In two short days we have gone from no cases at either of the hospitals we work at, to many cases and now deaths. We now have healthcare workers sick as well. NO ONE is immune from this novel virus. More importantly, despite popular belief, the old and the sick are NOT the only ones getting really sick. There are many relatively healthy people that have been succumbing to this horrible disease. I want to make sure everyone understands that the information below WILL NOT prevent you from getting the virus (NOTHING WILL, except for isolation) but there is hope that we can control how our immune system responds to it and how the disease progresses.

Covid-19 is a respiratory virus, from the same family as the viruses that cause common colds. What makes Covid-19 so severe is the pulmonary damage that it causes, something called Acute Respiratory Distress Syndrome (ARDS). So the big question is why do some people end up with ARDS and some people have minor symptoms? We don't know but experiences and evidence coming from China and Italy are starting to shed light onto this issue.

There seems to be a high co-infection rate with this virus. Just like influenza where bad outcomes happen when people get secondary infections such as pneumonia, this virus seems to be behaving in a similar fashion. Seemingly the people that go on to develop these coinfections are the ones that progress to a clinically severe case and ARDS. As a side note, ARDS is where your immune system goes haywire (like goes into overdrive) and causes a whole bunch of bad things to happen to your airways (you may have heard the term "cytokine storm" being used in the media). This is where the argument about elderberry is coming in and I will touch on that later. So we have known for a while that these people have a high rate of coinfection but didn't know what? Is it another virus: influenza? RSV? or is it bacterial pneumonia on top of the Covid-19?

This is where some light is being shed on now. There is evidence now that the secondary pneumonia is caused by bacteria from the Prevotella genus. This is an opportunistic bacteria that normally lives in our mouths and is kept in check by the good bacteria of the oral microbiome and our healthy immune systems. This bacteria is responsible for periodontal disease; also when chronically overgrown it colonizes the respiratory tract and causes pneumonias (this is the mechanism of disease in cystic fibrosis - their clinical picture is very similar to what Covid patients are presenting as) . Covid-19 is lowering the function of our immune systems and this opportunistic pathogen takes advantage and goes to war. This may be the reason azithromycin (z-pack) is showing some benefit in treating these patients.


Working with the hypothesis that it's the combination of Prevotella and Covid that creates the deadly combination, the natural question is how do we control Prevotella? There are two groups we can look at: compounds that naturally have anti-prevotella properties and oral hygiene to improve oral microbiome.

1) Compounds that have anti-prevotella activity: Ginger, citrus peel, rosemary, peppermint, clove, pomegranate, paprika, cayenne, onions, blueberries, cranberries, kale, and elderberries(rich in quercetin - it chelates iron - which bacteria need to survive), green tea(contains compounds called catechins which have both antiviral and antibacterial properties; but also enhances the function of azithromycin).

2) oral hygiene - green tea (prebiotics for healthy microbiome), tongue scraping, brushing teeth, mouth washing, increasing stomach acid

Everyone has now heard that anti-malarial drugs are being used in Covid-19 patients but we are not sure what the mechanism of action is. Well hydroxychloroquine and chloroquine are both zinc ionophores which means it helps to pull zinc inside the cell where it acts to halt viral replication. Zinc floating around in our vascular system is not doing us any good, it needs to be taken up by the cell to exhibit its activity. Interestingly enough both quercetin and catechins (compounds I mentioned above; that the above foods are rich in) are zinc ionophores!! Quercetin is about to be used in a clinical trial for Covid, but has already been shown to be successful in Zika and Ebola.

Take aways:

- increase your foods that have anti-microbial (specifically anti-prevotella) properties - LOTS OF ONIONS, they have the highest concentration of quercetin

-DRINK GREEN TEA - you already know I love green tea for many of its other amazing health benefits, this just gives me more reason to drink it

-brush your teeth several times per day - use a toothpaste with peppermint and/or cloves

-rinse your mouth - preferably with something better than Listerine. this is a good brand

-if you are on a PPI (nexium, protonix, prevacid, etc), try getting off it, or slowly weaning the dose. This is a much bigger topic and plays into the health of microbiome and how important it is to keep a lower stomach pH. But for now it is enough to say that bad bugs die in the super acidic environment of the stomach. If you let the pH increase, more bad bacteria will survive and propagate; offsetting the delicate balance of your oral and gut microbiome

-eat less refined sugar and refined carbohydrates: this is what bad bugs love to eat

It seems to be more and more true that all disease begins in the GUT!

Now onto elderberry, since everyone is asking about it. There is some concern about elderberry being implicated in causing a more severe cytokine storm and hence more severe ARDS. The way I see the disease now is almost in two parts. You need a robust immune response in the beginning of the infection to control the spread of the virus; but you also can't have your immune system go into overdrive once you are sick in order to avoid the dreaded ARDS. Elderberry has known antiviral activity and is known to be beneficial in other viral infections. There is no data implicating elderberry in producing a more severe cytokine storm. Due to this and its known efficacy in influenza and other viral infections, I continue to support the use of elderberry.