A note from Dr. Wright on Covid-19

Please practice good prevention: wash hands frequently, minimize physical contact with others while maintaining social cohesiveness, and be safe during travel. Please reach out to loved ones and neighbors via phone and email from safe distances and use kind gestures to support one another. Be kind to yourselves too. Embrace a slower pace if possible, trust the process, get good nutrition and rest, and get outside for exercise or fresh air if safe for you.

Other suggestions: check that you and loved ones have 2-3 months of essential medications related to any underlying pulmonary condition (COPD, asthma, cancer or fibrosis in the lung, cystic fibrosis) or cardiovascular condition (congestive heart failure, coronary artery disease), as well as diabetes.

When to seek urgent care for your best safety and prevention:

If you are in a high risk health category (** see CDC list below) for contracting COVID-19 AND are experiencing symptoms of flu, contact your primary health care team and seek care as guided and using your best judgement. If you are experiencing severe symptoms seek urgent health care.

Severe symptoms include: difficulty catching your breath or getting enough air to feel comfortable (whether from coughing, activity or at rest), pain with coughing, symptoms that prevent eating or staying hydrated, fever that doesn’t respond to acetaminophen/ Tylenol, and inability to swallow liquid or food. For these or other severe symptoms do seek immediate care by going to an urgent care facility or hospital.

What about other, non-severe symptoms?  Some people may experience mild or ongoing nausea/vomiting/diarrhea in addition to other flu symptoms such as sinus congestion, cough, fever, sore throat and/or generalized aches and pains. If not experiencing severe 

symptoms you may be safely guided by your health care team to use supportive care at home. I can be a resource for you in supportive care as well. However, If your symptoms are severe and prevent good airflow in your airways or prevent you from eating/drinking, seek urgent care.

I cannot address individual flu-related questions by email.

Do not consume supplements known for general “immune support” without guidance. 

Use of essential oil steam inhalations may be helpful in supportive care. Read more here.

To best support existing clients, I created a list in Fullscript called “Daily Viral Immune Support” to include supplements that are safe and evidence based for supportive care. 

You will also note several essential oils on that list and attached please find an education instruction for home steam inhalations using essential oils. Many of the supplements in the fullscript list are in capsule form. If you are someone who cannot swallow pills/ capsules, I trust we have discussed alternatives already such as opening capsules into food. Also, zinc lozenges containing 3 – 7 mg zinc gluconate are a safe supportive therapy to use 3-4 times daily and are available over the counter in addition to Zinc piccolinate capsules. Many local natural food stores are re-stocking this frequently. Please note: you are not obligated to buy supplements in Fullscript or take any supplements in this list.

Here is the “Daily Viral Immune Support” list in Fullscript:

• Zinc  
• Vitamin D3 
• Aller- C (vitamin C + bioflavonoids) 
• Chestal 
• Essential oil for steam inhalations 
• Melatonin
• Licorice root tea 
• Himalayan Chandra nasal wash, neti salt

Other supportive care suggestions for risk reduction:

• Get enough sleep. It supports your immune system! Shorter sleep duration increases the risk of infectious illness. One study found that less than 5 hours of sleep (over 7 days) increased the risk of developing rhinovirus associated cold by 350% when compared to individuals who slept at least 7 hours per night.¹ Important to COVID-19, sleep deprivation increases CXCL9 levels. CXCL9 is a monokine, induced by interferon, and which increases lymphocytic infiltration,² and which is implicated in NLRP3 inflammasome activation.³ Adequate sleep supports the secretion of melatonin, a molecule which may play a role in reducing coronavirus virulence.
 

  • Stress management: Psychological stress disrupts immune regulation and is specifically associated with increased pro-inflammatory cytokines such as IL-6. Various mindfulness techniques such as meditation, breathing exercises, guided imagery, etc. reduce stress, reduce activated NFkB and CRP and do not appear to increase inflammatory cytokines.⁴
  • Zinc: Coronavirus appears to be susceptible to the inhibitory actions of zinc. Zinc may prevent coronavirus entry into cells and appears to reduce coronavirus virulence.⁵ Typical daily dosing of zinc is 15mg – 30mg daily. Lozenges (in smaller doses) may provide direct protective effects in the upper respiratory tract. ⁶
  • Vegetables and Fruits +/- isolated Flavonoids: Many flavonoids have been found to reduce NLRP3 inflammasome signaling, and consequently NFkB, TNF-a, IL-6, IL- 
1B and IL-18 expression. Some of the specific flavonoids which have been shown to have this effect, are found in the diet and/or via use of dietary supplements include:
  • Baicalin from Scutellaria baicalensis (Chinese skullcap)
  • Glycyrrhiza glabra (licorice root)
 -mucolytic, anti-viral
  • Quercetin in onions and apples. Of note, quercetin also helps  transport zinc into cells. This could, theoretically, enhance the anti-viral actions of zinc.
  • Myricetin found in tomatoes, oranges, nuts, and berries.
  • Apigenin found in Chamomile, parsley and celery
  • Curcumin found in turmeric root
  • Epigallocatechine gallate (EGCG) from green tea has been found to have antiviral activity against a wide range of DNA and RNA viruses, especially in early stages of infection by preventing viral attachment, entry and membrane fusion. EGCG, like quercetin, may enhance the antiviral actions of zinc.
  • 5 – 7 servings vegetables and 2-3 servings fruit daily provide flavonoids as part of healthy / anti-inflammatory diets.
  • Vitamin C: Clinical trials have found that vitamin C shortens the frequency, duration and severity of the common cold and the incidence of pneumonia. Typical daily dosing of vitamin C ranges from 500mg to 4000mg daily with higher doses given as 1000mg per dose at intervals such as 2 hours during acute infection. 

  • Melatonin: Melatonin has been shown to inhibit NFkB activation and NLRP3 inflammasome activation.⁷ In fact, the age-related decline in melatonin production is one proposed mechanism to explain why children do not appear to have severe symptoms and older adults do. Melatonin also reduces oxidative lung injury and inflammatory cell recruitment during viral infections.⁸ Typical dosing of melatonin varies widely from 0.3mg to 20mg (the latter used in the oncological setting). 

  • Nasal saline spray, lavage or neti using Himalayan salt
  • Essential oil or herbal steam inhalations
  • Dr. Bronner’s arnica menthol magic balm –great for chest, back, nasal passages 

• FullScript

  To access the "Daily Viral Immune Support" list in Fullscript, you can log into your Fullscript account and click on Catalog--> Categories--> then Daily Viral Immune Support. You can access supplements in your recommendations, and the "Daily Viral Immune Support" list. At this time the full catalog is not available beyond my selected recommendations for clients. Please know that backorders happen, requiring me to locate substitutions the best I can.  Fullscript is quickly restocking for backordered supplies ongoing so please check back.

   

• Tele-health consults

  Of course, everyone is unique, so if you have questions about supportive care for your symptoms or whether these or other suggestions are right for you, please request a tele-health consult. If you become ill and would like a consult or have underlying conditions and want to discuss prevention or supportive care, I will try to schedule you as soon as possible. 

•  

• Please know I am thinking about you all. I hope you are staying safe and finding opportunities for connection with yourself and loved ones.  With good wishes for your continued health,

Dr. Wright

**From CDC Website:

• "Those at high-risk for severe illness from COVID-19 include:

• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
• People with chronic lung disease or moderate to severe asthma
• People who have heart disease with complications
• People who are immunocompromised including cancer treatment
• People of any age with severe obesity / body mass index BMI≥40 or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk"

• Share facts not fear poster: https://www.cdc.gov/coronavirus/2019-ncov/about/share-facts-h.pdf

   

  REFERENCES

  1 Prather AA, et al. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015;38(9):1353-9.

  2 Gorbachev AV, et al. CXC chemokine ligand 9/monokine induced by IFN-gamma production by tumor cells is critical for T cell-mediated suppression of cutaneous tumors. J Immunol. 2007;178:2278–2286.

  3 Romero, JM, et al. A Four-Chemokine Signature Is Associated With a T-cell-Inflamed Phenotype in Primary and Metastatic Pancreatic Cancer. Clin Cancer Res. 2020 Jan 21 [online ahead of print]


  ⁴ Black D and Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann NY Acad Sci. 2016;1373(1):13.


  ⁵ Phillips JM, et al. Neurovirulent Murine Coronavirus JHM.SD Uses Cellular Zinc Metalloproteases for Virus Entry and Cell-Cell Fusion. J Virol. 2017;91(8).


  ⁶ Han Y-S, et al. Papain-like Protease 2 (PLP2) From Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV): Expression, Purification, Characterization, and Inhibition. Biochemistry. 2005;44(30):10349.


  ⁷ Hardeland, R. Melatonin and inflammation – Story of a Double-Edged Blade. J Pineal Res. 2018;65(4):e12525.


  ⁸ Silvestri M and Rossi GA. Melatonin: its possible role in the management of viral infections – a brief review. Ital J Pediatr. 2013;39:61.