Thankfully, it would seem that British Columbia is ahead of “the curve” for COVID-19 mitigation and that our efforts are paying off as we head into warmer whether. Unfortunately, the same cannot be said for Ontario and Quebec, as well as New York state and New Jersey, but there is a light at the end of those tunnels too and I am hopeful that they will see it soon. With respect to COVID-19, recently there has been a lot of talk about testing, treatments, prevention and when things are going to get back to “normal”, so I thought I would write an update on what we might see coming down the pipe, as there is certainly a lot of speculation out there.
What actually prompted this post, was a NEW genetic report that was shared by researchers (Mark and Jon) at Nutrahacker which suggests susceptibility risks for SARS-CoV-2 based on 11 cited studies related to a SNP (rs2070788) in the enzyme TMPRSS2. TMPRSS2 is a enzyme protein that cleaves (cuts) ACE 2, which one study suggests makes this ACE 2 protein more susceptible to viral attack. So what does this mean ….
Well, a few weeks back I was thinking to myself, there has to be a functional reason (like all health concerns) for the increased susceptibility and severity of risk associated with SARS-CoV-2 in some people. Why else would the majority of peoples risk be negligible but the minority have a risk of infection with very serious adverse outcomes. Perhaps, others have been wondering the same thing. So one thought I had was general nutrition. Perhaps that has something to do with it, which I am sure it does in some ways. Comorbidity and age also clearly play a role, which makes sense, as it would be hard to recover from overwhelming respiratory failure. But what about those 20 or 30 year olds that seemingly have no significant risk factors. So … like most health concerns, I thought that there must likely be a genetic variable playing a role. Thank you Mark and Jon for outlining one of these genetic variables.
In this report, there is also a reference to prevention and treatment, for susceptible people. One study referencing that nicotine affects outcomes negatively, which makes sense, while the other outlining chloroquine as a valid therapeutic option. Of course the language used in these reports is not supported by a high level of commitment, as there are still a lot of unknowns, and likely a lot more to the equation than just this SNP in TMPRSS2, but I was happy to make a little more sense of the epidemiology.
There is also a trial starting in Canada using the gout and pericarditis medication colchicine to help prevent the severity of symptoms for sufferers of COVID-19. Colchicine is also being studied in Greece and perhaps Canada is piggy backing off of this research with trials running concurrently in Quebec and Vancouver. The nice thing about colchicine is that it is 100% natural, dervived from the autumn crocus flower bulb! Participation is voluntary and side effects can be significant. Side effects include mostly dose related toxicity and common gastrointestinal symptoms. Mechanisms for the drug is the disruption in cytoskeletal functions by inhibiting β-tubulin polymerization into microtubules, preventing activation, degranulation, and migration of neutrophils associated with mediating some gout symptoms. In familial Mediterranean fever, cochicine is thought to interfere with intracellular assembly of the inflammasome complex present in neutrophils and monocytes that mediate activation of interleukin-1β.
https://www.ncbi.nlm.nih.gov/pubmed/?term=cochicine+and+CoVID-19
So what is going to happen next. Well, I for one, am hopefully that SARS-CoV-2 is seasonal, suggesting that as we head into summer and early fall there will be a dramatic drop in risk of transmission and case burden, but this has yet to be definitively determined. I am also anticipating that some degree of social distancing and hygiene guidelines, including the wide spread use of masks, will continue into our future. If I had the skills I would be starting a trendy new cotton mask business … as I am going to predict this will be the newest accessory, right up there with watches and sunglasses.
If anyone is following the testing for COVID-19, then they would know that it is a fairly sad state of affairs, with both false positives and false negatives being pretty unacceptable and all over the map. Further, the FDA has approved wide spread testing across laboratories in the United States. In fact, many of the testing companies that I use in the US are providing the infamous reverse transcription Polymerase Chain Reaction (rtPCR) nasal swab testing that is fairly standardized across the world at this time. Generally PCR testing boosts high specificity and sensitivity (accuracy) to detect known infections, but apparently this is not the case for COVID-19 as there seems to be a wide array of reported false positives and negatives with testing. So what does this mean? Well it is hard to really know what the epidemiology of a disease is, when the testing being relied on has the potential to be inaccurate.
In summary, Dr Henry, BC’s Provincial Health Officer has deemed Naturopathic Medicine an essential service in British Columbia and with the current statistical positive rates reducing here in BC, I am cautiously heading back to the office one day per week. In-office consultation, with respect to The College of Naturopathic Physicians of BC (CNPBC) guidelines, should be confined to situations in which a client is at risk of imminent or serious harm and alternative care is not available. Since I do see patients that meet these criteria, I would be happy to consider consulting with patients that need this level of care. As a medical professional, sterile techniques are very important to me. I will be wearing gloves, mask and eye protection in the office and sanitizing with Health Canada approved sanitation methods between patients. As an additional precaution for the months to come, for those patients requiring in office visits, I will be providing gloves and masks if they do not have their own. At this time, I still strongly encourage remote consultations to those who are comfortable with telemedicine. And for other businesses? Most will need to adapt to the new norm, until such a time that 70 to 90% of our population has immunity to the noval coronavirus of 2019. Support local business, where ever possible!!