Coronavirus (COVID-19) Q&A

The common cold is a major cause of visits to a doctor and time away from work and school. The common cold is usually caused by viruses, including other coronaviruses in the same family as COVID-19. Common cold symptoms typically include runny nose, congestion, sneezing, sore throat, cough, and sometimes headache, fever, chills and malaise.

Vitamin C has been proposed for treating respiratory infections caused by viruses since it was discovered in the 1930’s. Vitamin C is an efficient antioxidant and may be beneficial by protecting against oxidative stress caused by infections. The benefit of vitamin C supplementation however is still widely debated.

In a recent review of 29 trial comparisons involving 11,306 participants which sought to answer this question, three important findings were noted:

1. In people who take vitamin C every day, there is a modest, consistent benefit in reducing the duration of common cold symptoms by 8% in adults and 14% in children. That may translate in a decrease in symptoms by 1-2 days once someone becomes infected.
2. In a few studies of 598 participants exposed to short periods of extreme exercise (marathon runners and skiers) vitamin C decreased the risk of getting the common cold by half. However, vitamin C has not been shown to prevent ordinary people from getting the cold.
3. Once someone has a virus causing a respiratory infection, using high doses of vitamin C as treatment is not effective in decreasing severity of symptoms. 

The conclusions we can draw from this study therefore is that if you regularly take vitamin C (i.e. daily) there may be a modest decrease is how many days you are ill from the common cold. But vitamin C cannot be used to prevent getting a viral infection or as treatment. This is likely also true for COVID-19; while we may not expect daily supplementation to prevent infection, it may reduce the duration of symptoms in persons with mild or moderate cases.  

Yes, Tylenol or acetaminophen are acceptable for reducing fever and body aches caused by COVID-19 infection.

There are no specific lung exercises that can help people recover from COVID-19 pneumonia. Hospitalized patients with lung disease or other conditions might benefit from the use of an incentive spirometer. This is a device that helps people take slow and sustained deep inhalations, which helps fully expand our lungs and prevent lung collapse, a condition called atelectasis. An incentive spirometer can help prevent atelectasis, which occurs in hospitalized patients who are usually lying in bed and not very active. For most other patients with pneumonia, there are no specific breathing exercises that help improve lung function. Patients with chronic lung disease like COPD can benefit from exercise in general as part of a structured pulmonary rehabilitation program.

There is not enough evidence to suggest that any particular type of diet protects against getting the coronavirus. However, there is evidence that poor metabolic health is more common among people hospitalized with coronavirus. Being obese, having high blood pressure, or having diabetes has been associated with coronavirus hospitalizations.

Because nutrition can affect these risk factors, it is reasonable to think that healthy nutrition may reduce risk of severe complications, but this has not been adequately studied. While a keto diet offers short-term improvements in weight, blood pressure, and blood sugar, there is greater evidence that long-term metabolic health is better achieved with an unrefined, plant-based diet made up mostly of fruits, vegetables, whole grains, potatoes and beans and strictly limited in added fats and sugars. 

Cannabidiol (CBD), a non-psychoactive component of marijuana and hemp seed oil, has anti-inflammatory properties and may be helpful in cases of severe inflammatory response. There is new research suggesting that CBD can also change the levels of ACE2 receptors through which the SARS-CoV-2 virus (which causes COVID-19) enters cells. These studies suggest that hemp seed oil may be used in treatment or prevention of COVID-19, but this research is very new and no human studies have been done.

On the other hand, there is currently no data to suggest that hyaluronic acid can protect against COVID-19. In cases of severe COVID19, hyaluronic acid has been observed to fill the lungs as a part of the inflammatory response in overdrive. This may contribute to lung failure as hyaluronic acid retains water in the lungs.

The human gut microbiome, a community of microbes living in the gastrointestinal tract, has a profound influence on human health. The beneficial influences of the microbiome include nutrition and metabolism, regulation of the immune system, and protection from disease causing microbes.

Disruptions of the gut microbiome by viral infections has been shown to increase viral infectivity and severity associated with gastrointestinal and respiratory tract infections. Probiotics, beneficial bacteria that restore the disrupted microbiome to a healthy state, are effective in treating viral infections possibly by enhancing the intestinal surface, protecting against microbe and viral infection and enhancing the immune response to respiratory tract infections.

Emerging evidence suggests a potential role of the gut microbiome in COVID-19 progression and severity. In fact, the microbiome may be at play in individuals who develop gastrointestinal symptoms and more severe disease. While development of effective drug therapies and vaccines is ongoing, probiotics may offer an alternative strategy for treatment of COVID-19 using a similar strategy that has been successful for other viral pathogens. However, more evidence is needed before recommending treatment of COVID-19 patients with probiotics to manage the gut microbiome. 

In May 2020, the World Health Organization issued a statement that tobacco smokers are more likely than nonsmokers to develop more severe cases of COVID-19. Patients who smoke are more likely to develop serious symptoms of COVID-19, be admitted to an ICU, need mechanical ventilation, and die. COVID-19 is a disease that attacks the lungs and risk is increased in people who have underlying conditions like heart disease. Smoking (and e-cigarette use/vaping) exposes users to chemicals and particles that damage lung tissue and affect the heart, both of which can put users at higher risk for COVID-19.

Claims of a protective effect of nicotine for coronavirus are currently unsubstantiated by the available data. Some people think nicotine could have a protective role and suggest possible ways this could happen in the body. The available evidence is largely based on several studies that showed that there were fewer smokers among hospitalized patients than would be expected based on the number of smokers in the population. However, there are other explanations for this observation:

• Many health systems do not consistently assess whether patients smoke or vape;
• Patients may be reluctant to admit to smoking or vaping or may be unable to communicate if they are very sick when admitted; 
• Smokers may be more likely to die at home; and 
• Since smokers are more likely to have underlying conditions like respiratory conditions or heart disease, they may be more likely to be confined at home so less exposed to the coronavirus.

If research does show any possible therapeutic role for nicotine in the future, it will be important to use FDA-approved forms of nicotine medication (for example, nicotine gum, patch, or lozenges) rather than cigarettes and e-cigarettes that can damage the lungs and other organs. Nicotine medications also have the advantage of being shown to be effective in helping people quit tobacco use completely.

There is no scientific evidence supporting the use of ephedrine sulphate to ease shortness of breath with COVID-19 or any other form of pneumonia. Ephedrine is an adrenergic agonist that was used in the past to treat asthma, but newer and safer medications are now available and it is no longer preferred. Ephedrine can cause a rapid and irregular heart rate, and should not be used in older patients.

While certain forms of zinc may be important for immune responses to pathogens, it is entirely unknown whether oral zinc supplementation would have any antiviral activity against the COVID-19 virus, SARS-CoV-2, and it would certainly not be safe to test this by ingesting calamine lotion.

Zinc is an essential trace element that is necessary for human health and must be consumed regularly through a healthy diet (in red meat, poultry, beans, nuts, some seafood, whole grains, etc.). Zinc is important for normal growth and development as well as immune responses to pathogens and studies have shown that populations that are deficient in zinc are at risk of viral infections such as HIV or hepatitis C.

Clinical studies have yielded mixed results on whether oral zinc supplements (like those found at the grocery store or pharmacy) can improve the clinical outcome of a viral infection. These studies have used a wide range of doses and formulations (i.e. zinc aspartate, zinc gluconate, zinc sulfate) but none has ever used zinc oxide, which is an ingredient in the over-the-counter anti-itch cream calamine lotion, or pyrithione zinc, an antimicrobial compound found in shampoos and face creams.

Calamine lotion and beauty products containing pyrithione zinc are only intended for topical application and should NOT be swallowed. In case of accidental ingestion, you should seek medical assistance or contact a Poison Control Center immediately.