Surgical techniques and wound care principles were learned from battlefield conflict. We now have a war with the coronavirus presenting another chance to learn something beneficial.
Stem cell treatments may be a resource offered to patients, but for the next six months I will be a Corona Doctor in NYC. This is not my usual practice, but to provide testing and guidance for patients the next few months is part of age management and survival.
- Can it come back?
- Can I get it again?
- What does it tell me?
Concern with the recent coronavirus is danger of reinfection. A vaccination may be coming but none for SARS or MERS (cousins of coronavirus) has yet been developed.
This is a new zoonotic virus (zoonotic—occurs and can transfer between animals and humans) and this pandemic is the first contact with a human. It is unknown if it follows the course of previous viral infections. (See this BBC article)
Let us look at the sequence of a virus infection. The patient has what is called a first response, which is generally nonspecific and involves fever and other common symptoms. This is the body's manner to try to resolve the infection. The virus is killed because of active T lymphocyte cells. Antibodies (Ab) are formed for protection. The presence of B lymphocyte cells serve as memory to produce an antibody if there is another encounter with the virus.
The infectious course may be:
1. A few viral particles cause an asymptomatic infection but no antibodies are formed—the body is strong enough to resist.
2. Asymptomatic infection occurs with antibodies. The patient does not carry virus and is not susceptible to infection.
In Iceland 50% of the general population are asymptomatic Ab carriers of coronavirus. The tolerance with this pandemic may be due to genetics. Improved nutrient and mineral density of food and animal products, and the use of high-quality animal protein in the diet may lead to a high level of resistance.
Different populations may have had an asymptomatic disease and developed antibodies (ranging from 20 to 50%). Think about the difference between white versus Asian, for example.
3. A symptomatic infection occurs with positive antibodies. The patient does not carry virus and is not susceptible to infection.
4. A symptomatic infection occurs with no antibodies formed (which can occur in 30% of the infected patients). This may be part of a suboptimal healing response.
Patients may have such a potent immune system that it overcomes exposure to the virus but is not enough to produce antibodies in their bloodstream.
Maybe B lymphocyte cells are not working properly. It may also represent the individual is immunocompromised or this represents a delayed individual response to develop antibodies.
There is suboptimal immune function overall. Only 70% of convalescent patients have developed antibodies. Recovered patients can be a source for convalescent serum but not everyone can be a positive donor of convalescent serum.
My guidelines are the following:
1. Give the serum antibody test for IgM as well as IgG. If IgG is present. No restrictions are necessary.
2. If a patient is IgM positive and IgG negative it indicates that they are early in the course of the exposure. In this case, I would do a throat swab and then repeat the blood test for antibodies in two or three months.
3. Remember hygiene in all cases.
4. If serum antibodies are negative a nasal swab test will be done to see if the patient is an asymptomatic carrier.
5. Caution needs to be taken as far as social distancing if there is danger of infection. Remember hygiene in all cases.
6. I will also recommend several protective measures:
- Availability of KN 95 medical mask for protection.
- Look at betadine salt water nasal and throat spray. This is convenient, effective, and inexpensive. (See this Linked In article)
- Monolaurin 3000 mg a day as a maintenance dose.
- Repeat testing for antibodies in three months.
These are my concerns:
1. Vaccinations have not been developed for SARS and MERS, both of which are cousins of the coronavirus. Those outbreaks are now controlled because a large portion of the population are naturally immunized. That, in essence, is what vaccinations attempt to do—they may not be a good option here. Time will tell.
2. This virus is zoonotic (occurs and can be spread in both animals and humans) so there may be some unknowns that we will not foresee. However, this will also help teach more how to manage epidemics in the future.
3. Improved hygeine and nutrition measures in the population are part of our survival.