Covid-19: risk factors...is age alone a risk factor?; flattening the curve by exposure avoidance PLUS immune competence
Dear Editor
In view of the 26 March Editorial's subheadline implicating age as a prime risk factor, I wonder if any research has tried to disentangle age from known comorbidities correlated with age, so we can tell whether and how much the healthy elderly without the known risky comorbidities are indeed at special risk due to age alone.
Risk should also be highly sensitive to individual immune competence. Obvious and accepted ways to strengthen immune and repair competences in the general population (and especially in at-risk subpopulations)—sleep, hydration, nutrition, exercise, calm, alcohol and toxin avoidance, physiological balance—should slow contagion just as isolation, distancing, and hygiene for exposure avoidance do. Yet of these two complementary classes of ways to flatten the curve, 'community immunity' seems oddly absent from official guidance (WHO, USCDC,...) so few practitioners and citizens emphasise it. Surely we need wide adoption of both modalities now.
A US internist/intensivist (with strong Ebola experience) and I published on 29 March two informal posts [1,2] (the first, and its accompanying material, documented to the medical literature) suggesting both canonical and less orthodox—but strongly supported by 2018–20 clinical trials [3-6]—ways to repel and resist infection by SARS-CoV-2, other viruses, and other pathogens.
Inter alia we suggested offering multi-gram, fully reduced, fully buffered oral l-ascorbate, divided through each day, to at-risk populations including healthcare providers. This agent's prophylactic value against viral respiratory infections was clearly established in Korean Army recruits (n=1444) [3] and indicated against pneumonia by three trials [4]. Its therapeutic value against colds was found by all 21 1970–17 trials dosing ≥1 g/d, and against pneumonia by two trials [4]. New metastudies demonstrate its ability to reduce ventilator hours (in patients requiring >10) by 25% [5] and ICU days by 9% [6], stretching these scarce resources; needing 3/4 as many ventilator hours is equivalent to having 4/3 as many ventilators. (Of note, reference [4] is by the senior author of the 2013 Cochrane Review [7], often misinterpreted as having disproven l-ascorbate's value.) These multi-g/d oral doses are of course clinically different from tens-of-g/d IV infusions now proving safe and effective from Shanghai to New York as adjunctive acute therapies for influenza- and COVID-19-related ARDS [e g 8]. Yet similar mechanisms are at work, from setting cellular redox potential low (suppressing viruses) to quenching free radicals that cause disease symptoms. In all, l-ascorbate may well be the most potent known antiviral agent.
So what are we waiting for? This agent is so safe, inexpensive, and ubiquitous that not taking it, whilst we ponder its value amidst the exponential phase of a pandemic, seems riskier than straightaway having a go.
Rapid Response:
Covid-19: risk factors...is age alone a risk factor?; flattening the curve by exposure avoidance PLUS immune competence
Dear Editor
In view of the 26 March Editorial's subheadline implicating age as a prime risk factor, I wonder if any research has tried to disentangle age from known comorbidities correlated with age, so we can tell whether and how much the healthy elderly without the known risky comorbidities are indeed at special risk due to age alone.
Risk should also be highly sensitive to individual immune competence. Obvious and accepted ways to strengthen immune and repair competences in the general population (and especially in at-risk subpopulations)—sleep, hydration, nutrition, exercise, calm, alcohol and toxin avoidance, physiological balance—should slow contagion just as isolation, distancing, and hygiene for exposure avoidance do. Yet of these two complementary classes of ways to flatten the curve, 'community immunity' seems oddly absent from official guidance (WHO, USCDC,...) so few practitioners and citizens emphasise it. Surely we need wide adoption of both modalities now.
A US internist/intensivist (with strong Ebola experience) and I published on 29 March two informal posts [1,2] (the first, and its accompanying material, documented to the medical literature) suggesting both canonical and less orthodox—but strongly supported by 2018–20 clinical trials [3-6]—ways to repel and resist infection by SARS-CoV-2, other viruses, and other pathogens.
Inter alia we suggested offering multi-gram, fully reduced, fully buffered oral l-ascorbate, divided through each day, to at-risk populations including healthcare providers. This agent's prophylactic value against viral respiratory infections was clearly established in Korean Army recruits (n=1444) [3] and indicated against pneumonia by three trials [4]. Its therapeutic value against colds was found by all 21 1970–17 trials dosing ≥1 g/d, and against pneumonia by two trials [4]. New metastudies demonstrate its ability to reduce ventilator hours (in patients requiring >10) by 25% [5] and ICU days by 9% [6], stretching these scarce resources; needing 3/4 as many ventilator hours is equivalent to having 4/3 as many ventilators. (Of note, reference [4] is by the senior author of the 2013 Cochrane Review [7], often misinterpreted as having disproven l-ascorbate's value.) These multi-g/d oral doses are of course clinically different from tens-of-g/d IV infusions now proving safe and effective from Shanghai to New York as adjunctive acute therapies for influenza- and COVID-19-related ARDS [e g 8]. Yet similar mechanisms are at work, from setting cellular redox potential low (suppressing viruses) to quenching free radicals that cause disease symptoms. In all, l-ascorbate may well be the most potent known antiviral agent.
So what are we waiting for? This agent is so safe, inexpensive, and ubiquitous that not taking it, whilst we ponder its value amidst the exponential phase of a pandemic, seems riskier than straightaway having a go.
[1] https://medium.com/@amorylovins/dont-just-avoid-the-virus-defeat-it-by-s...
[2] https://medium.com/@amorylovins/a-users-guide-to-vitamin-c-in-the-contex...
[3] BMJ Mil Health 2020, pubmed/32139409
[4] Nutrients 2017, 9, 339, doi:10.3390/nu9040339
[5] J Intens Care 8(15), 2020, doi:10.1186/s40560-020-0432-y
[6] Nutrients 2019 Mar 27:11(4), doi:10.3390/nu11040708
[7] doi:10.1002/14651858.CD000980.pub4
[8] Expert Rev Anti-infective Therapy 18(2), 2020, doi: 10.1080/14787210.2020.1706483
Competing interests: No competing interests