CAN WE LESSEN THE RISK OF SEVERE COVID-19?
Emerging evidence suggests that the severity with which the SARS-CoV-2 virus affects its host strongly depends on the host’s immune health and underlying pre-existing medical conditions. Dr Sly Nedic believes COVID-19 outcomes could be improved by taking a preventative integrative medicine approach.
Scientists supporting integrative and functional medicine streams are describing this phenomenon as pandemics within a pandemic. Here, they refer to the presence of inflammatory comorbidities – such as obesity, diabetes, hypertension, cardiovascular problems, etc. – all present in a modern society in pandemic numbers.
These conditions are mostly addressed, taking a conventional medical approach, using chronic medications and symptomatic treatments that are not cutting to the heart of the disease. This the main reason why a large group of the world’s population exposed to the virus are ‘falsely healthy’, yet actually suffer from baseline inflammation.
Similar circumstances arise from a weaker host’s immune health, which has also been affected in pandemic numbers in modern society. This happens with chronic stress, insomnia, electromagnetic influences from Wi-Fi, nutritional and vitamin deficiencies, malnutrition, the toxic burden from junk food, and environmental toxicities.
Furthermore, younger infected individuals may suffer severe Covid-19 outcomes as a weaker immune system can be present at any age. In the elderly, immune health is severely affected due to immunosenescence (aging of the immune system), so, logically, their defense will be jeopardized.
Simplified further, if the SARS-CoV-2 virus lands in a healthy body with a robust immune response and no pre-existing medical conditions, it would likely present no symptoms, mild flu-like symptoms, or moderate flu that will have 100% recovery.
Can we predict the outcome of COVID-19?
To predict the outcome, we need to understand how this viral disease behaves in our body.
As with any other virus, exposure to a significant viral load is essential for the course of the disease. A higher viral load is expected to inhibit the immune activation necessary to get ahead of the virus. Basic preventative methods such as washing the hands, wearing masks in public, physical distancing, and isolation should be employed to protect from a possible high viral load. Protecting from high viral loads is, however, not always easy for health workers despite these interventions.
As mentioned, a robust innate immune response is the crucial first-line defense mechanism against the virus. This understanding comes from emerging evidence suggesting that the SARS-CoV-2 virus firstly attacks macrophages – a critical part of our innate immune response that is necessary for subsequent adaptive immunity.
An integrative medical approach to eliminate factors that may weaken an innate immune response and add support by using scientifically proven supplements, vitamins, botanicals, etc. is paramount to an excellent COVID-19 outcome. Some early identifiers from a clinician such as a lymphopenia delayed Type I Interferon response, and others can predict poor outcomes down the line.
However, every immune response carries with it a natural increase in inflammatory cytokines, which can favour virus clearance. That said, it can also fuel further damage by recruiting more immune cells and creating the potential for cytokine storms. Cytokine storms with associated sequelae such as oxidative stress, septic shock, microvascular thrombosis, and multiple organ failure, starting with the lungs, can lead to high fatality rates in COVID-19. The patient’s baseline level of systemic inflammation, if high, hugely affects this fatality risk.
And it is exactly this high baseline inflammation that we see in comorbidities such as diabetes, obesity, and hypertension. That is why patients at a higher risk for cytokine storms are candidates for immediate integrative medical interventions rather than waiting until they become infected. We need to treat the cause of comorbidities and decrease baseline inflammation yet still navigate the interplay between adequate immune system activation versus maintaining the levels of inflammation necessary to kill the virus.
Risk factors for severe COVID-19
Identifying whether an individual is at an increased risk of developing severe COVID-19 and poorer outcomes are critical for doctors in planning integrative prevention and treatment. Assessing the risk factors for severe COVID-19 means evaluating the state of the health, immune system, and systemic inflammation of each individual. It also means assessing the possibility of being exposed to a higher viral load.
Individuals at risk for high mortality rates from COVID-19 are:
- Individuals with known comorbidities: particularly obesity, hypertension, diabetes, cardiovascular disease, and insulin resistance, where baseline inflammation is a risk factor and malignancy, kidney diseases, and auto-immune disorders.
- Healthcare workers: they are potentially exposed to larger viral load volumes.
- Older individuals: hospitalization rates for COVID-19 increase with age and are highest among older adults. The majority of hospitalized patients have underlying conditions, immunosenescence, which makes their immune system weaker, and inflamm-ageing, which increases the possibility of cytokine storms.
- Individuals with respiratory problems: asthma, COPD, idiopathic pulmonary fibrosis, etc.
- Individuals with genetic susceptibilities: genotype testing to assess patients’ glutathione (GSH) functional capacities may be clinically useful. For example, patients with GSTM1 (null) genotype can develop a cytokine storm and a worse COVID-19 outcome.
It is well established that an early robust immune response and the absence of systemic inflammation may be predictive of a milder form of COVID-19 presented as the simple flu. We clearly understand that patients at higher risk for severe COVID-19 are candidates for immediate vigorous interventions before they become infected.
Preventative integrative approach
This approach should be a priority for each individual, integrative medicine physicians, and society at large. Integrative medical professionals offer science-based protocols for these individuals that address their health issues holistically, which should include:
- Eliminating lifestyle factors that can cause dysregulation of the immune system, including insomnia, stress, glycemic control problems, dietary factors, microbiome (gut) issues, excessive exercise, etc.
- Supporting a correct immune response with supplements, vitamins, minerals, and hormones scientifically proven to have a modulatory role in an immune system – these include melatonin, vitamin D, vitamin A, quercetin, zinc, etc.
- Treating comorbidities by addressing the cause of the problem before an individual becomes infected.
- Using interventions to decrease inflammation and prevent cytokine storms.
With immunologists predicting that the SARS-CoV-2 virus is here to stay, the public needs to be educated about the ‘pandemics within a pandemics’ and take the proactive approach.
References available on request.