Blog by Balingit Acupuncture on health, medicine, lifestyle -San Diego

Coronavirus: 28 Days Plus Recommendations

by Carl Balingit on March 9, 2020

in Chinese Medicine

Image by Kilworth Simmonds [flickr/davidwithacamera], CC BY-SA 2.0

It’s been almost 28 days since my last post on COVID-19. We can now look back at the stats and see what has changed.

At that time, 99% of COVID-19 cases were isolated to China. But for the first time, around Feb 26, there were more new cases outside of China than within. As of Mar 9, China now represents 73.8% of global confirmed cases. There are now confirmed cases in 104 countries, and COVID-19 appears—in some cases—to be spreading by community infection (i.e. no clear source of infection).

COVID-19’s global presence and apparently increased transmission efficiency is technically a pandemic. But the World Health Organization is reserving that term for later use, probably in an effort to prevent panic. While COVID-19 is pandemic, I believe there is optimism in this shifting tide…

The number of COVID-19 cases in China is declining. Mainly, this may be attributed to the widespread quarantine measures taken, but also to the possibility that the infections have peaked. So, within a couple months, ground-zero China has been able to get a good handle on this novel virus.

This is optimistic for us because we have the benefit of China’s experience and the capability to compress their timeframe in resolving the caseload.

As the world watched China grapple with COVID-19, we’ve had time to prepare. We’ve increased our awareness of the risks of community transmission; our healthcare system has been anticipating increased cases as a natural progression of a novel infectious disease; and we obtained the DNA of SARS-CoV-2, early on, to get started on a vaccine.*

[Update, 3/14/20: A good friend corrected me on the “DNA of SARS-Cov-2” as follows…

The virus doesn’t contain DNA, only viral RNA. This is why it’s been challenging to perform the tests, RNA degrades easily and special reagents are required to prevent exposure to RNAase enzymes found abundantly on our skin etc…

RNA has to be stabilized and protected so it can undergo PCR to form cDNA (antisense RNA)–not naturally occurring–which is more stable; and this is what is sequenced to determine if a person is infected with COVID-19.

Much appreciated, S.G.]

While there has been a delay in the availability of COVID-19 testing kits, we still have the benefit of prior knowledge. We know the symptoms, the severity and the risks. The risk of community transmission is still relatively low, and we can mitigate that risk further by sticking to standard precautions.

Also at the time of my previous post, the fatality rate was 3%. This is relatively unchanged. As of Mar 9, the global fatality rate is 3.5%. Outside of China, it is 2.4%. The fatality rate is greater in China, as they were ground zero, with no advance measures in place.

The last statistic we looked at was the basic reproduction number, R₀. It is the average number of people that a contagious person can be expected to infect. In my last post, R₀ ranged from 1.4-5.5. This range is fairly broad due to a discrepancy between sources. Currently, R₀ remains within that range. The median is 2.79. Since this number has always been above 1.0, statistically it is no surprise that COVID-19 continues to spread. “Spread” does not mean unmanageable.

So now that it’s here, what do we do? We recognize that we are not defenseless…

Supportive Care

If you suspect you may have COVID-19 and your symptoms are not severe, then try to self-quarantine and not overload healthcare facilities so they can accommodate more severe cases. In self-quarantine, follow supportive care by focusing on rest and nourishment. Protein and fluids are required.

Think: chicken soup, or porridge (with chicken or egg). With added herbs:

- Astragalus root for immune system support
- Ginger and licorice root for cough

If you have a high fever, and a lancet (30 gauge or above), lightly prick the apex of either ear to quickly lower the fever.** Find the apex by folding your ear forward to the side of your face; the apex is located at the kink on top of your ear. If you have a mild fever, let it run its course and focus on water intake. (Fever is part of our defense mechanism against pathogens.)

While the U.S. healthcare system gets a poor grade in managing chronic disease, I believe this is the place to be for the treatment of severe infectious disease. We have the facilities, innovation and expertise. So, if you have severe symptoms, do not hesitate to tap into our healthcare system.

After 14 days of being symptom-free, seek acupuncture to revitalize your health and tone your immune system.

And if you’re looking for hand sanitizer, wait a couple months. Soon they’ll be sold for dimes on a street corner near you, as hoarders dump their supplies.

Notes

*A vaccine is a long-term solution. It can take 1.5-2 years, at best, to go from drug discovery to broad market availability.

**Pricking the ear with a safety lancet is simple and painless, but technique matters. If you’re uncomfortable with your technique, then seek a professional to perform the procedure. I am not responsible for your technique.

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Coronavirus: Perspectives and Woad Is Me

by Carl Balingit on February 17, 2020

in Chinese Medicine

Image by Jay Javier (flickr/cooey), CC BY-NC-ND 2.0

The latest coronavirus, which was officially declared this past New Year’s eve, is actually the third one of its kind. The first coronavirus was the severe acute respiratory syndrome (SARS) outbreak in 2002; the second, the Middle East respiratory syndrome (MERS) in 2012. While coronaviruses are responsible for the majority of common colds, these three are distinct because they were transmitted to us from another species.

This outbreak is suspected of originating in bats and was first labelled 2019-nCoV—short for novel coronavirus (novel, because it’s a new strain never before seen in humans). The World Health Organization (WHO) has updated the name to COVID-19. [Here, I’ll use the names interchangeably, either based on the source or for prosaic flow.]

Because this is a new virus, we lack historical data. So any conclusions drawn from what we do know seem to evolve in real-time; and the statistics discussed here may soon be revised. However, let’s get some perspective on current statistics.

99%

Ninety-nine percent of global laboratory-confirmed cases have occurred in China, based on WHO Situation Report-27 dated 2/16/20.

All other cases seem to have been exported from China. So, travel within China or contact with someone who has traveled within China is the biggest risk factor. While “contact” is a loose term, based on six degrees of separation, at least all the U.S. cases tested by the CDC seem to fit the risk profile. Specifically, 5% of the U.S. cases were found to be positive for COVID-19.

[Update, 2/18/20: According to the WHO Situation Reports, there was an almost 38% jump in global cases from 2/16/20 to 2/17/20. The large increase is attributed to a less restrictive inclusion criteria that now adds clinically diagnosed cases rather than just the laboratory-confirmed. Therefore, the new numbers are more conservative. The 99% statistic remains valid.]

The fatality rate for 2019-nCoV is 3%.

This rate is less than that of the other coronavirus outbreaks. SARS and MERS had death rates of 10% and 40%, respectively; and those outbreaks barely put a dent in our memory. This too will pass. But to be fair, as the world actively responds to the ongoing outbreak, that rate can change by significant degrees.

1.4-5.5

Another value to look at is the basic reproduction number, R₀ (“R naught”). This is the average number of people that a contagious person can be expected to infect. For 2019-nCoV, R₀ ranges from 1.4-5.5. Generally, an R₀ > 1 increases the risk of an epidemic. But to put it into perspective, the MERS R₀—that had a death rate of 40%—was less than 1.

SARS had a similar R₀ range of 2-5.

SARS 2.0

COVID-19 is similar to SARS in that they invade our cells via the same receptor protein, ACE2. So, the current assumption is that they will behave the same. This assumption is supported by their similar R₀ values.

Based on the pathogenetic similarities between COVID-19 and SARS, there is speculation that we may benefit from SARS prevention measures.

During the SARS outbreak in 2002/03, Traditional Chinese Medicine hospitals in China were using woad root (Isatis indigotica) for the treatment or prevention of SARS. The clinical basis was that woad root is a well-established anti-viral in Chinese medicine. However, it is important to note that the resolution of SARS should be mostly attributed to the quarantine measures taken and not to some superherb.

While woad root has historically been a strong and effective anti-viral, novel virus strains present new ball games; especially viruses that adapt and evolve quickly like SARS did, and possibly COVID-19. That’s not to say it isn’t worth putting woad root to the test, but that the primary focus should be on standard prevention, monitoring yourself and others, testing suspected infections, and quarantining confirmed cases.

Standard Prevention:

- Wash hands frequently
- Avoid touching eyes, nose, mouth
- Covering mouth if coughing or sneezing
- Trying to stay at least 3 feet away from known cases of infection [Update, 3/17/20: prior to COVID-19, and at the original time of this post, the consensus standard for social distancing was 3 ft. The recommended distance has since been extended to 6 ft.]

After the primary focus has been met, woad root is definitely a candidate for an added layer of defense, or as an integrative treatment. It has a long history of use in Chinese medicine for viral infections.

Scientifically, the major chemicals in woad root are phenylpropanoids, alkaloids and organic acids. The most active ingredients appear to be clemastanin B (CB) and epigoitrin. While none of the compounds or individual chemicals have been shown to kill a virus directly (in vitro), they do inhibit virus multiplication and attachment.

Viruses cannot survive on their own. They need to attach to our cells before invading them, ~~then splice into our DNA~~ * after entering. ~~After reprogramming our “software,”~~ * they can replicate and build an army to seek and destroy more of our cells.

[* Correction, 2/18/20:

Coronaviruses are RNA viruses and do not enter the nucleus of the cell where our DNA resides. They use the components within the cytosol to replicate. For viruses that do enter the nucleus, alteration of our DNA is an infrequent event.]

Woad root works by first building a firewall at the cellular level, preventing virus attachment. The second layer of defense is to disrupt a virus’ ability to replicate. The cells that are infected would experience a natural cell death (senescence) and be cleared by our immune system.

References

Bajema, Kristina L, et al. “Persons Evaluated for 2019 Novel Coronavirus – United States 2020.” Centers for Disease Control and Prevention, 14 Feb. 2020, www.cdc.gov/mmwr/volumes/69/wr/mm6906e1.htm?s_cid=mm6906e1_w.

Battegay, Manuel, et al. “2019-Novel Coronavirus (2019-NCoV): Estimating the Case Fatality Rate – a Word of Caution.” Swiss Medical Weekly, 2020, doi:10.4414/smw.2020.20203.

Chen, Jieliang. “Pathogenicity and Transmissibililty of 2019-NCoV–A Quick Overview and Comparison with Other Emerging Viruses.” Microbes and Infection, 4 Feb. 2020, doi:10.1016/j.micinf.2020.01.004.

“Coronavirus Disease 2019 (COVID-19), Situation Report – 27.” World Health Organization, 16 Feb. 2020, www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.

“Coronavirus Disease 2019 (COVID-19), Situation Report – 28.” World Health Organization, 17 Feb. 2020, www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.

Fehr, Anthony R., and Stanley Perlman. “Coronaviruses: An Overview of Their Replication and Pathogenesis.” Coronaviruses Methods in Molecular Biology, 2015, pp. 1–23., doi:10.1007/978-1-4939-2438-7_1.

NIH, National Institute of General Medical Sciences (NIGMS). “Our Complicated Relationship with Viruses.” ScienceDaily, 28 Nov. 2016, www.sciencedaily.com/releases/2016/11/161128151050.htm.

Su, Jia-Hang, et al. “Modes of Antiviral Action of Chemical Portions and Constituents from Woad Root Extract against Influenza Virus A FM1.” Evidence-Based Complementary and Alternative Medicine, vol. 2016, 2016, pp. 1–8., doi:10.1155/2016/2537294.

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