COVID_19 Update 03.19.2020 PM

Great, great to be here with everybody again. Been having a lot of questions coming to me today through social media, as well as emails on patients I've been seeing in the office. So what I've decided to do is just try to answer these questions quickly. There's so much information going out there, so, so much stuff spreading around, so much concern. So I feel like one of the best things I can contribute just to try to answer the pressing questions that people having and things that are coming up. A couple things we'll talk about today are fevers, anti inflammatory medications, some of the new things that the President just mentioned today, drugs that might be pushed forward, and then things you can do to keep yourself healthy if someone in your house gets sick. So first thing is the whole conversation with fever. Back in 1996-2000, when I was in medical school at that point in time I was actually taught that if someone in the ICU who was septic had a fever, giving them an antipyretic or an anti fever medication like Tylenol could actually increase the risk of the sepsis killing the patient. We have data going back to 1990s. Even in 1918, we had the Spanish influenza. When we saw that was about three to four years after aspirin actually come to market. And so they started using lots and lots and lots of aspirin to actually treat the fever of people that had the Spanish flu. One of the things they saw is that patients are treated by homeopathics, physicians or practitioners at that point in time actually had almost a 30 plus fold increased chance of survival than those who are actually given aspirin. So as far as then, we knew that anti inflammatories weren't the best plan, best idea. What happened was the French Minister of Health came out a couple days ago and said, look, in France, no one should take non sterile anti inflammatories. This is your ibuprofen, your Aleve, your diclofenac, which is used more in Europe. The World Health Organization came out and said the exact same thing. They're recommending against using non sterile anti inflammatories. The problem is they recommend using Tylenol. So let's talk about what these medications do and why they're maybe not the best idea. The first thing is inflammation. Prostaglandins are these inflammatory molecules your body makes that ibuprofen blocks. It helps with pain reduction, it helps with fever reduction. The thing about it is also is prostaglandins boost immunoglobulin production. So immunoglobulins are the proteins your body makes to fight off infections. So you actually are lowering your body's ability to make immunoglobulin to make antibodies. When you do, when you take a non sterile anti inflammatory, that might be one reason why those medications actually are not good for immune system. But the other thing is fever reduction. Your fever is actually by its natural response reaction. Maybe it's an American thing, maybe it's a western thing, but in our medical system we look at fever as a bad thing. If it goes up, some bad things can happen. The reality is, for every degree your body goes up one degree, increasing your temperature, your metabolism, your metabolic needs increase between 10 to 15%, your body makes more antibodies, your antibody production is actually boost a lot part of your immune system that involves things like interferon, which is a cytokine. These are molecules that actually boost your innate immune system. So your innate immune system fights off viruses and cancers. Your antibody immune system fights off bacteria. So both of these sides are actually being boosted greatly for every degree your temperature rises. So when you take an anti inflammatory like ibuprofen, you're actually suppressing your body's immune response. That's not as big of a deal if it's a small runny nose, a head cold or whatnot. But if you have a serious infection, lowering your temperature can actually lower your immune response. That's the gist of what they're saying. And this is real data goes back a long time. I will say the caveat about the 1918 literature in that they were taking crazy high doses of aspirin. They're actually taking it until people got toxic. So it's kind of hard to ferret out how much was the massive doses. That's also back in the day when we didn't realize about Reye's syndrome, we actually gave kids aspirin, which we don't do anymore. So lots of caveats to this research. But the concept of fever reduction, lowering your body's immune capacity is not a new concept. It's just now becoming international. Now, what about the Tylenol story? Why is Tylenol not the best idea? Well, for some of you all may know that Tylenol decreases your body's glutathione levels. Okay, what's glutathione? Glutathione is your body's primary intercellular antioxidant. Antioxidants treat inflammation, infection, inflammation, disease. You know, you can hopefully see the link there. And one interesting caveat is if you were to go into the emergency room with a Tylenol toxicity, you overdosed on Tylenol, they would actually use N acetylcysteine to reverse tunnel toxicity to save your liver. So N acetylcysteine is a substance I've been talking about for the last couple weeks that can boost your immune system, has antiviral activity. It can actually improve your immune system around your lungs and it boosts glutathione. So when you take Tylenol, you're actually lowering your glutathione levels. So the gist is if you're having a fever, you know, maybe using not using an anti inflammatory or a non sterile anti inflammator or a Tylenol kind of thing is not the best idea, especially if you're really sick. If you're not that sick, then probably not that big of a deal. But the reality is right now we're not sure who's going to be really sick and who's not going to be. So best to stay clear. The next thing. The president came out today and talked about chloroquine and how he might push to be using it for as an antiviral. We talked about that before and put some articles out on social media a couple weeks ago talking about chloroquine and how it improves zinc in your cells. You know, great thing to consider. They actually have done research in South Korea and China. The thing is you need to be sick enough to do it. One, two, you need to see a physician to take it. Three, it's not FDA approved. So that's where the government's coming in. Might help fast track that kind of stuff. But there are other things that work like chloroquine to get zinc in your cells, like quercetin, like egcg, which is a green tea extract. Again things we've been talking about for the last couple weeks here on our videos. So you can do, and you can do that preventively. You can take four to six cups of green tea or a capsule of EGCG daily. You can take Quercetin 500 milligrams twice daily, four times daily. You can do these things to actually increase zinc. The other thing about how hydroxychloroquine and chloroquine work is that they require your zinc levels to be sufficient. And A significant about 15% of Americans have insufficient zinc levels. And if you're over 60, 40 to 60% of Americans will have a zinc deficiency or insufficiency. So what you Want is to take these things with zinc. Now there was French researcher actually published an article talking. He said he had 100% cure rate. That's a pretty big, pretty big claim. 100% cure rate using a Z Pak basically azithromycin with chloroquine. Lots of patients ask me about that article. I have a couple of concerns about that article. First, it has not actually been peer reviewed and published. What peer review means is people like myself, my other colleagues, physicians, Ph.D. researchers get a chance to look at the article, say is this valid? What are the gaps here? What are the links here, what are the errors in it? This is just being pushed straight out now. There are good things about that and it allows us to get that data and not take months and months or even years sometimes for articles to be published. When I published in Lancet several years ago, it was about a two year process just to get an article published. So this is actually a good thing. The information is getting on there. The concern is that chloroquine and azithromycin can both lengthen your QT interval on your heart. So what is that? Basically they can increase your risk for having a cardiac arrhythmia. So if someone's older or sicker, this would only be happening in a hospital situation where they being watched really closely. There's already research coming from China and South Korea about IV vitamin C that doesn't really have hardly any risks. Very, very minimal. There's an NIH study currently on IV vitamin C and sepsis and for coronavirus. So that seems like a better option acutely. But a lot of these things are only going to happen if you're in a hospital under a physician's care. Again, things you can do outside the hospital are the things we've mentioned before. The other interesting thing about azithromycin that we've known for years is that it's an anti inflammatory and actually has antiviral activity which a lot of antibiotics actually are anti inflammatories and antivirals and have immune modulatory effects. Doxycycline, back before we had immunologics was actually used to treat rheumatoid arthritis. So again this is not necessarily new news stuff but it is new to the public and people getting really excited about it. There are nutritional things you can do that will actually help boost your immune system in similar ways which again we've talked about. They're on social media. Take a check, take a look there. Third round of questions. People have been asking about is, okay, what's going on with numbers? It's skyrocketing. I'm worried. We've been talking about that for the last several weeks. We expect to see the numbers skyrocket. The mmw, the Morbidity and Mortality, which is a report from the cdc, was published today or tomorrow, and that's going to be linked below here for all y' all to want to see. The numbers showing that we are having a big uptake, but the morbidity actually is not that high for those less than 55 years of age. The morbidity. So the mortality so far seems to be less about 4.4%, which is actually not as high as we're expecting. Again, we need more data. But the numbers, the numbers are going up and spiking. We're not seeing a spike and deaths. And so that's actually what we want to see. We want to see a big spike in numbers and not to have the hospitals jam crammed with people. And actually in the Richmond area, that's actually what we've been seeing. One of my colleagues is actually an ER physician and he was actually kind of happy that there haven't been a lot of everybody coming to the ER is having heart attacks, strokes, that's still going, but they're not having lots of sepsis. Pulmonary infection. Patients from. They are seeing that, but not in massive droves. And the MMWR from the cdc, again, it's a weekly thing they put out showing that as the numbers are going up, the death rate is not skyrocketing. So these are things we expect. Keep on following these things. I'm going to be posting these here below on Facebook and social media for everybody who wants to look at the actual data, they can actually look at it. Other question, last final question is what do you do about loved ones? If someone in your house gets sick, they can give it to everybody else. Typically, if one person gets this, they're going to spread to 2.5 people. In a typical flu epidemic season, 25% of people who are exposed get it. But that's because there's immunity already in the environment. So if you're in a close quarter, the chance of getting it is a lot higher. So what does that mean? It means no kissing, no hugging, no snuggling. The person should stay separate from everybody else. You want to look for signs of them getting really sick. This person should stay the house and not go out. If they have signs of respiratory distress, they're breathing really fast, they feel short of breath, they can't catch the breath. They're sitting, breathing fast. If they're a kid, they're flaring their nostrils when they breathe. Those are signs of respiratory distress. That person needs to see a doctor. If otherwise, they're sleeping. Keep them hydrated. I had some in my office today that had owned fluids in the corner for about an hour just to keep them hydrated, to keep them out of the hospital because they were stable, they were fine. We are open for business. Most of people's primary care doctors are still open for business. They should be doing screening before people come to the office to make sure they're not getting sick. People in the office. But for your family members, they should stay at home. Watch the concerning signs, but expect a lot of people to get sick. The expectation is between 70 and 80% of Americans are going to get this over the time and that might be over. Hopefully it's going to be spread over the next year or two. Hopefully. Hopefully we can have a summer come quickly. This will be put off and then we'll have to deal with some more infections in the fall. Again, these are topics we've already discussed. Look at the past videos again. What I plan on doing is trying to answer people's questions. If you have more questions, you can put them on Facebook, Instagram. We'll be collecting them and collating and we'll try to answer what we can as they come out. But for the bigger topics that require more explanation, I'll continue to do these. Let me know if this is helpful. I'm gonna get a lot of positive feedback, so keep that positive feedback coming. It keeps me going, keeps my wife going. She's the tech person who's gonna make this actually go where it's supposed to go. And put subtitles so people can read what I'm saying. Because sometimes I talk a little fast. So stay safe and we'll see you next time.