zhu H-Y, Zhang Y-Y, Lu Y, Li H, Chen D-F. In vivo effect of quantified flavonoids-enriched extract of Scutellaria baicalensis root on acute lung injury induced by influenza A virus. Phytomedicine. 2019;57:105-116.