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This COVID-19 one pager, made up by a Seattle ICU/ER doc (Nick Mark, MD) and which reads like the ultimate cheat sheet for a one hundred question exam on the virus, has been circulating among some of my medical colleagues. As a naturopathic physician, I thought I’d take a moment to draft a multi-part blog post which breaks down everything in it, with some links to studies. 

And whenever possible I’ll link to some studies in natural medicine which may be related to the topics at hand. However, it needs to be reiterated that there currently are no registered medical treatments for COVID-19, and of course that includes natural and naturopathic medicine.

You’ll note the square at the top of the page, which can be scanned for updates.

Nomenclature

  1. Infection: Coronavirus Disease 2019 a.k.a. COVID-19 (1)
  2. Virus: SARS-CoV-2, 2019 Novel Coronavirus (2,3)
  3. NOT “Wuhan Virus.” As this Atlantic article explains, the term Wuhan virus suggests COVID-19 to be nothing but a Chinese scourge, but this terminology is a “racist trope.”

Biology

  1. 30 kbp, +ssRNA, enveloped corona virus. A kbp is a measurement unit used in genetics (DNA or RNA) signifying length and equivalent to 1,000 base pairs (standing for kilo-base pair). +ssRNA means it’s single-stranded. The corona virus has an envelope or outer wrapping, which comes from the infected host cell’s plasma membrane, as it “buds off” and forms virus particles. An envelope can help a virus live longer and potentially make it more infectious. (4)
  2. Likely zoonotic infection; source/reservoir unclear (Bats? / Pangolins? → people). The infection is likely caused by pathogenic germs from animals but it is unclear, precisely, from what reservoir. In fact, China has banned the consumption of wild animals as a result of COVID-19. (5)
  3. Now spread primarily person to person; can be spread by asymptomatic carriers! Yep. In fact, 80% of carriers are asymptomatic, and it is presumed that they can spread it, but the potential false-positive rate is high. (6,7)
  4. Viral particles enter into lungs via droplets. As with flu and rhinovirus, viral transmission is believed to occur via droplets from coughing and sneezing, but aerosol transmission is also possible. I don’t believe this has been proven yet but it makes sense. (8,9)
  5. Viral S spike binds to ACE2 on type two pneumocytes. COVID-19 uses its spike protein (S) to bind to receptors in an enzyme present type two pneumocytes in the lungs called ACE2. In other words, ACE2 is how COVID-19 enters the cell! Pneumocytes are surface epithelial cells of the alveoli and type two are particularly responsible for producing and secreting surfactant, which is a molecule that helps lower pulmonary fluid surface tension, thereby contributing to lung elasticity. Hence,ifyour type two pneumocytes go off line, pulmonary fluid tension will rise and lung elasticity will go out the door. (10)
  6. Effect of ACE/ARB is unclear; not recommended to change medications at this time. By the way, medications such as ARBs (angiotensin receptor blockers) actually upregulate the expression of ACE2 by three to five times, and thereby could give COVID-19 more portals of entry. Animal studies have shown that renin-angiotensin (RAS) inhibitors could relieve symptoms of acute severe pneumonia and respiratory failure by reducing poor prognostic indicators of severe pneumonia, such as ACE. When COVIC-19 binds ACE2, ACE2 is exhausted, and then the RAS pathway is inhibited, exacerbating acute severe pneumonia. As of yet there are no studies demonstrating beneficial or adverse outcomes in the use of antihypertensive medications, ACE-inhibitors or ARBs, for COVID-19. (11)
  7. Other routes of infections (contact, enteric) possible but unclear if these are significant means of spread. As mentioned, the host may be bats (particularly, BatCoV RaTG13), but the transmission routes may vary, as they include direct transmission (cough, sneeze, droplet inhalation), contact transmission (oral, nasal, eye mucous membranes), saliva, and potentially fetal-oral. (12)

Resources:

  1. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence [published online ahead of print, 2020 Feb 25]. J Med Virol. 2020;10.1002/jmv.25722. doi:10.1002/jmv.25722
  2. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. doi:10.1016/j.ijantimicag.2020.105924
  3. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [published online ahead of print, 2020 Feb 26]. J Autoimmun. 2020;102433. doi:10.1016/j.jaut.2020.102433
  4. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1–23. doi:10.1007/978-1-4939-2438-7_1
  5. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [published online ahead of print, 2020 Feb 26]. J Autoimmun. 2020;102433. doi:10.1016/j.jaut.2020.102433
  6. Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19 [published online ahead of print, 2020 Feb 21]. JAMA. 2020;e202565. doi:10.1001/jama.2020.2565
  7. Zhuang GH, Shen MW, Zeng LX, et al. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(4):485–488. doi:10.3760/cma.j.cn112338-20200221-00144
  8. Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview. J Chin Med Assoc. 2020;83(3):217–220. doi:10.1097/JCMA.0000000000000270
  9. Cascella M, Rajnik M, Cuomo A, et al. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554776/
  10. Gurwitz D. Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics [published online ahead of print, 2020 Mar 4]. Drug Dev Res. 2020;10.1002/ddr.21656. doi:10.1002/ddr.21656
  11. Sun ML, Yang JM, Sun YP, Su GH. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):E014. doi:10.3760/cma.j.issn.1001-0939.2020.0014
  12. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9. Published 2020 Mar 3. doi:10.1038/s41368-020-0075-9