You asked, and we dug into the research to share some background and advice for support in the midst of the COVID-19 pandemic, written from a pediatrician’s perspective – Dr. Lizzie Bird, who recently joined our clinic team.
First, some background: Coronaviruses are a large family of viruses ranging from strains of the common cold to the relatively recent SARS (Sever Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) epidemics. Community-acquired coronaviruses are everywhere investigators have looked. They appear to be somewhat seasonal, occurring primarily in the winter, with some smaller peaks in spring and fall. Coronaviruses are zoonotic, meaning they are transmitted between different species.
The first people to have been known to be infected by the current COVID-19 worked in a Chinese market in Wuhan, China. COVID-19 appears to be at least as contagious and somewhat deadlier than the flu, though these are still relatively early days and we won’t have accurate data until its later stages.
Coronavirus requires a host to replicate; it can’t reproduce unless it has found a home inside a mucous membrane such as a nose, mouth or eyelid. However, it can survive outside of a host (on doorknobs, countertops, gasoline pumps, etc) though it is unclear for how long. Other coronaviruses’ ability to live outside of hosts range from a few hours to 9 days.
Thankfully, COVID-19 does not seem to be particularly deadly or virulent among children or young adults, but unfortunately, the young and healthy are able to transmit it to the older and more vulnerable among us, sometimes without realizing that they are infected. So managing kids’ germs is actually going to be quite important to containing the spread of this virus.
Simple, but powerful – hand-washing, alcohol-based sanitizers, and don’t touch your face
One good piece of news is that this virus is actually fairly helpless when it comes to hand sanitizers and old-fashioned soap. Coronaviruses are envelope viruses, meaning they have a coating that is easily disrupted with alcohol-based hand sanitizers and soaps (other viruses like norovirus and rhinovirus are not, and require serious hand washing to mechanically rinse them away). Without its envelope, the virus is incapacitated.
Washing your hands and not touching your face is actually one of your best defenses against this virus. But try telling that to a toddler… or teen. This is a fantastic occasion to practice positive parenting and consensus building. At our dinner table last night, we were each assigned a buddy to count how many times we touched our faces throughout the meal. It was enlightening for my tween and teen kids to realize how often they do so without realizing it. This lay the groundwork and context for them to think about how often they come into contact with germy objects whose germs they inoculate onto their faces. It also helped to drive home the idea that handwashing is super important. Ellen has a fantastic bit on handwashing for the whole family to watch.
We should all be thinking about how we handle shopping carts, gasoline pumps, doorknobs, etc. I am a big fan of paper towels for door handles and faucets in public restrooms. It is also key to have ready access to an alcohol-based hand sanitizer for when washing your hands is not practical or possible.
Ok, so you are washing your hands, not touching your face, mindful of your doorknobs, and keeping tissues for your kids to sneeze into (and then discard)… What else can you do?
Keep your immune system as robust as possible
Be your healthiest self! Maintain a healthy, nutritionally dense diet, mind your stress and get your sleep. Minimize sugar consumption. Identify your individual health challenges and vulnerabilities and work to optimize health and reverse disease; this is where functional medicine really shines. This is as good a time as any to get your proverbial house in order. This is not the last time we will be hit with a nasty bug that will tax our health care system and individual immune systems.
Ensure that your D3, vitamin C and zinc levels are optimized for immune health. I generally prefer sourcing my nutrients from whole foods, but it may be beneficial to supplement these nutrients, particularly during a tough viral season.
It can be hard to get enough D from diet alone and I recommend that most folks supplement D during the winter months: in general, babies can take 400iu/day, school-age 600-800iu and adult 1000-2000iu.
Vitamin C is ubiquitous in citrus fruits and many vegetables; some of my favorite sources of include oranges, bell peppers, tomatoes, and cauliflower. There is evidence that supplementation with 200mg daily throughout the year can help shorten the frequency and duration of viral illnesses. There are a lot of pleasant-tasting vitamin C chewables that school-age kids can enjoy. Vitamin C is water-soluble and generally well-tolerated, but I am cautious about larger doses in smaller kids, given its potential for diarrhea and nausea.
Though it is not hard to get your dietary zinc (meats, legumes, and seeds, shellfish, eggs, to name a few), there is some evidence that lozenges, allowed to dissolve slowly in the mouth, work to prevent viral upper respiratory illnesses and shorten their duration. In fact, the controversy around zinc’s utility in fighting viruses may really have everything to do with how the zinc is being delivered. Studies using cell cultures have demonstrated that zinc can impair viral replication and there are studies specifically on coronaviruses demonstrating this phenomenon. I see no downside to sucking on a high-quality zinc lozenge at the first sign of illness or even a few times a day as a preventive measure. Just remember that zinc can impair copper metabolism and you don’t want to overdo it. For kids that are too young for lozenges, there are a variety of zinc sprays that you can spray into their mouths. I would limit it to 5-10mg per day in children between 6mos and 2 years and 15-20mg daily in school-age kids. Some of the adult studies have folks taking as much as 75mg daily but, again, you really can have too much of a good thing here.
A handful of extra-targeted strategies to keep in mind
Beyond doing the important work of ongoing health maintenance, there are some targeted strategies that I recommend, for both prevention and mitigation of illness.
Irrigate your sinuses to help prevent the virus from taking hold. Xlear nasal spray offers a great alternative to those too young or squeamish for a neti pot. It contains xylitol and grapefruit seed extract, both known to have antimicrobial properties. I am not above squirting Xlear into sleeping children’s noses (my kids are all deep sleepers).
Propolis is another great tool for your antiviral arsenal, with very little downside. Though clinical studies are limited, it appears to have antiviral and antimicrobial properties, is safe for use in kids and can also be found as a spray. It also appears to have anti-inflammatory properties, which may be a helpful remedy for symptom relief, should you actually get sick.
At the first sign of illness, I would also consider having a ready supply of oil of oregano and palmitoylethanolamide (PEA).
Like zinc, oregano oil has been shown to stop replication and kill coronaviruses in cell cultures. We are lacking human studies that test this phenomenon further, but small doses of oregano oil are generally well tolerated for short periods of time. It should be used conservatively in children, as it can inhibit iron absorption. This is one that you should talk to your functional medicine health care provider about before trying at home.
As for PEA, Kara sums up the literature on PEA quite nicely in her blog about influenza pandemics. It is quite an interesting compound with a fascinating history. Again, very little downside to its use and there is compelling evidence that it may help reduce both severity and length of viral illnesses. It has a history of use in children, though not extensive, and I would limit its use to children > 5 years of age.
Do your research and consult your health care provider before administering any medicinal substances. Herbal remedies and nutritional supplements can vary in potency from one product to another and can be toxic.
A reality check – fight fear with facts
At the end of the day, COVID-19 presents an opportunity to take stock of your health, identify your family’s vulnerabilities and work towards minimizing them. As health care providers, my husband and I will more than likely be exposed to this virus at some point. For us, this is an opportunity to think about our work-to-home transition, our in-home infection control practices, and how we will protect our more vulnerable elder family members. It is also useful to take a deep breath and remember that even though it is a novel virus, we have seen the likes of nasty, highly contagious viruses before. As Elisa Song, one of my favorite sources of pediatric wisdom likes to say: “We can fight fear with facts!” And in this particular case, I feel the facts are stacked in our collective favor.