COVID-19 Prevention and Treatment

Covid-19 Prevention and Treatment

Prepared by:

Tom Augat, DC, MS, CCSP, FASA

Ronald Farabaugh, DC, CCSP

Wayne Whalen, DC, FIACN, FICC

Alec Schielke, DC

Jay Greenstein, DC, CCSP, CCFI-L1, CKTP, FMS

Cheryl Hawk, DC, PhD, CHES, LMT

Purpose:

The purpose of this paper is to provide relevant, timely, and accurate information regarding conventional medical and non-pharmacologic treatment and prevention options regarding COVID-19. The Clinical Compass (Council on Chiropractic Guidelines and Practice Parameters) recognizes the worldwide impact of COVID-19 and is concerned over the distribution of inadequate, misleading, and often inaccurate information spread primarily over social media.

Background:

The Clinical Compass is an evidence-based organization with a mission to improve patient outcomes by advancing evidence–based care to transform healthcare through knowledge translation. COVID-19 is virulent, easily transmissible, and is mutating. As a result, millions of Americans have contracted the virus and hundreds of thousands have died from it.

The Clinical Compass:

• is concerned over misleading or inadequate misinformation regarding COVID-19 medical treatment and conservative preventive strategies often cited on social media platforms;
• recognizes the value of governmental agencies charged with the distribution of public health information;
• recognizes the contributions of both conventional medical AND non-pharmacological therapies to improve health in general as a preventive measure, and to treat patients once exposed or infected by COVID-19;
• encourages individuals to openly discuss both conventional medical and non-pharmacological treatment options, including relative risks versus benefits, with healthcare providers;
• believes in personal medical freedom of choice and we encourage all individuals to become thoroughly educated in order to make responsible personal decisions about healthcare strategies, and accordingly recommends that all individuals consider the merits (risks vs. benefits) of the current and evolving medical and non-pharmacological healthcare strategies in dealing with COVID 19.

Causes and Transmission:

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus affecting the upper respiratory tract(nose, sinuses, and throat) and/or the lower respiratory tract (bronchi, bronchioles, and lungs). COVID-19 spreads primarily through respiratory droplets released into the air by an infected person, whether symptomatic or not. ( Centers for Disease Control (CDC)) The droplets spread mainly through close contact from person to person, including between people who are physically near each other (within about 6 feet). Surface transmission is also possible according to the World Health Organization (WHO). The incubation period between contact with the COVID-19 virus to the appearance of symptoms ranges from2 to 14 days, averaging five days. Some populations, including those of African-American or Latino heritage, have a higher incidence of COVID-19 infection. “Closed” communities such as nursing homes and jails are particularly susceptible.

Symptoms:

CDC: COVID-19 SYMPTOMS

Typical symptoms of a COVID-19 infection may include fever or chills, coughing, dyspnea, fatigue, muscle or body aches, headache, the new loss of taste and/or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea. Critical symptoms may include significant trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and cyanosis. Most people with the COVID-19 infection experience mild to moderate respiratory illness and recover without requiring special treatment. Risk factors for severe and possibly life-threatening illness are age over 65, smoking, and comorbid conditions, including diabetes, obesity, cancer, cardiovascular disease, kidney and liver disease, and chronic respiratory conditions. The long-term effects of this infection are still undetermined.

Medical Interventions:

Vaccines:

Many COVID-19 vaccines are in various stages of development. The WHO maintains an extensive database on these, updated twice a week — learn more: WHO COVID-19 Vaccine database. Currently, the U.S. is administering the first two FDA-approved vaccines (from Pfizer and Moderna). Both are mRNA vaccines, a relatively new type of vaccine using RNA to trigger an immune response — learn more: CDC: HowVaccines Work. RNA vaccines do not necessarily require the inclusion of adjuvants used in traditional vaccines — learn more: Nature: mRNA Vaccines, FDA Fact Sheet Dec 30, 2020

Other resources: NIH COVID-19 Treatment Guidelines

Medications:

• Recommended:
  • Remdesivir is recommended only for patients at high risk of disease progression or hospitalized patients who require minimal or increasing amounts of supplemental oxygen
  • Dexamethasone is recommended only for hospitalized patients requiring increasing amounts of supplemental oxygen or require ventilation
• Recommended against due to insufficient evidence:
  • Other medications such as ivermectin, chloroquine or hydroxychloroquine with or without azithromycin and Lopinavir and other HIV protease inhibitors

Other:

• Nutritional factors necessary for achieving and maintaining health areimportant to consider. It should be understood, however, that there is no current evidence for these in the prevention or treatment of COVID-19.
  • Healthy diet emphasizing whole foods, adequate nutrients, and fiber may be helpful to reduce inflammation and oxidative stress — learn more: Reducing Inflammation and Oxidative Stress through Diet and Nutrition—2020 review
  • Vitamin D — learn more: Vitamin D deficiency and COVID-19—2020 meta-analysis
• Decreasing COVID-19 risk factors through adopting and/or maintaining healthy lifestyle habits may have a beneficial effect because they are effective in the quest for improved overall health — learn more: Healthy People 2020. These preventive factors include:
  • Adequate sleep
  • Physical activity
    • Physical activity and immune system—2020 commentary: manual therapy including chiropractic care can contribute to people being physically active by improving pain and physical function
    • Chiropractic and chronic MSK pain—2020 CPG
  • Maintaining a healthy weight
  • Stress management

Non-Pharmacological Strategies:

Recommended preventive measures

With COVID-19, the consistent advice from the CDC is to:

• Wear a mask in all public settings
• Maintain social distancing of at least six feet (two arm’s length)
• Avoid touching your nose, mouth, eyes, and face
• Frequently wash your hands with soap and water for 20 seconds or to use a hand sanitizer with at least 60% alcohol (and to rub this thoroughly into the hands until dry)
• Cough or sneeze into the crook of your elbow and immediately wash your hands afterward
• Clean and disinfect all frequently touched surfaces
• Regularly monitor your health, temperature, pulse oximetry, and potential signs/symptoms
• Avoid traveling on planes and/or other public transportation unless absolutely necessary
• Avoid traveling out of state or country unless absolutely necessary
• Avoid congregating – particularly indoors and never without wearing a mask

In addition, state and local governments have mandated a variety of shutdown initiatives with limited consistency and varied results.

Conclusion:

In choosing what behaviors and precautions should be embraced to help decrease one’s chance of contracting COVID-19, healthcare providers and the general public should evaluate the most current research and recommendations. Additionally, the CDC, FDA, NIH, and WHO have many resources available for the healthcare community and public. Their websites provide up-to-date public health recommendations and information. Understanding and leveraging all available resources helps providers and patients alike make the best possible educated decisions.