We Are Fighting For Our Lives: Covid-19 Update

This Health Tip might contain more about Covid-19 than you’ve read online or heard on a news program. It might even be more than you really care to know.

Obviously we Americans we have some real challenges, far greater than many countries smaller and less “powerful” than the US. We’re running out of personal protective equipment (PPE) for our healthcare workers and first responders. There are no masks. One of the best ways to determine if someone has Covid-19 is to take the temperature, but finding thermometers has become a real challenge.

Test kits? Give me a break. We’re also running short of ventilators and 170 recently sent to California from the federal government arrived broken and in need of repair.

Someone suggested you could improvise a facemask with coffee filters and duct tape. Ah, duct tape, its uses are innumerable. Duct tape, coffee filters? Are we a developing nation already?

Oh, and in addition. Did you lose your job and with it your health insurance? Too bad for you. Trump so detests the Affordable Care Act that he announced he would not re-open enrollment during the pandemic. Instead, the government is “exploring other options.”

Here’s a link to an interview with Scott Z. Burns, the guy who wrote the screenplay for the film Contagion. You must have seen it by now. If not, it’s available free on Netflix.

Even though Contagion was made nine years ago, it’s painfully accurate regarding our current crisis. Burns attributes this accuracy to the expert advice he received from epidemiologists and virologists. One thing he didn’t predict:

I never contemplated a federal response that was so ignorant, misguided and full of dangerous information. I thought our leaders were sworn to protect us. I don’t get to write this story this time. This is a story we are all writing together.

Let us be grateful for the responsible governors and mayors and healthcare workers who will get us through this.

First, some guardedly good news
The death rate from Covid-19 is much lower than originally predicted. In fact, these numbers are about half of those predicted a few weeks ago:

–Under age 40, nearly zero death rate (1% hospitalized)
–40s, 0.2% death rate (3% hospitalized)
–50s, 0.6% death rate(8% hospitalized)
–60s, 2% death rate (12 % hospitalized)
–70s 4.3% death rate (15% hospitalized)
–80s 7.8% death rate (19% hospitalized)

It’s estimated that 50 to 80% of the world population will get the virus. Click here for our diagnose-it-yourself guide to Covid-19, which distinguishes its symptoms from those of strep throat, allergies, and other common conditions.

Virus overview
Being invaded by Covid-19 is like being attacked and eaten by a zombie. The virus is not alive, but it’s not really dead either. Like hundreds of other viruses, Covid-19 has been lurking in the environment in a variety of forms, inside different animal species, and changing itself in order weasel its way through the barrier of your immune system to gain access to you.

Normally, our immune systems have all sorts of safeguards against unwanted invaders. That’s why healthy populations can generally enjoy a lifespan of close to 100 years (and why we don’t die within hours of being born). Remember, though, you have no immunity to Covid-19, and breaching a body gives the virus a new lease on life. If it could speak, it would say “A fresh body! All these cells (yum!). Now I can replicate.”

Really, haven’t we all seen this movie?

The virus spreads like a prairie fire across a dry Kansas plain. Your immune system screams OMG!  and goes into ultra-high gear to get rid of this pest, this critter, this ultimate villain.

Pause button: This is why people who have taken meticulous care of their immune systems do better against the virus than others. Immune systems thrive on a high-nutrient diet, a few immune-support supplements, and zeroing out unhealthy habits, like smoking, too much alcohol, and fake foods.

But now things get complicated
Envision your body as the battleground between Covid-19 and the immune system. Lucky for you, your immune system more often than not comes out on top. You emerge from it all bloodied but unbowed. You feel like a Mack truck ran over you, reversed, and ran over you again. But you’re alive. You never noticed how gorgeously blue the sky can be. And all those green leaves. Alive!

However, if your symptoms become severe, you’ll find yourself in the hospital (if there’s any room in the hospital—many are already-overcrowded with virus victims). Since there are no medications available yet to kill the virus, you’ll receive what doctors call supportive care. This means oxygen, fluids, and food. A majority of people recover from hospitalization and walk out quite alive, though again this is dependent on hospitals and the brave people who work in them not being overwhelmed.

So why do some people die?
You’ve read that people with co-morbidities have a higher death rate. This means they already have heart disease or diabetes or chronic lung disease. For these patients, the added stress of the virus is just too great. The combination of infection and weak lungs, for example, is too much for the body to fight effectively.

Another cause of death is a poorly understood phenomenon called a cytokine storm. Your immune system, facing the virus and now in high gear, suddenly can’t turn itself off. To kill the virus, it has released a cascade of chemicals, called cytokines.

Cytokines are pro-inflammatory, meaning they support inflammation, because inflammation is your most powerful defense against disease. Pro-inflammatory cytokines literally flood your body in order to kill the virus. These cytokines include interleukin-6 (IL-6), interleukin 1 (IL-1), ferritin, C4a, tumor necrosis factor (TNF), and interferons, your immune system grinding them out to kill the virus and save your soul.

Your immune system knows your life is at stake.

But sometimes the cytokine system can’t turn itself off, which means the inflammation becomes unstoppable. Now the tables are turned. If left unchecked, your own immune system can kill you. Inflammation courses through your body and you’re caught in the whirlwind of a cytokine storm.

Every cell starts collapsing from inflammation, like mobile homes crumpling in an Alabama tornado. You’ve read the phrase “multiple organ failure.” Liver, heart, lungs, brain—they’re all delicate structures that can’t deal with this immunological onslaught.

We don’t know right now why some people become storm victims and others are spared.

But there is actual light at the end of the tunnel
Well, maybe not a bright light, but at least there’s a tunnel, which is better news than last week. There are five steps that will end this nightmare. You know a lot of this already, so bear with me.

One  You must avoid exposure to the virus to the very best of your ability. Stay at home. Have groceries delivered if possible. Wash your hands with soap and water. No book clubs in person, no game nights with friends. If you have to go to the store, take advantage of the early hours for senior citizens (if you are one), off-hours for the rest of you, when fewer people will be shopping. Stay at least six feet away from others. Use hand sanitizer or isopropyl alcohol and wipe down everything before you touch it. Then disinfect your hands afterward. Masks are in gravely short supply, but if you have one, wear it. If not, wrap something around your nose and mouth. Don’t touch your eyes, nose, or mouth. These mucous membranes are the virus’s point of entry.

Two  Consider supporting your immune system with a high-nutrition diet and immune-boosting supplements.

Three  The promise of antiviral medication is very real. We know this can be done. We’re already using valcyclovir to kill herpes, oseltamivir (Tamiflu) to kill seasonal flu, and three antivirals combined into Biktarvy to keep the HIV retrovirus under control.  On the horizon for Covid-19 there’s favipiravir, under the brand Avigan, which looks very promising.

Four  Researchers are also making progress against the dreaded cytokine storm. There are several blood tests that can predict the storm. The most readily available is ferritin, which is commonly used to measure iron stores in the body, but it also accurately measures inflammation. If a Covid-19 patient is doing poorly and the cause is a cytokine storm, doctors can start any of a readily available group of medications called immune modulators. Normally, these calm the overactive immune systems of people with autoimmune diseases like rheumatoid arthritis and lupus. But they can also quell a cytokine storm.

Currently being tested are the immune modulators tocilizumab, anakinra, and the well-known hydroxychloroquine. You’ve heard of other approaches being tested but you’re smart enough to wait for me to prescribe them if they’re found to be effective: anti-inflammatories (like cortisone or Celecoxib/Celebrex) and some surprises like statins (cholesterol-lowering meds).

Five  Vaccines take longer, but billions are being spent to develop one. With time, having this virus will be no more harmful than having a cold. You can show your grandkids a t-shirt that says “I survived coronavirus 2020.” They’ll feign polite interest, little knowing how close they came to never being born. The entire world is working together on this. The breakthrough might come from a virologist in Seattle, a pharmaceutical team in Tel Aviv, or a fifth generation herbalist somewhere in China.

Mainly, don’t be afraid. Let’s support each other around the US and around the world. And please just stay at home for now.

Chicagoans, trust me. Next year Governor Pritzker and Mayor Lightfoot will let you enjoy a guilt-free St Paddie’s.

Be well,
David Edelberg, MD