Coronavirus (Covid-19) & Lyme

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Updated: 4/3/20 and 3/9/20; first published: 3/4/20

I significantly updated this article on 4/3/2020 to include new information on:

  • death rates
  • homemade face masks
  • supplements to decrease the infectivity of Coronavirus
  • supplements to prevent and limit cytokine storm to prevent lung damage, and
  • treatments that decrease the virus and improve outcomes when a person is infected with Coronavirus.

This article still includes useful information on:

  • prevention strategies like physical distancing and
  • ways to boost the immune system to help fight the novel Coronavirus infection.

I wrote large parts of this article to answer the types of questions I am receiving from my patients and those that participate in my weekly free Lyme Q&A Webinars. I hope you find it useful as we navigate this crazy new world of stay-at-home orders and Zoom happy hours. 

In Health,

Marty Ross, MD
Seattle, WA

About Coronavirus (Covid-19) and Lyme

Many people with and without Lyme are fearful of Coronavirus also called Covid-19. In my Seattle Lyme practice, I am answering questions about what one should do to protect themselves and to boost their immune systems. Many wonder if immune dysregulation, caused by Lyme, increases their chances of acquiring the virus, having a severe case, or even death.

Here is what I am discussing and recommending.

Coronavirus Severity

First, most people who get Covid-19 have mild to moderate illness. In fact the US Centers for Disease Control and Prevention (CDC) now states that up to 25 percent of people who have Covid-19 do not have any symptoms of the illness.

When I first wrote this article on 3/4/20, there were numerous estimates of the death rate for Covid-19. These estimates ranged from 1.4 percent to 3.4 percent. This compares to .1 to .2 percent for the seasonal flu.

While these statistics look bad, they probably dramatically over-estimate the severity of the illness. First, many with the illness appear to go undetected. If all people infected are accurately counted, this would drive down the suggested death rate and rate of severe illness. Current figures from South Korea reported by Worldometer on 4/3/20 show a case fatality rate of 1.7%. Reports show a German case fatality rate of 1.1 percent. The German and South Korea numbers are based on widespread testing. But, their widespread testing may still miss those that do not show symptoms of Covid-19. This means the real death rate from Covid-19 could be less than 1% when all infected people are actually counted.

Covid-19 now appears more infectious than the flu. It appears to be spread through respiratory droplets that can travel as far as 6 feet from an infected person. This means it can be spread more easily in tight quarters or through social contacts like churches or in families.

What About The Person with Lyme & Covid-19

Most with Lyme will not have a greater problem handling this infection than any other person. Lyme may suppress the immune system to fight Lyme. This does not mean the immune system is suppressed to fight other germs like new or even common viruses such as the Flu.

While most with Lyme do not have broad immune suppression against all germs, there are some that do. A small percentage of Lyme patients have a history of getting most virus infections that come along or of getting severely knocked down and sick with each viral or bacterial infection they acquire. These types of Lyme patients may, but we really do not know, have a type of immune suppression that makes them higher risk for a poor outcome with Covid-19. 

Risk Factors for a Poor Outcome with Covid-19

People with high risk factors for getting severe illness or death with Covid-19 should take steps to limit getting the infection. High risk medical conditions include:

  • Diabetes,
  • Heart disease like congestive heart failure
  • Lung diseases like chronic bronchitis, asthma, emphysema, and smoking damage
  • Immunosuppression from chemotherapy or other illnesses (this category may include a small percentage of Lyme patients as I describe above.)

Prevent Covid-19 Infection

There are some simple steps that people can take to prevent getting this infection. These are common recommendations put forward by public health departments like the US Centers for Disease Control and Prevention and Public Health - Seattle & King County. You can download the Seattle & King County flier here. While infection rates in a community are high, to prevent overwhelming hospitals, communities should have stay at home orders like those in place in many parts of the country and world. 

Practice Physical Distancing

Stand at least six feet away from others. This decreases your chances of contacting respiratory and mucous droplets that carry the virus. Some call this "social distancing." I prefer to call it "physical distancing."

Wash Your Hands Frequently

Washing your hands for 20 seconds with soap and water or a hand sanitizer removes germs you may pick up. Simple soap works great.

Avoid Touching Your Face, Mouth, Nose, and Eyes

Covid-19 is spread through respiratory droplets. If these get on your hands and then you touch your face or parts of your face, you could spread the virus to yourself.

Wear a Homemade Mask

Newer evidence suggests facemasks, if worn by those infected with Covid-19, prevent spread of the infection. Masks work better at preventing transmission from a person with the illness than they do at blocking a person wearing one from breathing in the infection. Because 25 percent of infected patients do not have symptoms, wearing face masks could prevent these people from spreading the infection.

Surgical and the N95 face masks are in short supply. They likely work better than homemade masks, but we should save surgical and N95 masks for the heroes working on the frontline of this illness. Refer to this New York Times article for information about how to make a face mask.

So, how do you properly use a mask?

Follow these steps I adapted from an article in Healthline:

  1. Clean your hands, either by washing with soap and water or by using an alcohol-based hand sanitizer.
  2. Before putting the mask on, inspect it for any tears or holes.
  3. Locate the metal strip in the mask if you are using a surgical mask. This is the top of the mask.
  4. Place the top part of the mask on the bridge of your nose, molding the metal strip, if you have one, to the shape of your nose.
  5. Carefully loop the elastic bands behind your ears or tie the long, straight ties behind your head.
  6. Pull the bottom of the mask down, ensuring that it covers your nose, mouth, and chin.
  7. Try to avoid touching the mask while you’re wearing it. If you must touch or adjust your mask, be sure to clean your hands immediately afterward.
  8. To take off the mask, unloop the bands from behind your ears or undo the ties from behind your head. Avoid touching the front of the mask, which may be contaminated.

 

Support Your Innate Immune System

There are two parts of the immune system that fight infections. One part is called the “innate immune system” and the other is called the “acquired immune system”. The innate immune system fights new germs, like Covid-19, the body has never seen before.

The acquired immune system includes cells and antibodies primed to fight infections which the immune system has learned to fight. For instance, in chronic Lyme it is white blood cells and antibodies in the acquired immune system that help fight the infection. The acquired immune system also is activated by vaccines. See How to Boost The Immune System in Lyme for information about how to support the acquired immune system.

To fight Covid-19, it is the innate immune system that will act first. The innate immune system is composed of barriers like our skin and mucous membranes like those in the nose. It includes various types of immune cells like Natural Killer Cells (NK), Dendritic Cells, Macrophages, Phagocytes, and Mast Cells. Some of the innate immune cells produce protein virus and bacteria germ killers.

A healthy lifestyle helps. Both parts of the immune system work best when one gets seven to nine hours of sleep a night. Emotional toxins like stress and worry suppress immune function - so find ways to destress like counseling, meditation, keep hobbies, visit friends, and exercise.

There are a number of supplements one can take to support and boost the innate immune system.

  • Vitamin A supports mucous membranes that act like a barrier to keep germs out. Vitamin A also regulates the immune system.
  • Vitamin D modulates the immune system, prevents excess inflammation, helps macrophages kill germs, and increases antimicrobial proteins that kill germs. In the case of the Flu, people who take Vitamin D regularly have marked decrease in Flu symptoms and the severity of the Flu compared to those who do not take Vitamin D and have the Flu.
  • Beta-Glucans found in mushrooms like Reishi turn on Macrophages, NK cells, and Phagocytes.
  • Transfer Factors are proteins made by immune cells that turn on various cells like NK cells. One product made by Researched Nutritionals called Transfer Factor Multi-Immune is shown in a very small study to improve NK function by 600%.
  • Probiotics appear to prime most innate immune system cells.
  • Glutathione appears to help Dendritic Cells. This can be increased either by taking liposomal glutathione or N-Acetyl-Cysteine (NAC) which is a building block for glutathione.

Prevent Cytokine Storm

People die from Covid-19 due to Acute Respiratory Distress Syndrome. In this condition, the infection triggers the immune system to release very high levels of inflammatory cytokines. These excessive levels damage the lung tissue leading to death.

People with Lyme are very familiar with cytokines. Excess cytokines made by white blood cells to fight the Lyme infection give most of the symptoms we call Lyme disease symptoms. One type of cytokine storm is the Herxheimer reactions that people with Lyme have when they kill Lyme germs with antibiotics. As part of my Lyme treatments I recommend numerous ways to lower cytokines to improve immune function, decrease Herxheimer reactions, and to improve symptoms. For a detailed look at Cytokines and Lyme see Cytokines: A Guide to Fix Lyme Symptoms & The Immune System. For more information about Herxheimer reactions see Herxheimer Die-off Reaction: Inflammation Run Amok.

Cytokine production is controlled by a cellular genetic messenger called NF-kB. The herbs quercetin and curcumin block this messenger leading to lower cytokines. Antioxidants like liposomal glutathione lower cytokines acutely. It is also possible to turn on a cell messenger called Nrf2 that increases cell production of antioxidants. Curcumin and quercetin turn on Nrf2. Another way to limit cytokine production is to block kinase enzymes. Quercetin is a strong kinase inhibitor.

Stop Virus Replication

If you get infected with Coronavirus, stopping virus replication may help. Limited French studies show that an anti malaria medicine called hydroxychloroquine (Plaquenil) decreases virus numbers. A non-peer reviewed study from China, which included a control group of people who did not receive the drug, also suggests hydroxychloroquine leads to quicker resolution and less severe illness. While solid large controlled studies are lacking, a survey of treating physicians show that many are having success using hydroxychloroquine. In the French studies, the antibiotic Zithromax combined with hydroxychloroquine gave the best results at decreasing the viruses. It is not clear how Zithromax works as an antiviral, but it may prevent bacterial infections.

Zinc blocks the enzyme that controls virus replication inside infected cells. Hydroxychloroquine is an ionophore that helps carry Zinc into cells. Taking zinc supplements without an ionophore like hydroxychloroquine is not that helpful. Another zinc ionophore that is shown to help in laboratory studies is the supplement quercetin I mentioned earlier in the section on Cytokine storm. However, there are no reports about whether quercetin is helpful. One study suggests quercetin works best in the lab to decrease Coronavirus infectivity if the cells are treated first with quercetin before they are infected. So this herb may work best to help a person if they take it before they get infected.

There is one other way hydroxychloroquine could help. This medicine may also lower cytokines and inflammation. This could help prevent cytokine storms.

Note: Hydroxychloroquine is an anti-malaria medicine. There is an herbal medicine called Cryptolepis that is used to treat malaria and the Lyme coinfection called Babesia. Cryptolepis does not work like Hydroxychloroquine. In the last week, I have seen Cryptolepis flying off the shelves at Marty Ross MD Supplements. I think many mistakenly think that if hydroxychloroquine works for Covid-19, that Cryptolepis will too. Unfortunately, Cryptolepis is not a zinc ionophore, nor does it work to lower cytokines. In other words, Cryptolepis is not an effective agent for Coronavirus.

My Recommendations

Before You Get Infected

1. Prevent contact with the Covid-19 infection.

See “Prevent Covid-19 Infection” section above or the Public Health - Seattle & King County flier for more information. Wear a homemade face mask in public.

2. Practice a healthy immune system supporting lifestyle.

  • Get seven to nine hours of sleep a night.
  • Find ways to lower stress like those mentioned above.

3. Use supplements to support innate immune system function*

  • Transfer Factor Multi-Immune by Researched Nutritionals 1 pill 2 times a day
  • Reishi Mushrooms 400 mg 1 pill 3 times a day
  • Vitamin A 5000 IU 1 time a day
  • Vitamin D 5000 IU 1 time a day. Be careful by working with your physician to keep your level between 50-80. Levels above 150 can be toxic.
  • Probiotics like Corebiotic by Researched Nutritionals or HMF Forte by Seroyal/Genestra 2 pills 1 time a day
  • NAC 500 mg 1 pill 3 times a day or liposomal glutathione 500 mg 1 time a day.

4. Decrease Virus Infectivity and Prevent Cytokine Storm*

This probably works best if taken before you get infected based on the lab studies showing it works best if cells were pre-treated with quercetin before they were infected.

  • Quercetin 250-300 mg 2 pills 3 times a day
  • Zinc 100 mg a day

Note: Quercetin is in short supply as information about this herbal medicine spreads. At Marty Ross Ross MD Supplements we are working to find a stable high quality supply.

If You Get Infected

1. Stop Virus Replication and Decrease Cytokines

  • Hydroxychloroqine 200 mg 2 pills 2 times a day for one day, then 200mg 2 times a day for 4 more days.
  • Azithromycin (Zithromax) 500 mg 1 pill 1 time a day for 5 days
  • Zinc 100 mg a day

2. Prevent Cytokine Storm*

  • Curcumin 500 mg 1 pill 3 times a day
  • Quercetin 250-300 mg 2 pills 3 times a day
  • Liposomal glutathione 500mg 1 time a day

* Be aware there is no research showing these will actually help someone with Lyme who acquires Covid-19. But based on their function seen in lab experiments, these may help.

Disclaimer

The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

 

References

View Citations

Immune Boosters

  1. Rountree R. Therapeutic use of immunomodulators. Oral presentation at: The Institute for Functional Medicine Immune Advanced Practice Module; Feb, 2019; Palm Springs, CA.
  2. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. Published 2017 Feb 15. doi:10.1136/bmj.i6583
  3. Cannell, J. J., R. Vieth, J. C. Umhau, M. F. Holick, W. B. Grant, S. Madronich, C. F. Garland, and E. Giovannucci. "Epidemic Influenza and Vitamin D." Epidemiology and Infection 134.6 (2006): 1129-140
  4. Gill, H., Rutherfurd, S., & Cross, K. (2001). Dietary Probiotic Supplementation Enhances Natural Killer Cell Activity in the Elderly: An Investigation of Age-Related Immunological Changes. Journal of Clinical Immunology, 21(4), 264-271.
  5. Adams CA. The probiotic paradox: live and dead cells are biological response modifiers. Nutr Res Rev. 2010 Jun;23(1):37-46. doi: 10.1017/S0954422410000090. 
  6. Murphy, E & Davis, J & Carmichael, Martin. (2010). Immune modulating effects of β-glucan. Current opinion in clinical nutrition and metabolic care. 13. 656-61. 10.1097/MCO.0b013e32833f1afb. 
  7. Researched Nutritionals. Research Alert: A Study on Transfer Factor. Los Olivos, CA: Researched Nutritionals, 04/2019. Print.
  8. De Flora, S., Grassi, C., & Carati, L. (1997). Attenuation of influenza like symptomatology and improvement of cell-mediated immunity with long-term N acetylcysteine treatment. European Respiratory Journal, 10(7), 1535-1541.
  9. Kim HJ, Barajas B, Chan RC, Nel AE. Glutathione depletion inhibits dendritic cell maturation and delayed-type hypersensitivity: implications for systemic disease and immunosenescence. J Allergy Clin Immunol. 2007 May;119(5):1225-33. Epub 2007 Mar 1.

 

Quercetin: Coronavirus and Zinc

  1. Dabbagh-Bazarbachi H, Clergeaud G, Quesada IM, Ortiz M, O'Sullivan CK, Fernández-Larrea JB. Zinc ionophore activity of quercetin and epigallocatechin-gallate: from Hepa 1-6 cells to a liposome model. J Agric Food Chem. 2014;62(32):8085–8093. doi:10.1021/jf5014633 https://pubmed.ncbi.nlm.nih.gov/25050823/
  2. Chiow KH, Phoon MC, Putti T, Tan BK, Chow VT. Evaluation of antiviral activities of Houttuynia cordata Thunb. extract, quercetin, quercetin and cinanserin on murine coronavirus and dengue virus infection. Asian Pac J Trop Med. 2016;9(1):1–7. doi:10.1016/j.apjtm.2015.12.002 https://pubmed.ncbi.nlm.nih.gov/26851778/

 

Cytokine Reducing Supplements

Read my article on Cytokines and see it's references: Cytokines: A Guide to Fix Lyme Symptoms & The Immune System

Hydroxychloroquine and Zithromax

  1. Franck Touret, Xavier de Lamballerie. Of chloroquine and COVID-19. Antiviral Research, Volume 177, 2020, 104762. https://doi.org/10.1016/j.antiviral.2020.104762.
  2. Breaking Results: Sermo’s COVID-19 Real Time Barometer Study. International survey of doctors who are treating COVID-19 https://public-cdn.sermo.com/covid19/c8/be4e/4edbd4/dbd4ba4ac5a3b3d9a479f99cc5/wave-i-sermo-covid-19-global-analysis-final.pdf
  3. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial [published online ahead of print, 2020 Mar 20]. Int J Antimicrob Agents. 2020;105949. doi:10.1016/j.ijantimicag.2020.105949 https://pubmed.ncbi.nlm.nih.gov/32205204/
  4. Zhaowei Chen, Jijia Hu, Zongwei Zhang, Shan Jiang, Shoumeng Han, Dandan Yan, Ruhong Zhuang, Ben Hu, Zhan Zhang. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv 2020.03.22.20040758; 
    doi: https://doi.org/10.1101/2020.03.22.20040758

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About the Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State where he has treated thousands of Lyme disease patients in his Seattle practice. 

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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