HOW IT STARTED
On Sunday, July 12, 2020, my phone rang at 6:30 AM. As a physician with a concierge functional medicine practice in Los Angeles, California, I assumed it was one of my patients reaching out with a serious medical issue.
When I looked at my call display, I was surprised to see that my mother was calling me so early on a Sunday – which I knew could not be good news. When I answered, my mom said my name in a way that immediately told me that something was definitely wrong. Slowly and deliberately she explained that my father, a world-renowned immunologist, woke up that day with a fever of 102°F and a sore throat. I immediately knew that he was infected with SARS-CoV-2.
Three very big thoughts entered my mind at the same time: 1) I need to prevent my father from dying from this virus, 2) I need to prevent my mother from dying from this virus, and holy sh*t 3) I saw my father yesterday afternoon – which meant that I and my 2-year-old daughter had been exposed to a very large amount of the virus, as we had visited him dead in the middle of the presymptomatic window. This short time period is when viral transmission is usually at its highest, so I knew that I was likely infected with the coronavirus. It’s hard to describe the totality of this knowledge hitting me at once, but there were two dominant emotions – disbelief and fear.
As a physician, I accepted the fact that there was a possibility that I might become infected with COVID-19 from an unknowing patient. While the odds are low, even screening tools and masks can’t fully protect from contracting the virus. However, as a functional medicine practitioner, I practice what I preach. I eat clean, exercise, get enough rest, and more, so my fear of becoming infected with SARS-CoV-2 had far less to do with me getting sick, and far more to do with unknowingly infecting my 76-year-old father – whose body does not have the same strength to fight the virus as mine.
I did everything I could to avoid becoming infected and to protect my father from my potential exposures – so when the exact opposite occurred, my mind had a very difficult time processing that reality.
When my father spiked a fever, the source of his COVID-19 infection was a complete mystery. We later surmised that his infection was the result of indirect contact with an infected and unmasked maintenance worker, who had been fixing something in my father’s workspace during the high viral load presymptomatic window, and left only a few minutes before my father arrived at work. While my father always wore a mask when out in public, he removed it that day when he entered his workspace and saw that nobody was present – not realizing that his environment had been contaminated.
WHAT HAPPENED NEXT
I entered quarantine, switched my practice entirely to telemedicine, and awaited my fate. I began a diligent anti-inflammatory diet, reduced my sugar intake even lower than usual, increased my sun exposure, and began contrast showers to give my immune system every little boost I could muster. Given that my father was symptomatic less than 96 hours after his exposure to the virus, I was aware that he was likely to become very ill. I began to carefully monitor his illness and keep a watchful eye on my mother for signs of infection.
On Tuesday, July 14th, 72 hours after my exposure to the virus, I experienced my first symptom during the mid-afternoon – when a sudden wave of fatigue came crashing over me, forcing me to lay down. After about an hour, the extreme fatigue passed and I called my doctor’s office to move my nasal swab appointment up to the following day.
The next day, I woke up feeling a sensation of pins and needles in my face and scalp. This was accompanied by extreme lethargy. I dragged myself through my normal morning routine and commenced seeing patients remotely. Overall, I felt fine throughout the day, but I could tell that I was fighting something. Late that afternoon I received my test results, and no surprise it came back positive.
On Thursday, July 16th, I began to experience severe muscle and joint pain. This was nothing like the achiness I had gone through with influenza or swine flu – this was severe stabbing pain all over my body. CBD oil did a good job controlling the pain while I slept, but overall these symptoms were far more severe than I expected. Fortunately, I had no fever, no sore throat, no cough, no loss of taste or smell, and no intestinal symptoms.
Throughout the next day, I continued to experience severe muscle and joint pain. Thankfully this was the last day I had to endure the pain caused by the infection.
Then on July 18th, I experienced the most extreme brain fog I have ever known. I felt like my body was awake, but my brain was still back in bed. The culmination of everything left me feeling completely drained, despite sleeping properly. Thankfully, the extraordinary brain fog finally began to lift in the late afternoon. In fact, I felt surprisingly normal that night. This, I learned, would end up being a cycle that would repeat for the following 7 days – symptoms in the morning – that dissipated throughout the afternoon – followed by feeling fine during the evening.
Sunday, July 19th through Sunday, July 26th were essentially all the same – I would wake up every morning feeling completely worn out, despite sleeping for 9 straight hours the night before. Doing anything significant in the morning was a real challenge. Since physical activity is such an instrumental part of my normal routine, I tried to push through slow and gentle methods of exercise to no avail. Fortunately, I never experienced a cough, tightness in my chest, or mucous.
Monday, July 27th – I woke up feeling miraculously like “myself.” Unfortunately, as I continued seeing patients via telemedicine, the fatigue crept back in and I had to cut the day short to rest.
The very next day I woke up feeling completely normal, and thankfully the return of energy and mental clarity unfalteringly continued, and I have not had a single lingering issue since.
Overall my symptoms lasted 14 straight days and then vanished.
THE EMOTIONAL IMPACT
I kept a journal throughout my COVID-19 experience to chronicle what I was feeling physically each day. In retrospect, it would have been good to have noted what turned out to be the most difficult part of the illness – the emotional side. Even with all of my medical knowledge about the coronavirus, I found myself experiencing levels of anxiety at times because I was in unchartered territory.
My entire family was in quarantine for three weeks, which presented its own set of emotional challenges. Overall, I found that the mental/emotional impact of COVID-19 is greater than the physical – even for those that end up hospitalized!
As we continue to learn more about this virus, and more people share their own coronavirus experience with others, we’ll all be more prepared and able to get through the infection when it touches us.
COVID REGIMEN
As a physician who practices functional medicine, I am well versed in the benefits of nutritional supplements. Before I contracted COVID-19, I was always being asked what supplements I recommend to help keep the body’s immune system functioning optimally during the pandemic.
What I took
From the very moment that I learned that I was exposed to SARS-CoV2, I started a more enhanced supplement routine. The supplements I took fell into the following categories:
Immune enhancers
• Vitamin C 1000 mg twice a day
• Vitamin D 5,000 IU twice a day
• Zinc 25 mg twice a day
• SBI Protect 4 capsules twice a day
• Echinacea and goldenseal
• Elderberry extract
Mitochondrial support
• MitoCore – 2 capsules twice a day
• CoQ10 – 300 mg twice a day
• Niagen – 300mg twice a day
Adrenal support
• Eleuthero – 2 capsules twice a day
• Ribes Nigrum – 1 tablespoon once a day
Anti-inflammatories
• Fish oil – 3 grams a day
• Turmeric – 1 gram a day
• Trizomal Glutathione – 10 cc twice a day
• NAC – 500 mg three times a day
Below is a photo of my COVID-19 regimen
WHAT I DID
I listened to my body and responded to its needs. I also made sure to get enough sleep, meditate daily, and even though our family relied on Uber Eats and InstaCart, we made healthy choices.
I also frequently took contrast showers. To learn more about the benefits, click here.
A FEW PIECES OF ADVICE
I was exposed to SARS-CoV2 because of unmasked indoor exposure while practicing social distancing. As a result of this personal experience, I am an even bigger proponent of wearing a mask to minimize the viral load at the time of exposure.
At the very least, when indoors with individuals that are outside of your immediate bubble, wearing a mask (unless you are eating or drinking) is advised. When indoors, I recommend opening windows and doors whenever possible to decrease the chances of airborne spread.
THE SPECTRUM OF COVID EXPERIENCES WITH MY IMMEDIATE FAMILY
In total, 5 members of my family were infected with COVID-19 as a result of my father becoming infected.
Ages ranged from 2-75 and the experience varied widely:
• 2-year-old (my daughter) mild fever and runny nose for 48 hours
• 31-year-old female (my wife) – mild fatigue, mild runny nose, loss of taste or smell for 5 days
• 38-year-old male – (me) detailed above
• 66-year-old-female – (my mother) severe flu-like symptoms, weakness, cough, fever, diarrhea – 18-day course to resolution
• 76-year-old male – (my father) severe flu-like symptoms, weakness, cough, fever – required hospitalization and followed a 21-day course to resolution
WIDE RANGE OF SYMPTOMS
The most difficult and anxiety-provoking aspect of COVID-19 is the wide spectrum of experience from large percentages of the population being asymptomatic to others requiring hospitalization. This makes it very difficult to understand what to expect with COVID and how aggressive to be in managing it.
Three things determine what an individual SARS-CoV-2 infection will look like:
1. Viral load at the time of exposure
The amount of virus that one is exposed to at a given time represents a very large influencer in what an individual’s COVID-19 experience may look like. If at the time of exposure, one is exposed to very large amounts of viral particles, the likelihood of a significant illness goes up. If one is exposed to a small amount of viral particle, the likelihood of an asymptomatic and mild symptom course of COVID-19 goes up.
These differences were demonstrated in two cruise ships that experienced coronavirus outbreaks:
On the Diamond Princess cruise ship, no masking was performed for the passengers on the ship. Ultimately 18% of all of those that tested positive were asymptomatic.
In the case of the Antarctic Peninsula cruise ship, surgical masks were given to all passengers and N95 masks were given to all crew. Ultimately 81% of all of those that tested positive were asymptomatic.
In an attempt to prove that the masking model reduces viral load, and thus creates an environment for less transmission or more mild clinical symptoms associated with infection, researches performed an experiment on hamsters that proved exactly that. Hamsters that were masked were significantly less likely to transmit and infect others, particularly when the recipient hamster was masked as well.
In an attempt to prove that masking reduces viral load – which in turn reduces the chances of transmission, or at the very least diminishes the severity of infection-related symptoms – researchers performed an experiment on hamsters that proved exactly that. Hamsters that were masked were significantly less likely to transmit and infect others, particularly when the recipient hamster was masked as well.
The scientific findings are clear, masking results in less virus being spread and milder symptoms when infected. The bottom line? Wear a mask at all times when you are outside of your own home.
2. Prior immune exposure (exposome)
When the body is invaded by what the immune system identifies as an intruder, the immune system sends out an innate response to annihilate the enemy by throwing everything it has at the threat. While the immune system is releasing its “army,” the acquired (or adaptive) immune system goes into action like a team of Navy Seals on a mission to learn exactly what exact combination of attack will take down the target (germ).
Once this combination is determined, the system remembers it in the form of an antibody or via T cell memory. This crack code enables the body to immediately eradicate the microorganism, should it try to infect the body again. This is the reason why everyone wants to know if they have immunity to SARS-CoV-2.
The adaptive immune system mainly utilizes B-Cells and T-cells, working collaboratively together to protect the body against recurring infections and disease. To date, most of the conversation surrounding immunity to COVID-19 has revolved around antibodies. Recent literature suggests that an alternate form of immunity, which centers around T-Cells being able to directly recognize the virus, may play a very large role in immunity – and explaining why some individuals seem to be unaffected by the virus.
Studies are beginning to indicate that via T-cell mediated immunity, 40 – 60 percent of the population may have at least partial immunity to SARS-CoV-2 – which could partially explain the wide variance in experiences with the viral infection.
This immunity comes from the similarity of certain portions of SARS-CoV2, and other common respiratory viruses in the coronavirus family – a phenomenon known as cross-reactivity or epitope sharing. In this scenario, an individual has an immune system that is able to quickly recognize and combat SARS-CoV-2, rather than having to learn and develop an entirely new defense against a completely foreign virus. In this rapid and powerful response, infection may be entirely prevented – or the infection may result in asymptomatic disease or mildly symptomatic disease.
Currently, the CDC estimates that 40 percent of all COVID-19 infections are asymptomatic and T-Cell immunity may be a reason for this. Learn more.
3. Current immune state
4. Robust innate and adaptive immune system
5. Diet, regular exercise, sleep plays the biggest role here
It seems rather straightforward to me that the health of one’s immune system can impact how you are affected by the virus and your impact on others.
For some reason, current proactive measures to improve immune function have become controversial. My take is that though there is currently no data to fully substantiate things like diet, exercise, sleep and supplements can help reduce the chances of contracting COVID-19 or improve the body’s ability to battle the virus once infected, there is plenty of evidence to support the fact that these healthy lifestyle choices can have an impact on the function of the immune system. So why not implement these positive habits and hope for the best?
Diet: Cut out the processed and inflammatory foods, cut back on the alcohol and sugar.
Exercise: 150-180 minutes of cardio weekly – walking counts!
Sleep: At least 7.5 hours a night of uninterrupted sleep
Supplement use in the world of COVID-19 has also turned into a contentious discussion, for understandable reasons. Overall my position is that there are supplements that represent a viable way to modulate or support immune function. Whether supplements are specifically useful in relation to COVID-19 remains to be seen, but having a conversation with your physician about your personal use seems appropriate – given that most represent low risk and potential benefit.
CLOSING THOUGHTS
Although we’ve been in the SARS-CoV-2 pandemic for what seems like forever, we are actually still in the infancy of managing this virus. The good news is that every day we learn a bit more about COVID-19, but it’s difficult to be definitive on every front right now because of the wide spectrum of experiences amongst those who have been infected.
I am confident that we will continue to learn why there is such a high variability of responses to the coronavirus in the coming months. For the time being, the biggest players are viral load at the time of exposure, current immune state, along with prior immune exposure and immune memory.
When it comes to how much viral load you encounter, maintaining social distancing and appropriate masking, is the most effective way to avoid contracting the virus – or at the very least reduce the viral load you are exposed to, should SARS-CoV-2 manage to make its way into your system. The lower the viral load you are infected with, the better chance your immune system has fighting the virus.
For anyone that ends up hospitalized with SARS-CoV-2, rest assured that the American healthcare system is now well equipped to effectively manage infection – and healthcare workers are doing an admirable job caring for patients! The protocols in the hospital are clearly working, and medical/scientific professionals are constantly investigating new protocols. I have high hopes for our future, based on what the scientific community has done so far. If united, and without outside interference, I believe the medical community can solve this for all of us soon.