In the meantime, doctors and other practitioners are, to a large extent, improvising. They are employing best-care practices for the very sick in hospital and providing best-guess advice for those with mild symptoms who are self-isolating, and for those who have no symptoms and would like to keep it that way.
It's important to remember that there are no proven treatments for coronavirus. The picture changes daily. But right now, the main treatment for severe cases is not a drug at all but supportive care and oxygen therapy, administered via ventilators in order to help people breathe.
Comment: Unfortunately ventilators may be killing more people than they are saving!
Some doctors are giving standard antibiotics to prevent or treat secondary infections. A few are trying experimental drugs, like the novel antiviral Remdesivir, not yet approved for widespread use.
Others are using "off label" treatments — drugs or drug combinations not originally intended for the treatment of coronavirus, such as chloroquine with or without hydroxychloroquine (both are anti-malaria drugs) or the antibiotic Zithromax. Just this week, the U.S. Food & Drug Administration authorized the use of anti-malaria drugs to treat coronavirus, stating that the benefit outweighs the risks, despite emerging reports of problems with both the drugs, especially worryingly high heart rates and stories of hydroxychloroquine poisonings in the U.S. and Africa following an ill-advised tweet by President Trump.
Results from short-term trials for other drugs are starting to come in, but so far none are very encouraging.
Back to basics
Given these problems, some practitioners are taking a back-to-basics approach. They're looking at remedies we already know about that have a low toxicity and some efficacy in other strains of influenza, to see if they might work with coronavirus.
Just last week FDA gave the go ahead — on a case-by-case basis — for using the antibodies in plasma donated by coronavirus survivors to treat patients who are critically ill with the virus. This relatively simple treatment was most recently used to treat patients during outbreaks of Ebola and avian flu. But it also saved countless lives during the flu pandemic of 1918, when there were no vaccines or antiviral drugs.
In some hard-hit New York hospitals, doctors have begun to administer large intravenous doses of vitamin C, 3-4 times per day, alongside other treatments. Those who get the vitamin C do "significantly better" than those who don't.
There is both historical and current data to show this is a reasonable choice. Vitamin C is short-lived in the body and prolonged infection depletes it faster. Studies show that supplementing is effective against some strains of coronavirus in humans and animals.
Based on their experience, Chinese officials are now recommending vitamin C for prevention and treatment of COVID-19. A new clinical trial is underway China, premised on the fact that the antioxidant activity of vitamin C may help prevent cytokine-induced lung damage. Cytokines are small proteins released by cells, which trigger inflammation in response to infections. Severe lung inflammation with COVID-19 can lead to respiratory distress and even death.
In addressing coronavirus, professional complementary and alternative medicine (CAM) practitioners are doing exactly what conventional doctors are doing — basing their advice on what is already known to be effective with similar viruses.
Likewise, nutritionists are advising from a perspective of foods and nutraceuticals that are known to support health and immunity.
Data is accumulating on the kind of pre-existing conditions that leave us more vulnerable to coronavirus. Noted UK cardiologist Dr. Aseem Malhotra has found that the majority of those who fall seriously ill with the disease are suffering from chronic metabolic diseases including heart disease, high blood pressure and diabetes.
An early audit of hospitalized UK patients supports Malhotra's findings, showing that two-thirds were overweight. Combined with lowered immunity, excess weight against the chest means muscles have to work harder to draw in a full breath.
Environment, and particularly air pollution, is important, too. During the 2003 SARS outbreak infected people living in areas with high levels of air pollution were twice as likely to die as those living in less polluted areas. With the MERS coronavirus outbreak, first seen in Saudi Arabia in 2012, tobacco smokers were more vulnerable to the disease, and more likely to die.
Comment: That doesn't appear to be the case with Covid-19: Another study finds smokers are less likely to be hospitalized with COVID-19
On the plus side, researchers in Melbourne, Australia have tracked the immune responses of one of Australia's first COVID-19 patients. Their data shows that a healthy body that has never been exposed to coronavirus before does have the ability to fight the virus and recover from the infection.
The picture that is emerging adds another dimension to the notion of hygiene. Washing hands and maintaining good hygiene practices at home is vital. Social hygiene — maintaining a safe distance from others — is also important.
But so is internal hygiene. What you eat, how you manage stress, your environment, how you act to support your own overall health — all of this is relevant to how well your body responds to infection with the coronavirus.
Why is information on CAM so hard to find?
For a variety of reasons, many people feel they either have to, or want to, manage their health at home. According to a major U.S. government survey, 38 percent of adults aged 18 years and older use some form of complementary and alternative medicine to do this. This is a substantial proportion of the population.
Alternative treatments, for instance with supplements or herbs, nutrition or stress management, all have a role to play in maintaining good health.
But, as with conventional treatments, good advice on the potential of these approaches in relation to the coronavirus outbreak is hard to find.
In fact, these days advice on natural health solutions is generally scarce since "information providers" like Google have decided to make websites providing this information harder to find, based on claims that these websites are pedaling fake news.
This information suppression is real and concerning. One Google whistle blower has collected over 950 pages of Google documents that show how the search engine is manipulating the flow of information online according to its own political agenda.
The vitamin C story, however, suggests that whether Google approves or not, some doctors at least are returning to tried and tested, low-risk strategies for the treatment of hospitalized patients with coronavirus.
So what else could be effective? There are certainly plenty of tips and recommendations flying around at the moment, though not all of them have reasonable evidence to back them up. Here, then, is a summary of some of the better alternatives for maintaining health at home.
It goes without saying that this is not a time to indulge a craving for junk food, prepackaged snacks or what has been dubbed "quarantinis." As experts at Johns Hopkins Bloomberg School of Health note, a glass of wine is fine, but regular home based happy hours — especially with hard liquor — can suppress immune responses and leave you more vulnerable to respiratory illness.
Food rich in polyphenols is good for health under any circumstances, but now serious research is looking into the role of polyphenols in fighting the coronavirus. In the lab, natural compounds like hesperidin and diosmin (abundant in citrus fruits, their pith and peels), rutin (found in apples, buckwheat, figs, green and black tea and figs) and apiin (found in parsley and celery), have been shown to target an important protein, M(pro), which is responsible for helping the coronavirus to reproduce.
Even the skin on peanuts, so often blanched off in pre-prepared spreads and foods, has been shown to have a powerful antiviral effect, with researchers recently concluding that its polyphenol content "inhibits the early replication stages of the influenza virus."
Can dietary polyphenols do the same thing? According to researchers from Harvard T. H. Chan School of Public Health, polyphenol compounds — abundant in fresh, whole foods — are antioxidant and anti-inflammatory and have been shown to offer protection against certain cancers, cardiovascular diseases, type-2 diabetes, osteoporosis, pancreatitis, gastrointestinal problems, neurodegenerative diseases and lung damage.
In the gut, polyphenols could also help support beneficial gut bacteria (your "microbiome"), while inhibiting invasive or pathogenic species. This is important because gut health, or lack of it, may also increase vulnerability to viruses like the coronavirus.
According to Tim Spector, professor of Genetic Epidemiology, King's College, London, recent research has shown that a healthy microbiome — one with a diversity of "good' bacteria" — plays an essential role in the body's immune response to infection, helping it mount a robust response to infectious pathogens like coronavirus. The natural diversity of the microbiome can decline with age, which is why it is particularly important to ensure our elders are eating well.
The best way to increase microbiome diversity is to eat a wide range of plant-based foods, which are high in fiber and which help to "feed" diverse bacteria in the gut.
Comment: Why is that those who promulgate advice about consuming a 'wide range of plant-based foods' neglect to mention that inflammation caused by plant toxins can wreak havoc on the body's immune system?
You can, however, also use supplements. Those containing a mixture of strains of lactobacilli and bifidobacteria have been shown to reduce the risk of upper respiratory tract infection in children and acute respiratory infections in adults.
When choosing a probiotic, look for one with a high number of colony-forming units (CFU), which indicates the number of viable cells. At least 10 -20 billion per dose is reasonable unless advised to take more (or fewer) by a healthcare practitioner.
Apart from 1-3 g vitamin C daily and probiotics, you might want to ensure you are getting enough vitamin D.
In the Northern hemisphere spring is upon us. This would be the time that most of us would naturally be going outdoors and topping up low vitamin D stores through exposure to sunshine.
That's harder to do if you are sick or under quarantine indoors.
Vitamin D enhances the body's natural immune response helping it fight infections, including influenza and, according to an analysis in the British Medical Journal, acute respiratory tract infections.
Newer evidence suggests vitamin D could help reduce illness and death from coronavirus.
Former director of the U.S. Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, is among those supporting the idea that adequate vitamin D can be a preventative. Even Anthony Fauci has stated that strategies like vitamin D (and vitamin C) are unlikely to harm and might even help.
Get regular physical activity outdoors, or sit by a sunny window if you are stuck inside. If you are supplementing, a reasonable daily dose for adults and children is around 1000 IU and 400 IU vitamin D3, respectively.
Vitamin A is also crucial to our immune response, coordinating both our innate and adaptive immunity. It supports the epithelium (which lines the outer surfaces of organs and blood vessels throughout the body, as well as the inner surfaces of cavities in many internal organs) and crucially, it protects the integrity of the mucus membranes of the body, such as in the gut and lungs, making it harder for infection to take hold.
It can be obtained through diet: organ meats, oily fish, cheese and butter are animal-based sources of vitamin A, while carrots, sweet potatoes, squash and green leafy vegetable like spinach and kale supply beta-carotene, which the body converts into vitamin A. The recommended daily amount of vitamin A, according to the Mayo Clinic, is 900 micrograms (mcg) for adult men and 700 mcg for adult women.
Zinc is another immune-enhancing supplement. A 2013 data review by the prestigious Cochrane Collaboration found that, for the common cold, zinc — particularly in lozenge or syrup form — "inhibits viral replication." Another study from the Netherlands found that zinc can inhibit the replication of a relative of the coronavirus, SARS-CoV, the cause of the 2003 SARS outbreak.
The recommended daily amount of zinc is for 15mg per day for adult males and 12mg daily for adult females. Don't be tempted to megadose. With lozenges, use them at the first sign of a scratchy throat rather than as a daily preventative and stop using once symptoms resolve. Some people may experience bad taste in their mouths or nausea from lozenges.
Whatever supplement you choose, buy the best quality you can afford and remember that nutrients often work together. GrassrootsHealth, a nonprofit public health research organization studying a large cohort of 16,000 individuals, has found that those who take supplemental vitamin C alone are 35 percent less likely to get the flu. For those who take omega-3 (another good anti-inflammatory), the figure is 38 percent. But those supplementing with both were 59 percent less likely to get the flu.
Elderberry (Sambucus nigra) often taken as a syrup and widely available over the counter, has a potent antiviral effect against the flu virus. Scientists suggest it stops the virus from reproducing by blocking key proteins that help the virus attach to and enter a host cell.
Elderberry is safe to take as a daily preventative and there is some evidence to suggest that, should you fall ill, it could significantly speed recovery. Newer evidence shows effectiveness against human coronavirusHJcov-NL63 — one of the main circulating coronaviruses worldwide.
Comment: See also:
Echinacea (Echinacea purpurea) has both an antiviral and antibacterial activity. New research out of Thailand suggests that preparations could serve as effective prophylactic treatment for all coronaviruses including the current one. This is not (yet) peer-reviewed research but, as with vitamin C, there is historical evidence of echinacea's effectiveness and again, like vitamin C, echinacea has been shown to interfere with cytokine activity and therefore may help to reduce inflammation and help to ease symptoms.
Always take herbs as directed on the package or by a healthcare professional.
Essential oils are known to be rich in antimicrobial compounds that can help kill bacteria and viruses. Laboratory studies on infected cell cultures are far more abundant than human studies, however.
A helpful review from 2017 published by the Tisserand Institute details antiviral effects from tea tree (Melaleuca alternifolia), cinnamon (Cinnamomum zeylanicum), bergamot (Citrus bergamia), lemongrass (Cymbopogon flexuosus), blue gum (Eucalyptus globulus) and thyme (Thymus vulgaris) oils, when applied to the cells in the lab.
But can that be translated into personal use at home, for instance through diffusers?
Influenza particles can be spread by airborne droplets, close contact with infected people or touching surfaces. Coronavirus particles can remain viable in the air for up to three hours and on surfaces for up to three days. Cleaning surfaces, therefore, is essential.
Cleaning the air may also be beneficial. There is some evidence that passive diffusion of certain essential oils via diffusers, combination diffuser/humidifiers and room sprays, can help neutralize airborne viruses.
In one study, under controlled conditions, vapors of bergamot and blue gum completely inactivated the influenza virus within 10 minutes. Cinnamon, lemongrass and Geranium (Pelargonium graveolens) worked after 30 minutes.
Another 2010 lab study found that even a highly diluted commercial essential oil blend containing cinnamon, blue gum, clove bud (Syzygium aromaticum), sweet orange (Citrus sinensis) and rosemary (Rosmarinus officinalis) oils, reduced the infectivity of the influenza virus, lending support to the idea that low concentrations via room diffusion could help sanitize the air.
Essential oils can also help reduce stress and anxiety — and this can have a knock-on effect of bolstering immunity (see below). Lavender (Lavandula angustifolia) has proven benefits for anxiety as do citrus essential oils such as sweet orange (Citrus sinensis) or lemon (Citrus limon).
When diluting essential oils for room diffusion follow the instructions for your specific machine. If there are none, try somewhere between a 2 percent (12 drops of oil to 20mls of water) and a 5 percent (30 drops of oil to 20 ml of water) dilution.
Stronger oils like cinnamon may need to be more dilute, lighter oils like citrus less so. Intermittent diffusion — 30-60 minutes on/30-60 minutes off — is thought to be more effective than continuous diffusion.
Even the normally conservative CDC recognizes that coronavirus is escalating feelings of anxiety and stress.
When we are stressed, the immune system's ability to fight off infection is reduced. Stress also promotes inflammation.
The effects of stress are direct — e.g. — the hormone corticosteroid, released when we are stressed, can suppress an effective immune response by lowering the number of infection-fighting lymphocytes circulating in the body. But they can also be indirect — e.g. by interfering with sleep, or prompting unhealthy behavioral coping strategies such as snacking, drinking and smoking.
Another effect of prolonged stress is its ability to activate latent ('hibernating') cytomegaloviruses (CMV) which many of us unknowingly carry. Viruses in the CMV family cause diseases like herpes and chickenpox but also fever and flu-like symptoms. As with coronavirus, there is no current treatment. Combined with coronavirus, a secondary infection like this may be particularly risky for the elderly, pregnant women and those with pre-existing conditions.
Relaxation techniques are an important therapeutic strategy for stress-related diseases. One recent randomized controlled trial concluded that those who exercised or meditated had fewer severe acute respiratory illnesses than those that did neither.
Comment: One of our favorite meditation and breathing techniques, Éiriú Eolas, is easily learned and has immediate effects in calming and reducing stress. Learn and practice the technique here!
Relaxation works for kids, too. In one clinical trial of children between ages 8-12, guided relaxation therapy decreased frequency of colds. Relaxation therapy was shown to increase levels of secretory immunoglobulin-A, one of the molecules responsible for protecting mucosal surfaces, like those on the lungs, from infection.
You don't need a therapist to relax. Meditate, read, listen to music, engage in an absorbing hobby, talk to friends even if it is across the internet, do the crossword, walk when you can out in a green space, do yoga — whatever engages you fully and takes you out of your head for a while counts as relaxation, so find what works for you.
With coronavirus, a multifaceted approach to health and care is absolutely warranted. The four out of 10 of us who wish to use alternative treatments for uncomplicated self-care should feel confident to do so.
Google may not help you find the best — or any — CAM information, but the following websites are a good place to start if you want to know more:
- Organic & Natural Health Association
- Natural Health News
- Mind Body Green
- American Botanical Council
Pat Thomas is a journalist and author of several books on health and environment including "Complete Wellness and What Works, What Doesn't - The Guide to Alternative Healthcare." She is also the editor at Natural Health News in the UK. See more on her website. Thomas frequently writes for the Organic Consumers Association. You can sign up here for OCA's news and alerts