COVID-19 should be a wake-up call for the American health care system – and most Americans. We should not be seeing the hospitalization and death rates that we have in this country.
COVID-19 is the disease that results from infection with SARS-CoV-2, otherwise known as the novel coronavirus. In most cases, people infected with this virus do not need any treatment, as they will have mild symptoms or no symptoms at all. However, a small percentage of people become severely ill and many of these die. Why is there such disparity in individual response to the virus?
This question can be eloquently answered by combining the wisdom of James Carville and Louis Pasteur. Carville, while working on Bill Clinton’s presidential campaign, boiled the critical issues down to the number one priority for voters when he succinctly proclaimed, “It’s the economy, stupid.”
Louis Pasteur, one of the most accomplished scientists ever, who was a pioneer in medical microbiology and vaccinations, apparently had a change of heart on his deathbed. He is said to have uttered the words, “The pathogen is nothing; the terrain is everything.”
“It’s the terrain, stupid!”
Obviously if some people are symptom-free while others die from the same virus, the explanation for this disparity is not the virus; it is “the terrain”. If soil conditions are right, weeds spring up and thrive. Under other conditions, they do not. Human biological terrain is the result of an interplay of positive and negative influences, including: genetics, nutritional status, structural integrity, rest, stress, exercise, toxicity, dysbiosis, chronic infections, pH, hormone and immune imbalances, sunlight, relationships, and spirituality. Genetics are usually a minor player and all the other factors are modifiable.
A number of studies have looked at the characteristics of the people becoming critically ill and dying from SARS-CoV-2 infection. A study published in the Journal of the American Medical Association on April 22nd examined the characteristics of 5700 patients hospitalized with COVID-19 in New York between March 1 and April 4, 2020. It was determined that 94% of these patients had at least one comorbidity (chronic condition). These included hypertension, obesity, diabetes, coronary artery disease, asthma, congestive heart failure, cancer, COPD, chronic kidney disease, and a few others. 88% of the hospitalized COVID-19 patients had more than one comorbidity.
What can we conclude from all this?
If you want to survive COVID-19 get healthy!
Research has shown that all of these comorbidities are preventable and reversible to a major degree through appropriate diet, exercise, and lifestyle.
Very importantly, we can move beyond disease labels and look at underlying pathophysiological mechanisms, which leads to more foundational, life-changing interventions. The goal is reducing severity of COVID-19 infection.
There are probably a number of aberrant physiological factors that tie together the comorbidities associated with severe COVID-19. Perhaps the most important factor underpinning these comorbidities is a dysregulated immune system that results in seemingly paradoxical lowered resistance to infection and simultaneous excessive inflammation. COVID-19 kills people primarily by evoking an out of control inflammatory response, which, among other things, damages organs and increases blood clotting. Those individuals with a dysregulated, inflammation-prone immune response are more likely to have severe COVID-19.
There are many potential modifiable factors that contribute to chronic inflammation. Therefore, each case is best approached individually. This is what functional medicine provides.
There are many important points to cover related to inflammation, which I will be doing in future blogs and webinars.
For now, I want to share one important study.
Sixty percent of Americans have a chronic condition (comorbidity) and 40% have two or more chronic conditions. Obviously, not everyone infected with this virus who has a comorbidity becomes severely ill.
What is it, beyond comorbidities, at a a more descriptive physiological level, that causes some people to do worse with COVID-19? Is there a way to identify these individuals ahead of time and do something about it? A study has identified 20 proteins in the blood that may predict severity of COVID-19 illness. One of these is lipopolysaccharide-binding protein, which increases in response to lipopolysaccharide (LPS) – a cell wall structure from certain bacteria. Elevated blood LPS, known as endotoxemia, is inflammatory and commonly results from leaky gut syndrome. A blood test I use to check for leaky gut syndrome measures antibodies to LPS. Does leaky gut syndrome predispose to worse COVID-19? I think so.
Most of these predictive 20 blood proteins are inflammatory in nature and were found to correlate with readily available lab tests for inflammation. I routinely test all of my patients for one of these: hs CRP. If you have an elevated hs CRP you may have a worse response to COVID-19 if you get infected. The same study found a connection between certain types of intestinal bacteria and the elevated blood markers! Perhaps everyone should have blood tests for inflammation & leaky gut syndrome, plus a stool analysis to check for the implicated bacteria. Targeted preventive treatments for any dysbiosis (bacterial imbalance), leaky gut syndrome, and inflammation could potentially defuse coronavirus infection, should it occur.
