COVID Q&A With Dr. B – Round 2

(Audio transcript below)

All content from the conversations in this podcast are created and published for informational purposes only. This is not intended to be a substitute for professional medical advice and should not be relied on for personal medical decisions. Always seek the guidance of your doctor with any questions you have regarding a medical condition.

Hey, this Dr. Biddle. It’s the 7th of May, 2020 and we’re continuing our series of talks on COVID and taking questions from listeners. Our outreach coordinator, Robyn Paulete is here to help me out today.

>> Hi, Dr. Biddle, hello everyone!

So, you have a list of questions that people have sent in that they’re curious about. But before we begin, I wanted address that we had kind of a sudden ending to our last talk and I want to add on to our talk about the major, most important supplements to take. We talked about vitamin C and magnesium and vitamin D, but didn’t get to zinc and NAC.

Zinc is one of the most important supplements to take. First of all, it’s dirt cheap, so that helps. It should be taken in a form that’s bound to an amino acid like zinc picolinate or zinc methianine. There’s lots of easy forms, but you don’t want to zinc sulfate cause it doesn’t absorb very well.

Zinc can be really hard on the stomach, so you always want to take it with food. But even with that, you want to watch out, cause some people don’t tolerate it very well. The usual dosage is 30 to 50 milligrams once a day with food for prevention. But if you get sick, you increase that to four times a day. And zinc is important because it’s the way the hydroxy-chloric acid works…like the hydroxy-chloroquine, which is that medication that’s used for malaria. It’s called a zinc ionophore, and it helps zinc get transported into our cells and that then helps kick the virus off of our hemoglobin. So it stops dissociating the iron from the hemoglobin, which is how the virus is causing the low blood oxygen. So zinc, zinc is a biggie!

>>  It does sound like a biggie! Perhaps even bigger than others. You’ve mentioned vitamin C or magnesium as really important before.

Yeah, if I had to pick the top two, I’d probably say vitamin D and zinc. I mean, I love vitamin C, magnesium, all these are important. But I think if I was forced to pick the top two, vitamin D and zinc would be the top two. And then my next one would be NAC. It stands for N-acetylcysteine. It’s an amino acid. And I know it all the way back from medical school. It was used to thin mucus, it was called Mucomyst. In your sinuses, in your lungs, it makes you mucus easier to get up and out. As an ER doctor, we use it to save people’s lives from Tylenol overdose. When you take too much Tylenol, it depletes the glutathione in your liver.  And then about a week later you die a horrible death from liver failure. But after we pump your stomach, we stick NAC down there, it regenerates glutathione and detoxifies the Tylenol. So it’s an amino acid. And glutathione is our final common pathway of detox. So the usual dosage of that is 500 to 600 milligrams once or twice a day for prevention. And then for treatment, that would go to four times a day, also with food. Most amino acids can be taken on an empty stomach, but NAC is kind of rough on the stomach. So better with food.

>>    Okay. Am I understanding correctly that the NAC is helping the liver flush the body of unwanted things?

Well, yeah, it helps the liver to detoxify things all the way from mercury & petrochemicals to Tylenol and things like that. But I think the way it really helps in the COVID-19 virus is thinning the secretions and helping to make the lining of the lungs, called surfactant. Surfactant is what premature babies don’t have enough of yet. When they have trouble breathing, surfactant is the  soapy-like lining that helps form a bubble of a thin film of liquid on the inside of our lung sacks called alveoli. And people who have a deep defects in a surfactant get premature emphysema even without being smokers. So yeah, so it’s affecting the lung function and it helps save them from being damaged.

>>    Okay. And the NAC is helping to produce more? 

I believe so. Yeah. One of the cool things in natural medicine is how one thing can affect so many other things. So the NAC is thinning our mucus, it’s helping make surfactant, it’s supporting glutathione and helping us detoxify. All of that for a simple amino acid.

Alright,  well, what are some of those questions, Robyn?

  >>    Yes. We’ve had some listener questions that have come in over the last two weeks. The first one is about a physicians statement, which I have not heard, personally. I’m not sure if you have either… It says there is a physician statement from Brooklyn that says the COVID-19 symptoms that they’re seeing resemble things they see in high altitude sickness and they’re wondering if the medicines that they use for high altitude sickness could be helpful for COVID treatment?

Uh, kind of. So the reason COVID looks like high altitude sickness is, as I understand it currently, (and this is a rapidly evolving and I try to spend about an hour a day keeping up on both the conventional literature that’s being published as well as the alternative thought leaders this, and you know, they’re often at odds, so it’s some psychic tension to integrate all that) But the way this virus seems to cause its damages by knocking iron off of our hemoglobin, which is the molecule that makes our blood red and carries our oxygen and it runs on iron.

And then if you knock the iron off you can’t carry any oxygen. And so you get oxygen desaturation long before you have any lung damage. And in fact that free iron is a horrible inflammatory. That’s part of what causes that cytokine storm in the lung that causes the lung damage.  And so with that lung damage, the ventilators don’t really work. And in fact, putting people on ventilators may actually increase their risk of dying, which is already extraordinarily high when you’re at that point. But doctors are seeing people show up at the hospital who are not really having difficulty breathing. And in medicine we call that dyspnea. So they’re not really having dyspnea. They look not too bad, but you check their oxygen and they’re already down at like 80% oxygen saturation because of this desaturation, of the hemoglobin and the dissociation of the iron from it. Meanwhile, the free iron is, is ravaging their body…increasing this cytokine storm. And one of the strongest predictors of a bad outcome is having high iron levels, which is why three weeks ago I went to the red cross and donated blood to lower my iron level.

And I do recommend anybody who can go donate blood to do that now. If you’re a woman who’s menstruating, you might not have any spare iron to give though. But it’s interesting to note that the death rate is about two to one, men to women. And this is probably the reason why…women are protected because they have lower iron from menstruating every month.

So the treatment really is high dose oxygen. And just yesterday I saw some preliminary studies that a couple places are starting to experiment with hyperbaric oxygen therapy, which is the thing therapy that makes the most sense to me. Putting you in a chamber that increases the pressure to push oxygen into your bloodstream so it can be delivered even without your hemoglobin needing to carry it is smart.

It creates bubbles in there because of the pressure. And so pressure dissolves gas into liquid and we can dissolve oxygen into our bloodstream by being under pressure. And that’s how the hyperbaric oxygen tanks work. And that’s why it’s used for altitude sickness. It’s used to treat the bends….people who are coming up from deep sea diving too quickly. And we use it for brain injuries….we use it for chronic infections like Lyme disease…..we use it for surgery recovery. And it makes complete sense in the COVID situation cause you can deliver more oxygen into the blood.

The problem in therapies we’re seeing is not with the ventilators, they’re just increasing the pressure of delivering the air to the lungs. And that just causes more damage to the lungs. In this situation it doesn’t seem to be really be working. Now the other thing that they use for altitude sickness is certain specific diuretics. I haven’t had time to think through that all the way and I’ll certainly ponder it more, but I would not be thinking that would be an appropriate response.

>> A diuretic is when we’re wanting to lose water from the body, right?

Yeah, exactly. Fluids. But these diurestics are not just affecting the fluids,  they change your metabolites too. Like some of them help you pee off more sodium or potassium. And the specific ones used for an altitude sickness…that’s supposedly how they’re working. But I don’t think that would be the issue here.

>>    Interesting. But the hyperbaric, the pressurized oxygen, the more oxygenated blood, it seems like that’s going to be really helpful?

Yeah, really helpful. Now the problem with hyperbaric oxygen is it’s not widely available. If you’re one of the rare people who has a chamber at home, great. We have chambers in our clinic…in fact we have three chambers. One stays here and two we let people take home. But you know, we can’t just be having people come in who are infected with COVID-19 cause then we’ll all get exposed and we would have to close the clinic for three weeks and completely shut-down. Even right now we’re not bringing people in to the office. Everything is telemedicine until June. Right.

So, hyperbarics are a hard therapy to come by. And you know, hospitals do have these chambers but for some reason they’re very, very strict about who they let use them. There’s 13 Medicare approved diagnoses, like non-healing diabetic wounds and gangreen. And that’s all you can use them for in the hospital. And even if you walk in with a wheelbarrow full of cash and asked to use their chamber, they won’t let you.

>>    Haha, oh my goodness. The wheelbarrow full of cash just doesn’t work in that situation?

Well, I don’t might…now that our local hospital is privately owned, I’m sure it would.

>>. Okay. So if somebody can come by a hyperbaric oxygen tank, that’s great. Is it possible if they can  show up with a negative test and use one? I know testing has been hard to come by…

Yeah, testing is more available now actually. I’ve been surprised at kind of how expensive it’s ended up being though! And of course there’s two types of testing. There’s the DNA test, which is called a PCR polymerase chain reaction. That’s the nasal swab to see if you currently have it. And then there’s the blood antibody tests, which we’re looking at getting within the next couple of weeks…and that shows if you have had it. And there’s currently over 90 tests that have been rushed to the market before the FDA.  I just read an article this morning, it’s like the wild wild West of testing out there and there’s very few restrictions except within 10 days.

The companies after releasing and starting the testing, the companies have to send data to the FDA to show how good it is. But UC Berkeley tested 16 different antibody tests and only three of them passed muster. Wow. Which means that the false positives and the false negatives were low enough because if you have a test with 14% false positive rate or false negative rate, that doesn’t do you much good, you’ve got to get that down to like 1% or 2% false results.

>> Some of those tests are going to be more available in the next few weeks?

I sure hope so. We’re looking at getting our hands on one from the Netherlands that looks like we might be able to offer it for like $20 as a finger prick.

>>. Like checking the blood sugar for a diabetic?

Yeah, exactly. And it’s an in-office test, so we get results in 15 minutes after just a fingerprick type of thing. And I haven’t seen the specificity and sensitivity results on that yet, but that, type of stuff looks promising. Otherwise the other labs offering tests locally are going to be at least $200 – $250 for the antibody tests for the pricing I’ve seen so far.

>>    And is that something insurance is not covering for most people? 

I don’t know. I don’t have the slightest idea. I know we don’t bill insurance, so you know, if we’re doing it, it’s a cash transaction. We can write a prescription, and people can go to the lab and then it’d be billed to their insurance and I think they’re supposed to be covering it. But that’s, you know, that’s politics, not medicine.

>>    That’s right. So we move on to another question. What do you think are the realistic chances of getting widespread herd immunity before the next year or two? 

Well, it all depends on how many people get sick. They way to get herd immunity is either to have vaccines, which there’s never been a successful vaccine for a Corona virus because they mutate too quickly and they change around, so I’m not real optimistic. If there’s going to be a successful vaccine that’s going to be long lasting, and even if it is, then you know how the flu changes every year so that the vaccine they came out with doesn’t work well….”oops, it was only 13% effective this last year”. So that could be the same issue with this. With herd immunity….the other way to get it is for everybody to get sick and then gets antibodies. And of course, you know, then you can’t use herd immunity for prevention. By definition it’s just the the late stage result of an uncontrolled pandemic where everybody got it.

And if everybody gets it, that means 1% to 2% are going to die from it. So out of, you know, 400 million Americans that’s gonna be a 8 million deaths….4 to 8 million deaths. If you know, you want to read, that’s the price of herd immunity.So when people start promoting herd immunity, I’m like, okay, we’re going to line up 50 of your friends and family and I want you to walk up, looks at them in the eye and tell them that you’re the one…they’re the one that you picked to sacrifice for the cause that they need to die now. So that you know, you can open up the economy again.

>>    That definitely makes it more real at home!

Yeah. And I want you to make sure you’re looking at them in the eye when you tell them that.

>>    Well, that’s a good segway into another question that we have about this inevitable reopening, which for North Carolina’s starts, at least its first phase, by 5PM tomorrow….so someone asks, with the inevitable reopening, how can we best step into that with minimal losses of life? 

Yeah, that’s the great question. And I’m in favor of life continuing! I think we’re gonna definitely have new normals. I think we’re going to be learning more and more about this, we’re going to be learning about…do masks really help? and if so, what kind of masks and does it matter if you’re inside or outside, and how far do you actually have to stay away from people and do gloves really do any good. Obviously things are gonna change. We’re all gonna not shake hands and we’re gonna give more space and we’re going to be washing our hands compulsively with soap and water…. Which by the way, the soap and water actually works better than the alcohol because the soap disrupts the fatty lipid membrane. This protecting the RNA of the virus. So if you have a choice between washing your hands or putting that 70% alcohol in your hands, you take the soap and water, it actually is better. Alcohol is a second choice.

>> Hmm. That’s good to know because the things I’ve read about the requirements for businesses that are reopening is that they have hand sanitizer available for everyone, and I guess it would be hard to make it soap and water available without touching everything first.

Yeah. You kind of need a sink for soap and water. The hand sanitizer is definitely more available. You can do it more often and more places. You know, when I’m going someplace and I get back into my car, I don’t have a sink and soap right there, so I have a bottle of hand sanitizer!

>>    So the alcohol still works. It’s just not as effective. Is that accurate?

Exactly. Yeah. So I mean, I don’t have any special crystal ball to know how this is going to go. I do believe we should all take caution. I personally feel very cautious because my four year old has asthma and I saw one study that having asthma does not seem to mean an increased risk of dying from this, which is a little bit backwards from all the other infections…so I’ll be looking forward for more data coming in, but we’re certainly leery. But at the same time we’re far enough into this now where the first three weeks were kind of exciting and novel and you get to do some yard work and stay home, but now we worry about, okay, kids social, mental, emotional development being isolated and you know, parents and increasing rates of domestic abuse and suicides and this and that. You know, some of that’s offset by fewer traffic fatalities. I hear car insurance companies are sending 20% refunds.

>>  Yeah, I got one!

There you go! Everything has to change at some point and what change that will be, we’re slowly stepping into. So we’re all gonna learn this together.

>>  And for you, since you are you are concerned about your young child with potentially a high risk issue, what kind of social distancing practices do you and your family employ?

Well, right now we’re in the house and we don’t have any social distancing in the house, but it’s what we’re all doing outside the house….and what you really have to do is choose who you’re going to be exposed to. Like, I’m sure you don’t social distance from your two daughters.

>> No, certainly not.

Right, and probably not from your boyfriend?

>> Nope.

And then you have to get it into, well then, you know, is he hanging out with his kids and who are they hanging out with? And…..

>>  Yes, the degrees of separation multiply really quickly. We have learned that as we mapped out that circle of exposure for our families.

Right. So for the first couple of weeks, my daughter had her best friend, her one playmate and they were playing with each other. But then each of that girls parents then had a girlfriend or boyfriend and then some of them had kids…and all of a sudden we realized that they couldn’t be playmates anymore during this. Now they have time together on FaceTime or something like that a couple times a week.

We’re going to be opening up the clinic this week. We’re bringing workers together for the first time and we’re trying to wear masks and keep distance and ozonate charts between handling them ,and things like that. And then after June 1st we’re going to bring patients back in and do a lot of the same things, and we’ll see how it goes. I think we’re going to learn a lot from the early stages of reopening, three states of which are on our borders, right? Georgia, Tennessee and South Carolina, and the next month will be very telling. Two or three weeks after that then you see if there’s a big spike.

>>   Do you think it’s the right time to end the strict quarantine? 

I don’t know. Again, this is almost more politics than medicine, you know, cause you’re balancing it with a lot of other things. Like how many deaths do you have from not only the suicides but down the road from people being unemployed, losing their health insurance, not having adequate food, stress, all these things. Poverty itself has a toll. There’s many things to balance there.  I’m personally in favor of very cautious re-openings

>> There’s there’s really no easy answer. 

There’s certainly no easy answer. No.

>>  I have a friend and actually this next question comes from her.  She has a mother who is quite severely immune-compromised. She’s elderly, she’s in her seventies. She recovered from breast cancer almost two years ago and so she’s taking hormone replacement therapy and she’s a type 1 diabetic.  They all have been completely quarantined both of her parents and now she wants to help her elderly and parents and make sure they’re spending time together. She’s wondering when can she safely go from her house to their house to visit and help them?

Right. Well, safe is all a matter of degree, isn’t it? I mean, life isn’t safe. I get in my car and drive home. Driving a car is not a very safe thing to do. It’s more dangerous than flying in an airplane statistically. So it depends on how good you’ve been quarantined yourself and how good your sterilization procedures are when you do have to go out.

But then when she does see them she can wash hands right when she gets there and wear a mask and it seems like that would be relatively low, but nobody really knows that. One of the factors is a factor loosely called the degree of infectivity. And so for example one is, for every person who has it, one other person gets it. Things like measles and mumps have factors of like 13 to 18, meaning one person’s going to infect 18 people in the course of their illness. And so those things spread really quickly. And they hang around a long time on surfaces and such. And this changes with social distancing. So you know, in places that didn’t do social distancing, the factors were up around like eight or nine and then the goal is to get them down to 0.6 and that’s when they’re thought to getting it controlled and the numbers will be declining when it is less than one.

>>    It’s been a while since I’ve read about the length of time they believed that virus does stick around on surfaces. Have you heard anything about that more recently?

Well it’s hard to know because the test you test is the planaria chain reaction. And just because you can find the RNA there, it doesn’t mean that the RNA is capable of infecting somebody cause it may have lost its lipid shield. And if it doesn’t have as lipid coat, then it’s no longer infective. So that’s the problem, they go into this cruise ship three weeks later and they find they can swab this and find the RNA. But that doesn’t mean that that is actually an infective, you know, have they able to culture the things they’ve found from those surfaces? That would be the way to prove that it’s still infective. So right now the understanding is, from the time you were exposed there’s no danger to anybody for at least three and up to five days for three to five days before you start shedding the virus.

So you’re infected, but you’re not shedding virus yet for the first three to five days. And then it’s going to be another three to five days before you actually get symptoms. So now you’re walking around shedding virus, but you have no symptoms and you may never get symptoms. You may go through the whole thing and recover and never know you had it or your symptoms may be so mild so it’s anywhere from about six to 10 days after you’re exposed and infected that now you’re getting the symptoms, and from the time you get your symptoms, it’s thought that you’re infective for another two weeks. So from the date of your first symptom, two weeks is probably safe. Three weeks is really safe…then you could probably go out again. But the one caveat to that is they’re worried that intestinal shedding may be longer.

They’re finding the virus come out in stool samples maybe longer. This part has to do with the fact that there’s different ways to catch it. And it seems like where you’re first exposed has some forbearing on what your symptoms are going to be and how severe they are. So if you get a lot of exposure, like you’re in a place and you’re surrounded by four different people who have it and you get exposed to a whole bunch of stuff, you’re gonna end up sicker. If you just get a little tiny exposure, then you might be better. If it gets in your nose, in your lungs, then you’re going to have those symptoms. That’s where it’s going to show up. If it gets in your eyes, you might have those symptoms, if you swallow it….like, if you order food from a restaurant does the person fixing the food have it? If they’re coughing all over it and they’re not wearing a mask and you eat it, then you’re going to get it in your gut rather than your lungs and that’s going to be a whole different set of symptoms.

>>    Right. I’m glad you said all of that. That way is, at least for me, and I hope for listeners too, that really helps give a more visual, concrete understanding of why staying close to home, staying home, staying safe, and why getting out in public around a lot of people really poses more of a risk. It’s because of all of the different ways in which you may be exposed or the number of times and different sources from to which we’re exposed really create a more severity of the illness or the possibility of a severe reaction.

And that can change your outcome. And of course some of it has to do with how good and healthy you are and some of it has to do with your genetics, which you don’t have much understanding of how that could react. Some of it has to do with your iron levels. And some of it’s apparently dumb luck. I mean there’s young people in their thirties and forties having strokes from it and that’s probably the inflammatory cascade from excess iron. Probably people have genetics for too much iron. But I’m just making that story up. I don’t know for sure. And yesterday I read 15 kids from the United Kingdome developed this autoimmune condition in their blood vessels after having COVID.

We’ve long known that different infections can trigger autoimmune attacks and it appears this is no exception.  Only time will teach us more about what this virus is capable of.

>>  Right. Well, I am out of listener questions for today. Is there anything else you feel that’s important that you’d like to add? 

Yeah, I’ll say the most important meme I saw today on social media was saying that lifting the social distancing restrictions doesn’t mean that there’s not an infection out there. It means that there’s room in the ICU for you. Now, we’re flattening in the curve, but that doesn’t mean that the curve has gone down to zero. It just means that the medical system’s not being overwhelmed. So society thinks it’s okay to loosen up some, but that hasn’t lowered your personal risk.

>>  It’s scary and sad and such a big mystery that we’re still in.

It is, it’s strange times. And I’d love to be part of the movement of changing from social distancing to physical distancing was social intimacy. Cause we need social connection. We need social intimacy. We just had to physically distance.

>>    Right!? Well thank you so much for taking your time today to answer these questions and explore more of how everybody can step into the next stage of social, emotional and physical health as we continue to pay attention and be in this mystery of COVID-19.

All right, Robyn and all everybody listening. Take care of yourself and others.


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