COVID-19 FAQThe information provided on this site is for educational purposes only and is not intended as medical advice. The Andrew Weil Center for Integrative Medicine, is not responsible for individuals who choose to self-diagnose, self-treat, or use the information without consulting with their own health care practitioner. You should never alter your dosage of prescription medications without first consulting with your physician and you should always inform your physician about any dietary supplements you are taking.
Q: I was around someone without a mask seven days ago, and I just found out they are positive for COVID today. What should I do?
A: First, I would find out when they first developed symptoms, to determine whether it was likely that they could have been shedding virus when you were together. If they developed symptoms within 48 hours after you were together, then there is a risk that you could have been exposed to COVID-19. Since it has now been 7 days, if you currently have no symptoms, you still have another 7 days during which you may still develop symptoms of COVID-19. The length of incubation after exposure to COVID-19 is from 2 days after exposure, to 14 days after exposure. During that period of time, you could be shedding virus (exposing others) for 2 days before you develop symptoms. For example, if you were with your mother today, without a mask, and you develop symptoms in two days, you could have been shedding virus when you were with her, putting her at risk for developing the virus. You should monitor your own symptoms for 14 days after a possible exposure and wear a mask universally.
It is recommended by the CDC that you wear a mask universally when you are with others who are not in your own household. This would include all instances that you are inside, and if you are outside and within 6 feet or not able to maintain 6 feet of physical distance.
Q: Is using colloidal silver a good idea with COVID-19?
A: Please refer to a recent post on this topic by Dr. Andrew Weil, Colloidal Silver: Looking for a Silver Lining?
One notable quote from the article, “Silver is an effective germicide against some disease-causing bacteria, but most of the claims for colloidal silver are entirely unfounded. It is not an alternative to antibiotics, nor is it a cancer preventive. Its supposed role as an immune system booster, or a useful treatment for everything from ear infections to tuberculosis, shingles and AIDS is fanciful marketing. In 1999 the FDA banned the sale of all over-the-counter products containing colloidal silver and silver salts, stating that these compounds have not been recognized as safe. The ban does not apply to dietary supplements containing colloidal silver, but the FDA has jurisdiction over such products based on the claims they make and if there are any potential safety issues.”
Q: With regards to using curcumin for anti-inflammatory effects, should it be taken with piperine or without?
A: Curcumin as an isolated flavonoid is poorly absorbed. There are multiple ways to enhance its absorption. One method is to consume turmeric powder which contains curcumin along with other essential oils in flavonoids, with fat such as coconut milk. This is how curcumin is obtained traditionally through diet. In using supplements, curcumin absorption can be enhanced by combining it with biopeperine which is a derivative of pepper. Curcumin absorption can also be enhanced when it is taken as a phytosome, which essentially complexes curcumin with a phospholipid. Another type of curcumin supplement combines curcumin with other oils derived from the curcumin plant. Finally, another curcumin supplement with enhanced absorption uses nano curcumin combined with gum ghatti. All of these forms of curcumin supplementation do have superior absorption but are also more costly.
Q: Is there evidence supporting high-dose vitamin C as part of COVID-19 treatment?
A: One study in the US found that 15g of intravenous vitamin C combined with hydrocortisone and thiamine for 4 days lessened the severity of COVID-19 infection. There are other trials which are planned or in process to better understand the potential and safety of vitamin C as part of COVID-19 treatment. Oral vitamin C in smaller doses, 500mg to 3g daily, provides anti-inflammatory and antioxidant effects. The body's need and capacity for vitamin C increases during infection so oral dosing with early symptoms may need to be on the higher side of the dosing range. The role of intravenous vitamin C in prevention is not established.
Also discussed in An Integrative Approach to COVID-19 webinar Q&A
Q: If I take vitamin D, should I stop it during this pandemic?
A: Many people are deficient in vitamin D and supplement with this vitamin to become sufficient. Vitamin D sufficiency is an important part of optimal immune function, bone health, and brain health. However, when the body is experiencing significant inflammation, such as can occur in some people who become severely sick from COVID-19 infection, vitamin D should be temporarily discontinued. This is because vitamin D can activate the specific inflammation pathway and inflammatory molecule, IL-1B, which characterizes and contributes to symptomatic COVID-19 infection. The vitamin D should be discontinued while symptoms are present and can be resumed upon return to health.
Q: Does vitamin D need to be taken with vitamin K? I've seen on the news that high vitamin D can lead to vitamin K deficiency.
A: Supplementation with vitamin D does not induce vitamin K deficiency. Vit K can be taken with vit D and the combination may be more effective in preserving health bone mineral density.
Q: Why is elderberry considered safe for prevention but recommended to stop with symptoms or positive COVID-19 test results?
A: Elderberry extracts may help to prevent the early stage of corona virus infections, which includes COVID-19. Elderberry contains compounds which decrease the ability of viruses to infect cells. Elderberry is considered generally safe and in influenza B (cause of common cold), use of elderberry shortens the duration of symptoms. However, as a part of its immune supportive actions, elderberry increases immune cell release of tiny chemicals called cytokines. Specifically, elderberry increases the release of a cytokine called IL-1B which is a part of the inflammatory reaction to COVID-19 that can result in acute respiratory distress. For this reason, to minimize the possibility that elderberry could aggravate the inflammatory “cytokine storm” associated with the more severe COVID-19 infections, it is recommended to stop elderberry at the first signs of infection (fever, cough, sore throat) and/or if you test positive for the virus.
Q: Is the cytokine suppression provided by Boswellia serrata helpful in cases of COVID-19 infection?
A: Boswellia serrata, commonly known as Frankincense, is an herb with significant anti-inflammatory effects. The resin from the trunk and bark of this tree has compounds in it which inhibit an inflammatory pathway driven by an enzyme called 5-lipoxygenase, or 5-LOX. Inflammation which is driven by 5-LOX can result in painful joints in arthritis and inflammation in various inflammatory bowel diseases. It is also true that Boswellia extracts have been studied for asthma and found to improve pulmonary function, reduce asthma attack frequency and decrease inhaler usage. This would suggest that Boswellia may, in fact, be helpful especially for someone with asthma as a way to reduce lung inflammation during prevention of Covid-19. Pre-clinical studies have shown that Boswellia extracts inhibit a broad range of inflammatory cytokines which suggests that this herb is unlikely to be harmful, and may in fact, be helpful in someone with mild symptoms of Covid-19 infection.
Q: I'm curious about using garlic to fight infection. Is it better to use it raw?
A: Garlic is a well-known and well-studied food for its antimicrobial (including antiviral) and anti-inflammatory actions. It may be most effective to prevent viral infections. Garlic is effective when cooked or raw.
Q: Is Red Ginseng ok to eat while battling the virus?
A: There are no known or predicted contraindications for red ginseng, or Panax ginseng, during COVID19. Red ginseng increases the release of interferon (both INF-alpha and INF-gamma), which is a key component of anti-viral immunity. Red ginseng also reduces symptoms of influenza from H1N1 virus - a different virus, but perhaps similar effects might occur in COVID-19. Red ginseng has anti-inflammatory actions in various inflammatory conditions ranging from asthma to autoimmune diseases to colitis. Red ginseng has been shown in preclinical studies to specifically decrease various inflammatory cytokines including Il-1beta. This cytokine is involved in the inflammatory response to SARS-CoV-2. Red ginseng is an adaptogen which means that it can reduce the harmful effects of stress, at least in the short term. Finally, red ginseng does not increase clot formation and may, in fact, lessen abnormal clotting.
Nutritional Yeast, beta-glucan, NAC:
Q: Is it safe to take nutritional yeast or beta-glucan to enhance immunity? Is it safe to take during illness such as COVID-19? Is it safe to continue taking NAC during COVID-19 infection?
A: We have no clinical data on this. However, erring on the side of caution and avoiding isolated beta-glucan during Covid-19 illness seems prudent to avoid adding to the inflammation generated from this viral infection. NAC, or n-acetyl-cysteine, may reduce symptoms of influenza infections, especially in the elderly. It also has the ability to reduce mucus buildup in the lungs, something which could be beneficial.
Q: Why is COVID-19 virus is called a novel virus?
A: The COVID-19 virus is called a novel virus because it has characteristics that are different from other Corona viruses. There is a lot of information emerging, but unfortunately there is great deal we do not yet know, and there have been no completed human trials. The information we previously distributed was based upon what we know from non-human laboratory studies, and may be different from older “tried and true” recommendations for other viral illnesses.
Mushrooms:Mushrooms also discussed in An Integrative Approach to COVID-19 webinar Q&A
Q: What is the reasoning behind stopping medicinal mushrooms if sick with COVID-19?
A: What our strategies specifically suggest is to stop isolated polysaccharides extracted from mushrooms. These would include isolated 1, 3 beta-glucan, lentinan, etc. The reason for this is that these isolated polysaccharides have been shown to increase IL-1b, a key cytokine involved in the inflammatory response to Covid19 infection and to its virulence. On the other hand, mushroom and mycelium extracts (not the isolated polysaccharides) contain a broad array of compounds which generate an immunoregulatory response that both increases and decreases various cytokines. The end result appears to be a reduction of inflammation, a benefit during covid-19 infection.
A: All mushroom supplements and their extracts appear to be safe and indicated for appropriate immune support during the COVID-19 pandemic. The questionable supplements are isolated beta-glucans, or mushroom saccharides. These would be, for example, lentinan (a polysaccharide extracted from shiitake mushroom) by itself. In contrast to more comprehensive mushroom extracts that have the immune modulating properties, these isolated extracts are more unidirectional in their impact on immunity and may contribute to inflammation.
Q: In regard to using Host Defense My Community and Stamets 7 if sick with COVID-19?
A: As far as we can tell (March 27, 2020), Host Defense My Community should be safe to take if you have Covid-19 symptoms as this is a blend of mushroom and mycelium extracts, not isolated polysaccharides, and is the mushroom/mycelium product that a recent publication showed has immune regulating actions. Specifically, these actions include lowering of IL-1B and increasing IL-R1a. What this means is that this mushroom/mycelium blend appears to downregulate the inflammatory cytokine response that characterizes the symptoms of Covid19 infection
A: Host Defense: My Community or Stamets 7 formulas are mushroom/mycelium full extracts and are therefore likely safe. The potentially unsafe extracts would be lentinan, PSK or PSP.
Q: What about Active Hexos Correlated Compound (AHCC)? It seems to be a mix of polysaccharides and other compounds (similar to Host Defense products)
A: AHCC is primarily an alpha-glucan extracted from the mycelium of Basidiomycota mushrooms, which includes Shiitake mushroom. AHCC does contain some beta-glucans, amino acids, lipids, and minerals so is not a pure extract of one isolated polysaccharide. Thus, while unique among mushroom extracts, it can be considered more analogous to mushroom/mycelium extracts than to isolated mushroom polysaccharides like lentinan (also from shiitake mushroom) or PSK or PSP (no longer available).
Q: Do you think there is a benefit to nasal irrigation with sterile NaCl for prevention of COVID-19?
A: The benefit of saline nasal irrigation is primarily to moisturize the nasal passages, to reduce inflammation, and to improve the function of the cilia (small hairs) to clear mucus. Saline irrigation is mostly used for symptomatic improvement in chronic rhinosinusitis. There was a small randomized trial published in Nature, Scientific Reports [Ramalingam S, Sci Rep 9, 1015(2019)] that found that saline irrigation reduced the duration of viral upper respiratory tract infection by a couple of days, reduced symptoms, and reduces viral shedding and household contagion. Whether these results can be expected for infection with SARS-CoV-2 is not known. However, this is essentially no risk associated with saline nasal irrigation so for that reason this could be helpful in the prevention and early stages of infection.
Q: Can a person infected with COVID-19 take transfer factors from colostrum to help ease symptoms?
A: Colostrum has been shown to reduce intestinal inflammation in adults with inflammatory bowel disease. There are also studies which have shown bovine colostrum to reduce the symptoms of flu. There are several components, including transfer factor, in colostrum which have immune-modulating effects and anti-inflammatory actions. Of note, colostrum reduces IL-1beta and TNFalpha, two key cytokines involved in the symptoms of COVID-19. And, there are some people with COVID-19 who have primarily intestinal symptoms, usually diarrhea. Whether colostrum would be of benefit for the digestive and respiratory symptoms of COVID-19 infection is not known, however, with a high quality product, there is very low risk associated with bovine colostrum.
Q: In reference to the stories that some severe cases in France had more Ibuprofen in their system and that this may have made things worse. Is this true?
A: As of right now (March 27, 2020), the answer is not true. This is a classic example of how an opinion, in the absence of data, became accepted fact.
Two weeks ago, some researchers in Switzerland published a letter in Lancet that said that since many of the patients from China had high blood pressure and diabetes, and were taking ACE inhibitors (e.g., lisinopril), this could be linked to their poor outcome. The cellular receptor named ACE2 is elevated when people take drugs like lisinopril. This particular cellular receptor is also the receptor for coronavirus.
In addition, there are one or two weak test tube studies that show that in the presence of ibuprofen, ACE2 receptors may also increase in many cells. This letter was published as a hypothesis, not as data. Suddenly, in France, their Ministry of health circulated a warning about ibuprofen. They encouraged people to start taking Tylenol. What they fail to mention, is that Tylenol use causes sudden liver failure in tens of thousands of people, and about 300 deaths per year in the US. In the absence of liver disease, people can certainly start with Tylenol, and then use ibuprofen if necessary.
Finally, from an immunologic standpoint, the fever response is the body's way of eliminating viral infection, as many viruses do not multiply as well at higher temperatures.
A2: Because nonsteroidal anti-inflammatory drugs (NSAIDS), such as Ibuprofen® may increase ACE2 receptor expression, there has been some concerns noted about NSAIDs possibly increasing the risk of COVID-19 as the SARS-CoV-2 virus uses ACE2 receptors for cell entry. However there has been no evidence that the use of NSAIDs actually worsens the clinical course of this disease. We also don?t know if the ACE2 blocking activity of NSAIDs somehow minimizes the risk of increased ACE2 receptors. At this point if someone is taking NSAIDs and they develop COVID-19, they are not discontinued on the NSAID. If someone is not NSAIDS, develops COVID-19 and fever, the first choice is acetaminophen.
Q: Are natural cleaners, e.g., tea tree oil, grapeseed, etc., effective disinfectants for coronavirus?
A: According to Rutgers University experts, natural products are not recommended for fighting coronaviruses.
Q: Can purchases from the supermarket carry the virus?
A: An article in Time Magazine accessed 3/3/2020 covers the topic of safe grocery shopping. Excerpt: The CDC also does not recommend wiping down grocery items at home. “Currently there is no evidence to support transmission of COVID-19 associated with food or food packaging”, the CDC spokesperson writes. However, she adds that people should make sure to wash their hands as soon as they get home, especially before eating or preparing food. If soap and water are not available, use hand sanitizer with at like 60% alcohol, she says.
Therapeutic Options for COVID-19 Patients :
Q: What types of medications are being tested for use against COVID-19?
A: From the CDC website on 3/30/2020 An array of drugs approved for other indications as well as several investigational drugs are being studied in several hundred clinical trials that are underway across the globe. The purpose of this document is to provide information on two of the approved drugs (chloroquine and hydroxychloroquine) and one of the investigational agents (remdesivir) currently in use in the United States.
Q: What about spirulina or NAC as potential tools for use against COVID-19?
A: There is preliminary in-vitro and rodent data regarding spirulina and n-acetyl cysteine are suggestive of benefit in supporting the initial defense against RNA viruses including coronaviruses. These agents may increase interferon production. Interferon serves as a component of the first line of immune defense against viral infections. This is especially true in epithelial surfaces such as the respiratory tract. Like most natural agents, how impactful NAC or spirulina might be in reducing risk of infection with Covid-19 remains speculative. It is always good to evaluate any possible strategy from a possible benefit v possible risk perspective, which is different for each of us.
Q: Would increasing the fever at the onset of the virus help the body fight it?
A: The body produces fever as a result of inflammation or infection. Cells release proteins, called cytokines, that increase body temperature. With most viruses, the fever is the body's defense mechanism, as many viruses do not “reproduce” at high temperatures. Some animal studies showed that lowering fever may prolong viral infections and increase the amount of virus we can pass on to others. Also, in older times, some conditions used to be treated with “fever therapy” (e.g., syphillis). No studies have been done with the coronavirus. It is also true that in many acutely ill patients, prolonged and/or high fevers are associated with worse prognosis. At this point it is not advisable to try to increase the fever that can be present with covid-19 infection.
Q: I am an ER doctor taking Vit C , Viracon (Zinc, Elderberry, etc.), and MRS Mushroom formula to try to boost my defense against the virus. I have been reading the recommendations to stop the use of supplements that which may increase inflammatory/cytokine response. Most patients with COVID have normal white blood cell count and no Lymphocytosis/left shift. My concern is that there is a delay or lack of immune response early in the infection.
Maybe stimulating the immune system (and cytokine) system earlier will allow the body to control the virus before the patient is critical or in cytokine storm due to widespread inflammation. I know we have no evidence on this but just a thought. What do you think?
A: Initially, with no symptoms of infection, focus should be on increasing immune defense. Your strategies all make sense in this regard. If symptoms develop, it would make seem the time to shift emphasis on continued anti-viral actions with strategies to reduce excessive inflammation. The MRS mushroom formula and vitamin C fit this bill. Based on pre-clinical data, additional compounds flavonoids such as curcumin, quercetin, as well as herbal extracts such as astragalus and Andrographis downregulate NLRP3 inflammasome activation while also maintaining the reduction of viral replication.
Q2: Is there any benefit of stimulating immunity early in the illness to prevent worsening/progression and do we know how long the immunostimulating effects of the herbs/foods lasts?
A: Once somebody has been infected with SARS CoV-2, the timeline of symptom progression is variable. That being said, serious manifestations of COVID-19 infections such as respiratory distress are extremely unlikely within the first several days of infection. The first several days after infection or initial symptom presentation time would, therefore, appear to be a good time to augment antiviral immune function. However, given the unpredictability of who may go on to develop cytokine storm, it would be prudent to focus antiviral strategies on the herbs, foods, and supplements that would not aggravate the risk of increased cytokines. Fortunately, most of the supplements fall into this category. Most of the immune actions of herbs, supplements, and food are not well characterized, but are unlikely to last more than several hours which is why supplements are typically dosed several times daily.
Autoimmune Disease and MS:
Q: Are people with MS at a higher risk for contracting COVID-19?
A: People with autoimmune disease, such as MS, do not appear to be at greater risk for developing COVID-19 infection. However, people with autoimmune disease may be at higher risk for having symptoms of COVID-19 infection.
More discussion of this topic in An Integrative Approach to COVID-19 webinar Q&A
Q: If someone had all the symptoms of COVID-19 but tested negative (test done January 2020), is it possible that they actually had COVID-19?
A: It is possible that this individual had Covid-19 infection. Testing for past infection by measuring antibodies should be widely available at some point in the future. This will confirm whether an individual had Covid-10 infection. It appears that people with antibodies (immunoglobulins) from past Covid-19 infection have immunity to re-infection, although the duration of this immunity is not yet known.
Q: If more than 95% of tests conducted in Arizona (question received March 30, 2020) are negative for COVID-19 and they are testing folks with symptoms of COVID-19, then what is everyone sick with? I know personally that my flu and strep tests were negative as was my COVID-19 test. Similar results for my co-workers.
A: Great question. I'm afraid that the problem may lie with the testing. A few issues: 1) Most of the tests for coronavirus have a high specificity: if the test is positive, you probably have it. But they are not very sensitive: our tests can miss many positive tests (either due to poor technique in swabbing, or other test issues). In China, it was estimated that up to 30% of the tests were “false negatives”; where a test was read as negative, but was really positive. 2) Many states are making their own PCR tests. A good University can craft a very sensitive test, but as it has not had months of quality control, the results may not be as accurate as we want. Due to high demand and urgency, we may be cutting a few corners.
As the NYT reported April 1, 2020, If You Have Coronavirus Symptoms, Assume You Have the Illness, Even if You Test Negative
An Integrative Approach to COVID-19 webinar Q&A
The webinar received hundreds of questions and comments submitted through chat and the Q&A form. Listen to how AWCIM faculty addressed questions on the topics of:
- Fish oil supplementation
- CO2 levels in a mask
- ACE Inhibitors
- Washing produce
- A few pros and cons of cannabis
- Medicinal mushrooms
- Hyperbaric oxygen therapy
- Intravenous Vitamin C
- Autoimmune disease
- Oregano and thyme oils
- Experts' final tips!