As our communities start to open up and the shelter-in-place orders are modified, our risk of encountering and becoming infected with the coronavirus increases. In studying COVID-19, researchers have discovered that there are four phases for which distinct responses create the best outcome:

Prevention – support is focused on immune surveillance and reduction of baseline levels of inflammation, and to improve outcomes if the patient becomes infected.

Infection – support emphasizes immune activity against infection.

Escalating Infection – support is focused on anti-inflammatory measures.

Recovery – support is focused on resolving inflammation, inhibiting fibrosis and other forms of tissue damage, curtailing losses of function, and restoring and reoptimizing function.  A concern at this phase is that patients have been observed to relapse back into the escalation inflammation phase. It is essential for clinical surveillance to continue well into what may appear to be the Recovery Phase.

Prevention

Just as a fence is placed around a pasture of cows to protect them from outside threats such as wolves and coyotes, our immune system is our defensive fence protecting us from outside invaders. Cattlemen ride their fences regularly to ensure that the first line of defense has no breaks, gaps or weaknesses. Calmglow helps patients uncover any weaknesses in their protective fence and to create a plan to reduce or eliminate those weaknesses.

Calmglow’s task during the prevention phase is to support our patients in anticipation of the possibility that they’ll contract the virus. This is accomplished by A) identifying and addressing ways to reduce baseline inflammation, and B) identifying and addressing deficiencies in key nutrients that are central to healthy, robust immune system activation. Calmglow orders full labs and work up for patients and uses the information obtained to address any disease, condition and/or inflammatory process which may encourage escalating COVID-19 viral disease processes.

Foundational Reinforcements For Our Defenses

These are the daily habits, healthy practices and foundational support which focus on anti-inflammatory and antiviral support and on strengthening our immune systems so that our bodies can mount the response needed to protect you should you become infected with the coronavirus.

Sleep – 8 to 9 hours of restful sleep nightly promotes an anti-inflammatory and antiviral state. If you are having a difficult time getting a restful night’s sleep, consider taking  Melatonin 3-10mg nightly, as needed.                        

Stress Reduction – persistent high stress levels are inflammatory and reduce the body’s immune function, measured by high or flat cortisol levels with elevations of epinephrine and norepinephrine (the stress hormones). Daily meditation helps to reduce stress. Try the “Calm” app. Call our office to discuss available adrenal support supplements.

Blood Sugar Control – Insulin resistance, obesity and sugar imbalances are associated with inflammation.

Anti-inflammatory Diet – improving diet by avoiding high fat (trans fats), fried, processed foods, chemical additives, and added sugar.  Eating a diet rich in nutrients has been shown to reduce inflammation. Consider a high quality nutrient dense diet that focuses on eating multicolored vegetables and fruits, rich in healthy fats (no beef or pork even if it is grass fed or naturally prepared).

Microbiome / Gut Bacteria Balance – Unbalanced of the GI microbiome bacteria has been shown to be a source of systemic inflammation and plays a symbiotic role with lung microbiome. Consider adding daily fiber (Herbulk 1-2 doses a day), diet rich in colorful vegetables and fruit, prebiotic foods, and daily probiotics. Of course, avoid cigarette/cigar/THC smoke and air pollution (may need a HEPA filter at work and home to keep the air cleaner).

Exercise – physical activity has long been known to be critical for proper function of all physiological systems. The right intensity is critical with moderate levels effective at lowering inflammatory markers, while high intensity does not.

Immune supportive vitamins and minerals – call our office to discuss available immune supportive vitamins and minerals, such as Vitamin D, Vitamin A, Zinc, Vitamin C, Quercetin, and Fish Oil.

Identify and manage any on-going diseases  – if left uncontrolled they may increase your risk of driving you into the Escalating Inflammation Phase of COVID 19 disease process.

Infection

As we shift from sheltering-in-place and are out in the community more, we most likely will come in contact with the coronavirus and despite practicing personal distancing, wearing a mask, and frequent hand washing, we could become infected with the virus. The focus for the early stage of the infection is on anti-inflammatory and antioxidant support and shoring up the components of immune system function that are essential to fight the infection. 

If you have a health complication such as asthma, COPD, cardiovascular disease, obesity, diabetes, chronic kidney disease, you are at higher risk to have a severe infection due to having an inefficient and over burdened innate immune system. 

In addition to individuals with underlying health concerns, there is a correlation between viral load and severity of the resulting illness. Therefore, healthcare workers who have more exposure to the virus have a higher risk of developing a severe illness. 

The goal at this phase is to keep the infection from escalating into the more dangerous and potentially fatal phase. 

Our innate immune system employs defenders called macrophages. Macrophages are our body’s garbage trucks; they get rid of the trash. A macrophage has the ability to locate and ‘eat’ particles, such as bacteria, viruses, fungi, and parasites. One concerning aspect of coronavirus is that it delays activation of, and even kills, our macrophages before it can activate our adaptive immune response.

To counter the virus’ ability to undermine key immunity responses, at this phase our focus turns to the foot soldiers of our immune system and providing additional antioxidant support.

Two specific white blood cells,T helper type 1 (Th1) cells and Natural Killer cells (NK), play a key role in antiviral immunity. Th1 and NK support each other’s activation. T helper type 2 (TH2) cells may improve TH1 antiviral response by improving stress chemistry (cortisol and norepinephrine), sleep regulation, asthma, and GI tract inflammation. 

Glutathione (GSH) is an antioxidant in plants, animals, fungi, and some bacteria and archaea. Glutathione is capable of preventing damage to important cellular components caused by reactive oxygen species such as free radicals, peroxides, lipid peroxides, and heavy metals. GSH and N-acetylcysteine (NAC) play particularly important roles in antioxidant support in COVID-19. GSH appears to play a key role in supporting both the immune surveillance and anti-oxidant/anti-inflammatory components of the strategy for addressing care for patients with COVID-19. 

In addition to continuing all of the Prevention phase recommendations, supplements which aid TH1 and NK cell support and NAC and GSH may be recommended. Call our office to discuss additional immunity support supplements such as Th1 support, Th 2 support, Baicalin-containing  botanical medicines, licorice root, Echinacea extracts and others. 

Escalating Infection

One of the complications caused by this phase of the infection is too much inflammation in the respiratory system which can prove to be fatal. A Chinese respiratory expert described COVID-19 as involving a “large amount of very sticky mucus in their small airways.”  The  goal of this phase is to help the patient stay away from manifesting the excessive inflammatory cytokine production and tissue destruction associated with sepsis, acute respiratory distress syndrome, and cardiovascular events. Acute respiratory distress syndrome is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. Natural approaches here are supportive, not primary. The unfolding disease process can escalate rapidly.

Natural anti-inflammatory supports are:

• Potassium – maintain a balanced blood potassium level (do not take extra potassium unless directed to do so by your practitioner).
• Turmeric  – which has documented antiviral and anti-inflammatory properties. Turmeric is found in Curcum-Evail.
• Resveratrol – which has been documented to reduce inflammation. Resveratrol is in Phytomulti and should be taken twice a day.
• Quercitin – a plant pigment (flavonoid) is found in many plants and foods, such as red wine, onions, green tea, apples, berries, Ginkgo biloba, St. John’s wort, American elder, and others. Quercetin has low bioavailability and therefore requires special formulations to achieve clinically effective blood levels. We suggest a product called D-Hist 1, take a capsule twice daily.
• Boswellia – efficacy of bromelain in reducing inflammation and inflammatory diseases has been documented in many studies. 
• Sulforaphane – a plant extract (obtained from cruciferous vegetables, such as broccoli and cabbage) known to have antioxidant and anti-inflammatory effects. 

Call our office for more information about the natural supports which are anti-inflammatory and which boost your immune system.

Recovery

This virus does not leave easily. Many people who were believed to have recovered from the worst of the disease have relapsed back to the escalating infection phase. Many of those who relapsed subsequently died from complications of this virus.

Continued care and continuing to support your immune system while in the recovery phase is essential.

Note: not all supplements should be taken by someone with hypertension and other health concerns. Safety and dosing of any recommended supplements have not been evaluated for pregnant women. 

Although there is much to be learned about COVID-19 virus, substantial knowledge of the immune system and clinical tools that support the immune function and help to prevent and treat this escalating viral disease exist. Each of the supplements recommended have their own specific concerns when mixed with other pharmaceutical drugs that you may be taking. Do not embark on use of these supplements without discussing your health condition and other medications with Calmglow. 

While avoiding becoming infected by this virus is everyone’s goal, it would be foolish not to be prepared. Before leaving the safety of sheltering-in-place and widely venturing into the community, call our office to schedule an appointment to discuss how you can best boost your immune system.

At some point in the future, this virus will be in our rearview mirror (be it due to a vaccine or acquired immunity). Until we reach that point, let’s best arm our immune system to defeat COVID-19.

To your health.

Dianne Hinton NP, PA, IFM-C