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Block the Virus, Build Immunity—Learning More About COVID-19

06/25/2020 | Umberto Fedeli

Building immunity is a topic of greater interest now than ever before as we gradually re-open the economy. What supplements, whole foods and health habits can prevent us from getting COVID-19, or improve our chances of recovering should we get the virus?

 Where do we stand with a possible vaccine—and how effective are antibody tests? If you already had COVID-19, does that mean you won’t get it again?

 I’ve had numerous conversations with friends and associates about immunity to not just COVID-19, but disease in general—because this will not be the last pandemic we face. I don’t have the answers, but I read as much as I can and summarize information to share with others to be helpful. I am fortunate to have wonderful relationships with those in the medical field like Dr. Tom Mihaljevic, Cleveland Clinic’s president and CEO, and his talented team of experts. We have a world-class healthcare institution in our back yard, along with their caregivers who have been working on the front lines. Cleveland Clinic proactively set up a COVID-19 unit in its Medical Intensive Care Unit and they’ve been studying the impact of the virus on parts of the body we never suspected would suffer when quarantine began in March.

My hope is to share some of the knowledge others have provided along with insight from articles related to building your immune system. I hope this insight will be helpful to you, your families, friends and colleagues. We can’t run our businesses if we do not have healthy associates, and the overall impact of this pandemic cannot be lessened without investments in health and safety.

 

First, How Does the Virus Spread?

The Centers for Disease Control (CDC) reports that COVID-19 spreads faster than the flu but not as efficiently as highly contagious measles. The more closely a person interacts with others, and the longer the interaction, the higher the risk of Covid-19 spread.

For the most part, the virus spreads person-to-person between people who are in close contact, and through respiratory droplets when a person coughs, sneezes or talks. Some believe that those who show no symptoms at all could spread the disease. However, we’re learning more about the virus every day. A couple of weeks ago, a World Health Organization (WHO) official stated that the virus spread was “very rare” by asymptomatic people—though WHO is not endorsing this as its policy. We are also discovering that the fatality rate is overall much lower than experts originally thought. Of the CDC’s most recent projections, their best-case scenario has death rates at 0.20% of those infected and their highest confidence estimate is 0.4%.

Meanwhile, we’re finding out that the large majority of COVID-19 deaths is occurring in long-term care facilities. A Plain Dealer article reported that at least 1,949 patients of nursing homes and long-term care facilities in Ohio have died from coronavirus, accounting for 71% of all known deaths in the state. This statistic aligns with Pennsylvania’s reporting.

 

Why Can Some People Fight Covid-19?

Based on what we know, there are at least thousands of people walking around with the virus, yet they are completely asymptomatic. Some get COVID-19 and never know it, while others are ushered to the ICU, put on a ventilator and suffer greatly. 

World Health Organization (WHO) data suggests that 80% of infections are mild or asymptomatic, 15% are severe and require oxygen, and 5% are critical, requiring ventilation.

According to the European Centre for Disease Protection and Control, from December 31, 2019 to June 19, 2020, there have been nearly 9.2 million cases of COVID-19 and about 477,000 deaths.

So, why are some primed to fight the virus? Scientists in Singapore found that those who came down with SARS—a coronavirus closely related to COVID-19—had a T-cell response to fight the novel virus. Researchers in Germany noted that the common cold gave those who could combat the virus the T-cells to handle COVID-19. An emerging theory is, exposure to other coronaviruses earlier in life helps some people fight COVID-19, based on a June 12 Wall Street Journal article.

But right now, we are still learning about the virus and there is no conclusive evidence about one’s immunity to COVID-19, even after being infected. (Read the information from Cleveland Clinic about antibodies below).

According to the CDC, almost 90% of COVID-19 hospitalized patients have some type of underlying condition: hypertension (high blood pressure), obesity, chronic lung disease or cardiovascular disease. New York University (NYU) showed that obese patients under the age of 60 were twice as likely to be hospitalized for COVID-19 than those of a normal weight; and 40% of adult Americans are considered obese. Most of these underlying risk factors are related to lifestyle.

There is also interest in blood type. A study published in the New England Journal of Medicine found stretches of DNA that harbor risks for severe COVID-19. One determines blood type. Findings suggest that people with blood type A face a 50% greater risk of needing oxygen or a ventilator if they are infected with the virus. However, people with blood type O seem to have a 50% reduced risk of severe COVID-19.

 

Supplements for Immunity

There have been many studies evaluating intakes of nutrients and how they might combat infection. Dr. Todd Pesek, holistic physician and author at VitalHealth Partners, advises supplementing a healthy diet with whole foods with the following:

Vitamin D3. A daily dose of 6000 to 8000 IU is when blood vessels are optimal, he says. A global collaborative study showed that Vitamin D supplementation can cut the risk of respiratory infection in half. Iodine. Take 3 to 6 mg per day, and double up during illness, stress or travel. Even fluctuating weather can stress the body and warrant a higher dose, he says. Probiotics. Dr. Pesek recommends 30 billion CFU of a good, quality probiotic blend. Zinc. According to the Harvard School of Public Health, inadequate zinc levels limit your ability to fight infection. Oral zinc supplementation reduces the incidence rate of acute respiratory infections by 35%, shortens the duration of flu-like symptoms by about 2 days and improves the rate of recovery. Studies used a dose of zinc ranging from 20/mg per week to 92 mg/day. Vitamin C. Again, Harvard reported that Vitamin C acts as an antioxidant by limiting inflammation and tissue damage. Some critically ill COVID-19 patients have been treated with high doses of IV vitamin C to hasten recovery. However, there is no clear scientific evidence to support this. Elderberry and Turkey Tail Mushroom. Dr. Pesek says these have shown to decrease the severity and duration of viral infections by more than half and are more effective than drugstore options like Tamiflu.

 

Stick to the Basics

Exercise most days and spend time outdoors, Dr. Pesek advises. The most important thing we can do is to practice good sanitary hygiene. That means washing your hands with soap and water for 20 seconds after using the restroom, before eating—and after using your phone. (How many of us remember to sanitize our cell phones?) Choose hand sanitizers with at least 60% alcohol (CDC recommendation).

As of June 16, CDC advised the following to protect yourself and others from COVID-19:

  • Maintain a social distance of about 6 feet to prevent the spread.
  • Wash hands with soap and water or use hand sanitizer.
  • Routinely clean and disinfect frequently touched surfaces.
  • Cover your mouth and nose with a cloth face covering when around others.

There has been much debate surrounding the issue of wearing masks, in spite of CDC recommendations. An article in the Plain Dealer shared that the 140 clients and six coworkers who had been exposed to two hair stylists who tested positive for COVID-19 did not test positive for the virus. The hairdressers and clients were required to wear masks.

Exercise is critical for boosting and maintaining immunity against disease. According to the U.S. National Library of Medicine, theories regarding exercise and immunity show the following:

  • Physical activity might help flush bacteria out of the lungs and airways, reducing the chance of getting a cold, flu or other illness.
  • Exercise causes a change in antibodies and white blood cells, which are the cells that fight disease. When they circulate more rapidly, they can detect illness earlier.
  • A rise in body temperature during and right after exercise could prevent bacteria from growing and help the body fight infection—similar to getting a fever to fight off infection.
  • Exercise slows down the release of stress hormones. Stress can increase the chance of illness.

 

Risk Prediction—A Cleveland Clinic Study

On June 15, Cleveland Clinic announced its researchers had developed the world’s first risk prediction model for forecasting a person’s likelihood of testing positive for COVID-19 and their outcomes from the disease. This model is called a nomogram and shows the relevance of age, race, gender, socioeconomic status, vaccination history and current medications as they relate to COVID-19 risk. This tool will help healthcare providers predict risk and make decisions about care.

              Understanding risk is key to care and treatment, according to Lara Jehi, M.D., Cleveland Clinic’s Chief Research Information Officer and a corresponding author on the study. The nomogram was developed using data from 12,000 patients enrolled in the Clinic’s COVID-19 Registry of more than 23,000 patients. Here’s what the study found:

  • Those who received the flu vaccine and PPSV23 vaccine for pneumococcal disease are less likely to test positive for COVID-19.
  • Patients who take melatonin, carvedilol (for high blood pressure) or paroxetine (anti-depressant) are less likely to test positive for the virus.
  • Those with low socioeconomic status are more likely to test positive.
  • People of Asian descent are less likely than Caucasian patients to test positive.

A Lerner Research Institute network medicine study showed 16 drugs and three drug combinations could be potential COVID-19 treatments, though additional study is necessary.

 

Antibody Tests—Answering Some Questions

If you already had COVID-19, does that mean you will not contract the virus again? Or, could someone who tested positive with coronavirus repeatedly get the disease? We are still learning about this novel virus every day.

As for antibody tests, these are supposed to detect the presence of antibodies in patients who have been hit by COVID-19. But how effective are they? According to Cleveland Clinic, early tests reveal problems, such as a false positive rate of up to 50%. In the Cleveland Clinic Journal of Medicine, Kamran Kadkhoda, Ph.D., wrote about the issues with antibody tests:

  • Antibody rates are across the board with COVID-19 patients. Some do not generate the antibody after infection, some lose antibodies, and some develop antibodies at low levels that cannot be detected.
  • We do not know if having already had COVID-19 makes you immune to the virus. There are some indications that you would not be immune long-term after having it, according to Dr. Kadkhoda.
  • Some severe, critical cases of COVID-19 show higher level antibodies—which calls question to the role they play.
  • With other common coronaviruses, people might become ill from them every cold season and even multiple times during the season. Therefore, immunity is short-lived. Dr. Kadkhoda says there is still a lot to learn about COVID-19, but it makes sense that the virus would act in a similar way regarding short-lived immunity. “That means that even with a good vaccine, we may have to get vaccinated every year as with the flu,” he wrote in article.
  • The danger with false positives is people might think they already had COVID-19 and will not get it again. Then, they could get the infection and spread it to others.
  • There are efforts to collect plasma from patients who had COVID-19 and recovered. The thought is, those patients built up antibodies that can be passed to sick patients via transfusion so the patient can fight the virus. It is unknown whether this treatment works. A China study showed it did not significantly improve recovery time for patients, according to Dr. Kadkhoda.
  • Should you get an antibody test? A simple test is thought to show whether you were positive for COVID-19 in the past. But, without information like when you contracted the virus, there’s not much to gain from the test. (Again, we do not know how long immunity lasts, if at all.)

 

Hope on the Horizon—Vaccine Updates  

This news is constantly evolving, but as of June 16, there were 10 vaccines in clinical trials, and researchers at the University of Oxford and AstraZeneca are hoping for “phase 3” data this summer. Optimists believe that hundreds of millions of vaccines could be ready by the end of 2020, but many infectious disease experts say that 18 months for a first vaccine is aggressive, according to a report by The Lancet.

The World Health Organization lists more than 100 vaccine candidates in preclinical development. Moderna’s vaccine, mRNA-1273, and AstraZeneca’s vaccine are already being tested in people, and Johnson & Johnson will begin testing in mid-July. Moderna’s CEO announced its vaccine could be available for distribution in 2021.

Currently, there are no approved COVID-19 treatments, but the one furthest along in clinical trials is the IV antiviral remdesivir, which was granted emergency use authorization by the FDA.

Vaccine Highlights:

There are countless efforts to develop a vaccine and treatment for COVID-19. The following are some updates I’ve gathered on how drug testing is advancing:

  • Gilead will begin human testing of an inhaled version of remdesivir with a goal to expand the use of the drug to healthier, non-hospitalized COVID-19 patients. Currently, the drug is given intravenously, so it is only available for use in hospitals. An inhaled version could allow those with the virus who are not hospitalized to access the treatment. Remdesivir works by blocking the virus from replicating itself inside the body.
  • Currently, remdesivir is considered the best option for treatment. In phase 3 trial data of remdesivir, patients taking it for five days were 65% more likely to show clinical improvement on day 11 than those in a standard care group. A National Institute of Allergy and Infectious Diseases study showed the drug led to more rapid recovery, and early treatment results in better outcomes.
  • Drug companies including Sanofi, Pfizer and Mylan sell hydroxychloroquine under different brand names, and the drug has been a controversial subject as researchers test new and old treatments to find a COVID-19 cure. Hydroxychloroquine is a safer derivative of chloroquine and is an anti-parasitic, disease-modifying anti-rheumatic drug approved for malaria, lupus and arthritis. It was originally approved by the FDA in 1955 and sold under the brand name Plaquenil. Hydroxychloroquine is thought to lift the pH level of an acidic part of the cell membrane, preventing the virus’s ability to enter the body and replicate. The FDA granted emergency use of the drug in late March, but recently revoked authorization saying its benefits do not outweigh the risks for COVID-19 patients. Still, there is interest in the drug with more than 100 trials active or recruiting, based on FDA information.
  • A British trial called Recovery is studying the steroid dexamethasone and is showing that it can reduce death rates by one-third among COVID-19 patients requiring ventilation and by 20% in those needing oxygen. The study involved more than 11,000 patients. The Recovery model of testing is different than U.S. clinical trial protocols because it assigns patients to different treatments at random and collects data limited to the most important measures of disease severity. Participation is easier; results are faster. However, U.S. public health officials do not support this model, according to an article in the Wall Street Journal written by Dr. Gottlieb, a resident fellow at the American Enterprise Institute and former FDA commissioner.
  • Researchers at Pfizer and other companies are exploring vaccine options to work safely in older adults who are more vulnerable to COVID-19 due to weakened immune systems. Americans older than 65 had the highest rate of hospitalization between March and June—double the rate of those age 50 to 64 and five times the rate of 18- to 49-year olds, according to the CDC. One option might be to increase vaccine doses or add a booster to the shot.
  • Pfizer researchers are testing whether a gene-based technology could be more effective in older adults. It uses messenger RNA to tell cells to make proteins that protect against the coronavirus.
  • GlaxoSmithKline is considering an adjuvant in Shingrix (shingles vaccine) as a booster to strengthen a vaccine’s effect on the immune system. GSK gave one adjuvant to Sanofi and six other drug makers to test. GSK had used this adjuvant in the H1N1 vaccine.
  • Boston Children’s Hospital researchers are trying to develop a vaccine for older adults. They are narrowing a search down to seven different vaccine candidates and evaluating about 50 adjuvants to boost the vaccine. They hope to begin testing next year, according to a Wall Street Journal report.

 

Choose Knowledge Over Fear

The constant, real-time media coverage of COVID-19 generates fear—but we have a choice. We can choose to eat healthy, to supplement if necessary, to get enough sleep and to exercise. We can choose to surround ourselves with positive people. We can choose to learn from this pandemic—to pivot, adapt, innovate and thrive.

I hope you found this summary of research helpful. And, I wish you and your families continued good health and happiness.

 

All my best,

Umberto P. Fedeli