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Up to date information on transmission + supplements March 21, 2020

by | March 21, 2020

Up to date information on transmission + supplements March 21, 2020

We are facing multiple challenges during these unprecedented times. We are dealing with a virus that has a powerful ability to spread (more on this below) with a rate of mortality estimated to be 10x greater than that of the flu virus. Information about Covid-19 (including guidelines for testing and treatment) is changing rapidly.

For background on Covid-19, including transmission and symptoms, you may find my article on Covid-19 from earlier this month here (note that the level of travel restrictions, distancing recommendations and number of cases as well as certain CDC recommendations discussed in the article have since been updated).

Here, I wanted to share with you several updates regarding:

  1. Transmission and viability of Covid-19
  2. Supplements that may cause harm in the case of Covid-19
  3. Up to date resources you can rely on to provide reliable, evidence-based information about Covid-19

1. HOW IS SARS-CoV-2 (virus responsible for Covid-19) TRANSMITTED?

An article published in the New England Journal of Medicine on March 17th reported stability of SARS-CoV-2 (the virus responsible for Covid-19) in aerosols and on a number of surfaces.

Here is what the authors found about SARS-CoV-2:

  1. It was viable in aerosols for the duration of the experiment which was 3 hours
  2. It was MORE STABLE on plastic and stainless steel than copper and cardboard
  3. Although the actual virus concentration was greatly reduced, the virus was detected for up to 72 hours on plastic and stainless steel surfaces
  4. On copper, no viable virus was measured after 4 hours
  5. On cardboard, no viable virus was measured after 24 hours

Based on this data, the authors confirmed that the virus can be transmitted via:

  1. Aerosol
  2. Fomites (inanimate objects, such as a surface, which can serve as a vehicle for viral transmission if contaminated)
  3. There is also evidence of fecal-oral route of transmission

What to clean surfaces with?

The virus is susceptible to common agents such as bleach, hydrogen peroxide and alcohol. To learn more about preventing the spread of the virus causing Covid-19, click here.

***An additional precautionary step: You’ve heard this many times by now, from me and many other sources, but it’s worth mentioning since we still do it and it’s such a persistent habit: WASH YOUR HANDS after touching surfaces, and DO NOT TOUCH YOUR FACE!

Note: If applying hand sanitizer instead of washing hands with soap and water, use an alcohol- based hand sanitizer that contains 60–95% alcohol.

Remember, it is estimated that a person can be contagious for 2 days before exhibiting any symptoms. We need to be extremely cautious. To read more about what to do if you or someone you know has had Covid-19, read this CDC page.

In a nutshell, CDC is currently recommending:

Individuals with Covid-19 who are isolated at home, can stop isolation if the following conditions are met:

If you will not have a test to determine if you are still contagious, CDC says you can leave home if ALL OF THESE 3 THINGS ARE TRUE:

  1. No fever for 72 hrs (3 full days) without use of medicine that reduces fever (e.g., acetaminophen or ibuprofen) AND
  2. Other symptoms have improved (e.g., cough and shortness of breath have improved) AND
  3. At least 7 days have passed since the symptoms first appeared

If you will have a test to determine if you are still contagious, CDC says you can leave home if ALL OF THESE 3 THINGS ARE TRUE:

  1. No fever without use of medicine that reduces fever
  2. Other symptoms have improved (e.g., cough and shortness of breath have improved)
  3. You have received 2 NEGATIVE TESTS in a row >=24 hrs apart

According to CDC, individuals with laboratory-confirmed Covid-19 who are asymptomatic may discontinue home isolation when at least 7 days have passed since the date of their first positive Covid-19 diagnostic test and have had no subsequent illness.

**Note: always discuss with your doctor when is appropriate for you to be tested or leave home isolation.**

2. WHAT ABOUT SUPPLEMENT USE?

In my article yesterday, I discussed How to Support Our Health and Immunity. Besides sleep, which is crucial for a strong immune system (aim for at least 8 hours per night), eating a whole food, plant-rich diet, and practicing stress management, there are supplements that may help boost the immune system (again, there is no data on Covid-19 specifically, and this is not a medical recommendation for prevention or treatment of Covid-19).

I also want to share a few warnings about supplements that have come to my attention.

A faculty member of the Andrew Weil Integrative Medicine Fellowship reviewed the existing literature and shared concerns regarding some of the supplements people are using to boost their immunity during these times.

I want to emphasize that there is NO DIRECT DATA REGARDING COVID-19. THIS IS PURELY EXTRAPOLATING INFORMATION WE KNOW FROM PRE-CLINICAL STUDIES and exercising caution in this setting.

“In the absence of human clinical data, caution is warranted with the following immune activating agents due to preclinical evidence:

Sambucus nigra (Elderberry)
Polysaccharide extracts from medicinal mushrooms
Echinacea angustifolia
E. purpurea
Larch arabinogalactan
Vitamin D”

The above supplements are thought to increase the risk of cytokine storm (the immune system overreaction to an infection that could be severe or life-threatening) based on pre-clinical data. Keep in mind that vitamin D plays an important role in immune function, so you should talk to your doctor about appropriate levels and supplementation for you.

Again, this is not medical advice and there is no data on Covid-19 specifically. If you have any questions about your specific supplements, please contact your qualified healthcare professional.

3. MY TRUSTED RESOURCES FOR COVID-19:

CDC – COVID-19 PAGE
NYS Department of Health
Up to date Statistics

Recent relevant articles by my fellow healthcare professional colleagues:
COVID-19 EXPERT PANEL FROM UCSF – March 15, 2020, published by my colleague Dr. Jordan Shlain
COVID-19: What You Should Know About Coronavirus by Dr. Andrew Weil

Stay healthy and safe,
Dr. Bojana Jankovic Weatherly

Disclaimer

Nothing stated or posted in this article is intended or should be taken to be the practice of medical or counseling care. The information made available in this article, including, but not limited to, interviews, text, graphics, images, links to other articles, websites, and other material contained in this article, is strictly for informational and entertainment purposes only. The information in this article is NOT (and should not be used as) a substitute for professional psychiatry, psychology, medical, nursing, or professional healthcare advice or services, nor is it designed to suggest any specific diagnosis or treatment. Please always seek medical advice from your physician or a qualified health care provider regarding any medical questions, conditions or treatment, before making any changes to your health care regimen, medications or lifestyle habits. None of the information in this article is a representation or warranty that any particular drug or treatment is safe, appropriate or effective for you, or that any particular healthcare provider is appropriate for you. Never disregard professional medical advice or delay seeking help from a health care provider due to something you have read or seen in this article. Your reading/use of this article does not create in any way a physician-patient relationship, any sort of confidential, fiduciary or professional relationship, or any other special relationship that would give rise to any duties. This article does not recommend or endorse any specific tests, healthcare providers, procedures, or treatments, and if you rely on any of the information provided by this article, you do so solely at your own risk.

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About the Author

Dr. Bojana

Dr. Bojana

Dr. Bojana (Boy•ana) Jankovic Weatherly is an award winning physician, double board certified in internal and integrative medicine. After completing internal medicine residency, she did a fellowship in integrative medicine, trained in functional medicine, nutrition and mindfulness. Her approach is rooted in evidence-based medicine that is personalized to each individual she works with.

2 Comments

  1. Alexandra Ryan

    So they’re saying to possibly decrease or stop taking elderberry, echinacea, reishi and vitamin D? I thought those were good, immune boosters. Or maybe I’m misreading it?

    Thanks!

    Reply
    • Dr. Bojana

      Great question Alexandra. We don’t have enough information and certainly no specific information with respect to Covid-19 to be able to provide specific guidance. Recommendations should also be specified to each patient by their qualified healthcare provider and any change in supplements should be done in consultation with a qualified healthcare provider. Generally, the concern with supplements that have been shown to play a role in cytokine release in pre-clinical studies, is during an active Covid-19 infection (not necessarily prior to the infection). For e.g., I currently take supplemental vitamin D to maintain normal vitamin D levels, because vitamin D is important for immune function (in addition to its other roles). In the setting of an active infection, however, I may hold off on vitamin D. Note that this is based on pre-clinical data, and opinions vary, as we do not have enough research and no guidelines on this.

      Reply

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