As COVID-19 cases start to accumulate, we are learning more about the virus and why in some cases, the morbidity and mortality might be significantly higher than the common cold or the flu.

COVID-19 seems to be attacking Hemoglobin. See COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. This attack is problematic for 2 reasons. Firstly, the interference with hemoglobin interferes with our ability to carry oxygen in the blood, which leads to hypoxia – a low blood oxygen saturation. Hypoxia ultimately leads to end-organ damage as the organ is starved for oxygen. Secondly, the disruption of hemoglobin releases free iron, creating a massive amount of oxidative stress in the lung. See Oxidative Stress: Is Your Body Rusty? for a review of this concept. This is why the CT scan of a COVID-19 patient will typically show bilateral ground-glass opacities. See Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.

These observations help to explain why a baseline elevated hemoglobin associated with higher disease mortality and why an elevated serum ferritin is associated with higher disease mortality.

Understanding the Mechanism of COVID-19 Helps us to Think About Treatment Options

In the allopathic medical world, we are hearing a lot about Hydroxychloroquine (also known as Plaquenil). Hydroxychloroquine is known as an anti-malaria drug. At first glance, this may seem strange because malaria is a parasite, but COVID is a virus, so why would this be postulated as a treatment option? The way that Hydroxychloroquine works is by inhibiting the Plasmodium parasite’s ability to attack hemoglobin, which is actually the same mechanism as COVID.

In the alternative medical world, we are hearing a lot about ways to combat the oxidative stress, notably high dose Ascorbic Acid (synthetic Vitamin C) and IV ozone. As mentioned above, the increased oxidative stress is likely a big part of the pathogenesis, so combating this directly may help prognosis.

We at PatriotDirect Family Medicine are not recommending either of these options routinely. We think at this time Hydroxychloroquine should be reserved only for severely ill, hospitalized patients on a case-by-case basis. The reason for this is (1) there is not enough data to support widespread usage and (2) Hydroxychloroquine may deplete bio-available copper levels, which would interfere with iron metabolism in the long-term. If someone is already on Hydroxychloroquine for Lyme Disease or a rheumatological issue, it should be continued.

We are also not recommending high dose ascorbic acid (synthetic Vitamin C) because the synthetic form of the Vitamin is actually a pro-oxidant. It is the whole-food form of Vitamin C that creates an anti-oxidant effect and has a long-term beneficial effect on iron/copper levels.

Our Recommendations for COVID-19 Prevention

  1. Continue precautionary measures. Social (physical) distancing and good hand hygiene are important preventative measures for spreading the disease.
  2. Whole food Vitamin C. The complete Vitamin C complex is necessary for anti-oxidant function. The complete complex also contains bio-available copper, which is necessary for long-term regulation of oxidative stress. Vitamin C itself is known to boost the immune system.
  3. Consider an additional immune system boosting supplement. Options for this could include Echinacea, Elderberry, or Reishi Mushroom Extract.
  4. Consider having your mineral levels checked. These would include an iron panel, bio-available copper (ceruloplasmin), and magnesium among others.
  5. Consider apolactoferrin or quercetin. Apolactoferrin is a glycoprotein that binds up iron in the body. Quercetin is a flavanoid that also chelates iron. Based on our understanding of the mechanism of the virus, this may be crucial in preventing severe COVID. Both are also known to be beneficial to the immune system.
  6. For patients with severe iron overload, consider therapeutic phlebotomy. Therapeutic phlebotomy is the most effective way of reducing excess iron in the body, but should be reserved for severe cases because of the need to come into the office.
  7. Continue to stay socially connected (virtually).  It is easy to get anxious and depressed when we are not in contact with loved ones. Consider downloading Skype, BlueJeans, utilizing FaceTime or another virtual method to have face time and connection with loved ones. Consider taking up meditation and relaxation activities to help with anxiety at this time. “Calm” is a fantastic app with meditations that are highly effective.

Additionally, we are encouraging everyone to maintain a positive attitude through this situation. There is no doubt at this point that this situation is serious and requires us to take drastic precautionary measures. However, we cannot allow the fear to take over. We have to trust our body’s innate healing system, continue to make healthy choices, eat well, and continue to be active. The fear mindset will itself interfere with our own body’s healing system.