Coronavirus (Covid-19) & Lyme

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Updated: 12/18/20

I significantly updated this article on 12/18/20. It includes new information supporting the use of the prescription ivermectin to prevent and treat Covid-19. I no longer recommend hydroxychloroquine due to the political controversies and mixed science regarding its benefit.

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 world of stay-at-home orders and Zoom happy hours.

For information about the Covid-19 vaccine see Should You Get It? The Covid (Coronavirus) Vaccine & Lyme Disease.

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. According to Worldometer the current death rate in the United States is 3 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.

What About The Person with Lyme & Covid-19

Most with Lyme do 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 at 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.

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."

Studies show the germ spreads when there is prolonged exposure of 15 minutes or more to someone or persons who have Covid-19. Because of this, doing activities in crowded indoor spaces like restaurants, bars, sporting events, and exercise facilities is not a good idea. There is only a small chance of getting it when a person wears a mask and only briefly interacts with someone who has the virus. Thus activities like grocery shopping carry limited to small risks if a person wears a mask.

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 Mask

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.

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.

Blood Clotting

Covid also appears to increase blood clotting. This can cause organ injury. In the hospital setting, the blood thinners like heparin are helpful. For mild to moderate cases of Covid 19, it is possible taking a baby aspirin a day could prevent blood clotting from developing.

Stop Virus Replication and Infectivity

If you get infected with Coronavirus, stopping virus replication or decreasing infectivity may help decrease the severity of the illness or even prevent death.

Decrease Viral Replication

Zinc blocks the enzyme that controls virus replication inside infected cells. Zinc gets into cells using ionophores. An zinc ionophore that is shown to help in laboratory studies is the supplement quercetin I mentioned earlier in the section on Cytokine Storm. 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.

Decrease Viral Infectivity

There is some limited scientific research showing that ivermectin, a drug approved to treat parasites, can limit the infectivity of Covid-19. It can block an enzyme that is responsible for Covid-19 getting into the center of cells to replicate. Studies show it can decrease the severity of the infection and decrease the number of days the PCR nose swab testing remains positive. It also decreases the death rate. There is one study showing it can prevent family members from getting Covid-19. In the study, family members receiving ivermectin got Covid-19 about 7 percent of the time while those not taking it got Covid-19 58 percent of the time.

While I support using Ivermectin as part of a treatment or even post-exposure prevention strategy, I have to admit the quality of this science is extremely poor. The treatment trials to date are not the gold-standard randomized controlled studies. They are observational studies which are subject to all kinds of bias. In addition, many of the studies are not peer reviewed.

My Recommendations

My recommendations below are for people who do not require hospitalization.

Before You Get Infected

1. Prevent contact with the Covid-19 infection.

See “Prevent Covid-19 Infection” section above. Wear a homemade face mask in public and do not gather for 15 minutes or more in settings like bars, restaurants, gyms, and packed sporting events.

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 Replication 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 Picolinate 60 mg a day

If You Are Exposed to Covid 19

1. Limit Virus Infectivity/Replication and Decrease Cytokines*

  • Ivermectin 150 to 200 ug/kg 1 time and repeat 1 time in 3 days
  • Zinc Picolinate 60 mg a day
  • Quercetin 250-300 mg 2 pills 3 times a day

2. Prevent Cytokine Storm*

  • Curcumin 500 mg 1 pill 3 times a day
  • Liposomal glutathione 500 mg 1 time a day

3. Support the Immune System*

  • 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.

IF You Test Positive or Have a Clinical Diagnosis of Covid-19

1. Limit Virus Infectivity/Replication and Decrease Cytokines*

  • Ivermectin 150 to 200 ug/kg 1 time and repeat 1 time in 3 days
  • Zinc Picolinate 60 mg a day
  • Quercetin 250-300 mg 2 pills 3 times a day

2. Prevent Cytokine Storm*

  • Curcumin 500 mg 1 pill 3 times a day
  • Liposomal glutathione 500 mg 1 time a day

3. Support the Immune System*

  • 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.

4. Prevent Blood Clots

  • Baby Aspirin 1 time a day

5. Breathing Problems

If you have breathing problems consider a steroid inhaler and the addition of Doxycycline 100 mg 2 times a day or Azithromycin 500 mg 1 time a day. The antibiotics can treat secondary bacterial infections.

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.

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

 

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

Ivermectin

Padhy BM, Mohanty RR, Das S, Meher BR. Therapeutic potential of ivermectin as add on treatment in COVID 19: A systematic review and meta-analysis. J Pharm Pharm Sci. 2020;23:462-469. doi:10.18433/jpps31457 (View

Prophylactic Ivermectin in COVID-19 Contacts. (clinicaltrials.gov)

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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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