Best Practices For Social Distancing To Mitigate COVID-19

To flatten the curve and mitigate the impact of coronavirus we should be practicing social distancing.

It is not obvious to most how this should be accomplished but there is a great article on this at The New Yorker which discusses an information sheet on the topic provided by Dr. Asaf Bitton,

The New Yorker piece goes into more detail on topics such as what to do when you go outside, how often to shower, the importance of walks, how to respond if someone you are sheltering with gets sick, and the whether it is best to order take-out food or cook your own.

I’ve reproduced the nuts and bolts of Dr. Bitton’s information sheet below the line.


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1. We need to push our local, state, and national leaders to close ALL schools and public spaces and cancel all events and public gatherings now.

A local, town by town response won’t have the adequate needed effect. We need a statewide, nationwide approach in these trying times. Contact your representative and your governor to urge them to enact statewide closures. As of today, six states have already done so. Your state should be one of them. Also urge leaders to increase funds for emergency preparedness and make widening coronavirus testing capacity an immediate and top priority. We also need legislators to enact better paid sick leave and unemployment benefits to help nudge people to make the right call to stay at home right now.

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2. No kid play dates, parties, sleepovers, or families/friends visiting each other’s houses and apartments.

This sounds extreme because it is. We are trying to create distance between family units and between individuals. It may be

particularly uncomfortable for families with small children, kids with differential abilities or challenges, and for kids who simply love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take four to five days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky—I definitely do not recommend that people do so outside of their family.

We have already taken extreme social measures to address this serious disease—let’s not actively co-opt our efforts by having high levels of social interaction at people’s houses instead of at schools or workplaces. Again—the wisdom of early and aggressive social distancing is that it can flatten the curve above, give our health system a chance to not be overwhelmed, and eventually may reduce the length and need for longer periods of extreme social distancing later (see what has transpired in Italy and Wuhan). We need to all do our part during these times, even if it means some discomfort for a while.

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3. Take care of yourself and your family, but maintain social distance.

Exercise, take walks/runs outside, and stay connected through phone, video, and other social media. But when you go outside, do your best to maintain at least six feet between you and non-family members. If you have kids, try not to use public facilities like playground structures, as coronavirus can live on plastic and metal for two to three days, and these structures aren’t getting regularly cleaned.

Going outside will be important during these strange times, and the weather is improving. Go outside every day if you are able, but stay physically away from people outside your family or roommates. If you have kids, try playing a family soccer game instead of having your kids play with other kids, since sports often mean direct physical contact with others. And though we may wish to visit elders in our community in person, I would not visit nursing homes or other areas where large numbers of the elderly reside, as they are at highest risk for complications and mortality from coronavirus.

Social distancing can take a toll (after all, most of us are social creatures). The CDC offers tips and resources to reduce this burden, and other resources offer strategies to cope with the added stress during this time.page3image3897750480

We need to find alternate ways to reduce social isolation within our communities through virtual means instead of in-person visits.

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4. Reduce the frequency of going to stores, restaurants, and coffee shops for the time being.

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Of course trips to the grocery store will be necessary, but try to limit them and go at times when they are less busy.

Consider asking grocery stores to queue people at the door in order to limit the number of people inside a store at any one time. Remember to wash your hands thoroughly before and after your trip. And leave the medical masks and gloves for the medical professionals—we need them to care for those who are sick. Maintain distance from others while shopping—and remember that hoarding supplies negatively impacts others so buy what you need and leave some for everyone else.

Take-out meals and food are riskier than making food at home given the links between the people who prepare food, transport the food, and you. It is hard to know how much that risk is, but it is certainly higher than making it at home. But you can and should continue to support your local small businesses (especially restaurants and other retailers) during this difficult time by buying gift certificates online that you can use later.

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5. If you are sick, isolate yourself, stay home, and contact a medical professional.

If you are sick, you should try to isolate yourself from the rest of your family within your residence as best as you can. If you have questions about whether you qualify or should get a coronavirus test, you can call your primary care team and/or consider calling the Massachusetts Department of Public Health at 617.983.6800 (or your state’s department of health if you are outside of Massachusetts). Don’t just walk into an ambulatory clinic—call first so that they can give you the best advice—which might be to go to a drive-through testing center or a virtual visit on video or phone. Of course, if it is an emergency call 911.

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I realize there is a lot built into these suggestions, and that they represent a real burden for many individuals, families, businesses, and communities. Social distancing is hard and may negatively impact many people, especially those who face vulnerabilities in our society. I recognize that there is structural and social inequity built in and around social distancing recommendations. We can and must take steps to bolster our community response to people who face food insecurity, domestic violence, and housing challenges, along with the many other social disadvantages.

I also realize that not everyone can do everything. But we have to try our absolute best as a community, starting today. Enhancing social distancing, even by one day, can make a large difference.page4image3858666928We have a preemptive opportunity to save lives through the actions we take right now that we will not have in a few weeks. It is a public health imperative. It is also our responsibility as a community to act while we still have a choice and while our actions can have the greatest impact.

We cannot wait.

Asaf Bitton, MD, MPH, is the executive director of Ariadne Labs in Boston, MA.


Yours in Distance,

-ACP

6 thoughts on “Best Practices For Social Distancing To Mitigate COVID-19”

  1. Did I offer u this?
    Coronavirus 2019, Covid19, the Wuhan or Chinese corona virus, SARS CoV2-19.
    “First principles. Simplicity”

    H. Robert Silverstein, MD, FACC

    First principles. Simplicity.

    This corona virus CoV2-19 is a RNA virus (as opposed ta DNA virus) that is brand new. Being an RNA virus is similar to hepatitis C and it is not a DNA virus. There are 200 viruses that can cause the common cold and several of these are corona viruses. That genetic RNA fact will affect anti-viral treatment decisions. It was detected by its having a new genetic sequence as recognized by GenBank—it may have been around for a thousand years, but it is just now discovered. The Chinese symbol for it is pronounced “wayG” and means both “crisis” and “opportunity”: two sides of the same coin. The first known novel and important coronavirus was called SARS = severe acute respiratory syndrome. There are only 2 known previous serious corona virus versions: SARS and Middle East respiratory syndrome = MERS.

    This Covid19/CoV2-19 corona virus is named for its site of origin as was the Ebola (a river in Zaire) and Rocky Mount spotted fever, etc. Symptoms are initially fever (50%) and later 90%, dry cough, mild shortness of breath, malaise, headache, but not a runny nose, diarrhea or vomiting. X-RAY/thin slice CT scan findings show “ground glass” bilaterally in both lungs, no lymphadenopathy, effusions, or pneumothorax. 80% of non-severe CoV2-19 cases have normal chest X-rays or CT scans. Symptoms develop on average 5 days after exposure. Onset to recovery is 12-32 days. High risk is the presence of high blood pressure, a d-dimer blood test greater than 1, and having an adverse SOFA sepsis score. One is safe 3 days after no fever + resolved respiratory symptoms + improved chest CT scan + 2 negative PCR tests separated by 1 day. Viral shedding can occur for up to 37 days after onset of symptoms. Viral RNA can persist in the blood for up to 29 days and does not correlate with symptoms.
    Although the Chinese are currently stating that the virus originated in the United States, almost certainly it originated in either what is called a live market where wild and animals are sold for food in the Wuhan, China, or the virus escaped the research Wuhan National Biosafety Laboratory close to Wuhan, China. Currently 80% of pharmaceuticals are manufactured abroad, mainly in China and India. Industrial rare earth metals are predominantly from China.
    There is no prior experience with this current CoV2-19 virus and it spreads easily. 95+% of the Chinese population did not contract the virus. In China, infectivity has decreased from 2 to 3 other people per infected case to 1.5 per case now. Incubation is 2 to 11 days, for an average of five days. A cough can send infected droplets 15 feet. A sneeze can send infected droplets 25 feet. The virus can live in the air for three hours, on wet surfaces for three days, four hours on copper, 24 hours on cardboard, and 3 days on plastic or stainless steel. The first known USA case was 1/20/20. Infectivity doubles every five days. In China with their strong quarantine and isolation procedures, new cases have slowed to a trickle. South Korea has been the best and most effective country in dealing with this infection by using strong quarantine and GPS tracking of contacts. South Korea has drive-through testing which is only beginning in the USA.
    As reported by Anthony Fauci, MD, Chief of the National Institutes of Health (NIH) Infectious Disease section, the current influenza virus is 0.1% lethal and this CoV2-19 virus is 1% lethal, ONLY 5% will need the ICU.
    As of 3/16/20, there are 330 million Americans, 4,000 known cases of CoV2-19, and 71 have died from this disease. Worldwide there are 180,000 reported cases, half have recovered, and there are 6500 deaths. Most of those in the USA were elderly nursing home residents in Washington state. Pneumonia is known as “the old man’s friend” and is the usual cause of death for CoV2-19. 127 have died so far in France as of 3/16/20 with its much smaller population of 67 million, compared to the USA = 330.000,000. 7500 Americans die of all causes every DAY normally. In the USA there are 500,000 flu hospitalizations per YEAR, and 35,000 flu deaths per YEAR. There are 180,000 reported CoV2-19 CONFIRMED CASES, 7,000 deaths, and 78,000 recovered.
    An excellent website to follow the virus world-wide is by 17-year-old self-taught prodigy Avi Schiffman: ncov2019:live. For optimism, check out the twitter of a garbage man whose handle I lost: it had 3 letters in caps at the end.
    A very good source of information & perspective on CoV2-19 is Harvard’s infectious disease specialist Dr. Lindsey R. Baden of Brigham and Women’s Hospital.
    In 1348, the BLACK PLAGUE killed 1/3 to 1/2 of the world’s population. That was due to the bacteria Pasteurella or Yersina pestis carried by the rat flea. As a further sense of perspective, the SWINE FLU H1N1 virus of 2009-2010 originated in Mexico when there was an open Southern USA border during the Obama administration era. Should the border have been closed immediately? That is uncertain since the 2 nations were already so connected. The Swine Flu virus was in the United States 7 months before a national emergency was called and several months after it was named a pandemic by the WHO/World Health Organization. The current national emergency was called 2 months after the virus was first here and several days after the WHO named it as a pandemic. 61 million Americans contracted the Swine Flu and 12,000 died. 34 million Americans have been affected by the 2019-2020 INFLUENZA virus. 400,000 have been hospitalized and 35,000 have died.
    Travel bans have been set up by Saudi Arabia, Russia, Poland, Kenya, Morocco, Argentina, Brazil, Canada, Denmark, and others as well as the quite appropriately and early on, the USA beginning on 1/31/20. That early quarantine was supported by the NIH’s infectious disease chief Dr A. Fauci. The virus is in 110 countries.
    The Israeli company MIGAL says it has a vaccine that will be finalized in three weeks and ready for distribution in 90 days. J Craig Venter, the team leader who first sequenced the human genome and an originator of chromosome insertion has his own California institute that in all probability more quickly than anyone else in the USA will develop an efficient CoV2-19 testing and the relevant & an effective CoV2-19 vaccine.
    At the present time almost all of us feel off balance because of the inability to find out if we are (+) or (-) for the CoV2-19. There has been a general loss of joy across the United States. The press with its model of “if it bleeds, it leads” has been acting as if its moniker is “Project Fear” which is translated as a “loss of reason and a wave of fear.” The press and media as a whole have functioned as the voice of doom avoiding the evenhandedness demonstrated by the federal government. And although I believe allowing oneself to panic is a personal responsibility, in my mind, the press and media were responsible for predisposing the susceptible to panic on a nationwide basis. People will eventually adjust out of reason and/or necessity. It is important to be careful, but not to be paranoid.
    Early on it was apparent that the hold up for reliable and adequate testing was caused by mistakes at the CDC (Center for Disease Control) and specifically virologist and chief there Robert Redfield, MD—had he and his predecessors not learned, started preparing after Ebola, SARS, and MERS what preparedness was needed?!?!. He was responsible in large part for the current lack of preparedness and not having the necessary vision for understanding what was happening and what the appropriate response should be. Until now, old and outdated legislation empowering the CDC has been quickly and swiftly and correctly discarded by the current administration. Those rules held back allowing cities, states, and the private market to independently create their own testing. Moreover, the tests that were available from the CDC had a technical flaw and proved unreliable. Now that the President has joined hands with industry; the Roche pharmaceutical company in particular has developed a simplified and automated technology that will increase testing from 30 to 1,000 tests per day and Roche will be quickly able to upscale its production and distribution of this simpler and accurate CoV2-19 virus testing. Independent test development by D S Chugh, MD, of Washington state allowed the recognition of the first case of coronavirus/CoV2-19 which, remarkably, was in a teenager–as it is now felt that they are relatively immune. Initially she was held back by the CDC and eventually decided on her own to correctly develop accurate testing by NOT adhering to CDC guidelines. The proper sample culture areas are nasopharyngeal, oropharyngeal, and sputum, but not urine, blood, or stool. Companies that are making test kits: GeneMatrix, Chembiao Diagnostics, Hologic, GenMark, Integrated DNA, Pharma Mar, GeneMatix, Thermo Fisher. 3M is scaling up N95 face masks.
    From elsewhere: “A State Department official ignored a presidential order to hold returnees from China overseas in quarantine. Worse, due to a 1938 regulation, inattention and foot dragging in the CDC, the bureaucrats there and in prior administrations, the CDC was not prepared and actually, hindered a faster response. …officials at the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) stymied private and academic development of diagnostic tests that might have provided an early warning and a head start on controlling the epidemic that is now spreading across the country. …the CDC required that public health officials could only use the diagnostic test designed by the agency. That test released on February 5 turned out to be badly flawed. The CDC’s insistence on a top-down centralized testing regime greatly slowed down the process of disease detection as the infection rate was accelerating. … On February 29, the FDA finally agreed to unleash America’s vibrant biotech companies and academic labs by allowing them to develop and deploy new tests for the coronavirus that causes COVID-19.”
    Quoting the New York Post:
    “Overregulation of diagnostic testing has played a major role in this delay… Test protocols using the polymerase chain reaction (PCR) were publicly available shortly after Chinese researchers published (or described) the sequence of the virus in mid-January. The World Health Organization (WHO) used a freely available German procedure to create a test kit, shipping 250,000 tests to 159 laboratories worldwide. … CDC testing criteria have precluded recognizing community spread because of requirements stipulating recent travel to China or exposure to an infected person. Adherence to these guidelines delayed testing in the first probable case of community transmission… The FDA has not allowed the experienced and highly skilled professionals at public-health, academic and commercial laboratories to set up their own laboratory developed tests (LDTs), and no manufactured test kits have been authorized for sale in the US. In Europe, several companies, at least one US-based, have regulatory approval to sell test kits there.”
    In the American population there are 950,000 hospital beds, 45,000 ICU beds and 150,000 available in ventilators. Entrance is gained to the human body via a protrusion on the virus’s outside cover that attaches to an enzyme called ACE2 in the human body. Interestingly that is an enzyme that is blocked in the treatment of high blood pressure; it has been reported that patients who are on a related blocker called an “ARB” such as losartan are resistant to the CoV2-19 virus infection.
    “Pipeline: Investigations therapies fo COVID-19/CoV2-19.
    Diana Ernst, RPh MPR March 11, 2020
    Currently, there are no antivirals licensed by the FDA to treat patients with COVID-19. While no specific treatment for coronavirus disease 2019 (COVID-19) is currently available, several therapies are being investigated globally.
    Antivirals
    AbbVie: the Company is collaborating with select health authorities and institutions to determine the antiviral activity of lopinavir/ritonavir (Kaletra) against COVID-19.
    AIM ImmunoTech: developing Ampligen, a broad-spectrum antiviral that will be tested as a potential treatment for COVID-19 in Japan. A significant survival effect was observed in a trial evaluating mice infected with the earlier Severe Acute Respiratory Syndrome (SARS) coronavirus.
    Gilead: developing remdesivir, a broad-spectrum antiviral agent that is being investigated in a double-blinded, placebo-controlled study sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH). In addition, Gilead is initiating two phase 3 trials to evaluate the safety and efficacy of remdesivir in adults diagnosed with COVID-19, following a rapid review and acceptance by the Food and Drug Administration (FDA) of the investigational new drug filing for the novel antiviral.
    Immunotherapies and Other Investigational Therapies
    Algernon Pharmaceuticals: developing ifenprodil, an N-methyl-d-aspartate (NDMA) receptor glutamate receptor antagonist, which is being prepared for US clinical trials for COVID-19 based on results of an animal study that showed the investigational therapy significantly reduced acute lung injury and improved survivability in H5N1 infected mice.
    CEL-SCI: developing an immunotherapy using LEAPS, a patented T cell modulation peptide epitope delivery technology, to stimulate protective cell-mediated T cell responses and reduce viral load.
    Innovation Pharmaceuticals: developing brilacidin, a defensin-mimetic, that mimics the human innate immune system and causes disruption of the membrane of pathogens, leading to cell death. It has already been tested in humans in phase 2 trials for other indications.
    Mesoblast Limited: investigating remestemcel-L, an allogeneic mesenchymal stem cell (MSC) product candidate, as a treatment for patients with acute respiratory distress syndrome caused by COVID-19. Remestemcel-L, which is comprised of culture-expanded MSCs derived from the bone marrow of an unrelated donor, is administered in a series of intravenous infusions and is believed to have immunomodulatory properties to counteract inflammatory processes.
    Q BioMed: partnering with Mannin Research to develop a potential treatment that addresses vascular leakage and endothelial dysfunction, which may potentially help patients with severe cases of COVID-19.
    Takeda: developing an anti-SARS-CoV-2 polyclonal hyperimmune globulin (H-IG) to treat high-risk individuals with COVID-19 (TAK-888). Pathogen-specific antibodies from plasma will be collected from recovered patients (or vaccinated donors in the future) and will be transferred to sick patients to improve the immune response to the infection and increase the chance of recovery.
    Tiziana: developing TZLS-501, which has been shown to rapidly deplete circulating levels of interleukin-6 (IL-6) in the blood, a key driver of chronic inflammation. Excessive production of IL-6 is believed to be associated with severe lung damage observed with COVID-19 infections.
    Vaccines
    Altimmune Inc: developing a single-dose, intranasal vaccine against COVID-19 using its proprietary NasoVAX technology. The vaccine is moving toward animal testing.
    Applied DNA Sciences: collaborating with Takis Biotech to develop a DNA vaccine candidate using PCR-based DNA (“LinearDNA”) manufacturing systems; preclinical testing in animals are expected to begin in the second quarter of 2020.
    Codagenix Inc: co-developing a live-attenuated vaccine with the Serum Institute of India using viral deoptimization.
    GlaxoSmithKline: collaborating with Clover Biopharmaceuticals to develop a protein-based coronavirus vaccine candidate (COVID-19 S-Trimer) using Clover’s proprietary technology (Timer-Tag©) and combining it with GSK’s pandemic adjuvant system.
    Inovio Pharmaceuticals: developing a DNA vaccine (INO-4800) to address COVID-19; human trials to begin in the US in April.
    Johnson & Johnson: partnering with the Biomedical Advanced Research and Development Authority (BARDA) to develop a vaccine using Janssen’s AdVac® and PER.C6® technology, which provide the ability to rapidly upscale production of an optimal vaccine candidate.
    Moderna Inc: vials of the Company’s mRNA vaccine (mRNA-1273) have been shipped to the National Institute of Allergy and Infectious Diseases to be used in a phase 1 study in the US.
    Novavax: currently evaluating multiple recombinant nanoparticle vaccine candidates in animal models; initiation of phase 1 testing is expected in late spring of 2020. The COVID-19 vaccine candidates will likely include the saponin-based Matrix-M™ adjuvant to enhance immune responses.
    Sanofi: collaborating with BARDA to develop a vaccine using Sanofi’s recombinant DNA platform. The DNA sequence encoding the antigen will be combined into the DNA of the baculovirus expression platform and used to produce large quantities of the coronavirus antigen which will be formulated to stimulate the immune system to protect against the virus.
    *This list is not all inclusive. Updates will be made as more information becomes available.”

    Israelis moving quickly to get out a COVID19 VACCINE0
    By Howard Richman 3/15/20
    “Israeli scientists at the MIGAL Galilee Research Institute had worked for four years and had successfully developed a Coronavirus vaccine for chickens which passed clinical trials. When they saw the genetic sequencing of the COVID-19 virus, they realized that they could quickly adapt their chicken vaccine to the human virus. Ella Dagan, a spokesman for MIGAL told Europorter:
    When the genetic sequence of the new coronavirus COVID-19 was published, the researchers realized that the two viruses have the same infection mechanism similarities so they can use it, with small amount of adaptation, to achieve an effective human vaccine in a very short period of time.
    Dr. Shahar, one of the scientists told nocamels.com:
    It’s a little bit like fate that we were working on this coronavirus vaccine at the same time that the world was suddenly hit by this epidemic of coronavirus for humans.
    MIGAL created its vaccine by synthesizing two proteins. Unlike vaccines that are created by injecting a dead or weakened disease-causing virus, there is little danger that synthetic virus protein segments) will give patients a disease.
    Its vaccine creates antibodies in the mucosal immune system of the body which consists of thin permeable barriers to infection in the lungs, gut, eyes, nose, throat, uterus, and vagina. Dr. Chen Katz, MIGAL’s biotechnology group leader, gave Europorter a detailed cellular-level description of how MIGAL’s vaccine works:
    The scientific framework for the vaccine is based on a new protein expression vector, which forms and secretes a chimeric soluble protein that delivers the viral antigen into mucosal tissues by self-activated endocytosis (a cellular process in which substances are brought into a cell by surrounding the material with cell membrane, forming a vesicle containing the ingested material), causing the body to form antibodies against the virus.
    Israel’s Minister of Science and Technology, Ofir Akunis, is expediting the human vaccine through Israel’s approval process. According to Eureporter:
    The minister has instructed the Director General of the Ministry of Science and Technology to fast-track all approval processes with the goal of bringing the human vaccine to market as quickly as possible.
    Dr. Katz of MIGAL told Times of Israel that Israel’s approval process only involves about two months of actual testing:
    The clinical testing experiments themselves are not so long, and we can complete them in 30 days, plus another 30 days for human trials. Most of the time is bureaucracy — regulation and paperwork.
    CEO David Zigdon of MIGAL told Europorter that MIGDAL’s goal is to get their vaccine approved in just three months:
    Given the urgent global need for a human Coronavirus vaccine, we are doing everything we can to accelerate development. Our goal is to produce the vaccine during the next 8-10 weeks, and to achieve safety approval in 90 days.
    There are at least two American COVID-19 vaccines in the works:
    1. Moderna Therapeutics has developed a synthetic virus made from mRNA and has gotten it approved by NIAID (National Institute of Allergy and Infectious Diseases) for testing with human subjects. Those tests won’t begin until April.
    2. Regeneron Pharmaceuticals will soon have a treatment that will serve as a vaccine for those who don’t have coronavirus and a treatment for those who do. They will inject corona virus antibodies directly into the bloodstream instead of relying upon a vaccine to create those antibodies. They used a similar treatment to prevent and cure Ebola.
    The Israeli government could approve the Israeli vaccine in as little as three months. President Trump may have to intervene in order to get NIAID moving just as fast with an American vaccine.”

    Here are some of the Preventive Medicine Center positions: these are based on fact, judgment, reasoning, and experience.
    Avoid MILK-DAIRY products 100 (100!!!) %. My belief is that ANY MILK-DAIRY thickens the mucus reducing clearance of the invading virus, allowing it to “settle in and invade.” A single drop begins this allergic type adverse pathway. It is 100% milk-dairy avoidance or as you choose. SWEETS including dried fruits, and juices except Pom Wonderful pomegranate juice function as sweets = sugar = reduce/immobilize immune functioning at multiple levels. Basically, consume an organic unprocessed whole foods diet, ideally “macrobiotic” grains-vegetables-beans-fruit-nuts-seeds = GVBfns. See the http://www.thepmc.org website for general wellness information + this paper + how to prevent and or reverse high blood pressure, diabetes, open heart surgery, angioplasty, high triglycerides, overweight at the 95+% level.
    Read Bill Spear’s Primer on Macrobiotics: http://www.williamspear.com. For cooking, rely on “The Changing Seasons Cookbook” making 1 recipe EXACTLY according to directions-avoid as many processed foods and wheat products as possible therein. Take the book with you to the natural food store to be sure to get the exact ingredients in that one recipe. Miso soup with kombu, millet + cauliflower, scallions and daikon, brown rice with pickled shiso. Live refrigerated sauerkraut. “Cough Sync” is a newly developed tool for aspirating thick lung secretions more effectively. CLEANING solutions: 4 teaspoons of bleach in a quart of water, 0.125% peroxide, 80% ethanol, and 75% isopropyl alcohol.
    Medicine and supplement considerations to be specifically decided between you and your physician: take supplements daily for the first 2 weeks and then 5 DAYS A WEEK thereafter. Chew gum to keep your throat lubricated in order to “wash out” the virus. For colds or CoV2-19: the PMC position is to take vitamin C 500 mg 3 times a day, vitamin D3 5.000 units a day 5 days a week, Immune Renew 2 twice a day (Host Defense & OM also have beta glucan immune stimulating products, as is Brewer’s yeast). AHCC 2 twice a day (as just said, 5 days a week) is the top selling supplement in Japan. Glucosamine. Singulair (montelukast) is a lung leukotriene inhibitor that reduces lung inflammation and is worth considering in the armamentarium. If you are taking high blood pressure medication, try to have that be an ARB (angiotensin receptor blocker such as losartan). If on cholesterol lowering medicine, Livalo/pitavastatin seems more beneficial than Crestor/rosuvastatin or Lipitor/atorvastatin. Personally, my guess is that the gout treatment medication allopurinol would be helpful for serious CoV2-19 infection
    Dulera inhaler for bronchial cough issues. Zantac + Zyrtec (for complete histamine blockade) twice a day for nasal congestion. Fish oil is a generally anti-inflammatory: Carlson’s Cod Liver Oil (2 teaspoons = “a swig”) once or twice a day. Elderberry capsules for further immune enhancement. For a bothersome cough for my aptients I recommend elderberry syrup 2 tsp 3 times a day. Generic Robitussin DM 2 tsp 3 times a day as necessary only for bothersome cough. For chest issues, the glutathione supporting antioxidant NAC 600 mg 2 or 3 a day. If there is a deep cough, in order to prevent scarring due to fibrosis/scarring consider taking serrapeptase 2 three times a day. If there is bacterial invasion in the lungs and pneumonia development, antibiotics should be chosen based on sensitivity: if treatment is begun without a culture, doxycycline would be my antibiotic of choice as it has an anti-inflammatory effect. Read the 2020 Progress in Cardiovascular Diseases article by Mark McCarty & J DiNicolantonio regarding nutraceuticals inhibiting NOX2, thereby stimulating type 1 interferon response via Toll Receptor 7 (TLR7). HO-1 (heme oxygenase-1) enhancement to treat RNA viruses. Discussed/“recommended” in that article are alpha lipoic acid, sulforaphane, ferulic acid, resveratrol, spirulina (phycocyanobilin). EGCG as capsules or as green tea, with white tea for its high antioxidant content.

    H. Robert Silverstein, MD, FACC
    Medical Director, Preventive Medicine Center
    1000 Asylum Avenue #2109
    Hartford, CT 06105
    (860) 549-3444 or (800) 789-PREV fax (860) 549-3569
    http://www.thepmc.org

  2. Good post Doc. I’m all about Western democracy and culture, but what an interesting juxtaposition when we look at an authoritarian communist country like China, and their response to this. Here in the USA we are relying on a haphazard mix of some government clamp-downs depending on where you are, some businesses, some people, some blogs, etc. It has ramped up for sure, but slowly, and still not completely. Maybe, just maybe after this calamity runs it long course, our country and its leaders will prioritize (in cash money, logistics, systems etc) the fight against infectious disease equal to, or in my opinion greater than the prioritization of military operations around the world. Look at what immense damage to our economy and way of life this has created.

  3. In Australia schools are not being closed. Prime Minister Scott Morrison explained that while seeming counter intuitive, this strategy is based on the Italian experiences, where schools were closed.

    In Italy, parents continued to work, and children were cared for by their grandparents.

    Old folk are very susceptible with a death rate at least 8 %, which is 40 times greater than 20 year olds. Chinese Department of Health data.

    The grandparents, rather predictably, contracted the virus in great numbers.

    This sudden increase in elderly infections overwhelmed Italian hospitals.

    Mr Morrison explain that this strategy of keeping schools open would flatten the sharp peak seen in Italy, and allow hospitals to deal with a flatter peak over a longer time, and not get overwhelmed.

    Australia is a multicultural society, and it interesting to see the differences in behaviour between different cohorts.

    Rationing is introduced in supermarkets, and in some areas police patrol the supermarket aisles to enforce behaviour, and stop fighting.

    The Prime Minister describes hoarding as unAustralian, especially where black marketeering is involved.

    A tourists was tested positive, and was instructed to self isolate. This was ignored, and the tourist continued to travel to a popular tourist resort, with potential spread of the virus.

    Overseas students were supposed to self isolate for 2 weeks, but ignored that and continued to party on.

    Self isolation on the honour system seems to be one of the many weak links in the Australian chain.

    A great strength of Australia is the friendly cooperation of most of the political parties to provide a united approach, with only one minor party opting to attempt to make political capital from this crisis.

    Watching NATO reports on TV it seems that NATO nations are continuing the traditional infighting, while the situation in Afghanistan seems as hopeless as ever.

    Nationalism has surged, with Britain once again taking advantage of their island status, with Brexit a fortunate happenstance that allows border closure.

    The EU was based on open borders, which nations are now keen to close to protect their citizens. 90 % of EU residents are also in NATO countries, so a very interesting mix of conflicting strategies.

    1. Chris,
      I really appreciate hearing your observations on the situation in Australia.
      Aaron Carroll recently tried to answer the question of closing schools (https://theincidentaleconomist.com/wordpress/is-closing-the-schools-a-good-idea/) . He mentions the possibility of grandparents watching the at home children as one of the potential downsides but doesn’t emphasize it as you have.
      Please keep us up to date on your situation.
      Dr. P

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