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COVID-19 UPDATE* MAR 17 2020
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COVID-19 UPDATE* MAR 17 2020

I have been fielding an increasing number of questions asking me about Coronavirus disease 2019, now known as COVID-19, and I would like to offer a summary of the observed clinical course of COVID-19 as well as offer some potential supplements and lifestyle practices to help support your immune system during this time.  Please remember these are not ways to 100% prevent, mitigate, or treat coronavirus-related illnesses; however my hope is to help you enhance your immune system so that your own body will do a wonderful job at fighting and warding off any possible infection bacterial or viral in nature.

NEW CDC GUIDELINES: As of March 17, 2020
If you think you have been exposed PLEASE DO NOT GO TO a hospital
UNLESS you are having respiratory issues or shortness of breath DO NOT GO TO THE ER
PLEASE call the office 303-929-0308, I am currently in contact with CDC and maintaining constant communication to answer any and all of your current COVID-19 questions.  As a PCP I am receiving constant information hourly, as I am updated I will let all my patients know if there is anything that drastically changes. I have created a health check list that allows me to quickly decide if you a candidate for testing.
YOU NEED A DOCTORS NOTE to be tested at the State Testing sites
I am willing to offer these quick phone calls FREE of charge but they NEED to be scheduled

Observed Clinical Course for COVID-19 
The median age for those infected is around 50 years old, with a slightly higher incidence in men. Children appear less vulnerable to infection and appear to have milder symptoms than adults. There have been NO reports of deaths in children aged 0-9 years of age. One very small study of 9 infants under 1 year of age infected with COVID-19 found that none of the infants experienced severe illness or complications. Pregnant women do not appear to be at any higher risk than the general population. 
Most infected people appear to have mild infections, with mild cold-like symptoms and fever. There are even case reports of asymptomatic carriers. 

Most people who contract COVID-19 have symptoms including: 
Fever (high fever 101-103)
Muscle aches
Uncomplicated upper respiratory symptoms
(cough, sore throat, nasal congestion, headache)
Some patients will experience more severe symptoms, which may include:
Difficulty breathing 
Mild pneumonia
Severe pneumonia
Acute Respiratory Distress Syndrome (ARDS)
Sepsis and septic shock
Death
Outside of Hubei Province, China, the fatality rate appears to be likely no more than 1-2%.  Let me reframe that, 98-99% of individuals who contract this coronavirus will recover. 

COVID-19 is a novel illness, and to date there is no data showing any evidence of protection or treatment with any agent (pharmaceutical or natural.)  Currently drug and vaccine testing are underway with existing and novel antiviral medications. 

PREVENTION IS KEY!!!
Please remember to regularly wash your hands with soap and water for at least 20 seconds, especially before eating, and avoid touching anywhere on your face with unwashed hands. Take any antiviral herbs/vitamins that you know about (if you don’t know please ask, you can also peruse my on-line medicinary http://us.fullscript.com/welcome/kpetersonnd), keep your diet clean (see Carolyn’s suggestions below), insure adequate sleep and if you do fall ill, make sure that someone is attending to you so that you have proper care.

In this time I encourage us to look on the bright side:

It is a time home on your self or with loved ones.
It could be just the moment to tackle a small project that’s been on the to-do list forever.
Because we are restricted with gyms closing.  Enjoy another setting for exercise, here are some at-home workouts www.allaroundhealth.us/blog.html. And if you’d like to do a yoga class at home, there are many on-demand.
Body-mind medicine helps boost your immune system. If you have not found time to learn how to meditate or practice mindfulness, check out the CALM app. Those with underlying anxiety will be more at risk for feeling worried right now, so it’s a good time to address anxiety. This could be the perfect time to introduce stress reduction efforts like mindfulness, meditation, breathing exercise, a gratitude journal, and time in nature.
Bring in music, upbeat podcasts, books, and more positive news outlets.
I often ask my patients, “What do you do for fun?” Increasingly over the years, people stare back and me and have no answer.  This is a time for you to discover what makes your heart happy and joyful.
Enjoy taking a nap. Rest will help support your immune system and reduce overall anxiety.
Eat healthy nutritious foods such as the one’s listed below from Carolyn.

Nutrition That Helps The Immune System 
Vitamin D
An important nutrient in the body to help the induction of regulatory T cells, which differentiate between harmful cells and your own cells keeping your immune system from attacking your own body.  Most people are deficient in Vitamin D due to lack of sun exposure, not enough dietary intake from foods like salmon, cod liver oil, egg yolks, and organ meats, and fat malabsorption since vitamin D is fat soluble.  It is important to eat spinach, broccoli, apricots, and almonds as each of these contain K2 that is needed for Vitamin D to be absorbed.  If taking Vitamin D as a supplement, be certain to take it at night as Vitamin D is best absorbed while sleeping.
Garlic
Garlic’s immune-boosting properties seem to come from a heavy concentration of sulfur-containing compounds, such as allicin.  Allicin, its chemical constituent, it is responsible for its antibacterial and antiviral properties.  Studies have supported that garlic raises the level of antioxidants and is effective in destroying many organisms, including bacteria and viruses.  The consumption of garlic improves the number of T-cells in the bloodstream, and they are vital for a strong immune system and protection from viruses. Garlic releases its allicin-type compounds while the cloves are baked, peel it and leave it uncovered for 15 minutes in order to get the highest levels of infection-fighting compounds.  Roast your garlic and spread it on toast a great and yummy way to boost your immune system.  
Vitamin C  
Increases the production of white blood cells.  The body does not produce or store vitamin C, therefore it’s important to get your daily vitamin C.  Citrus fruits are excellent sources of Vitamin C, in addition, red pepper (highest source), broccoli (raw), and spinach (lightly steamed).
Green Tea
Contains flavonoids, epigallocatechin gallate that enhances immune system. Green tea also contains L-theanine that aids in the production of germ-fighting compounds in T-cells.
Mushrooms
A nutrition powerhouse, providing B vitamins, minerals, fiber, protein, antioxidants and beta-glucans and other bioactive molecules that fight harmful bacteria, viruses, and toxins.  Shitake, maitake and cordyceps mushrooms are each high immunomodulators that stimulate the immune system’s defense mechanisms. 
Colostrum
Overall the best for fighting bacteria and viruses.  Colostrum is found in mom’s milk and goat’s milk and contains cytokines which is part of your systemic immune system.  These hormones keep communication between immune cells active (low communication means low immunity, frequent sickness, and susceptibility to illness).   It also contains polypeptides, immunoglobulins, and lactoferrin that play an important part in strengthening the immune system.
Selenium
Important for the function of both the adaptive and innate immune response, adequate selenium is helpful to support immune function and the healthy response to exposure to viruses. Foods high in selenium include, brazil nuts, eggs, sunflower seeds, shrimp, mushrooms, cottage cheese, chicken, turkey, and spinach.
Gut Health
Don’t forget about gut health, where 70% of your immune system is located.  A whole foods diet with plenty of anti-inflammatory foods will keep your good bacteria happy. Some additional foods and supplements that will help quell inflammation and support a healthy gut lining include things like bone broth, glutamine, colostrum, omega 3 and probiotics.

Below I have listed some of my favorite natural anti-virals:
Garlic (doses vary depending on preparation)
Elderberry (doses vary depending on preparation)
Lactoferrin, 300-500 mg 2-3 times daily 
This was tested against SARS-CoV virus and showed participation in host immune response to prevent invasion with the virus by enhancing NK cell activity and stimulating neutrophil aggregation and adhesion. In ex vivo studies, lactoferrin inhibited at the viral attachment stage, blocking the binding of the spike protein in a dose-dependent manner. Lactoferrin may bind to heparin sulfate proteoglycans and lock the preliminary attachment between the virus and host cells.  In addition to lactoferrin’s role in viral attachment and immune response, it may also help ameliorate or balance resultant inflammation in the lung (and other tissues) after exposure to an infectious agent.
Resveratrol: 250 mg 3x daily 
In a cell study, resveratrol significantly inhibited MERS-CoV infection and prolonged cell survival after MERS infection. Resveratrol also down-regulated apoptosis of affected cells induced by MERS-CoV in vitro.
Flavonoids 
These have been shown to inhibit the proteolytic activity of SARS-CoV 3C-like protease in cell studies. 
Red Marine Algae
Nettles (Urtica diotica)
Licorice
Quercetin
Quercetin has been studied by a Canadian researcher, Michel Chretien, for its effect on coronaviruses. In late February 2020, the Chinese government partnered with his lab to conduct a human clinical trial on quercetin in Wuhan for treatment of COVID-19. No data as of yet, but preclinical data is promising enough to warrant a trial.
Intravenous Vitamin C (If you would like to schedule this please feel free to call the clinic today 303-928-0308)

During the winter months, it is a great idea to focus on supporting the immune system. Some key considerations for general immune support include: 

Ensure adequate vitamin D levels. A 2015 study in Thorax by Dancer et al. demonstrated that vitamin D deficiency contributed to development of acute respiratory distress syndrome (ARDS) and suggested that serum 25(OH)D levels <50 nmol/L may predispose to the condition. Additionally, in experimental animal models, vitamin D deficiency resulted in exaggerated alveolar inflammation, epithelial damage, and hypoxia, suggesting that vitamin D is important for optimum respiratory health. 1.
Selenium. Has also been studied for immune support in response to RNA viruses 
(which coronavirus is a RNA virus). A state of selenium deficiency can lead to development and mutation of other RNA viruses like coxsackievirus and influenza into more pathogenic strains. Since selenium is important for the function of both the adaptive and innate immune response, adequate selenium is helpful to support immune function and the healthy response to exposure to viruses. 
 Zinc. Another mineral known to support immune function 
Multivitamins. A good quality multivitamin is a good place to start to ensure
adequate intake of nutrients. 
Good immune supporting Probiotics. Probiotics can support immune function and have been found in a Cochrane review to reduce incidence of Upper Respiratory Tract Infection (URTI). 
Respiratory Support 
While we naturally turn to ingredients which may support immune function or target viral replication or infection of host, it’s also essential to think about nutrients and botanicals which may support optimal respiratory function. Maintaining healthy respiratory tissues could help ensure that any clinical course affecting the lungs is as mild as possible. An article in Biomed Research International in 2018 summarized this clinical process and how agents may assist in mitigating the negative effects of inflammation on the respiratory tract.

Some considerations include: 
Andrographis paniculata
Quercetin
Probiotics 
Curcumin

If you would like to scan any of the immune support that I have mentioned or discussed above please feel free to visit my online medicinary at www.us.fullscript.com/welcome/kpetersonnd You can scan through all of my immune support items and know that you are getting good quality products.

If you would like to support your immune system with nutrition please feel free to call Carolyn and discuss ways you can nutritional support yourself!  She will happily send you information.

All of us at All Around Health care about your health and well-being first and foremost!  We are also taking steps to keep the office a safe and healthy environment!  
If you do feel sick and are concerned about exposure please call ahead to the office first and I will happily talk to you over then phone to assist you in finding the best route for your health and well-being.

May each of you stay safe and healthy in these upcoming weeks.  If there is anything I can do to help please let me know, your overall health and well-being are top priority.

Sincerely,


Dr Kat and the Entire Team at All Around Health

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