Dear Mark: Coronavirus Questions

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Okay, so this situation is upon us. There’s no denying that all anyone can focus on is the coronavirus. There are several different names used for it, but I’ll use coronavirus and COVID-19 for today’s post. I asked across different venues for your questions and concerns about the topic. I tried to get to as many as I could.

Let’s just get into it:

Why do you think kids have not been so affected?

Good question. Many of the more serious issues with this happen in the lungs as a result of prior “co-morbidities” such as smoking, diabetes, COPD, or just having lived in an area of high air pollution for many years. Then there’s the notion that much of the damage that happens to infected people happens as a result of “cytokine storms,” an example of an immune system over-reacting to the insult. Because adults have been exposed to other strains of flu over their lives and have other antibodies for those flus, there might be a dangerous “mismatch” between what’s needed for COVID-19 and what their arsenal currently holds. Kids haven’t had the time to develop all the mismatched antibodies. All speculation.

And also, kids definitely have the potential to carry and transmit the virus even if they themselves don’t exhibit strong symptoms. One recent Chinese study found that 90% of kids with the virus were asymptomatic or showed just mild or moderate symptoms.

How safe do you think U.S. kids are?

I think kids are quite safe as long as this is reasonably curtailed.

When they say risk increases with age, they mean cellular age, not chronological right?

I hope so! That’s certainly part of it. If you are healthier and more robust in general, regardless of chronological age, you are likely to be more “robust” when under immune assault.

Tips for pregnant women and COVID-19?

Do whatever you can to avoid exposure. Full stop.

The CDC maintains a page for information regarding pregnancy and breastfeeding with COVID-19, but frankly it’s a lot of “we don’t know.” So far according to the CDC there is no known transmission from mother to baby via amniotic fluid or breastmilk. Of course, please consult your doctor immediately if you are pregnant and develop any symptoms.

Do you think that it’s overhyped or a real danger?

Both. It’s a real danger for some (mostly older infirm individuals with co-morbidities) and they should do whatever they can to avoid contracting. OTOH, the damage to the world economy is even now almost incalculable. How much of this was due to over-hype versus just poor prior planning will be the subject of debate for decades to come.

I do think once more testing rolls out, we’ll see that far more people are infected than we think, but that the fatality/severity rate drops.

Why the fear and hysteria from the media… what am I missing?

Humans are story-tellers by our nature. We have always used storytelling as the primary means of communication. Fireside tales, books, radio, TV, movies, Internet, gaming, school history classes, jokes—they are all stories. Every good story needs a villain. In this case, the media has found the consummate villain: an actual threat that hits all the right notes. In order to compete with other media outlets (and hence to sell ads) the tendency is to take a set of facts and weave them into a narrative that is both compelling and horrifying. COVID-19 allows for an infinite number of tales of woe and heroics—not to mention the ability for all sides to play politics with the other side.

Is it really as bad as the media is putting on?

IMO, no, but it’s early days and the situation is changing every hour. We will see.

According to UK researchers who created a mathematical model of transmissibility, each coronavirus case infected on average 2.6 other people in Wuhan. They also estimated that blocking over 60% of transmission would be necessary for infection-control measures to effectively control the outbreak. The outbreak is worsening in Europe, particularly in Italy as of today, but South Korea appears to have slowed its epidemic for now. This article in Science Mag credits the slowing number of new cases in South Korea to diagnostic capacity at scale, tracing contact with infected persons, and case isolation.

There’s another angle that I haven’t seen discussed much: air pollution. Wuhan is notoriously polluted, with terrible air quality and high levels of particulates in the air. The population also smokes quite heavily, particularly the men (who happen to be at greater risk). Smoking (and, I imagine, constant exposure to air particulate pollution) has been shown to increase ACE2 expression. That could very well be why it hit that area so hard.

If you catch & recover, is there a chance of future health issues as a result of having had it?

Apparently, reports are that a smallish percentage of people who contract this and recover are left with some damage to lung and or cardiac tissue. Maybe that recovers over time. Too early to opine. The same thing happened with SARS, if I recall correctly.

Can you get it more than once?

Remains to be seen. Some researchers are saying yes, that people are getting re-infected. Others are saying a person can “recover” but the virus lies dormant and reemerges. We just don’t know and won’t until long-term data is available.

Do you think fasting would have any positive effect on resisting it?

I would not undergo any dramatic fasting protocols at this time. I personally would adhere to my compressed eating window and limit intake to healthy fats, quality proteins, and organic vegetables. Fresh is great, but frozen and some (BPA-free) canned, jarred, vacuum-packed, and pantry items can provide quality Primal nutrition as well.

How does keto affect the body’s immune system?

In most cases a keto diet seems to support a healthy immune system, provided the foods you are eating are real, natural, etc. Whether that offers any specific protection against COVID-19 is impossible to say.

Do you think we should transition to workouts that aren’t at a public gym?

I would certainly limit my exposure to other peoples’ sweat and exhaled gases. I don’t plan to do any public gym workouts, and now most gyms have closed temporarily or will likely close across the country as the virus continues to spread. There are tons of things you can do in your home or your yard or even in a vacant field.

This is the perfect opportunity to get outside, get some sun (or cold), and move your body through fresh air. The fresh air will reduce the risk of transmission, as will the lack of people around you. The sun will increase nitric oxide, which showed some effectiveness at reducing the ability of a related virus—SARS—to replicate. And exercise is a great way to improve your overall health and resilience, as well as get out of the house and out of your own mind.

Best practices for fevers?

Stay hydrated (water and electrolytes; salty lime/lemon water). Stay in bed. Rest.

Avoid sugar and refined carbs. Sugar is one of the worst immune suppressors.

Do all the things your body is telling you to do.

In adults, I see no reason to reduce it until you’re getting to very serious temperatures—over 105, 106ºF. There’s actually very little evidence that fever in and of itself is dangerous. Rather, this study suggests that it’s whatever’s causing the fever that’s dangerous. The fever is the response. Animal studies indicate that treating fever with anti-pyretics might actually increase the risk of mortality, at least in influenza.

In fact, news stories are circulating, questioning whether it’s advised for patients to take ACE inhibitors and anti-inflammatory drugs such as ibuprofen if they’re experiencing COVID-19 symptoms. An article published on Science Alert suggests that the World Health Organization is digging into research presented in The Lancet that hypothesizes that COVID-19 patients with diabetes, cardiac diseases, or hypertension who are treated with ACE2-increasing drugs are at a higher risk for severe (and possibly fatal) infection. There’s concern among cardiology societies about these suggestions; the WHO has yet to release an official recommendation.

But, of course, if you’re running an extended fever and you suspect you might have coronavirus, get medical attention immediately and let them take it from there.

Are endurance athletes more at risk?

Probably. I say that because most endurance athletes overtrain to the point of occasional immune compromise. Now is not the time for that. Cut training back to 40% during this time.

Meat and corona?

Possibly my favorite meal.

My son is 22 and has asthma. Should I be worried?

Given the recent data, he is probably less likely to suffer severe consequences if he is infected based on his age, even though most of the severest cases involve lung and/or cardiac damage. Still, if I had asthma, I would do everything possible not to contract this. Not worth the risk.

Do you think when the sun comes out to play again this will die down?

I think it will absolutely help. Check out this thread on the UV index of the most affected areas. It really does seem like UV and weather and humidity can affect the viability of the virus and its ability to take hold, but this is all speculation.

A real problem will be the damage done to global economies. That might take a while to recover.

Good items to stock up on?

See Primal Provisioning for Staying at Home.

Would you travel during this outbreak?

Absolutely not.

Will taking vitamin D help people avoid getting sick?

This is a tricky one. Normally, I’d say yes, it can’t hurt and very well might help. But with coronavirus, that gets more complicated. One thing vitamin D may have the potential to do is increase ACE2 expression, and ACE2 is the same receptor to which coronavirus binds. It’s the “entry point,” how it gets in and starts destroying cells. Organs with high rates of ACE2 receptors, like the lungs, appear to be the most affected organs.

If vitamin D increases ACE2 in the lungs, for example, that could leave you more open to infection. I certainly would avoid “megadoses” of vitamin D. If you take it, do something like 1000 IUs max, or get it through food (salmon, sardines, pastured eggs, mushrooms) or cod liver oil.

Similar to the Spanish flu in 1918?

Maybe. It seems to show some similar patterns, but diverges in others. Basic concept of virulence seems similar and the same danger of overloading the medical system applies.

Tips on remaining calm and perspective amongst the panic?

The majority of the damage will be done and over in a few months. Accept what is, and know that you are doing the best you can with the tools you have.

Avoid stress. Stress increases ACE2 expression, dampens general immunity, and makes your time hanging out and relaxing impossible and miserable.

I read somewhere that a low-carb diet and high doses of vitamin C could reduce one’s chance of getting (seriously) sick from the virus. Is there any proof on that or reason to believe those claims are true?

Probably very little proof, but it’s not out of the realm of possibility. The single best thing you can do to shore up immunity is avoid sugars and industrial seed oils, get sleep, limit stress. One of the co-morbidities I’m seeing bandied about in serious patients are blood sugar disregulation, type 2 diabetes, and other conditions linked to poor glucose tolerance. In that case, using a low-carb diet to normalize glucose levels certainly won’t hurt. Of course, you don’t have to go low-carb to normalize glucose levels; it’s just that many people find that works for them.  

Vitamin C has promise. There were reports of Chinese doctors using IV vitamin C in patients and having success. IV vitamin C is a little difficult to arrange at home, but oral vitamin C is perfectly safe even at high doses and liposomal vitamin C seems to be even more effective than plain oral vitamin C.

Is it possible that frequent hand washing and sanitizer could actually hurt us by removing beneficial protective bacteria? I’m washing but also bathing my hands in dirt.

You have to look at this from two angles: acute and chronic.

Chronic sanitization of our environments and bodies promotes a worse immune system that’s more susceptible to illness and more likely to overreact to otherwise innocuous inputs.

Acute sanitization of our environments and bodies can protect us against dangerous microbes.

If you’re picking lettuce out of your garden, you can probably eat it without washing your hands.

If you’re in LAX (Los Angeles International Airport) opening the bathroom stall, touching the faucet, and flushing toilets, you should wash your hands.

And if there’s “something going around,” it’s a good idea to wash your hands and be a little more vigilant. Native Americans had robust immune systems and got plenty of microbial exposure and likely had incredibly impressive gut biomes and very little incidence of autoimmune diseases. But when they encountered smallpox, they died. They were vulnerable to an entirely novel infectious agent because they’d never encountered it before and it was sufficiently virulent.

Preparation we DO need to make… What are you doing???

I’m staying in my condo with Carrie. I have enough food stored for several weeks. I’m only going outside to go to the beach right outside the building, go for rides on the beach, runs, sprints, etc.

Staying calm, staying serene, and being prepared.

Also, read this thread and take it to heart.

That’s it for today, folks. If you have any follow-ups, I can try to get to them for next time. Ask away down below. Thanks for reading, and make sure to take care of yourself and your family.

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