Post Details & Comments


Dr. Nesreen Hassan ND

COVID-19 Update, 3/17/2020 12:00:00 PM

COVID 19 is the most recent pandemic that has affected most of the countries around the globe. The last number of reported infected people globally is 198,178 with 7,965 deaths. The rate of infection spread is high and the fear is building up around the world. Up until now, there has not been a cure found for this viral infection.

We will try our best to review the latest research and keep you updated.

The most recent outbreaks of viral infections over the last twenty years were (SARS-CoV) in 2002, H1N1 influenza in 2009 and the Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The number of infected cases was 8000 cases of SARS with 800 deaths and 2500 cases of MERS with 800 deaths.

The purpose of this post is to provide you with a brief understanding of what COVID-19 is and to enhance our community awareness in an effort to decrease the spread of the infection.

Virus characteristics:

The origin of the virus is unknown but there is a lot of speculations that it has an animal origin. The size of the virus is about 60-140 nm.

The estimated R0 "basic reproduction number," or R0 (pronounced R-nought) of the virus is 2.20 to 3.58, meaning that each patient can spread the infection to 2 or 3 other people. But, the transmission is still dynamic and it’s still too early to know for sure how many people a single person can infect.

Methods of transmission:

Droplet infection is caused by coughing or sneezing. Infecting droplets could travel for 1-2 meters and could deposit on surfaces. The virus can remain on surfaces for days but can be destroyed in less than a minute by effective disinfectants. Some people are super spreaders; they can spread the infection to a large number of people fairly quickly. The infection could also spread from asymptomatic individuals. The virus spread doesn’t differ for symptomatic and asymptomatic individuals. This is a very important thing to be aware of. You may believe that because you aren’t experiencing any symptoms, you don’t have the virus or are less likely to infect others. But this is false. This is why it is very important for all of us to maintain social-distancing to prevent getting infected or infecting others without even noticing.


There are some records that reinfection happened to some individuals.


The most common symptoms of COVID-19 are fever, followed by cough, dyspnea (shortness of breath), myalgia (muscle pain), and headache. Rhinorrhea (runny nose) and sore throat were only present in 4% and 5% respectively.
The incubation period (the time from infection to symptoms appearance) ranges from 2-28 days.
Several reports documented the median time from the appearance of symptoms to shortness of breath was 5 days, hospital admission 7 days, and acute respiratory distress syndrome 8 days.

Risk factors:

The people who are most at risk of getting the infection and experiencing worse symptoms are those with cardiovascular diseases, hypertension, and diabetes. There is also evidence that older age and comorbidity (presence of another chronic disease or condition) are risk factors for higher transmission and poorer outcomes.

Death rate:

SARS: Up to 10%
MERS: Up to 35%
COVID-19: 5.7%.

Most of the fatality has affected patients above 50 years of age. The severity of the disease ranged from mild (81%) to severe (14%), and critical (5%) of the cases according to the Chinese CDC. A large case study indicated that the case-fatality rate was elevated among patients with coexisting medical conditions.


X ray abnormalities didn’t show up till day 6-7 in some cases. This means that sometimes a patient may have negative X ray results, with nothing worrisome, but abnormalities could appear later on in X ray.

The WHO and other organizations have issued the following general recommendations:
• Avoid close contact with subjects suffering from acute respiratory infections.

• Wash your hands frequently, especially after contact with infected people or their environment.

• Avoid unprotected contact with farm or wild animals.

• People with symptoms of acute airway infection should keep their distance, cover coughs or sneezes with disposable tissues or clothes and wash their hands.

• Strengthen, in particular, in emergency medicine departments, the application of strict hygiene measures for the prevention and control of infections.

• Individuals that are immunocompromised should avoid public gatherings.
• Effective sanitization could be done through alcohol 75%, chlorine containing disinfectants, and peroxyacetic acid.

Steps to prevent infections:

• Stay home if you can
• Keep social distancing (2 meters away from other persons)
• Wash your hands frequently.
• Don’t touch your face, nose, or mouth.
• Keep a hand sanitizer with you all the times (at least 75% alcohol).
• Keep a kleenex package with you to use for sneezing or coughing.
• Avoid presence in crowded spaces.
• Avoid social gathering to help each other to contain the infection.
• Use Clorox wipes to wipe shopping carts and let it dry to kill the virus.
• Use face masks for immunocompromised persons or with high risk people. N95 is the only effective mask.

How to support your health generally:

Be careful with all claims that are flying online! There is no prevention or cure for this viral infection. All the following recommendations are to support general health. You need to check with your doctor what suits you personally.

• Change your lifestyle into a healthier one. Manage your sleep. Get enough hours of sleep (7-9 hours per night).

• Eat high nutritious foods. Try to eat all the rainbow color vegetables. Aim to 5 servings of vegetables a day.

• Good quality protein is very important to build a healthy immune system.

• Support your gut and gut flora, the beneficial bacteria that play a major role in balancing your immune system. Prebiotic foods that help to populate gut flora: sauerkraut, kimchi, onion, garlic, and leafy green vegetables.

• Honey has antimicrobial, antioxidant, anti-inflammatory, and antioxidant activity. Take one teaspoon of honey with a glass of water with lemon in the morning.

• Black cumin seed oil is known to have antimicrobial, antiviral, anticancer, and anti inflammatory effects.

• Licorice has antiviral and antimicrobial effects. It also balances mood and improves energy. It is not recommended for people with high blood pressure.

• Curcumin (turmeric) has antimicrobial, antiviral, and anti-inflammatory effects. Different forms of curcumin affect its absorption and bioavailability. Quality of curcumin plays an important role in its effectiveness as well.

• N acetyl cysteine has been found to decrease the frequency and severity of influenza-like symptoms.

• Combination of antioxidants has an important role to support the immune system. Vitamin A, C, E, alpha lipoic acid and selenium are important nutrients that could help to support your health.

• Vitamin D. Having a high normal level of vitamin D is very important to support your immune system.

• Keep hydrated as the mucous membranes are your first defense mechanism to protect your body from pathogens invasion.

• Avoid sugar as it suppresses the immune system.

Stress affects the immune system tremendously. Keep calm and try to enjoy your time with your family and be creative in entertaining yourself and family indoors. A study that was published in a prestigious scientific journal experimented the rate of infection of healthy individuals who were given nasal drops that had viruses that cause common cold (including another type of coronavirus) and correlation with stress. They found that the rate of infection was 74-90% according to the level of stress.

These are general guidelines as there is no treatment for this viral infection as of now.

This is a stressful time for everyone but please know that we can get through this if we take the proper measures. Schools and public places are closed with the intent to decrease the number of infected. To those young and healthy, you may not face the brunt of this virus, but this doesn’t mean you can continue on with active socialization. Our primary concern should be for our families, those immunocompromised and elderly. This is not a matter to be taken lightly. Take care of yourselves and your families, practice social distancing, keep yourselves entertained, take the proper measures to build your immunity and we will all get through this.


Cascella M, Rajnik M, Cuomo A, et al. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.

Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. New England J Med. 1991;325(9):606–12.

De Flora, S., Grassi, C., & Carati, L. (1997). Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment. European Respiratory Journal, 10(7), 1535-1541.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.

Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect. 2020 Feb 6. pii: S0195–6701(20)30046–3.

Middle East Respiratory Syndrome Coronavirus. Available at:

Moghadamtousi SZ, Kadir HA, Hassandarvish P, Tajik H, Abubakar S, Zandi K. A review on antibacterial, antiviral, and antifungal activity of curcumin. Biomed Res Int. 2014;2014:186864. doi:10.1155/2014/186864

Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020.

Samarghandian S, Farkhondeh T, Samini F. Honey and Health: A Review of Recent Clinical Research. Pharmacognosy Res. 2017;9(2):121–127. doi:10.4103/0974-8490.204647

Tavakkoli A, Mahdian V, Razavi BM, Hosseinzadeh H. Review on Clinical Trials of Black Seed (Nigella sativa ) and Its Active Constituent, Thymoquinone. J Pharmacopuncture. 2017;20(3):179–193. doi:10.3831/KPI.2017.20.021

Wang L, Yang R, Yuan B, Liu Y, Liu C. The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Acta Pharm Sin B. 2015;5(4):310–315. doi:10.1016/j.apsb.2015.05.005

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Feb 24

World Health Organization. Coronavirus disease 2019 (COVID-19) situation report Accessed on March 16, 2020.

Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606.

Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020.

David Baud, Xiaolong Qi, Karin Nielsen-Saines,et al., Real estimates of mortality following COVID-19 infection.Lancet Infect Dis. 2020. Accessed on March 16, 2020.


Comments 0