Thoughts on Epidemics from a Clinical Physician written February 2, 2020
COVID-19 in February 2020 by Paul Herscu ND, MPH
First Things First. The Immune System with Relation to the 2019 Novel Coronavirus (2019-nCoV)
Over this period of days, we have seen more and more articles from medical journals moving in the direction previously highlighted. Both focusing on your immune system, and highlighting that people who had worse outcomes were people who already had a disease burden that made them susceptible. This will remain true. Supporting your immune system to be the most efficient and effective it can be remains important and is a place where you and your patients have some control. Today! Read what Dr. Rothenberg and I mentioned here last time.
2019 Novel Coronavirus (2019-nCoV):
Comments I shared here last week remain true and are seen in the writings coming from across the globe. I want to focus on why this is of outmost importance to you!
While the current official numbers of infected are around 14,000, other medical journals are estimating the numbers to be closer to 75,000. This would be in keeping with the numbers I mentioned last week of 40,000-50,000 as the true numbers last week. And at this time the official death toll is around 300 people, with the first person to die outside of China. I mentioned that the mortality rate and disease burden outside China is the one that really matters to science, and to us. Here’s why:
First the numbers. Every year, regardless of the epidemic in question the numbers reported out of China are a fraction of those seen in the rest of the world. This is known. And really, a great deal of work is being done to help the current situation. For example, China has, give or take, 1.3 Billion people. The USA has 350 million. The USA vaccinates a high percent of the population for influenza. China hardly vaccinates. Nevertheless, the annual dead toll of influenza in the USA is around 20,000-60,000, depending on how you count it with let’s say 50,000 on average. And in China where the toll should be at the very least 4 times greater, the official numbers are always extremely low. China reports only death caused directly by influenza whereas the USA reports not just those numbers but also those who succumb in the aftermath of the influenza. For example, if you develop pneumonia afterwards and succumb to it, it is reported as part of the flu related death in the USA but not in China. But aside from this reporting difference, getting the real numbers is always tricky. Both for science, but this time also because of politics, which I am not commenting on. The point being, knowing the real number of infected is important for modeling how average or how highly infectious this epidemic is. Because we do not have this number from inside China, we can make better predictions from those infected outside China.
The related second point is trying to understand what percent of those infected have to be hospitalized for a severe form of the infection and what percent die from the infection. Again, while we know the death number is around 300, we do not really know the full extent inside China. If it is true that the official infected numbers are 14,000 and 300 died, that would be a lethal rate of 2.1%, and if this were true we are in for a horrible period of time. However, if the 300 that died are out of 75,000-100,000 people, then the mortality rate would only be 0.3%. A bad number for sure, but MUCH less severe than any horrific epidemic. Also, the official Chinese estimate that 20% of those infected develop a horrible form of the disease, and if that were true, we are also in it for a very bad period of time. But again, the numbers do not add up for me. Regardless, we are starting to get a pretty good idea of the reality of it. And while no one is saying it yet, I would like to share some thoughts and numbers.
My first problem with the official numbers is this. We have around 200 people outside China who are confirmed with this strain of the coronavirus. Problem #1. One person has died from all these folks, which would place the mortality rate near 0.5%, much less than the 2% estimated. Second, it seems as though mostly, these folks have not easily passed the germ to many other people, which would be a good sign in terms of what the actual Ro number is now.
The related number, which is a VERY important number, though it has not been shared with us yet, is what percent of those infected, outside of China, actually developed a serious form of the disease. Again, the official numbers were 20% inside China, but in fact, I have not heard of any numbers disclosed by any country outside of China as to how severely ill attended patients are. I hope enough pressure is brought on officials to release this number as it will help for public health preparedness and government response.
As I mentioned last week, personally, I believe that these numbers will be much lower than currently thought.
Until we have accurate numbers, prudence is in order, but not panic. Take care of your overall health, practice good public health measures, and let’s see how this develops.
The Physical Crisis:
Regarding the actual disease, when it shows itself in a severe form we see:
A. the direct damage of the virus upon the organs, such as the lungs
B. the cytokine storm that threatens the life of the patient
C. the after-effect of the cytokine damage, which is potentially the most dangerous
A. It seems as though there are reports that some specific antivirals are working well enough for the situation at hand. Not perfect, but perhaps well enough. Recall the natural antivirals, too.
B. With regard to limiting the cytokine storm, I think looking a specific removal of these immune components, by adapting the sort of technology that Cytosorbentsuses is not out of reach.
C. Here, I still believe both checking the level of serum C1-INH in the most ill patients and then giving those with a relative deficiency of plasma C1INH more C1-INHis a workable, affordable, targeted solution. I hope they will soon start to measure C1-INH in severely ill patients, using it as a sort of biomarker for treatment and prognosis.
The role of those practicing in naturopathic, homeopathic, and integrative medicine settings in general and during the time of 2019 Novel Coronavirus (2019-nCoV), February 2, 2020:
The main point I made earlier is still relevant: understand that during this or any epidemic, sound logic should rule the day. Testing any number of interventions (pharmaceutical, botanical, homeopathic, etc.,) that might help should lead to a workable solution. This at least is how most of science works, when one is at the academic/regulatory level. However, at the public perception level, it does not always play out so well. Often, when someone suggests a solution that may exist in the integrative medical world, it is ridiculed, at least until there are so many people using such approaches that ridicule stops. We saw this with acupuncture in the past generation. During this generation we have seen the same with prolotherapy/stem cell work, moving from ridicule to standard of care. Sadly, there is time delay here and in that time delay, missed opportunities abound.
An example of this was seen last week when a section of the Indian government said that since, at this time, there does not seem to be good treatment or prevention method available, they would like to utilize homeopathic/herbal/naturopathic prevention options that are generally recognized as safe and have a track record of human use for hundreds of years. But by the next day, the media backlash brought upon the government was relentless which made them walk back their recommendation. What is especially sad here is that much of the negative criticism came from people who did not even read the recommendations, as their comments missed the recommendation completely. This type of overt bias has no place in science.
What news sources reported was that the Indian government was suggesting that you don’t have to take basic precautions but rather only use homeopathy. In fact, this was not at all the case, as you can see from their official proclamation. They suggested what every government, NGO, and WHO, and CDC suggested. But along with that, for prevention they added other interventions that might or might not help, just like adding any drug to be tested at this time.
I would like to juxtapose this with the most common recommendation being to wear a mask, as can be seen by so many photographs of China and really around the world.
In most instances these masks are at best useless. The virus passes through these easily enough and would not prevent transmission of this virus. Ironically, these kinds of masks present several real problems. They trap germs inside the mask, and unless you continually change them daily, you might become sick from wearing them rather than preventing illness. But for me, the biggest threat to people using masks is false security. And in so doing, they are not practicing all the other things that could really help, the basic public health measures that are in your control. I cannot think of a better way to exemplify this than by the two articles I just referred to. In the one critical of the Indian government, the authors refer to these most agreed upon WHO recommendations as the “usual hygienic niceties” thereby diminishing their strengths. Whereas, in the Indian government proclamation they place public health measures at the top of the list, where they belong.
As important, the Indian government attempted what the other governments did not, when tackling the tricky question of the face masks. While the regular face masks that are sold do not really work, the R95 masks do, which they highlighted. Of course, with this mask, the main problems with them is wearing them improperly and not changing them regularly.
The role of those practicing homeopathic in general and during the time of 2019 Novel Coronavirus (2019-nCoV) in February 2, 2020:
I want to start by saying that the comments I made last week are still the most important ones for us. Good public health measures that you can take will slow down and eventually stop this epidemic. They will help to keep you safe. Every organization has the same comments. Keep to them, and share them with your patients. They are important to you and to your family. But onward now.
I have to say that it is unlikely that there is any homeopath who has treated any patient with 2019-nCoV at this time. That said, using the comments I made last week, as well as the ones I made discussing past epidemics, we have to segregate those exposed into at least 4 groups: a. Those exposed and not developing symptoms or having subclinical manifestations, b. those that develop a life-threatening or life-altering manifestation, c. those who present with a worsening of their chronic symptoms and lastly, d. those that develop an acute manifestation. A lengthy discussion on this topic can be found on this website in prior writing, as well as in Herscu Letters #33-38.
The reason I want to start with this, as I had in the prior epidemics, is that for the most part, most of what I have heard from the homeopathic community is preparation for the horrific presentations, whereas MOST of the people who contract 2019-nCoV, will not develop such symptom pictures at all. If you are using homeopathy, most of the people you will encounter will need their constitutional remedy. As I wrote about this last month before the 2019-nCoV became an issue, the main remedies at that time were Gelsemium, Merc, Eup-per, and bit of Nux-v, and Bryonia. At this time, Gelsemium is still being used, but so is Bry, Bell, but most especially, a person’s chronic remedy. Many patients that you will see, will fit one of these remedies at this time. PLEASE KEEP IN MIND, this is not specific to 2019-nCoV, but rather to the URIs that are occurring across the USA at the time of this writing.
The Whole Epidemic:
Epidemiologists say, and it seems true to me over these past 30 years, that every epidemic is unique. One aspect often overlooked is one that a classical homeopath should consider. We look at the whole individual – mentally, emotionally, and physically. That said, during an epidemic, I find that many people abandon that philosophical foundation. They stop thinking critically, and like many others, react to news of the epidemic is a way that is emblematic of the remedy state! By which I mean when looking at the whole population, we can see, at this time, an extreme panic, and also, sadly, a sort of hysterical xenophobia against people from China. I might blame it on this or that reason. For example, I can blame it on the ignorance of most of evolutionary biology, population density, etc., but the bottom line is that it is occurring at this time. And for the classical homeopath, one should consider this fear and xenophobia as part of the case, when looking for a genus epidemicus. I wrote a great deal on this topic during the Anthrax scare, which you can read on this site in the 2001 writings on Anthrax. Don’t simply try to explain it away but be observant of this reaction. When and if we have the opportunity to use homeopathic remedies with people who have this virus, this feature may well play into our remedy choices.
The bottom line as of now, is do the hygienic measures that are within your control. Wait until we get the number outside of China to see how problematic this epidemic will be, and take appropriate action. I believe these lethal percentages will begin to diminish in this first wave.
In health,
Paul Herscu ND, MPH