Neurology Solutions Movement Disorders Center (NSMDC) is a private movement disorders practice based in Austin that provides comprehensive care and treatment of movement disorders such as Parkinson’s disease, dystonia and essential tremor. The first subspecialty movement disorders clinic in Central Texas and a leading Parkinson’s treatment center, Neurology Solutions is headed by Dr. Robert Izor, a board-certified neurologist and fellowship-trained movement disorder specialist. Learn more>>>
Covid 19 Threat: Dr. Izor’s and NSMDC APPs’ Analysis and Recommendations
We are all highly concerned about the clear and present danger from Covid19. We are taking utmost precautions utilizing telemedicine as well as staff wearing masks, eye protection and disinfection of hands and commonly touched surfaces frequently throughout the day. With these efforts, we are still available for in-office visits for those who cannot perform a telemedicine visit or have complaints that require direct patient examination. In those cases, we request all patients, and up to one caregiver, must wear some form of mask during the entire visit unless directed to remove for examination purposes. Upon entry to the office please use the provided hand sanitizer and again right before leaving the examination room. If a decent hospital mask is not available to you at your home, a homemade mask is acceptable. The mask can be a simple doubled over triangle bandana or large handkerchief tied behind the back of the head to adequately cover the nose and mouth from any spray droplets while talking with providers and staff. If you are actively sick from upper or lower respiratory symptoms, we will offer telemedicine visits only. We are doing everything we can to make ourselves available to you and the community for the long-haul during this time of crisis while protecting other patients and ourselves. Here is our latest analysis of the Covid19 threat and recommendations we encourage all to implement.
Most people, greater than 85%, who become infected with Covid19 will have none, mild or moderate illness and recover fully without permanent injury or need to be hospitalized. Sick people should self-quarantine for at least 2 weeks and take extra precautions around high risk people for at least a week or so after all symptoms have resolved. High risk people include: elderly particularly over 65, worse above 70, and much worse over 80; those living in nursing homes; immunocompromised; pre-existing cardiovascular/pulmonary disease (COPD, emphysema,) obesity BMI >40; uncontrolled chronic disease like diabetes/kidney/liver; and smokers are all at higher risk for more severe sickness and/or hospitalization. Severe cases advance to severe acute respiratory syndrome (SARS) which kills many of these patients, often from viral sepsis induced cardiomyopathy and/or cardiac arrest. The clinical course from initial symptoms to death can take up to 6 weeks.
Since the transmission rate is 2-3 times that of the flu, and the death rate is probably 3-4 times worse than the flu, if we all get sick at once without taking precautions, the healthcare system will be overrun and 3-5 times more people will get very sick and/or die than if we take reasonable precautions, and/or draconian lock-down measures if we don’t have masks and/or universal testing needed to identify asymptomatic spreaders with enforceable tracking/quarantine protocols. We find ourselves in the latter situation and therefore the majority of low risk people must make sacrifices to minimize transmission risk to the high-risk minority to keep hospitals from being overrun until we have more liberal mitigation strategies available. Unfortunately, there are serious dangers to the economy which we must balance or we may find ourselves with just as much suffering and many deaths and suicides unrelated to the viral threat. Here are my best recommendations which we will update as new data emerges:
Personal Protective Protocols to Reduce Infection Transmission Risk:
- High risk people should avoid contact with others who may be asymptomatic viral shedders by “social distancing” as much as possible.
- Wash your hands for 20 seconds after touching suspect surfaces before eating or touching face/mouth.
- Wipe down and disinfect surfaces, door knobs and handles, twice a day, and after interactions with others.
- Get or make a mask and wear eye protection (which can be big eyeglasses or sunglasses) around others who may have been exposed to virus some of which are shedding asymptomatic viral carriers.
- Avoid being in small rooms or in transit with anyone coughing, sneezing or any other suspicious symptoms, and if unavoidable, make sure you are wearing any kind of mask and glasses.
- Walking and talking next to someone outside is very low risk as long as they don’t talk and spit directly at your face and vice versa as you may be an asymptomatic shedder.
- If you can’t avoid someone who may have been exposed, and are not wearing a mask and eye protection, maintain at least 6-8 ft distance, especially when that person is talking right in front of you.
- For those who are asymptomatic, assume they are shedding carriers and stay 3-6 feet away when talking directly in front of you, and preferably wear any kind of mask and glasses to catch any saliva/spray during conversation or if the person inadvertently coughs or sneezes on you.
- If you think you are getting sick wear a mask all the time to limit spread of virus to others as well as surfaces around your home. Make a mask using a large handkerchief if necessary.
Basic OTC URI/Viral Survival Strategy
- Stay home and rest, stay in limited areas of home as much as possible to protect others, and follow protective precautions as stated in Personal Protective Protocols to Reduce Infection Transmission Risk.
- Current recommendation propagated by a French Minister is to avoid Ibuprofen but this is not from any controlled studies and is probably a politically motivated recommendation. Until we know more, Tylenol for pain and fever, up to 500-1000 mg every 6 hours.
- For congestion, take Mucinex DM OTC 12 hr. twice a day. If still not enough with chlorpheniramine, you should try adding decongestants like Sudafed (phenylephrine or pseudoephedrine.) Use with caution if hypertensive. Nasal sprays inhaled deeply into the lungs through the nose may be helpful and safe for short term use, like Afrin (oxymetazoline.)
- Sleep as much as possible using stronger first-generation antihistamines (preferably chlorpheniramine every 4 hours or diphenhydramine every 6 hours) to control secretions and help with congestion. These have very strong anticholinergic effects which will control congestion/secretions better than other antihistamines, and induce sedation/sleep which is desirable when you are really sick. If not severely ill, you may use second-generation non-sedating antihistamines (Allegra, Zyrtec, Claritin) during the day.
- Maintain an adequate nutrient dense diet, avoiding processed carbohydrates and prioritizing whole food sources of protein and healthy plant-based fats.
- Take food grade medium chain triglyceride (MCT) oil (Premium Sports Research with C12 lauric acid, Amazon), ½ to 1 tablespoon up to 3-4 times a day. MCT has antibacterial and antiviral effects. If you can’t tolerate it use it like a lotion on your skin which will absorb systemically.
- If you have nausea and vomiting, simplify food intake with frequent smaller amounts of preferably high protein bone broth (or lower protein chicken broth if necessary,) and as tolerated supplement with MCT oil and/or extra virgin olive oil or avocado oil (or any cold pressed food grade oil that isn’t rancid, like cod liver oil, flax oil, etc.)
- Supplement diet with adequate hydration preferably from electrolyte drinks (Pedialyte, similar OTC alternatives, or Dr. Izor’s Antioxilyte drink.)
- For severe nagging cough especially at night, try you need a prescription for Tessalon (benzonatate) and if insufficient add codeine or hydrocodone from your doctor. Unfortunately, the latter are now triplicate medications and not as easily available because they require a special handwritten prescription. These are very powerful cough suppressants and also very anticholinergic to dry up secretions which can be critical at night to help induce sleep so important for a strong and effective immune response.
- Alternatives for cough may include cannabidiol (CBD) 10-25 mg four times a day, Atrovent (ipratropium) and albuterol inhalers which require Rx. Ultram is another option (also Rx but not a triplicate, caution drug interaction risk with some antidepressants and dextromethorphan in Mucinex DM.)
Mucinex DM, or Mucinex if you can’t tolerate DM
Phenylephrine or pseudoephedrine
Chlorpheniramine and Benadryl
Allegra or Claritin
Medium Chain Triglyceride oil
Bone broth preferably, or any broth (vegetable broth is ok too)
Extra virgin olive oil, avocado oil or high oleic sunflower oil
Pedialyte or preferably lower sugar knock offs, although we don’t have any experience with them. We make our own Antioxilyte drink that is zero carb. Gatorade and fruit juices/milk, aren’t optimal for electrolyte replacement and proper hydration in serious sickness.
Antiviral Potential Preventatives and Treatments
Zinc Gluconate 15mg daily is maintenance dose on top of dietary zinc found in a whole foods diet. If you follow a standard American diet, taking 15mg twice a day, especially during this viral threat. If getting cold/flu symptoms, increase to 15mg, 4 times a day until symptoms resolve. Some multivitamins contain zinc but not all formulations of zinc are highly bioavailable and therefore may not increase intracellular levels of Zn2+ as well. Unfortunately, these have not been studied very well to determine which is most bioavailable or most potent increasing intracellular Zn2+. Supplements do increase intracellular Zn2+, which helps block viral replication. Hydroxychloroquine works as a zinc ionophore, helping increase even more Zn2+ intracellularly to help inhibit some viruses including coronavirus. Other alternatives that are relatively bioavailable include zinc picolinate and zinc carnosine. There are clinical trials which suggest benefit with the common cold (which includes coronavirus,) but no prophylactic studies.
Medium Chain Triglycerides (MCT) oil (Sports Research Premium, Amazon) or Coconut MCT oil, ½ to 1 tablespoon up to 4 times a day (target total of 45-60g/d (3-4 Tbs).) I prefer mixed MCT oils or coconut oil separated from the palmitic acid long chain saturated fats. MCT has antibacterial and antiviral effects. If you can’t tolerate it use it like a lotion on your skin which will absorb systemically. MCT higher in C8 and C10 with less C12 is absorbed better through the skin, and less greasy. However, lauric acid, C12 seems to have the most antiviral/antimicrobial activity of the 3 main MCT fatty acids, although the others have more specific activity against certain microbes and viruses including HIV and HSV. Unfortunately, there are few small clinical trials and no large clinical trials testing antiviral effect in humans. Regular coconut oil is OK if you don’t have access to MCT, but the dose for maximal efficacy may be up to twice as much, 90-120g/d (6-8Tbs) which is a lot of calories and a large percentage of long-chain saturated fat which can be unhealthy for those with metabolic syndrome, diabetes and/or cardiovascular disease.