COVID-19: Can Asymptomatic Carriers Spread the Virus? What's the Truth?

Plus The World Health Organization warns about INFODEMIC (misinformation) 

Edison de Mello,MD, PhD

FACT: When the first few cases of the coronavirus hit the U.S, many thought that our country would be able to contain it with simple preventative measures such as washing our hands and staying indoors. What we didn't know back then, but discovered just last week, is that the virus can spread through asymptomatic carriers.

Why the rapid spread to all 50 states and territories? Because of the interactions with asymptomatic carriers. For example, as recently reported, about half of NBA players and staff who tested positive were asymptomatic when diagnosed. Also, 13 out of 23 residents at a nursing home in King City, Washington tested positive with no symptoms upon diagnosis.

But why? According to a shocking article by ProPublica, perhaps the time when "viral load," the total amount of virus emitted from an infected person's cells, is highest in the first few days of infection. 

Symptomatic vs. Asymptomatic. Does it really matter? Infectious disease experts aren't much concerned with categorizing infections as "symptomatic" or "asymptomatic". What's more critical is testing. They believe that the real reason why the virus has been able to spread so far and wide is because those who have mild symptoms may take over the counter meds and continue to use public transportation and work outside their home. Many people in these circumstances may not have access to doctors or testing, desperately need the income - and cannot afford not to go to work.  

Are most transmissions still occurring via droplets? How about surfaces? The virus is spread through liquid droplets (sneezing, coughing), meaning that your mouth, eyes, or nose must be in contact with liquid droplets of  an infected person. This also means that touching a surface contaminated by an infected person's liquid droplets, and then touching the mouth, eyes, or nose, puts you at risk for contracting the virus. 

Is the use of face masks still controversial? Not anymore. Perhaps the ongoing- shortage of masks for healthcare professionals contributed to the current debate on whether a mask was needed. The recommendation has recently changed. If you need to leave the house to buy groceries, for example, wear some sort of mask or facial covering, and wash your hands for 20 seconds immediately upon returning home. 

Masks during outdoor exercising? Running, biking, or just walking are great ways to get out of the house, but make sure that you wear a mask and maintain six feet of distance between those that are not your immediate family. 

The bottom line on supplements for coronavirus

Potassium. Potassium (K) is believed to play a significant role in the treatment of COVID-19. According to on-going studies, doctors in China reported that among a group of 175 patients hospitalized, 69 (78%) had mild hypokalemia (low potassium) to very increased levels of K. They have recommended three grams of potassium daily to help correct this deficiency.                                      

Food Sources: Bananas, beans, squash, and potatoes. Deficiency, other than in people taking certain medications affecting the kidneys or the GI system is uncommon. Individuals taking potassium-sparing diuretics (such as spironolactone), ACE inhibitors (such as captopril), or antibiotics like trimethoprim/sulfamethoxazole (Septra) should not take K supplements without medical supervision because dangerous levels of K may develop. 

Note: There are theoretical concerns that taking prescription ACE-inhibitors and angiotensin receptor blockers (ARBs) are thought to increase ACE2 on cell surfaces, thus increasing the risk of COVID-19 (Fang, Lancet 2020; Diaz, J Trav Med 2020). But more research is needed. Do not stop taking such medications without discussing it with your cardiologist. (Danser, Hypertension 2020; de Simone, Eur Soc Cardio 2020). 

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Vitamin C: Vital to the function of white blood cells (leukocytes) that fight infections, vitamin C is also essential for iron absorption. Iron  deficiency can make one more vulnerable to infections. A cup of orange juice, sliced orange, or a cup of sweet peppers, tomato juice, or kiwi contains about 80 to 90 mg of Vitamin C. 

Taking vitamin C before getting a cold may decrease the severity and duration of a cold but won't stop one from getting a cold.  High doses of intravenous vitamin C, are currently being tested in COVID-19 patients with pneumonia. Vitamin C may potentially help people who are critically ill on ventilators. (Hemila J Intens Care 2020).

Side effects: There may be severe risks with high doses of vitamin C. In addition to causing gastric distress and diarrhea, high doses over the long-term may increase the risk of cataracts and ALSO reduce the effectiveness of certain medications and blood tests.

Vitamin D taken daily in moderate doses, may help to reduce the risk of respiratory infections. A recent Italian study reported that adequate vitamin D levels decreased the risk of COVID-19 infection. Getting sun exposure, at least three times a week for about 20-30 minutes, and taking a vitamin D supplement is a safe and preventative measure for protecting against respiratory infections. To boost low levels of vitamin D, higher doses of 2,000-5,000 IU daily are generally required. 

Quercetin: Quercetin has been found in laboratory studies to inhibit a wide variety of viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV), which is related to COVID-19. According to preliminary research, quercetin works by preventing viruses from entering cells, thereby reducing "viral load." A clinical trial investigating the use of oral quercetin in patients with COVID-19 is underway in China. Most clinical studies use quercetin 500 to 1,000 mg per day in 2 divided doses.

Caution: There are potential side effects and interactions with a variety of drugs including rosuvastatin (Crestor), atorvastatin (Lipitor) and pravastatin (Pravachol)

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Zinc: Zinc deficiency is more common in the elderly due to reduced zinc absorption. In older populations, supplementing with 20 mg per day may help prevent respiratory tract infection, as suggested by a study of nursing facilities patients in France. 

Others who may be low in zinc include vegetarians and people on certain medications that reduce stomach acid. The daily requirement for zinc varies by age, but for adults, it is about 10-30 mg daily. (zinc-containing foods)

Melatonin: Melatonin is a hormone that helps regulate sleep, and has been suggested as a potential treatment for COVID-19. Although more studies are needed, the rationale for its use stems from the fact that it can affect immune responses. Laboratory studies  have shown that melatonin increases the levels of immune-regulating molecules called cytokines, leading to an "overreaction" to infection known as a cytokine storm. This damages the lungs and is suspected of playing a role in severe cases of COVID-19 (Mehta, Lancet 2020). Melatonin is believed to help regulate cytokines and to reduce virus-related mortality, but this has yet to be demonstrated in study trials. Also, because melatonin levels fall with age and in people with chronic disease, it may be one of the reasons why older age is a risk factor for COVID-19. The usual dosage for sleep is 0.3 mg to 3 mg, about 30 to 60 minutes before bedtime.

Other Supplements that may help reduce COVID-19 symptoms:

NAC (N-acetyl cysteine):  This amino is converted to the powerful "scavenger-like" antioxidant, glutathione and NAC may improve specific blood markers of the immune system.  A clinical study using 600 mg of NAC taken twice daily during flu season found that fewer infected people were symptomatic. 

Elderberry extract: This herb has been shown to inhibit the replication of  flu viruses. Preliminary trials suggest that taken within the first day of experiencing symptoms, elderberry shortens the duration of the flu. But there is currently no evidence that elderberry extract can prevent or treat COVID-19.(Mehta, Lancet 2020).

Astragalus (huang qi): This herb that has traditionally been used in Traditional Chinese Medicine or TCM, to strengthen the immune system and treat colds. It has also been promoted as a remedy  against COVID-19. Potent compounds in astragalus may increase the production of white blood cells and other cells crucial to the immue system (Integr Cancer The). Astragalus has also been shown to have anti-inflammatory and antiviral effects against a type of coronavirus that infects poultry. ( Int J Biol  Sci 2020).  

Caution: Due to its strong  immune-stimulating effects, people with autoimmune disease or on immunosuppressant drugs should not take astragalus;  it may stimulate histamine release leading to allergic reactions (Upton, Astragalus Root Monograph American Herbal Pharmacopoeia 1999). Astragalus may also lower blood pressure. It should  be used with caution in hypertensive individuals and in pregnant or breastfeeding women (Tond, J Clin Pharm Ther 2014).

Coconut Oil:  Preliminary research is underway on the antiviral effects of lauric acid and its metabolite monolaurin found in coconut oil.  A clinical trial is on-going using virgin coconut oil (3 tablespoons daily), monolaurin (800 mg daily), and/or monocaprin (800 mg daily) in patients with COVID-19. (study website) 

Echinacea: Accorring to  current research, echinacea may inhibit coronaviruses. But , there is only limited evidence that taking echinacea can prevent or treat coronavirus infections. A laboratory study that has not yet been peer-reviewed found that a particular form of echinacea inhibited specific coronaviruses, including MERS- and SARS-CoVs and it could potentially have a similar effect on COVID-19. Clinical trials of suggest a possible benefit for other types of viral respiratory infections, like colds, although results have been mixed. 

Garlic has been shown in laboratory studies to inhibit particular flu and cold viruses. At least one clinical trial suggests garlic supplements may help prevent colds. However, there is no current evidence that taking a garlic supplement can help prevent or treat COVID-19. Coronavirus disease (COVID-19) Myth busters.

           Allicin Care

Turmeric is best known for their modest anti-inflammatory effects. Curcumin, the active compound in tumeric, has  been shown to inhibit certain viruses in studies, including one suggesting that it may inhibit COVID-19. In animal studies, curcumin injections have been shown to protect the lungs from injury and infection, including viral-induced acute respiratory distress syndrome, possibly by reducing inflammatory cytokines and other mechanisms. 

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Apple Cider Vinegar:  Like most kinds of vinegar, apple cider vinegar contains acetic acid, which has antibacterial and antiviral properties. Currently, although no studies are proving that apple vinegar is useful for preventing or treating colds, sore throats, or COVID-19, anecdotal reports by practitioners have shown that patients report a decrease in the length of sore throat after gargling with it twice a day for 3-5 days. 

CBD (cannabidiol) has been heavily promoted to prevent coronavirus. While CBD has been shown to inhibit certain viruses, there is no evidence that it can prevent or treat COVID-19. (Cannabinoid Res 2020). CBD is helpful for anxiety and anxiety-related sleep disorders, making it useful for people struggling with anxiety due to the current pandemic. But in a small percentage of individuals, CBD may worsen anxiety and insomnia.

Footnotes

1. Chen, Caroline. “What We Need to Understand About Asymptomatic Carriers If We’re Going to Beat Coronavirus.” April 2, 2020. https://www.propublica.org/article/what-we-need-to-understand-about-asymptomatic-carriers-if-were-going-to-beat-coronavirus/amp.
2. Chen, Caroline. “What We Need to Understand About Asymptomatic Carriers If We’re Going to Beat Coronavirus.” April 2, 2020. https://www.propublica.org/article/what-we-need-to-understand-about-asymptomatic-carriers-if-were-going-to-beat-coronavirus/amp