Q: How important is social distancing?
A: It is the difference between saving lives or not. Please do your part. Social distancing practices allow the healthcare system to prepare for more cases and also not have all those most sick to come to the hospital at once, which would overwhelm the hospital and exceed their capacity to take care of those who are the most severely ill. My hope is that while we are physically distancing ourselves, that we actually have a stronger feeling of connection to each other as we all share in this extraordinary time in history and help those who will be worst affected.
Q: Should I be wearing a mask?
A: Using regular masks when you go outside in everyday life likely only provides limited personal benefit but may help decrease the spread to others if you happen to be a carrier of the virus. There is some evidence from countries and cultures where mask use is more common practice, that there was decreased transmission which may have come as a result of this, though we cannot be certain. What is more important for your own benefit however is not touching your face and washing your hands very, very frequently with soap and water. N95 respirator masks do NOT need to be used outside of the hospital setting with few exceptions, and even in the hospital setting likely only for higher risk procedures that result in increased aerosolization of droplets. Please consider donating these to hospitals in your area that may be in short supply if you have them.
Q: I am concerned I may have the Coronavirus. Should I go to the hospital?
A: If you think you were exposed to or have the Coronavirus with only mild symptoms, probably not. However, if you have shortness of breath it may be important that you go to the hospital, yes. Not all cases of people with the virus, in fact most, will NOT need to go to the hospital, and it may be better to stay away. It may be wise for those who are higher risk, in terms of increased age or if with other medical conditions such as lung, heart, kidney, diabetes or immunosuppressive diseases to seek out testing if they develop symptoms, but not everyone who has the virus should be tested at this point. If in doubt, please call to discuss with your doctor or a healthcare professional.
Q: Are there any treatments for Coronavirus?
A: The main treatments depend on how severe an illness you may experience. If you need help to breathe, you need to be treated in a hospital. While we are currently trying to understand what prescription drugs may be helpful and you may be offered some if your disease is severe enough, we can use other tools in the hospital to assist you to breathe if severe and necessary. If you do not need to go to the hospital treatments are speculative at this point, though people have suggested that Hydroxychloroquine and Azithromycin, Chloroquine phosphate, or Alinia may be helpful. These should not be taken without guidance from a healthcare professional. There are also numerous other supplement and herbal/botanical compounds being suggested online, some of which may be helpful, though we do not have any definite knowledge that they will help.
Q: Should I stop taking my blood pressure medication?
A: There has been discussion about the effect of two particular types of blood pressure medication (ACEi and ARBs) and whether they increase the risk of the virus getting into the body. Currently most medical professional organizations are not recommending patients stop them. A patient should make their decision about this after speaking with their doctor. Personally, I can only speculate but do have enough concern such that, if appropriate and with the right patient may suggest switching from their ACEi to an ARB.
Q: Do NSAIDs increase risk of Coronavirus related disease?
A: There have been conflicting suggestions from overseas governments and doctors here at home with respect to NSAID use (such as naproxen, ibuprofen, aleve, motrin, etc), often used for fever and pain, and increased concern for illness. Most of the information right now is theoretical, however all medication have side effects and potential downsides which we often do not highlight enough in our discussions with patients. At this point it is worth noting that the more cautious approach would be to avoid using NSAIDs if possible. However, for many of my rheumatology patients life might become intolerable from a pain point-of-view without them so while I look to other options as much as possible, there may be some situations where my patients continue to use them acknowledging some increase in possible risk.
Q: Are steroids harmful?
A: Sometimes when patients become critically ill, we use steroids in the ICU hoping they will help lung disease and respiratory failure. While not yet conclusive, they do not appear to be helpful for COVID19 critical illness and may even be harmful. For patients not yet sick, steroids broadly weaken the immune system and are something I would try to avoid more than I might prior to the pandemic. It is important however that people not just stop their steroids suddenly if they have already been on them. And there are likely situations where they still need to be used with patients now for other conditions.
Q: Should I continue to take my immune system blocking or rheumatology prescription drugs?
A: This is a question that needs to be addressed on a case-by-case basis between a patient and a doctor. Organ transplant and cancer patients may need to stay on them, though we suspect they could be at higher risk of serious disease. For many rheumatology patients there are many different types of immune blocking drugs that they may be on. Some of these drugs are very broad in how they interfere with the immune system, like Methotrexate, and may increase my concern for patients in they are using them, and others are very narrow in how they block the immune system, like many of the biologic drugs. Some of these rheumatology medication such as Actemra/Anakinra-Kineret and others like Xeljanz/Plaquenil-Hydroxychloroquine have been used and may even prove to be helpful in treating COVID19 related illness.
Q: I have read on the internet that 5G or WiFi causes the virus. Is this true?
A: As far as causing the virus, no. However, it is very plausible that it contributes to a weakened immune system and the inflammatory cascade that results in more serious illness related to the virus. There is scientific data on how radiofrequency/EMF pollution causes negative health effects, even though it is a non-ionizing form of radiation. It is certainly the more cautious approach but reducing your WiFi exposure (ie. using an Ethernet cable, turning off your wireless router whenever possible and at least at night, putting your cellphone in airplane mode) while creating some inconvenience, tilts the risk-benefit scale way in favor of taking these precautions for me.
Q: I have heard that Vitamin D might be bad. Should I not be taking it?
A: I have seen and read conflicting thoughts among different people in the integrative medical field about this. I think it is fair to say that you do not want to be Vitamin D deficient, so I would aim to just make sure you do not have low levels of Vitamin D and for many of us I think there is a good chance we should be taking some as many are deficient without knowing it.
Q: Should I not be taking Elderberry?
A: Elderberry syrup is often taken by people to prevent colds and flu during this time of year. There has been some discussion that it can lead to ‘cytokine storm’ which is a main concern for people who get serious forms of COVID19 related illness. While Elderberry can be immunostimulatory, in my reading and in my correspondence with some my herbal medicine mentors including David Winston, a respected elder in the AHG community, this is not likely a legitimate concern. In fact, we know for other coronaviruses it has some ability to block transmission and uptake which may or may not be relevant for this particular virus. For those with autoimmune disease, we don’t know whether it can provoke a flare or not of your disease, so for those particular patients it should be used cautiously if taken, but for most people, I do not think it needs to be avoided.
Q: Are there any other supplements that need to be avoided?
A: In theory, I would avoid Selenium, which I often have suggested to my patients with thyroid disease in the past. It upregulates the AT2 receptor, similar to ACEi blood pressure medication, which the virus uses to gain entry to the human body. However, Selenium may have other benefits that could overall mean it could be more beneficial than harmful. Because we do not know however, I am generally suggesting that people stop their Selenium at this time.
Q: What about Vitamin C?
A: Again, data is limited, but Vitamin C given intravenously has been under study in the USA and elsewhere for use in sepsis for some time. Some hospitals in China used several different protocols of Vitamin C for COVID19 patients. Some also used it for less severe disease in the community setting to help treat and avoid needing to go to the hospital. In New York some hospitals have been willing to use it with patients, without clearly knowing if it will be helpful. In my opinion there are several plausible mechanisms through vitamin C may help and especially to prevent progression to cytokine storm. I think it is a reasonable thing to take 2 grams by mouth divided into several daily doses (spread out throughout the day is likely better). There are many different forms of Vitamin C, some of which may be better than others. Also, should you become sick, the dose may need to be increased or titrated to bowel tolerance. Discuss with your doctor if you would like to pursue a course like this.
Q: Are there any herbs that are helpful?
A: No one has extensive herbal medicine experience with treating this illness. Regimens are essentially theoretical at this point. There are some herbs that were thought to have been helpful during the SARS outbreak and may be of benefit. Early on in the course of this pandemic, Traditional Chinese Medicine practitioners were reporting success with some of their various herbal regimens. It is difficult to universally apply what we know from their experience as TCM herbal treatment (and most herbal treatment generally) is very dependent upon the symptoms and presentation of each unique patient and even within the same patient can change over the hours and days through which the illness progresses. Keeping in mind many of these limitations, some of the herbs suggested by various people in the herbal medicine and integrative medicine community have included but are not limited to Andrographis, Sweet Annie, Licorice, Forsythia, Chrysanthemum, Prince Seng, Isatis tinctoria, Scutellaria Baicalensis, Astragalus, Reishi, Codonopsis, Cordyceps, Agarikon, Asian Ginseng, Ashwagandha, Echinacea, BoneSet tea and others. Not all of these herbs would be appropriate for every person, so it is important to work with someone knowledgeable about if it might be right for you to consider these.