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Cancer and COVID-19: Integrative Strategies to Reduce Risk and Manage Disease

Guest Post By Keith I. Block, MD

How can I protect myself and my family during the coronavirus pandemic?

This question has been uppermost in the minds of many during recent weeks. Pandemic risk-reduction practices such as staying home, physical distancing and frequent handwashing are helping us cut down the spread of this virus in the population.  But what else can you do to protect yourself and members of your family?

As an integrative oncology physician, I believe that some basic personal health practices—along with judicious and informed use of natural and non-toxic supplements—can help you adjust your body’s biology, and to give it the best chance of fighting off the virus should you be exposed to it, and to lessen the symptom load should you develop COVID-19.

You are now undoubtedly aware that there are no medical cures for COVID-19, and I must stress that I am NOT offering natural “cures” for COVID-19 in this article, because at this time there are none! 

Essential Strategies to DIAL Down COVID-19

What I suggest for now is following lifestyle practices that help build biological resilience and support immune function, which can help you fight against not only this virus, but other illnesses as well.

These practices include core integrative strategies for improving diet, exercise, circadian rest and activity and stress care; and suggestions for introducing supplements to enhance your antioxidant protection, provide gentle immune system stimulation in the event of exposure to the virus, and potentially reduce the harmful molecules of the inflammatory storm that can happen if your immune system overreacts to the virus.

Importantly, these recommendations also include advice about being in contact with your physician or local hospital if symptoms grow worrisome, specifics about which pre-existing illnesses may increase your risks for complications of COVID-19, and suggestions on how such illnesses should modify your use of integrative interventions.

I’m calling this set of recommendations my Essential Strategies to D-I-A-L Down COVID-19.

There is a lot of ground to cover, so in order to help you find your way through it, I’m providing a Table of Contents to the 6 parts of the post. I sincerely hope that you will find this material helpful, and that it will inspire you to proactively guard your own health, as well as counteract the feelings of powerlessness and anxiety that a crisis like we are all in can initiate.

Let’s begin with the Table of Contents, and then get started with your effort to DIAL Down COVID-19!

Table of Contents

Part 1. Coronavirus: Be Safe and Be Smart!

Part 2. Essential Strategies to Help you DIAL Down COVID-19, and Core Integrative Health Practices.

Part 3. Supplement Strategies

Part 4. When to Use Integrative Practices and Supplement Recommendations

Part 5. DIAL Down Strategies by Disease Stage and Comorbidities

Part 6. Special Instructions for Cancer Patients and Those with Comorbidities

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Part 1. Coronavirus: Be Safe and Be Smart!

We are smack in the middle of the worst pandemic that any one of us has, or will ever (hopefully) live through. Over the past several weeks, my patients have been asking me and my cancer treatment staff about the optimal ways to protect themselves from coronavirus and the disease it causes, COVID-19.

This is an illness that places us all at potential life threatening risk, and it is nothing to ignore or make light of. That said, the older you are, the greater your risk, especially if you have diabetes, hypertension, heart disease, or cancer, particularly cancer patients who are immunocompromised due to treatment or progression of the disease itself. As a case in point, according to early evidence out of China, patients with lung disease, and particularly lung cancer, have a mortality risk that is more than double the rest of the population.

Dealing with the disease itself, COVID-19, is complicated, since it can be asymptomatic, mild, moderate or severe. And even if you are asymptomatic, it is still possible for you to pass the virus on to someone else. With this in mind, please realize that if you behave AS IF you have the virus, staying at home and observing other essential precautions, YOU CAN SAVE LIVES! In fact, if you actually do this, YOU will contribute to saving lives in every corner of the earth. In addition, limiting contact with others will reduce the chance that you encounter a larger load of virus, which could occur if you inadvertently spend a long time with a person who is actively ill with COVID-19. The smaller the “dose” of virus you pick up, the lower your chances of contracting Coronavirus, exposing others, developing progressive symptoms, getting severe disease and losing your life.

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As you’ve likely heard by now, coronavirus is highly contagious. A single cough or sneeze has the potential of projecting a turbulent plume of coronavirus particles directly into your face, over your clothing or onto surfaces that you may touch. This can trigger the initial event in a slowly or rapidly cascading illness. Thus, the crucial advice that we all must maintain “physical distancing.” Six feet is a good distance to start with, but some evidence indicates 13 feet as an even safer distance.

Social Distancing, Not Social Isolation

The term “social distancing” that many have used is misleading. We have the ability and the need to connect with each other by phone or through the internet, or as my granddaughter and her neighbor friend heartwarmingly do, sitting in lounge chairs across the street from each other, chatting away for hours while playing music on their smart phones. So most definitely no physical contact, recognizing this essential need for physical distancing—but an absolute yes to socially connecting in safe ways in order to ease the insidious isolation and loneliness that can otherwise develop with time.

COVID-19 Prevention ‘Basics’ Are Paramount

I have worked with Block Center staff members to assemble an integrative strategy to help you reduce your risk of COVID-19, and recommendations for what you can do if you are exhibiting symptoms of the virus. But before presenting it, I want to stress the importance of the basics of pandemic control: stay home as much as possible, practice physical distancing when out of the house, wash your hands often, refrain from touching your face, disinfect frequently used or potentially contaminated surfaces and be sure to wear a mask and perhaps gloves if you go outside! Research does demonstrate that masks help in reducing the spread of viruses. As long as one avoids repeated touching of the mask or the face, the downside is negligible.

The Art and Science for COVID-19 Risk Reduction and Disease Management

It is important to mention that the recommendations we are currently able to make are not based on clinical trial experience with COVID-19, but rather on extrapolations from studies of pandemic influenza, colds (some of which are caused by different types of coronavirus), viral or bacterial pneumonia and similar conditions. There are no known ways to prevent or cure COVID-19 at this time, though there are several agents and strategies that are being tested, a few with genuine promise.

For now however, we feel it is reasonable to use non-toxic natural agents in a way consistent with what is known about the biology of coronavirus and other diseases in an attempt to reduce your risks or reduce your symptoms if you develop COVID-19, given the absence of well-validated medical treatment.

The biology of the immune system is pivotal in the progression of COVID-19. The immune system’s reaction to the virus can change over the course of the disease. COVID-19 can begin quietly with no symptoms; then evolve to mild disease with growing fatigue, slightly elevated temperatures (or not), to cough and upper respiratory symptoms (or not), to mild to marked diarrhea.

In moderate disease, symptoms appear and progress, like fatigue, waves of muscle and full body aches and pains, and terrible periods of profound lethargy through long nights of changing and sometimes frightening symptoms. This progression happens because the immune system can shift from being insufficiently active to mounting a runaway immune response we refer to as a “cytokine storm.” The cytokine storm floods the body with free radicals and inflammatory molecules in an attempt to quell the virus.  It can however, overshoot, and set into motion rapidly progressive inflammatory clinical changes including the sensations of chest restriction and pain, the breathlessness, confusion and respiratory distress seen in severe cases of COVID-19.

Part 2. Essential Strategies to Help DIAL Down (DIAL-D) COVID-19 Based on Core Integrative Health Practices.

D = Deliver Core Integrative Health Care Practices

Core integrative health practices apply to the wellbeing of each and every one of us facing this pandemic. By boosting your immune system and its activity through adopting a healthy lifestyle you can increase your ability to fight the virus.

First, by optimizing sleep and related circadian health and stress management practices, you’ll improve immune regulation. You can accomplish this by getting to bed earlier and, for most of us, aiming at around 7 hours of sleep. Circadian health means adapting our habits to the daily biological rhythms of the body, including the night-time production of the sleep hormone melatonin, which is among our most important immune regulators. Be sure to shut down your phone and your computer in advance of bedtime, so that the light they emit doesn’t delay or diminish your melatonin level. Keep your bedroom cool and as dark as possible. Also, a regular daily schedule of rest and activity including early morning sun exposure will help enhance your circadian integrity.

Chronic and acute stress erodes your immune readiness, so take some time to get away from the 24-hour COVID news cycle, and use techniques like meditation, progressive muscle relaxation practices, relaxed abdominal breathing, prayer, soothing music, and practices like yoga or qi gong to quiet adverse mental chatter, calm nerves, and ease anxiety.

Second, as long as you are able, it’s essential to be physically active. A study of older Japanese women found that those who walked for 30-60 minutes a day were less likely to die of pneumonia. Respiratory disorders like pneumonia and acute respiratory distress are common features of severe COVID-19. Moderate exercise like walking and using light weights, and less strenuous practices like yoga that promote flexibility are best. You can take advantage of the increasing number of free online home exercise programs to motivate you.  It is important to note, however, that intensive fitness training and exhaustive exercise can make even high-performance athletes more vulnerable to viral disease. Your immune system needs regularity, consistency, and time for recovery. So when it comes to exhaustive activity, don’t overdo it.

I strongly advise caution in adhering to increased physical distancing requirements as well as facemasks with moderate to strenuous outdoor aerobic activity for those already accustomed to it. We do not know how far droplets can spread with high pressure exhalation during such activity, but I’d encourage maintaining a separation of no less than 13 feet. If you see a runner coming toward you, it would be wise to move rapidly away to a safe distance. If you are that runner, be respectful by honoring that distance for those around you or, if possible, finding less frequented running paths.

Short bouts of intensive exercise, though, do have a place. Especially if you have been inactive, you should also incorporate what I call “recovery training.” Recovery training consists of short periods of more intensive aerobic activities like jumping jacks, working out on a stationary bike, a step machine, an elliptical trainer or other aerobic equipment, performed for just 1 to 3 minutes, followed by 3 to 5 minutes of complete rest.

This is not interval training, which is exercise that brings the heart rate up, followed by slowing down, then speeding up again, or “saw-toothing,” that is performed without stopping for complete rest.  While interval training is good for general fitness, it is not intended to train you for rapid recovery from severe biological stressors like COVID-19. Higher intensity exercise for 1, 2 or at most, 3 minutes followed by an immediate 3 to 5 minutes of rest will train your heart, lungs and broader physiology to undergo a stressful event and recover quickly.

Developing “recovery capacity” or bounce-back before you actually need it is among the most effective ways of building resilience.  As you are able, without leaving yourself feeling exhausted, add a second and even a third cycle of exercise followed by rest. Repeating this cycle three times once a day should be more than adequate to build your much-needed resilience, which generally declines or can be lost with age and illness.

Third, do as much as you can to eat a healthy, anti-inflammatory diet.  Emphasize mostly plant foods, like vegetables, legumes, nuts, seeds and low-sugar fruits like apples, pears, melons and berries as well as small portions of whole grains like quinoa, oats, wild rice and buckwheat. Among the better sources of animal proteins are fish and egg whites. It is best to avoid refined sugars and flours and overly processed foods.

Note that the fiber in whole grains, legumes and vegetables is important for the hundred trillion bacteria that make up your intestinal and full body microbiome, which is at the very foundation of your immune system. Adequate high quality protein also supports your immune system—and, yes, plant-based proteins are as good as animal food, with fewer downsides, if you consume proteins from a variety of plant sources daily (legumes, nuts, and some vegetables and whole grains are good protein sources).

Antioxidants from food are critical in readiness to combat the coronavirus. So vegetables and fruits containing antioxidant flavonoids are an especially important part of your diet.  Onions, apples, tomatoes, oranges, berries, nuts and celery are especially good sources, as is green tea.

In addition to an immune-friendly lifestyle, there are a few core supplements that are reasonable for most or all people to take when trying to reduce their risk of contracting the coronavirus infection.  Vitamin C at low levels—approximately 3 to 4 grams daily—is an excellent antioxidant, one of the foundations of coping with COVID-19. In addition, vitamin D is critical to immune functioning, so vitamin D supplements are appropriate, especially if your sun exposure is insufficient. But note that just 15 minutes daily of sunshine to three square inches of your face is generally more than adequate. Melatonin has immune and anti-inflammatory properties, and can be taken supplementally in small doses of one to three milligrams at bedtime, preferably a “long acting” (prolonged release) melatonin.

If you are on sedatives or strong medicines for sleep, it would be wise to consult with a knowledgeable integrative physician on how to test your melatonin level and begin melatonin safely.  Low doses of fish oil, a gram or three per day, can help maintain a generally anti-inflammatory environment in your body, but high doses of fish oil can become immunosuppressive, which is inappropriate while you are trying to reduce COVID-19 risk and when dealing with asymptomatic COVID-19 or mild disease, although antiinflammatories may play an important role in more severe disease.

Finally, some people should consider taking zinc supplements to avoid zinc deficiency, which suppresses immunity.  Vegetarians, especially vegans; elderly people (especially over age 75); and people on long-term proton pump inhibitors (such as omeprazole or esomeprazole) for GERD or other stomach conditions are more likely to become zinc deficient, which can impair immune response.

Zinc supplements are not needed as a preventive by most people, and could have adverse effects if taken for too long.  An easy, safe and enjoyable strategy would be to eat a tablespoon or two of pumpkin seeds daily.  Asian or American ginseng can be considered for long-term prevention since they both appear to help protect against influenza when taken for 3-4 months or more, but Asian ginseng may stimulate estrogen receptors and thus be inappropriate for some breast cancer patients

Part 3:  Supplement Strategies

Let’s discuss supplementation advice intended to have a more direct biological impact on COVID-19. I encourage the following three supplement strategies:

I = Introduce Antioxidant Protection

While trying to reduce COVID-19 risk, in cases of known exposure to coronavirus, and in cases of mild to moderate symptoms, antioxidants can provide important protection, particularly to patients who are more vulnerable due to either age or living with other medical conditions. During moderate to severe COVID-19 in patients with pre-existing diseases, it is not uncommon for the immune system to overreact with early onset of a pro-inflammatory cytokine storm, resulting in destructive levels of free radicals.  Thus, it is important for everyone to have an abundant supply of dietary and supplemental antioxidants; however for those battling coronavirus with or without symptoms, it is essential to have high levels in the blood and the lungs.

Appropriate supplements to add: vitamin C (3-6 grams), green tea extract, a multi-antioxidant formulation (note: if you have an underlying malignant disease, a routine multiple should be avoided and replaced by a cancer-specific formulations with growth promoting ingredients removed), food-based antioxidant supplements such as green drinks, coenzyme Q10, N-acetyl cysteine, rutin and other flavonoid supplements.

A = Activate Immune Attack

During the initial attack of the coronavirus, the immune system may be suppressed, allowing the body’s viral load to build up to high and risky levels. People who are already immunosuppressed, including older people and people with diabetes or cancer are more likely to experience this problem. Gentle immune stimulants taken after exposure to the virus or when the disease is mild, may be able to kick-start the immune system into appropriate action. However, as the disease progresses, the immune system may overreact, resulting in a worrisome proinflammatory cytokine storm, comparable to a biological fire, which can damage normal tissue. It is this event that is at the foundation of the lung damage and low levels of oxygen in the blood that is the hallmark of COVID-19’s clinical severity, which necessitates the use of ventilators and causes the tragic rates of mortality.

At this point, promoting immune activity through intentional stimulation is counterproductive. For this reason, we encourage patients with signs of moderate and progressive symptoms to stop immune enhancers. Note however, that people over age 60 and patients with co-existing conditions should stop immune stimulants any time, even when mild symptoms appear to be escalating.  A sudden and rapid progression of symptoms can accelerate into moderate and severe symptoms in hours. Thus, careful attention to symptom changes is essential—even before one experiences moderate symptoms.

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Appropriate supplements to add  for mild immune stimulation include: elderberry, andrographis, echinacea, medicinal mushrooms (reishi, trametes, cordyceps, chaga, shitake), holy basil, schisandra or umcka (Pelargonium sidoides). With our own patients, we provide combination formulations to achieve this end.  Zinc lozenges can be used for a week or so at the initiation of symptoms even without documented zinc deficiency; zinc has been observed to prevent some types of coronaviruses from entering human cells and also to reduce the duration of colds.

L = Launch Antiinflammatories

During the cytokine storm, an overactive immune system promotes major adverse inflammatory reactions, which can damage normal tissue. So, later in the disease, natural anti-inflammatory agents are an essential protective response. Note that we are not advocating the use of anti-inflammatory drugs on your own, although these are sometimes used when no other options are available, under the direction of your COVID-19 treating physician. Some questions have been raised about the use of ibuprofen and corticosteroids in COVID-19 and related types of respiratory distress.

Appropriate anti-inflammatory supplements include:  Additional fish oil (6-8 grams taken under clinical supervision for patients with blood coagulation issues), resveratrol, turmeric/curcumin, boswellia, Scutellaria baicalensis.

Please note that you do not need to take all the supplements in each category.  You may need to make decisions based on cost or availability as well as the possibility of developing interactions with other medications you are on. As is true within our own clinic, integrative physicians and/or integrative dietitians may be of immense help during this period when you are initiating a preventive and protective diet and supplement program. The Block Center is one of many integrative treatment facilities that are able to provide telemedicine consults to assist you in developing a personalized Coronavirus risk reduction or, if needed, treatment protocol.

D = Discontinue Immune Enhancers When They are Inappropriate

At the time a proinflammatory cytokine storm is evident, the use of immune enhancers should be stopped.  If you have access to laboratory tests, elevated C-reactive protein, sedimentation rate or IL6 are critical lab changes indicating that such a storm is mounting.  At such time, immune attack supplements should be stopped. People with moderate or severe symptoms, as well as high risk people with mild symptoms that are worsening should stop immune supplements.

Part 4: When to Use Integrative Practices and Supplement Interventions

We distinguish 5 stages of integrative intervention during the coronavirus pandemic:

Stage 1: Risk Reduction

The initial goal is to “catch Coronavirus before it catches you!” The best strategy is to reduce your risk of catching COVID-19 in the first place, in order to help reduce the development of symptoms as well as reducing morbidity and mortality. Physical distancing and other measures to slow infection are a primary prevention strategy. They should be implemented for the population as a whole. Integrative risk reduction strategies aim to build up your personal health, your immune protection and your resilience so that you will be as fit as possible if you are exposed and need to battle a coronavirus infection. Additionally, it must be said that lifting sheltering orders requires the capacity to test millions of people for both coronavirus infection and for immunity after having the disease, to trace contacts of known cases and to either treat COVID-19 medically or prevent it with a vaccine.  Moving too quickly out of current sheltering orders risks additional mortality, and is both preposterous and dangerous.

Stage 2: Post-Exposure Prophylaxis and Asymptomatic Disease

You should assume at minimum that you are in stage 2 if you know you’ve been exposed to coronavirus, for instance in caring for an infected family member, or when you learn that someone you work with has developed COVID-19. Until we have effective and universal testing, if you have experienced any known exposure, you must limit your exposure to others, assume you have asymptomatic disease, and thus protect those around you. The interventions in this stage are appropriate for people with verified asymptomatic COVID-19—a positive test for coronavirus but no symptoms.

Once you catch the virus, focusing on strategies to contain and reduce the coronavirus viral load and thus reduce your personal risk of developing more severe disease is essential. Additionally, with both asymptomatic disease and personal post-exposure prophylaxis, as well as with symptomatic disease, it is essential that strict attention is paid to not exposing others around you or those who are caring for you. CNN’s Chris Cuomo is an excellent example of a strategy to protect those around you. After a diagnosis and the development of symptoms, Chris followed careful self-quarantine measures by staying put in his basement. However, even with this effort, his wife still contracted the virus a few weeks after he self-quarantined. This is either due to a much longer than expected viral incubation period or an unrelated exposure. Chris’ doctors have advised that Chris and his wife remain apart since re-exposure may lead to reactivation and second bouts of disease. These episodes are not only possible, but have already occurred in disturbing numbers in places like South Korea and Italy.

Stage 3:  Onset of Mild Symptoms

Mild symptoms of COVID-19 may include fevers, diarrhea, cough, malaise and fatigue. However, you may not experience every symptom but still be infected. It is important to recognize that the older you are, the more co-existing medical conditions you have, and the more severe these conditions are, the more rapidly COVID-19 can transition into a severe disease requiring life-saving measures.

Stage 4: Development of Moderate Symptoms

Moderate symptoms of COVID-19, where diarrhea can be explosive with rapid dehydration, liver and kidney injury, leading to the need for dialysis, and coughing or upper respiratory changes that can occur and can restrict lung functioning, dropping the life-sustaining oxygen levels in your blood. The danger with this stage is that while moderate symptoms can be gradual and often even reversed, it is also possible that symptoms can shift quite suddenly and progress rapidly, with some patients transitioning from moderate symptoms to full blown severity in just a few short hours.

Stage 5: Alarming Shift into Severe Disease

It is critical that patients and care-givers try to recognize these stages, with particular attention during stages 3 and 4. This is essential since clinical management and expert advice are needed before one ends up in a full Stage 5 level crisis. Also, as noted above, the greater the age and the more significant the underlying conditions a patient has, the more essential it is to move quickly to expert care. Coming into an ER in full crisis does more than overburden our heroic medical staffs: it makes the steep ascent toward a patient achieving a full recovery that much steeper!

The core lifestyle care, therapeutic and supplementation strategies of some of these stages depend partly on whether you have other diseases (“comorbidities”) that are known to worsen outcomes.  Thus, the worse a patient’s overall health, the more important it becomes to monitor whether symptoms are transitioning toward a more serious disease. Some of these comorbidities were mentioned above; they include diabetes, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and cancer, particularly blood or lung cancers, as well as cancer patients who are undergoing or have recently completed treatment, including chemo, radiation, surgery, and bone marrow transplantation.

As is well known by now, while any COVID-19 patients over age 60 are at increased risk, more recent evidence demonstrates that this virus is also able to take on the very young, adolescents and teenagers, young adults and middle-agers, even when in excellent health, although obesity is emerging as a risk factor among younger people.

Below are the Block Center’s 5 Stages of COVID-19 Intervention, emphasizing in detail the symptoms for each stage. This will hopefully help you assess and stay on top of when medical care is needed and when to implement critical integrative strategies.

Block Center’s 5 Stages of COVID-19 Intervention: Symptom Summary

Stage 1: Asymptomatic, with No Evidence of Exposure

Please note that the risk of becoming infected and having significant disease is increased with age or existing comorbidities. The initial goal is to reduce your risk of catching COVID-19 using the widely recognized precautions and core integrative health practices discussed above

Stage 2: Post-Exposure Prophylaxis and Asymptomatic Disease

This category includes both people who are at risk of COVID-19 due to known exposure to others with the disease but who have not developed symptoms nor had a coronavirus test, and those who have no symptoms but nevertheless have a positive coronavirus test. Although currently most asymptomatic people in the United States are not tested, the use of tests will hopefully expand in order to better determine who must be quarantined. Some people may get tested as part of their job.  Additionally, heavy recurrent exposure, as in the case of our medical work force, provokes greater risk with potential for increased viral load (increased viral load can lead to increased symptoms and a more severe and aggressive disease.) Many of my colleagues agree that we will not overcome this pandemic until we have adequate viral and antibody testing available for multiple testing for each and every one of us.

Stage 3: Mild COVID-19 Symptoms

The primary symptoms include a dry cough, a fever of less than 100.4 degrees, loss of sense of smell or taste, muscle aches, headaches, tiredness, perhaps a sore throat or runny nose. Appetite can be normal or mildly diminished, normal activities and self-care abilities are possible, with no difficulty in breathing.  Mild disease in people under age 60 who do not have comorbidities usually has a very good prognosis and outcome. In any regard, do not wait to call your doctor at the first sign of symptoms. This is even more essential if you are over 60 or have comorbidities. Your doctor may have specific advice for you based on your medical history and overall health.

Stage 4: Moderate COVID-19 Symptoms

Progression of clinical symptoms includes a persistent and bothersome cough that may be enough to disrupt your sleep, an intermittent fever of 100.4 or higher, loose stool to explosive diarrhea requiring continual hydration and electrolytes, changes in kidney and urinary function, a heaviness or restricted chest sensation, breathlessness if you exercise or go upstairs but not when sitting still, possibly diarrhea and more persistent or recurrent headaches, mild to moderate fatigue that still allows you to shower and do some self-care, an ability to eat but less than usual, and generally feeling miserable.

Moderate disease in people under age 60 who do not have comorbidities usually leads to a very good outcome, though the clinically ill period is likely to be a considerable struggle to get through. If you reach this stage of disease, you must know that it is possible for some people to progress in a very short time window to a severe and life-threatening condition, especially if you have comorbidities or are over age 60. As much as you might feel you should be able to handle it on your own, this is definitely a time to consult with your physician(s) and be sure you are under clinical supervision, whether or not you are managed at home.

Stage 5: Severe COVID-19 Symptoms

Severe symptom that can become life-threatening include noticeable breathlessness, enough so that you may find yourself unable to walk around your house; or trouble breathing when sitting still; bluish lips; your chest hurts when you breathe; temperatures repeatedly run over 100.4 and possibly as high as 103 or 104 degrees; a loss of appetite enough to impair normal eating or drinking; or periods of confusion.

Expert medical attention is essential as severe symptoms can progress with surprising and unexpected rapidity. As much as you may want to avoid hospital care and think you may be better off avoiding the trip, symptoms can move quickly at this stage, and challenge your survival. Please, if you do hit stage 5 and don’t already have a physician on board, you must move quickly to get immediate medical help and expertise! Supportive treatment in a hospital can successfully bring the majority of people through this disease stage alive and well.

Part 5. Dr. Block’s COVID-19 Integrative Interventions by Disease Stage and Comorbidities

I’ve summarized when to deploy each of the integrative DIAL-Down COVID-19 strategies below.

Stage 1: Asymptomatic, with No Evidence of Exposure

For:  Risk reduction

Recommendations:

Deliver Core Integrative Health Care Practices

Introduce Antioxidant Protection

As previously noted, examples include:  vitamin C (3-6 grams), green tea extract, a multi-antioxidant formulation (note: if you have an underlying malignant disease, a routine multiple should be avoided and replaced by a cancer-specific formulation with removal of growth promoting ingredients), food-based antioxidant supplements such as green drinks, coenzyme Q10, N-acetyl cysteine, rutin and other flavonoid supplements.

Stage 2: Post-Exposure Prophylaxis and Asymptomatic Disease

For: people who have been exposed to coronavirus without a positive test and without symptoms; and for those with a positive coronavirus test, but with no COVID-19 symptoms.

Recommendations:

Deliver Core Integrative Health Care Practices

Introduce Antioxidant Protection

Activate Immune Attack with immune enhancers

As previously noted, examples include: elderberry, andrographis, echinacea, medicinal mushrooms (reishi, trametes, cordyceps, chaga, shitake), holy basil, schisandra or umcka (Pelargonium sidoides).

Stage 3: Mild COVID-19 Symptoms

Recommendations:

Deliver Core Integrative Health Care Practices

Introduce Antioxidant Protection

Activate Immune Attack with immune enhancers if under 60 and no comorbidities

Discontinue Immune Enhancers if over age 60, or if you have comorbidities, and with any evidence of symptom progression.

Comorbidities: Blood cancers, lung cancer, recent bone marrow transplant, current or recent chemo, radiation or surgery, other cancers (post-treatment), COPD, CKD, cerebrovascular disease, cardiovascular disease, diabetes, hypertension, more than one of the above, or taking immunosuppressant or immunostimulant drugs.

Stage 4: Moderate COVID-19 Symptoms

Recommendations:

Deliver Core Integrative Health Care Practices

Introduce Antioxidant Protection

Launch Antiinflammatories

As previously noted, examples include: fish oil (6-8 grams taken under clinical supervision for patients with blood coagulation issues), resveratrol, turmeric/curcumin, boswellia, Scutellaria, and baicalensis.

Discontinue Immune Enhancers

Watch symptoms closely, especially if over age 60 or with comorbidities.

Comorbidities: Blood cancers, lung cancer, recent bone marrow transplant, current or recent chemo, radiation or surgery, other cancers (post-treatment), COPD, CKD, cerebrovascular disease, cardiovascular disease, diabetes, hypertension, more than one of the above, or taking immunosuppressant or immunostimulant drugs.

Stage 5: Severe COVID-19 Symptoms

Recommendations:

Deliver Core Integrative Health Care Practices

Introduce Antioxidant Protection

Launch Antiinflammatories

Discontinue Immune Enhancers

Part 6. Special Instructions for Cancer Patients and Those with Comorbidities

Stage 1: Risk Reduction

For risk reduction, follow the Core Integrative Health Practices, including core supplements, and Introduce Antioxidant Protection supplements.

Stage 2: Post-Exposure Prophylaxis and Asymptomatic Disease

Follow Core Integrative Health Practices, including core supplements, Introduce Antioxidant Protection and Activating Immune Attack supplements.

Stage 3: Mild Disease

First contact your physician, who will probably tell you to stay at home. Second, locate an integrative clinician and integrative dietitian to assist you through your recovery. Follow core integrative health recommendations (you may not be able to exercise much, but try to move and stretch even if it is somewhat hard, and whatever you do, do not stay immobile for full days).

Use core supplements, Introduce Antioxidant Protection supplements and Activate Immune Attack supplements if you are under age 60 or over 60 and have no comorbidities.  If you have blood cancer, lung cancer, have had recent cancer treatment or any other of the aforementioned comorbidities, it is especially important to contact your physician, preferably a member of your oncology or specialist team.

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If you are told to care for yourself at home, take the Activate Immune Attack supplements for 5 days if your disease does not worsen, and then continue them and use the Launch Antiinflammatories supplements with 6-8 grams fish oil daily.  If symptoms worsen, even if it is earlier than 5 days, stop the immune supplements and start the anti-inflammatory supplements immediately.

However, if you are receiving chemo or other treatments and your blood platelets are low, discuss all supplements with an integrative cancer specialist or integrative dietitian. At the Block Center we adjust our individualized supplement protocols based on clinical and laboratory findings.

Please contact the Block Center if you would like to arrange a consultation with our clinical, nutritional and biobehavioral team for preventative, symptom management and relief and full treatment recommendations.

If you do not have knowledgeable clinical experts to work with you, a general rule for patients receiving cancer treatment is to watch your platelet levels carefully. If platelet counts drop below 60,000, cut all supplement dosing in half, particularly antiinflammatories and any known supplements that have an impact on coagulation.  You should stop all supplements completely if platelets drop below 30,000 and contact your doctors immediately.

If you are taking immunostimulant or immunosuppressant drugs, do not take the Activate Immune Attack supplements, and consult with your doctor.

Stage 4: Moderate Disease

Follow basic integrative health recommendations as well as you can (you will likely not be able to exercise, though you may be able to stretch while in bed; your appetite may be reduced). Take the Introduce Antioxidant Protection and Launch Antiinflamatories supplements, but not the Activate Immune Attack supplements.  If you have comorbidities, be certain that you call your physician. If you are told to care for yourself at home, use the Introduce Antioxidant Protection and Launch Antiinflammatories supplements with 6-8 grams of fish oil daily.  However, if you are receiving cancer treatment and your platelets are low, follow the instructions under Stage 3 for reducing supplement dosages. If you are taking immunostimulant or immunosuppressant drugs, do not take the Activate Immune Attack supplements, and consult with your doctor. Be certain to watch carefully for signs of severe disease, and if you observe them, seek medical help right away.

Stage 5. Severe Disease

If you have progressing moderate or severe disease, you must be evaluated by a hospital immediately. You will likely be hospitalized, and you may not be able to bring your supplements with you. As a note, some hospitals are trying intravenous vitamin C for patients with severe disease, especially for those patients who are on ventilators. Intravenous vitamin C has been evaluated for sepsis and acute respiratory distress syndrome due to influenza or pneumonia, both of which are related to the cytokine storm of COVID-19. The results of these studies are still preliminary, and it is not yet clear if this will be an effective treatment. Official clinical trials on intravenous vitamin C in COVID-19 are being conducted, so we will know before long whether this will be a helpful and successful treatment.

Use of intravenous high dose vitamin C as a preventive for coronavirus is not yet supported; it should be noted that intravenously administered vitamin C stays in the bloodstream for only a brief time, and it is not known if that is long enough to be effective in immune stimulation. In addition, we have some concerns about administration of high dose intravenous vitamin C during COVID-19 because of possible pro-oxidant effects of high doses in the disturbed environment of the cytokine storm.  However, we need the results of clinical trials in order to make conclusions and advise optimal treatment.

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This is a very difficult time for all of us. Patients and health care practitioners alike are struggling under a burden of insufficient knowledge about a disease that can be virulent, quite dangerous and even life-threatening for many people. We are all concerned about the major disruptions to families, job, businesses and society at large that have come with this pandemic.

As individuals we have no control over how the events in the world will play out.  But we hope that this information gives you a personal framework for positively moving ahead at an uncertain time and in an uncertain environment. We at the Block Center are available for telemedicine consultations if you feel you would benefit from focused consultation and advice, whether preventative or therapeutic, and if you have questions about your family or personal situation.

We encourage you to take this time at home to engage in self-care, increase “social” connecting activities that nourish you emotionally via phones and the internet while thoroughly maintaining “physical” distancing. It is an opportune time to focus on developing closer family relationships either in your home or over the phone or internet. Connect with friends or colleagues whom you are no longer seeing in person to lift your spirits and theirs and to gather energy for coping with whatever is coming your way.

And remember, there are some important silver linings. One thing that COVID-19 has done is to spur us all to have much greater appreciation of how our behavior impacts others throughout the world. We most certainly are all in this together.

Be safe, be smart and stay healthy!

 

Photo credit: BigStock.com/alexey_boldin