First, I will discuss some of the terminology and then discuss the statistics and finally discuss risk and finally what we can do to prevent disease.

What is COVID 19?

COVID 19 is the disease caused by the RNA virus SARS CoV-2. The original SARS virus was discovered in 2003 in China and did not seem to have a carrier state so it was easier to control. It is similar to MERS (Middle East Respiratory Syndrome). The spike protein attaches to ACE2 receptors which are found in our lung, kidney, and gut causing a respiratory or GI illness. The severe COVID 19 disease is mainly caused from a cytokine storm (first domino) caused by the body in reaction to the virus.

The risk factors for this domino are chronic diseases with ongoing inflammation. These include diabetes, high blood pressure, obesity, or autoimmune diseases. Also, those who are immune-suppressed as those on biologics for cancer, RA, lupus, eczema, organ transplants, etc) as well as pregnant women.

The second domino of the disease is a massive immune event and will cause worsening with those with a weakened body. These would include people with chronic kidney disease, chronic lung disease (COPD and Asthma), and heart disease (heart failure). This accounts for the higher mortality by age group from a 1% mortality rate in the 40s to a 14% mortality rate in the 80s.

The third domino is the post-viral syndrome which has not been discussed as much in the media. This can persist up to 20 months after the infection and can include chronic fatigue, myalgias, depression, insomnia, arrhythmias, and chronic lung disease. This is sometimes called long haulers syndrome.

Deaths from SARS COV2 are at the time of writing (9/22/2020) 2,152 in Tennessee, 199,865 in the US, and 966,574 worldwide. The number of cases is 184,409 in TN, 6,856,884 in US, and 31,409,623 globally. This represents about 2% of the population in Tennessee, as well as the US as a whole, and only 0.4% of the world population that has been infected. The death rate though bad is 0.06% in the US and 0.01% globally.

Certainly, it is a novel virus and a serious one, but it has become very politicized. This has hampered efforts for good discussions about it.

What can be done to help prevent disease:

First, I would try and obey the mandates for mask use, hand sanitizer or hand washing, isolation when appropriate, and other measures promoted by the CDC.

Second, I would make sure to support your immune system/body as a whole. These include a good diet rich in phytonutrients (vegetables), getting adequate sleep, getting regular exercise, and trying to reduce as much stress as possible. The pandemic, as a whole, has made exercise less available by closing gyms, and caused increased stress, both financial and emotional, as a society.

Third, I would encourage you to consider supplementation to support immune functioning. These include adequate vitamin D—up to 5000iu daily, zinc up to 50mg daily, melatonin (supports sleep as well as immune functioning), and finally CDP choline as it seems to be helpful in preventing the cytokine storm (similar to early hydroxycholoquine). Other things to consider I think should be more individualized but could include amino acids, mushrooms, licorice root, echinacea, arginine, CoQ10, and adaptogens to help with managing stress.

References:

• https://info.ifm.org/covid-19
• https://coronavirus.jhu.edu/map.html
• https://www.tn.gov/content/tn/health/cedep/ncov/data.html
• https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
• https://www.yalemedicine.org/stories/covid-19-glossary/