COVID-19 and The Labs No One is Talking About

Your Immune system and COVID-19
Best Practices to Empower Your Health During COVID-19
The First of a Four Part Series
May 19th, 2020

What do the numbers show us?

When we think of COVID-19, we immediately think of tracking the numbers. My favorite place to track the numbers is here:  https://www.worldometers.info/coronavirus/

At first glance it doesn’t look good, especially for the United States, we are in the lead… but in the wrong direction.  COVID-19 is now in 212 countries and Worldwide there are a total of 4.9 Million cases of COVID-19 with 323,091 deaths in total with 1.9 million recovered cases.  Unfortunately, compared to other countries the USA has the highest number of cases and deaths compared to all other countries.  We currently have 1.5 million cases and 92,808 deaths. However, we also have tested the highest number of people 12.5 million tested (all other countries pale in comparison… such as 2 million tested or 1 million).  However, if you look at the combined data of WHO, NIH and CDC you will note that the number of deaths per million in the USA is half to 1/3 that of the European countries. For the USA it's 281 deaths per 1 million population and for Spain it is 594, for UK 521, for Italy 532, France 429 and for Sweden 371.  That’s one number we can be happier about.

How does COVID-19 compare to the flu?  The mortality rate of the coronavirus is now considered to be 2% worldwide and just over 1% in the USA, whereas the flu is 0.1%. In other words, the coronavirus is 10x more deadly than the flu. However, realize that last year we had 650,000 deaths from the flu worldwide and so far we have 323,873 deaths from coronavirus. If you look at the rate of infectivity for every one person with the flu  1.3 other people become infected and for SARS it was 2.0. For COVID-19 the rate of infectivity is similar 1.4-2.5. The measles is much higher, it’s 18 meaning for every one person infected they infect 18 other people they come in contact with.

When we look at all the states in the USA, California is doing better than predicted. Based on mathematical models when the pandemic broke out it was predicted that California would have 30,000-40,000 deaths.  How many deaths do we actually have?  A total of 3,321 of which more than half of those are from Los Angeles (1,839). In fact, the Bay Area has successfully kept the number of deaths low, with 38 deaths in San Francisco, 38 deaths in San Mateo, 56 deaths in Sacramento and 4 deaths in Sonoma. California has done as many tests as New York – we are both taking the lead for the highest number tested of any state at 1.4 million. What’s California’s number of deaths per million? Nothing like the scary numbers we see in Italy, Spain, France or the U.K and much lower than the USA national average of mid-200’s… It’s a low 84 deaths per million. https://www.worldometers.info/coronavirus/usa/california/

How does this compare to other coronaviruses? 

Even though we are told this is a “novel” virus, as it is a new type of coronavirus, we have known about the 6 other types of coronavirus since 1950. In 2002 we had the SARS virus which had a mortality rate of 9.6% and was fully contained in 8 months. Worldwide it killed less than 400 people in in two years it was gone. In the middle east we had MERS virus in 2012 which had a death rate of 34% but by 2013 it was gone. 

Why are we freaked out by this virus?

Some of us may have been touched personally with knowing someone who died with this virus.  Worse yet, they weren’t elderly nor obese, diabetic or suffering other poor conditions. In fact, in some cases it seems as random as being struck by lightning. All it takes is one of your inner circle to die and this virus strikes fear in like an image of a rapid black scythe sneaking up behind you and taking your life away unpredictably.

The coronavirus pandemic is not our first, but it is the most virulent and fierce when you look at the numbers.

To me there are two unusual features with COVID-19 that make it particularly tricky: 

• It can live on surfaces for days- from 3 days on metal, such as your cell phone or computer and on paper such as your mail, grocery bags, plastic and paper around food. It can live for 2 years in a freezer on your plastic frozen food bag.
• You can be asymptomatic for up to 5 days during which time you may be spreading the virus onto surfaces and around other people.  In a matter of 1-3 days you can turn south rapidly if the virus goes into your lungs developing into an inflammatory storm, also termed the “cytokine” storm and in 10 days you can be dead.

We have been learning a lot about this virus as it unfolds onto the world stage. We know that the symptoms usually appear by day 5 but can appear as quickly as 2 days after exposure or as late as 14 days after exposure. We know the viral shedding peaks at day 6. We know that 71% of those who die of the disease are male and 75% of those who pass have pre-existing conditions that aren’t necessary pulmonary but inflammatory in nature:  diabetes, obesity, high cholesterol and heart disease. There is some conversation that this may be due to a particular set of medications that those type patients are taking for their hypertension or cholesterol that could increase the invasion rate of the virus based on a receptor on the cell membrane called the Angiotensin II receptor. However, we can’t broadly recommend going off those medications at this point in time. There are some gray areas here, as these medications are also important to maintain a health blood pressure and cholesterol level.

Washing your hands can reduce the spread of the virus as well as self-inoculation by 70% and wearing a mask reduces it by 60%.  Lesser promoted practices that I have personally adopted are keeping sanitizer in my car. Every time I go out to grocery shop, get gas, ride my horse or go to the post office, I sanitize the steering wheel, car handle, and my cell phone as I’m touching things like the gas nozzle then touching my car steering wheel or the grocery shopping cart and also the doorknobs after coming in the home. You can also keep hand sanitizer in your purse. You could wear gloves but then you’re still spreading virus from the gas station to your steering wheel through your glove, just don’t touch your face with your gloved hand. Wearing gloves only protects you if it’s reminder not to touch your face. Since virus has been found on the soles of shoes always take your shoes off at the door. If you can’t find hand sanitizer or have a skin reaction to it (I developed a rash from the gloves), use hydrogen peroxide or get your favorite natural cleanser spray bottle and dump out half of it and fill that with isopropyl alcohol so that it's 60% alcohol. These are the concentrations and types of hand sanitization passed for COVID-19.

There’s a lot of media out there and from other physicians about our immune system not being able to handle the transportation of virus through the air and the inefficiencies of masks. I think these are all really good points and I look forward to revealing all the incredible things we can do to boost our immune systems with natural medicine in the newsletters to come, however I think that we must take the stance of respecting our agreements and behaving in a way that helps respect the legitimate fears of others. If your spouse, child or the neighbor feels safest with you using hand sanitizer before you touch the outside door knob to your home, taking your shoes off immediately and then walking to the sink first thing and scrubbing your hands thoroughly with soap and water for 20 seconds… just do it. Not doing it can create a tremendous amount of stress for the person you live with. 

I like to add positive imagery to our social sanitary practices. Consider making a ritual of washing your hands of the woes of the world and entering into your home more consciously aware. In Bali they put incense outside their homes every morning and flowers as a blessing to the heavens and gratitude for their homes – I was very touched by this when I visited that country years ago. Consider creating a new ritual of pausing before you touch the doorknob or washing your hands at the sink upon entering your home. Play around with interweaving a mantra or affirmation such as “I’m grateful for my home – I wash my hands of any stress or fear.”, or “As I take my shoes off I enter my home, a sanctuary of safety– leaving the events of my passageway into the outer world behind me.”

The quandry of lab testing:

• Several questions are circulating in all of our heads:
• When I was sick this past winter, could that have been a case of the virus?
• If it was, does that mean I have developed a stronger immune response to it?
• The media is warning me that the knowing that I had the virus doesn’t necessarily mean I’ve developed immunity from getting it again- so now what?
• Once “Shelter in Place” lifts is it really safe for me to go back to work?
• Could I become an asymptomatic carrier? Then what?
• I heard some of the labs aren’t totally reliable, which lab do I get done?
• I’d like to be tested for the virus but I’m not “sick enough” to qualify because I don’t have a cough, fever or shortness of breath, now what?

Up till this point part of the problem is that COVID-19 testing has required the following three symptoms: fever, cough, and shortness of breath, yet up to 50% of people with COVID-19 may have no symptoms at all. We don’t really know how many cases we have out there, but we are estimating that for every 1 person who tests positive there are probably 10 more people who have it.

What test do you trust?

In a recent article on April 24th in the New York Times titled, “Coronavirus Antibody Tests:  Can You Trust the Results?” author Apoorva Mandavilli states that a recent scientific project comparing different labs has discovered that 11 out of 14 lab tests to check for the coronavirus were considered unreliable. A multidisciplinary team of researchers and physicians at UCSF, UC Berkeley, Chan Zuckerberg Biohub, and Innovative Genomics Institute worked around the clock comparing the results of 14 different lab tests, only to conclude that 11 out of the 14 lab tests were unreliable. The project was designed to perform a head-to-head comparison of commercially available lateral flow assays (also known as rapid serology tests) and ELISA immunoassays. Coronavirus has turned our world upside down so rapidly that efforts to come up with solutions have been just as rapid. In the world of science, faster is not always better.

Knowing IgG status helps give individuals and their healthcare providers insight for a more informed decision about returning to work and activity.

Antibody testing for SARS-CoV-2, including IgM and IgG responses, will enable us to understand the prevalence and incidence of SARS-CoV-2 infections. Knowing if you have developed antibodies to the coronavirus will help detect if you have potential protective immunity and are able to return to work, which is especially applicable to health care workers. Antibody tests will also help us know if a person’s serum or plasma could help potentially serve as a therapeutic option for severe COVID-19, although not yet confirmed (Cheng, Wong et al. 2005, Duan, Liu et al.2020, Roback and Guarner 2020, Shen, Wang et al.2020).

What are the main types of tests used for COVID-19?
The three types of tests they looked at in the study were;

1. Rapid serology antibody tests (ICT, LFA)
2. Enzyme-linked immunosorbent assays (ELISA)
3. Real-time polymerase chain reaction (RT-PCR) swab tests

If we look at these individually, unfortunately we find that there are problems with all three. Faster is not always better and the rapid serology antibody tests are proving inaccurate. The ELISA test also has some inaccuracies. This is the same issue I found with Lyme disease testing. Lastly, the RT-PCR test has to capture a viral load within a short window of time that is early on in the disease, ideally within 3 days of symptom onset and no less than 7 days afterwards.  It’s likely especially if a person may have COVID-19 for 5 days before they even get the symptoms that they won’t get the swab test done until they are out of that window. So, they may actually have had COVID-19 but by the time they get the swab done it doesn’t pick up on the virus. Inaccuarcies have been reported to be as low as 60% sensitivity, meaning it’s only picking up COVID-19 disease in 60% of cases.

So, what’s the alternative? I’m happy to report that there is another lab technique to check for antibody levels that is NOT the ELISA, it’s based on chemiluminescent and it’s 95-97% accurate.

The new kid on the block: antibody testing

We now carry two antibody tests. One is through Quest labs and another is through Boston Heart. As antibody testing has become available we can begin to get a clearer picture of how many people have been infected. Insurance is covering the cost of naso-pharyngeal swab PCR testing but not the other tests, so the antibody test is paid out of pocket. Please realize that antibody testing is still being examined and understood. Quest’s antibody test boasts an accuracy of nearly 100% based on a study of 1,000 patients. Boston Heart’s lab is proud of an extremely high accuracy rate also (above 95%) and has been studied on 200 patients.

From Quest’s website we get the following message:

It is reasonable to conduct an IgG antibody test after 14 days of being symptom-free because most people will develop an IgG response in that timeframe. Further studies may further define and/or shorten the testing window.

IgG antibody testing may be performed on healthcare workers and patients who currently have COVID-19.

If a serology test delivers a positive result for the IgG antibody, that means the individual was previously exposed to SARS-CoV-2 and may have developed some level of immunity to the virus.

Note: The SARS-CoV-2 antibody test has not been validated for purposes of diagnosis of infection or disease (COVID-19) and cannot be used to rule in or rule out infection of COVID-19. Quest offers the molecular test for diagnosing an active COVID-19 infection.

The IgG antibody serology test has not been reviewed by the FDA.

Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals.

Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status.

Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E.

Boston Heart is a lab that offers Ig M and IgG. 

This antibody test is authorized by the FDA and it tests the same two markers as the newly-developed CDC antibody test, IgM and IgG. They are using materials from an established company called diazyme, that is listed on the FDA EUA list. The test uses chemiluminescent immunoassay to measure the antibodies present; our test is run on an FDA-cleared platform that is used for a variety of other biochemical testing, and the chemiluminescent immunoassay methodology has been shown superior to traditional ELISA testing in multiple independent studies. In addition, we provide quantitative information regarding the levels of IgM and IgG specific for N and S1 and 2 proteins, to better guide your clinical decisions.

The test has been validated by the manufacturer using human RT-PCR-positive patients in China (n=200); the test was 95 and 97% sensitive and specific when compared to the RT-PCR. The sensitivity and specificity have been provided by diazyme, but are consistent with chemiluminescent testing evaluations for other viruses.

Comparison of chemiluminescent immunoassay and ELISA for measles IgG and IgM https://onlinelibrary.wiley.com/doi/abs/10.1111/apm.12413

The Labs No One is Talking About

 One of the reasons I love the field of Holistic Medicine to which I belong is that we are a group of physicians who think outside of the box. Medicine that’s inside the box follows protocol and is designed for economic efficiency paralleled with positive patient outcome. Medicine inside the box is strategic as it’s always looking at an economic bottom line. Holistic medicine is oriented primarily to patient outcome first and foremost. Economic costs are left up to the individual to choose. It’s the patient’s option if they want to get to root cause of their illness by using cutting edge labs or optimize their physiology by looking at components of their organ systems that can tell them the ultimate story of illness and give a clear direct path back to health. Due to the mysterious and baffling nature of the coronavirus in which some people are asymptomatic and others dead in 10 days… doctoring in a manner that can adapt to a multitude of scenarios is something I can offer you.

So, let’s break it down into a few scenarios you can relate to at a practical level:

• Scenario One: When I was sick this past winter, could that have been a case of the virus?

This is the lab for you: Quest lab’s antibody test called “SARS-CoV-2 IgG”. Based on a study of 1,000 people this test is just shy of 100% accurate. It will tell you if you HAD the disease.

• Scenario Two: The media is warning me that the knowing that I had the virus doesn’t necessarily mean I’ve developed immunity from getting it again- so now what. What can I do to optimize my immune system?

The lab for you to show how strong your immune system is something I’ve created based on the thoughts shared amongst natural health physician’s: 

Get the following labs:  25 (OH) Vitamin D level, HgB A1C, Fibrinogen, Ferritin, hs-CRP, Liver Enzymes (AST, ALT) and CBC

Here’s why knowing each of these lab markers is beneficial:

• Vit. D: You can decease your risk of getting COVID-19 by a factor of 4-fold with Vit. D. You want it to be in the 80-100 range. https://www.ncbi.nlm.nih.gov/pubmed/32252338
• HgBA1c: COVID-19 risk increases if you are diabetic, which HgBA1C screens for.
• Fibrinogen:  COVID-19 causes increased blood clotting which can lead to cardiac, kidney, brain issues. Fibrinogen screens for a condition in which thickened blood is an issue.
• Hs-CRP: this is an inflammatory marker and inflammatory states increase the risk of a worsened outcome due to increased risk of developing the cytokine storm.
• Liver Enzymes: you want to make sure your liver is working optimally to lower inflammation should you get the virus. If you have a blood test Ig M for SARS-CoV-2 that comes back positive or you have a nasopharyngeal swab that comes back positive then get your liver enzymers checked. You want them to be in the normal range to lower your risk of having a more severe case of COVID-19.
• CBC: low lymphocytes and high neutrophils can indicate a smouldering COVID-19 infection. There are other viral infections that can cause this, however it shows that your white blood cells which are the “soldiers” in your body are impaired by an active infective process by some kind of pathogen.

• Scenario Three: I just got tested for the coronavirus and I’m sick and in home quarantine. I’m so scared I could get respiratory distress, is there anything I can do?
These labs can help predict if you could go into respiratory disease:  ALT- elevation, HgB elevation, ferritin elevation. If you have high levels of these three markers plus myalgic pains (pain in the muscles) then the risk of developing Acute Respiratory Distress Syndrome, or ARDS is 80%.

• Scenario Four:  I’m ready to invest in my healthiest self. I want to optimize my whole body.  I’ve heard that there may be a link between air pollution and increased virus excretion through exosomes.  I want to clear my body of environmental toxins

This means uncovering silent toxins that could be building in your system that you can’t necessarily “feel”.  Having a robust endocrine system not only helps you manage mental and emotional stress but also gives a bedrock foundation to your immune system. In addition, we can take a look at the health of your intracellular energy powerhouses, your mitochondria which help lower the switch on inflammation Labs: adrenal hormones and sex hormones, organic acids to assess mitochondrial health and GPL-tox and GPL-mycotox for mold and environmental toxins.  D. Shanong Lu reports that we are able to detect early phase of Parkinson’s Disease with a sensitivity 94.1% and specificity of 85.5% overall accuracy of 97.5 % when we look at these toxic markers. This company is not available through all physicians- only those, such as ourselves that practice natural medicine.

I strongly advise you to invest in taking a close look at your immune system through lab work to see how you truly score and if you are ready for this fall and winter as well as increased stressors coming up. Take this Summer to get in tip top shape so that you can be ready for any resurgence of the virus or any other viruses such as the flu. Stay tuned for MORE education coming your way on the immune system ( such as ways to ward off a cytokine storm, emergency home health equipment to have just in case);  how to de-stress and keep your perspective in balance; adding movement into your new at home work life; and more on the gut/lung connection as well as the link between histamine, viral entry and electro smog.